FMGE Notes - Pediatrics

Foreign Medical Graduate Examination Lecture Notes

1. (acim for Foreign Medical Graduates)

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For Regular Course
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Paediatrics
Conrenrs
1. Growth Development 01-08
2 Neonatology 2 09-15
3. Respiratory system 16-18
4 CWS 19-24
5. Nephrology 25-28
6. Childhood Maligancies 29-34

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GROWTH & DEVELOPMENT

(Grow Is an neease in body size. I Is a continuous process starting In the intrauterino Me and
‘continuing throughout chikhood. Developmen ters o acquision of various sills appropriate apes

Growth
Periods of growth:
À. ina

o. onm- 01914 days
1b. embryo = 14 days rine weeks,
© fetus nine weeks to bith
4. Perinata ~22 wooks lo savon days
2. Sirene:
Neonatal: ta 28 days
‘fancy = 29 days to ne year
‘oder ~1t03 yas
praschool - 3108 yea
school — 610.12 yours
‘dlacconce~10 to 19 years
(a) varly=10 1013 years
(©) md 1410 16 years
(6) li 1710 19 yeas
Factors affecting growth
1. gonoie factors
2. mutation
3. chronic diseases
4. Homones: important hermenes for inrautorino growth are thyroxine (secroton stats at 12
wooks of inate fe}, run and glucocorticoids. Ar bth growth hormone ls the most
important hermonethrougheut load Thyroxine is also important. Gonadl hormones are
Important fr pubera put.
Assessment of growth
(Done by monitoring of arttropometic parameters mainly wo, length head crcurference

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Age EL Fe [One [ve | Three [re
year years | years

Weight =| Tate = Jax je Tex
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“Troy help to assess growth and diagnose deviaons. Normal range ls conventonal taken besweeh
{and 87th parent or mean +2 standard devas
NCHS chars (1977) Nationa! cone for healt statistis-basod on foma ed US population
COC charts (2000). Centre fr disease contro and prev.
WHO MGRS charts ubichod In 2008 and preconty recommended for use
1. Muticontar gro olrence ody (MGRS).
2. Representative of developing count.
3. Sample rom Brazi, Ghana, Ind, Norway, Oman & Unie States.
4. Breasted. goad socio economic class.
5. Exva Indeators: skin fol theknoes and BMI

Dieron issues of body grow at lrent rates
A. General growth spurtin te frst two yars—>slowing->pubertal spurt
8. brain growth — maximum in fi two years
©. Impr growth maximum between 4108 years
D. gonadal gowth — during puberty
dental gout
a. primary detiton
Central incisors | Lateral Inelors | Fist Molar | Canino
A one year TS menta | 18 monts | 2015 90 monta

Secondary denon
‘Mnemonic: mummy sn pain papa can make medicine
Fist Molar: Central Inde Lateral Inciso: Fist Promolars: Second Pramolare Carne: Second
Molar: Third Mlar8:7:89:10: 11:12: 18 (ag in yoare)

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A 8 3 e :
Short stature
Height < conte? standord deviations
Bases on Upper segrertiomer sn rato, sid as proportionate and proportion
[Normal Upper sagment to ner segment ato:
17 at th 3 althee years at six years 10 years 8 0.9 in dul
Causes:
Proportonte short stature (Normal USALS ratio)
‘Normal vcorts
14. Feri
2 Corn
Petia! E
+. Smmetñealinrautetn growth Resin
2. Torch infections
3. Chromosomal abnormalities Ike Down's syndrome, Tumats syndrome, Prado
Wa stom, Noonan syndrome, Russel Ser syndrome, Seche syndrome
4. Manuttion
5. cont dieses

6 endocrine
2. paychosocat

Disproportionate short stature E
Ineroased USAS, ra (shrtlimos)

1 Reta

2. Accra

3. Croiniemfunseatc, congo hypoityrokdem)
Docrsasod USALS ro short unk)

2. Vertobeal monaten

2. Mucopoysaccterdess

3. Scondvoeniphyseat dysplasia

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Ni parental height or prodited adult eight le haps to ind the causo
Bono age should be calculate and may be hell in finding eetology
Most useful xray fr bone age between 1 o 13 years s hands and wiss. Calulaton is done with
the help of Tanner Whitehouse scoring. Between 3 to 9 monts shoulder Jolt x-rays preferred and
between 12 o 14 years elbow and hip aya may be useful.
Bono age is generally the samo as high age and les than chronological age in mest cases. tie
‘marked delayed in hypothyroidism and ‘growth hormone deficiency. In fall short stature, ls
same as croneiogical age. in precocious puberty, bone age exceeds chronological age.
Most common causo of shot stature ln children consttuional growth del. These children are
normal at bith, grow normaly for 6 to 12 months and then thelr growth slows. The height velocty
again acocloratos around 2 1 3 years and they row ata normal velocity. Ont of puberty ls tro ate
but al height is normal. Fami shor stature: the cid is short because the parents ar short.
Adolescence:

arty adolescence: 10 to t9years

[Mid adolesconce: 14 to 16 years

Late adolescence: 47 o 19 years

‘Primary sexual characters: estar and pente gromt in boys and breast and werine growth nos
‘These changes ar produced bythe seg hormones estogens in gis and testosterone in boya
‘Secondary soxual charactor: pablo and aan ha growth, acne, axlary odour. These changes are
produced by adrenal andogens.

Pulsatle GaRH secreson—> increased gonadotopins—> increased sex hormones

‘Staging of puberty Is done by Tanner staging system and divided int stage Ito V. hiss also cal
the sexual mary rating (SUR stages 11 V)

Puberty in fomalos

Stats around the age of 10 years and is completed ve years

Thelarche (breast evelopment) —> Pubarcho (pubic hair development) —>Menarche (onsat of
‘menstrual cycles), The tine gap between breast development and menarche Is usualy 2 to 3 years.
Growth spurte ary and oocurs jet before menarche (SMA stage HI

Puberty in mates:

Starts around 11 19 12 years and is completo by 141015 years

Testcular enlargement —— ponte erlargement and pubic har davelopment—>apermarche

Grow spurts ato (SMR stage IV).

Development:
GROSS MOTOR:
jena Pree moat [Standing
Jeusponsion
oo Momentary its Sao [Almost comple

fcouch Head [head ig, back
predominant to one side founded

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esa” Head het up [Chin rise intemitenty [Head ng
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Defined ae eating of non mure substancos for at east one month. Common In children les than
ve years of ge. Co existent ron deicienc anemia and paras nfestations may bo tere.

Enurests

"Normal age cf lolo traning s around two yoars and most chidren are tala rained by fve year
Urinary incontinence bayond tha age of four years for daytime and ix yoars for nighttime or loss of
continence afer at least oo monte of dynees. Mest common fs primary noctuma Incontinence.

‘This is usualy opa; a strong family history may be present

Treatentinciudes behavior therapy, las, and crugs (desmopressin, mipramine, Oxybuynin)

‘Breath holding spots

‘Seen in chen betwoon sic months to 5 years of age. Proveked by xcosshe crying ater which tho
‘hid holds breath, stops breathing and becomes cyanosed or palo. Somo may have seize.
Treatment isto give a strong physical sinus atthe onset of spel. Ion supplementation in anomie

ction should be done.
{Attention def hyperactivity disorder

"Most common neurobehavioal disorder of school age chika. More common in boys. Cinial
features ince Ian, Impuls. hyperactivity, emoboal abit and difiediy in organizing
tasks. The behaviour must begin before seven years of ago and should bo present for atleast six
‘manths in two diferent setings. Treatment inchdes behaviowal therapy and dugs the

melpheridate, amphetamines.

Dyslexia

is the most common leaming dsably. There ls Difiuly in accurato word recogen and
<ecosing. Behaviour therapy and special education aro

red.

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Thing te common and physiological Between 21 5 years of ago and reassurance should be

von
Aula

Nis one ofthe pervasive developmental disorder, the her two being asperger syndrome and rett
[Smorcme. Diagnosis can be done by 18 months of ape. Is charactrisod by an Impalmant in verbal
and non-verbal communication and in social actions. These children have a poor aye contact,
olayed spacch, sorecypca body movements and solitary play. Soizwroe may be present. 12 may

bo margaly ess.
Rettexes

REFLEX [ONSET | FULLYDEVELOPED | DURATION” .

Palmar grasp [259% | SE we Fm

Footing EL [sw Tess prominent 1 mo
Nore Swe aT wk Sam

Tone neck [35m [imo rm

Parodie |7-0me | 10-14 mo Remains voughout ie
Und ad = Ze

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NEONATOLOGY

‘Noonatal pare: bith to <28 daye (say neonatal period bit to <7 d; late neonatal period 7:27
days)
Post necnatal prod: 28 days to less than one year
Perinatal period 2 weoks o lss than seven days
Tom nawbern: 37 vhs <A2 ks
Prete: <7 wes
Posi: >=42 ks
Low beth wei «26005,
Vary ow bith weight: < 15009,
Ecramoÿ lou bth weight <1000 y
CARE AT BIRTH AND RESUSCITATION.
‘+ Normal newborn establishes good crying effort spontaneously
‘+ Fo deans: Coan hands, Can deiner surface, Can cord eut, Clean corto, Clean card
stump.
‘+ Terporaure maintenance very inp (ciscussed later)
‘+ Rule out mar anomalles- TEF (pass a feeding tubo Into slomach} check cod for 2 arteries
and 1 vein (go UA assos wi GI and anal anomalies)
+ Injutamin Kinramuscilr 1 mg
= Into of brnstonding as son as poseo.
Resuscitation:
Resuscitation ls done in accordance wih neonatal resusctaton programme (NRP) The sequence of
resusctaton I newborns is TABC wih temperature taking precedence over away, breathing and
craaton, Temperalio maintenance l of utmost Importance as a hypathrmie baby i iit to
rocuctale.
Most babies wi establish a good spectaneous cy and respiration ater cord lampirg. Some babies
may be apneic or have gasping respiration. Such babes wil requre assistance in esiabshing
oda stab,
Resusotaton equipment Incudes sell nta amou bag with mask (capacty 250-750 mi)
Lannooscope with sight Blades, endotracheal tubes, oxygen source, reserva, drs (adrenalina,
‘naloxone, and normal sane), and sucton equipment.
Enderachoa ube sizos:<1000 9 25 Fr
100010 2000 9-30 Fr
200010 3000 93.5 Fe
>3000 9-49 Fr
100% oxygen used for resuscatión.

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“Assessments and decisions made every 30 seconds
Routne prolonged suction rot recommended and is botar avoided as & can cause bradycardia and
posa

Babes with meconium stained quod à nor-igrous require direct endotracheal sucioning and
should be intubated at bith,

Techniques for chest compresston- thumb technique (batir) and two Ingo achnique.

Apgar score mot needed lo determino the need for rosuscialon or the steps necessary for
‘eaurcton. indicates how wel the baby i responding to resusctalon.

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NORUAL NEWBORN

Vel re: heat rat: 10-60, reaper ral 40-0 best par mu, tempera 96.5378

Tempore shod be mesures ne sa for Dro ies. Resratory ess dead by

‘expat ate 0 ug, across.

Antroponety on e, ead rames 331037 om, chu crumfrece 3

ead comience (LGR bain is cerco > 3 en)

The fein foie hanamonn ar roma a newborn

Acq: prperl nos of hand and ots norma fa ow rs I nents
Hein: AO Vs mg manera an

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Copa Srcondarmunr sep ewig due o eubestaroous edema onthe presenting pat tis caused
bythe vonoue engorgement during labor. This ahou be ciertos from a cophalhomatoma wich
18 due to trauma and blood in the subporosea plane.
Eyam toda, Kis arash seen In normal newborns. Appears onthe second to thie day startog
one face and trunk. Usvatyresaves spontaneously ina wook to 10 days. Eosinophilic nivale,
Epstein peurs relations cyts usually sen on palo
Subconjunlvalhemorrhages, stork bes(callar/ hemangioma on eyes and forohaad)
Wähtrawal bleeding: female newborns may have vagina sacharge or vaginal bleeding Inthe fest
‘Wook du L wir of mater homes.
Phrsolgial weight los: newborns may lose upto 7-10% of bch weight inthe fist fou days. They
toga the bth wt. by around teh day and thereat slr gang wii.
‘Physictegca jaundice: may bo sean In he 60% of normal newboms. Starts on second or this day,
‘peaks onthe thir of day. general rondes by 7 to 10 day.
‘Transitional soos: increased frequency with reerich loose stots seen between third 1 ft day o
ie.
‘reas! ischarg or enlargement may be sean wich spotaneouly resolves.
‘The cord should be kept cy, as in 7 o 10 day.

‘BREASTFEEDING
Normal newborns should recive esco bresifeding fora si mond of ie.
Adrantages of excuse breastooding

‘+ vil mi cated colostum fic in antbodies especialy IgA which provides local respiratory

and gastonestinal mucosal ihmunty

+ loue ares

+ growth is beter

+ metigence quotient of excsvty breasted babies found higher

+ ester nedance of rections in eichood

Bones o mother: alpin trino invollon, les PPH, contraception, decreases chances of

‘breast and ovaron cancer, and helps in weight sheds.

Nik production many by pra and milk ejcton by oxyioin. Main stimulus for bots sucking by
‘me baby.
Colostrum ls the ill mil in st 3-4 days and is en in antibodies and vlamins À D, E K
“Transtional mis produced flor colostrum and mature mi sat in around tro weeks.
‘others vil prlorm babes have mik which is richer In prolins, sodium, ran, abodes and
cales (preterm mak)
Form ste nal art of rik which satisfies the baby tat I is more walery and has more
[moter ind ik is che in fat and calories and safes the babys anger.
Breast mik provides 7g carbehyérate and 1g protein per 100 mi. The breast mik Sugar
Pit asphyda
eine by WHO on basa of APGAR atone mint. A score of 407 is moderate th asphyia an

En

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core of 0 lo Sis severe Bath asp.
American Academy o Pociatis defines sovore bith asphyxia as card blood pH ess than 7, APGAR
‘0018 0103. more than five minuts or features of end organ dysfunction present inthe baby.
Mardestaons of bith asphyxia: almost al organ systems suffer damage, Renal damage i the most
‘common manifested se olgura, edema and in severe cases scute renal shutdown. Hypoxic
Ischaemic encephalopathy may occur. There may be melo complications Ike Hypoghcemts,
Iypocalcaemia; hyponatremia’ and metabolic ackoss. Respatory system: meconium espiraton
synctome. persistent pulmonary hypertension: necrotizing enterocolitis; thrombocytopenia. or
ssombatodinravaseular coagulation.
Neonatal selzures:
* 42 manifested a focal conc or subie seizures
+ common causes: bith asphyxia, hypoglycomia,hypocalcaomia
+ bostprognosis:hypocalcooma soute
+ antcontsant of choice: phenobarbitone
‘Neonatal sepsis:
‘+ maybe early onset oss than 72 hours) or late onset after 72hours)
eat oneot gonoray soon when mother has history suggestive of chooemniontis
+ late onset general originates from nursery or community
* common causes are gram negative organisms ike E.Coli, Klebsiella, Group B streptococcus,
stra, Staphyococcu aureus
+ ciel features inde lethargy, refusal fo foed,sdlerems, hemodynamic insti, apnea
+ Sopsis screen: includes total leukocyte count<5000), absolute neutrophl couri(<1800-Mo
Dest indicator), immature to total neutrophil ratio> 0.2), Crenclv poten (>1 mg) and
(MerDESR (age in days +3) If two or mere ofthese ae positive, a provisional diagnosis of
pei is mado
Low birth weight
Babies less than 2500 gat beth. May be preter or JUGR or both
UGR: weight ess than 10th percentile for gestation. chest cicumtoronce mere than 3 om lee than
head circumforonce, May be symmatical or soymmoten ~
‘Symmotical IUGR: causes-genetc, chromosomal anomabes, TORCH ifectons; poncerst
Index weight gigi cm cube *100)>=2
‘Asymmetrical IUGR: causes-matema diseases, PI, placenta insuficincy:ponderal index<2
Features of marty
ski gelatinous pink ranslucen in pret with vie vessels, Laruge ts abundant. IUGR
bébies have more mature skin with sparse Largo.
+ breast bud poorly developed wih faint area in preterm and me8-dewelopad à IUGR,
+ Earcartlage : poorly developed wit poor col in pret. wa developed wath a
in IUGR
+ Sole ceases: up lo anterior one rin preterm and more GR.

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© Gentala: female: poorly developed majora with vito minera and ello In prtarm in UGR
mejora covers minora and cis well. Mae: pocy developed scrotum wäh undescended
acte in preter, wol-doveloped scrotum with god rugotes and doscondod toos.
+ Expanded new balard score l a scoring method o determine maty.
‘Complcetors of low bith wok bein asphyda, nyponarmia, infectons, hypogycaoma,
Inpocalesemia, In peterms, respiratory disrss syndrome, inraventícar hasmortage, necrosis
enterocolitis retnopahy of promaury, proces of prom.
Fading of LBW:
>34 weeks, >1000 g breastfeeding:
1200-10009, 30-34 wooks- spoon or garage;
1200, <30 wooks- Ls 5
Hypothermia and temperature maintenance:
Newtoms aro suscopble o hypothermia bacauco of higher body surface rea o weigh ratio. Heat
loss ot ath occurs by conduction, convection, riaon and evaperation.
"Normal newborns main temperature withthe help of Brown falinon shivering themogeneas) Tits
‘dose Issue present in ale, around acrenas, porfena area and periscapular aro. Brown ats.
‘defor n preterm babies and IUGR babies making them more prone to hypothermia.
Normal temperature. 365 1037.5°C
1. Cold trees (nid hypotheia)-96 to 36.5"; hands and feo cold abdomen warm
2. moderate hpothermia 92 o 96°; bth parpherie and abdomen cold
3. severe hypothomia -<32°C
Warm chain: st of 10 steps inthe very room to maintain the femperature ofthe newborn.
Kangaroo Mother Care (KMC} continuous skin to skn contact between mother and healthy baby lo
maintain temperature. Used fr care of low bith weight abs.
Treatment of hypotonia: rapid warming 1 34°C and then lowly warming.
Mechanism of temperature maienance:cubatr-corwecton radiant warmes-radlaton.
Temperature range in which the basal metabole rate of babies ls minimum ls called theronaal
2209 and depends onthe aga and weight of he baby
Respiratory distress syndrome (hyaline membrane disease)
‘+ seenin pro babes loss than 34 weeks(10-16% incidence) though oler babies may have
this especially wi ith asphyia, aboli moter, caesarean delivery, aides
‘+ Surfactant Cefiienoy (normaly production starts a 20 weeks, peaks at 35 weeks)
+ mest common cause of rspralory dites in rem babies within the rt a hours
+ ray shows rlculograrular patio, ground gloss oppsoranco, lowvolume hangs, air
ronchogram or teca unge
‘+ steko test on amnioe ful may give an dea about hung matty
Transient tachypnea of newborn (TTX)
+ duo 10 oise clearance of hing uid
‘meaty s00n norm babies devrod by Cacearoen section
+ general a mid rospratory distros Hat

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© Sera may show hype expansion wi prominent vascular markings, ud in telar sure
Hypogtycaente
+ cos glucose ess than 40 mitgramidecatre
‘+ Common in lw bith weight, infant of diabetic mother, Large for gestatonal age, Rh
lncimmuncaton, sick babes
Hypocalcsemla
+ tal Caictum <7 mga or rise calcium <4
‘+ easy ons hypocalcaemia (les thn 72 tours): In pieerm loss than 32 weeks, nants of
‘abate mothe, bith asphyta, maternal hyperpaatiyricem
+ hato onset (more than 72 hours} mothers with vitamin P defcency, babies on
amconiisants; cow's med, À :

‘cessation of breathing for >= 20 seconds or less than 20 seconds but with bradycardia or
+ Shen of promshety sa la proto Daten between second o Oh day. srt la
Eye, cae.
tante of abode motora
+ Mages
+ mer chances ot Haine mentrano seso
+ Pypogyescmia, hypocalcaemia, ype Babin anaemia
+ postent
+ congontl anomatseapectacadovscter
+ cardomepaty an persistent umonaryhyperteron
+ lanyeftcolon syndrome
Nocrotsing entercols:
Sean gear babes alfa wek le, alt away noma ed. Cinca festes sar to
Sept wh abdominal selon and fed trance, X-ray wl show bowel ins and
sneunatns testa
Hamorrhalediesase of newbom
+ dueto vamin star
+ om (3) dueto matemal drugs ke anconnssats, INH, antenag.ats
+ lc) amos! ays boasted babies ue to adequate vai K
< ato onu}: to apa decoro malabsorption eyndromes
+ cay one and sal prove y vain K ph ath
# ty ose revered by var ento moter
Neonatal cholestasis
“rect bain mre than 2 mg per decir or more than 20% ol ta bin
moi causes oo exrobepa br tes (CHA) & neonatal epa
+ tee aundce, gy colours une and pao soos
+ EMBA be url as soon a poss ron reverso damage
= EXA: HIDA scan shows non-xerolon of ars, high GGT level, suggestive War boy

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aura prlferaton and fibres).
+ ver biopsy in neonatal hepa: necrosis, ballooning and giant cols
+ peroperaive cholangiography isthe gold standard
TORCH tafections or congenital Infections
+ transmita rom motnerto baby
+ ine features include growth retardation, microcephaly on hydrocaphahn,
hopaioplenomogaly, anaemia, thrombocytopenia, hearing los, ocular problems
= TOXOPLASMOSIS:
caused by Toxoplasma gost
vansmission ate creases wth gestation
casse triad: chororetnis, Hydrocephalus, cerebral caeiScaon E
treatment fr baby; pyrimothamino-cuadoxino and oatmon for mother: epeamyein
RUBELLA
‘ransmission maximum nat Eimestr and decreases wit esition
‘congenital rubella syndrome: cataract, sonsoinourl heating Is, congortal heart disease(PDA,
VD. Pumenary stanosis)
hearing loss isthe most common
ere defects: rotinopathy (salt and pepper retinopathy) more common than cataract
CYTOMEGALOVIRUS +
‘most common congeital infection
transmission at al stages of gestaton as wel as posinataly
(omg Inusion cease: microcephaly, chairs patospionomega jaundice, pince.
estiment gacidovir
HERPES SMPLEX
transmission is point
‘mostly caused by HSV2
‘most common manifestation Is encephalits and val septicaemia inthe camo
treatments intravenous any
CONGENITAL SYPHILIS -
‘+ transmision coca when mother has primary on secondary syphii at any gestation
+ feta ornoonata deat can occur
+ ary sions: (ist 2 yours) Remo anaemia, trombocitopenia. hepatoslenomegah.
nuncio, pmphadenopathy, OSTEOCHONDRITIS AND PERIOSTITIS, muoneuranacus rash,
ros.
+ lt sons (est 2 decades) bony deleite, Hutchinson loe, muerry molar, sde
ove shagades, con fits
+ agnosis by sercogical tests
+ vestment prin

"Melpline: 08810608460, Visit us at: wunw.afmg.co.n, E-mail [email protected]
35

MBBSHELP cé

18. e

zu AFMG

Academy for Foreign Medical Gr

RESPIRATORY SYSTEM

(Common cl ausatve organisms-sderovrus, Infuerza vis, minos, paraluonza vrs and
RSV (Respaiory Seal vs)
Acute tonilophanmglis : may bo Val Imporantbactral cause le Group A beta hoamobte
stepiocncoi
Herpangina: caused by Coxsackle A. Pharangis with papulovescla mucosa sons
‘Pharynonconjnctval fever: cused by adenovis
Acute opa:
+ Usualy bacterial, most caused by Hinfuenzas.
# Han fever, eroupy couch, dysphagia respatery stress, sico.
+ Diagnosis by laryngoscopy (eens epigotis vie) or by X-Ray
+ Treatment—Hospitalisaton, humid oxygon, antibiotics o emp
‘Acutolryngotracheobronchita or Vie! eroup
+ Via; Most common Para type 1; otvers- adenovirus, Infuenza vrus, rhinos,
parsnfucnza vin type 2 and and RSV (Respiratory Smoytalvrus)
+ CMS has roupy of brasey ough, mid over, sido and in savor cases respiratory disess
+X Ray may pin diagnoses
+ Smptomaic treatment given. Severe cases may need hosplassañon. Siglo dose of
steroid, nebuised epinephrine or budesonide may help
Preumenia
‘causes:
1) Vial RSV, adenovius, inuenza vos oranfuenza veus
2) Bacteria < 2 months—E.co, bia, staphylococo
3 mnts to 3 yars—HIefuenza,proumecoccus ad ssphlcencas
39 ye- proumocous and stphyococeus
Atpicat- Chlamydia and Mycoplasma
“Cana features: fever, cough, spray tress, voll, domina pain
+ Preumoo causes lobar poumon
“+ Staphyocoocus causas severe preumenia wit suppuraton and bronchoalveolar dstuctón
Premolecles characters on X Ray. Peumathorax common, Most common cause of
‘epyora in chien <2 years
+ Trestment—appronrite amies. Atypical pmeumana responds 10 macrokdes or
torsorcines.

ARI control programme

‘Acie lower respirator infections ae a leading cause of moray in cen under fe

has recommended cnialcrtra for agnosis of pneumonia In cidre at pray healthcare
{er contra of presumen deaths.

Helpline: 05810608460, Vist usa www afmgcoin, Email almg@redifimallgen,
E a

19. u
Academy t

mon

Gough oreo
0 fastireatting
het ng
no caera of sovere nass

Fast baling present CL] bites
Less than two months» Sm; 2 to 12 monthe> (coirmoxazale)
Sod: 110 00 menthe> in E

Shestindaning ‘Severe prenons | TV arabic and eer

ran severe chest indrawin, ably Teed | Very vers Want and er

Bronchiois:
+ Age gp-1 106 mont, possble uplo2 years
+" Cause- mosty RSV. Others, adenovius,Iuonza vis parsnfuenza virus
+ Fever, cough, coryza flowed by respiratory distros which con bo covers and can cause
death,
‘= Ray -typereion and trates
+ Symptomatic treatment. Warm hunidfelod oxygen, had bronchodlatos may hel.
[Nebulsed Ray In those wi immunodefcancy, congenital heart disease or etre ang

+ Wheozing associated lower resp) nas (WALRI)
+ Foreign bosies
+ Tropical eosinophilia
ASTHMA, x
# Increase responsiveness o the always Io vais stil
‘widespread narrowing of the aways causing paroxyemal dyspnoea wheezing or cough
+ obstuction othe a flow i reverse other spontaneously rar rearme
‘Symptoms Include recurrent aicks of wheezing, cough and brestNlessness In severe cases,
‘Symptoms may occu termtonty when called mia intere astima or maybe persistent
wih intormitot acute exacertatons. Acule ats may be of mld, moderate or ever itor,
Severe allacks ar charasiiand by cyanosis, lent ches and pulses naracanıs.
Investigations:

Ed

20. men AFMG
Academy tor Foreign Medical Graduates

"The important paramelers n spremeiny nude PEFR and FEVIFVC rado (n asthma rato fo
loss fan 0.8).

Treatment
Interior ana le treated wth brorchodistre most commonly bata-2 agente
Persistont esthma ls read wäh Inhaled coricostrids. Commonly used steroids Inluco
bociameihasone, budesonide and futcasone.
‘The drugs are preferably given by inhaled route and a metered dose Inhaler (MDI) is used.
(Chen less than 12 years of age may require a spacer with MDI. Children below 4 yoar of age
‘ually nod a epacer with mack wth MDL
‘Treatment cf acute exacerbation: asta ls marked by acute exacetbatons which can be of
varying sorry, moderate or sever.

Feature [mit Moderato ‘Severe
“Cour Nora Norma Pal e Bi
Benson | Normal Fes Agiaied
Rospiany — | Wersases, Tnereased Thereased
rate
Dyaproca | Absont can speak | Modoalo, can speak In | Savere, daily in

senioncos | phrases speech
CU CE A | Nabe absent
Trestmont

Mid attack: halo bet2 agonists by nobulcr or MDI with spacer.
Moderate to severe attacks: Inhaled boa? agonista requenty lus oral conicotercid.
Staus asthmaticus: oxygen inhalation, subcutaneous terbutaline or epinoptrino nection, rad
Ssalbutamo,ifectable steroids as soon as possible. If no improvement. thaophytine son
Magnesiom suphato fusion can also be used. Mechanical ventlaton Is requires ln
noneeeponcivecasee.
Foreign body aspiration
+ on 1104 years
+ History of choking episode may be prsen hrs symptoms dapend on Ih natura of
foroign body andthe lof obstruction.
+ The most common symptom is cough
+ _layrgeal foreign body wal manest as cough. hoarseness of voice and sido
+ foi bodies present in bronchi may lead to paral or complet obstruction. Symploms
Indu cough, recurrent wheezing and proumenia. Cllapco can cœur,
+ say may show peroo or cotapse
+ teatment is removal foreign body with a rigid ronchoscope.

Teli OBA, Va o wong coin, Ema Sg ell
Fe

w

21. mes AFMG

Academy for Foreign Medical Graduates
CARDIO VASCULAR SYSTEM

Development of heart stars around tn week of Inauterne Me and a four chambered heat is

formed by shot.

Fetal creation:

"Umblical vela —> poral ver —> ductus venosus—> inferior vena cava—> right tun —
> le Atrium rg vote — ort tough left vente or ducts arteriosus

‘Changes at bittcwhon tho cord ls clamped, th pressures inthe left-sided clio ris leading to
ostra of ara copa doect Increase in oxyparation isthe em for closure of ductus arteioeus.
Functional closure ofthe ducts occur n.aoind 48 Hours ahd añatomicalclosuro takes around 40
ays. forms the Fgamertum arterosum. The ductus venows closes and forms gamentum teres.

Congenital heart diseases
Madas erteria:
To evaluate fr presence of haart dato
Majo cons:
+ sole mum IM,
+ dastoe mumer,
+ canos,
+ congestive haar folure
Moe cera:
+ stole mumart< th,
+ abnommal second sound,
+ abnomal ECG,
+ abnormal ay,

+ abnormal ood pressure
presence of ane major o two minor teria indicate hear disease

Classification:
Acyanotis heart seas or left to right shunt
‘ASD, VSD, PDA
+ these patents have CHF around 4 196 weeks of ago
+ they have frequent chest infections
+ ro cyanoss
+ xtayshons plthoi ung filé
(Cyanati hear disease

2. decreased pulmonary blood flow (ght lo lo shuns) TOF, ticuspid atresia, El
anomaly, Falote physiology: these palerts have cyanate, cubbing. poleyhaenia,

| Helpline: 09810608460, Visit us at wow ating coin, E-mail afmg@rediftmallicom
9 en

22. w

eu AFMG
Academy for Foreign Medical Graduates
anal spals
bo normal or heroesed pulmonary blood Bowling lesions): TOA, TAPVO, True
arteriosus: these have cyanosis as wellas CHF

Obstructive lesions
Coarctaion 0 aorta, Acts Stnosis, Pulmonary Stenosis

Atril Septal Defect + ‘i
Ses:
+ Ostum secundumémare common): micportor fatal Saptumat fossa ovals
+ Cau peimum: die iow ata septum (oñdocargialcuetion defect)
+ Sirus venosus E
asso syndrome: hok oram syndrome, Downs syndrome,
Clinledt Manifestations,
+ Usually asymptomatic
‘+ RV heave often present
+ Systolic ection mumur in Pulmonk area, no shunt murmer
+ S2wde and constanti soit
‘+ Etsenmengor physiology nt before 20 ye

Treat HE

+, nocivo endocarcts rae, prophylaxis not needed

May spontaneously ose.

+ Surgical closure indicated in al sypomatc patients and asymptomatic patients with
(2p/0s rato> 2. Small asymptomatic ASD Pot closed

Ventricular Saptal Defecto
Most common congenital defect
Membrancus or muscular, membranous mere common
Clinical Manifestations.
+ symploms start around Bo 10 weeks of age
“+ Largor, ges growth fare, CHF, focumen lower reepatory infection
= pan systolic murmur at lower let sternal border (pameyaolo murmer only in
VSD.MR.TR} Smalr dect = louder murmux, asympomate
‘+ 52 maybe widely pl but variable
2-7 shows cardiomegaly with pulmonary plethora
+ Patents wih large defects develop pulmonary hypertension and
yperrophy wit the reversal of shunt(Esenmenger syndrome)

23. amos AFMG
Academy for Foreign Medical Graduates
> Most cose wahaul intervention
+ RECHE
+ common, pop required
+ May requre surgery allure of medical treatment, pulmonary hypertension, Qpfüs
ratlos

Patent Ductus Artetosus
‘Connects Pulmonary artery to Aora just ital fo Lo Subctavan a.
Ctnical Manifestations
+ Sal no symptoms
+ LargerL.-+ R CHF, low rom rpeated Lower esp rac infections E
+ Contmucus "machinory murmur (othr causes of continuous murmure AV fete,
pre sh of alata aortcopimonary sept! defect, bronchial collaterals, vencos.
um)
+ pafpbara sons of vide pulse pressure may bo seen
Treatment
+ Indomethec, Ibuprofen closes PDA by decreasing POE; loves in prete babies
+ Inter ables, may cosa by 1 mont, I not surgery I roqurod

(Cyanotie Heart Disease
‘otralogy of Fallot
Mod common cause of Cyanosis presenting during 3° weok of ie
4 components:
+ wo,
+ Right venti auto obstruction,
+ Right vote hypertrophy, nd
+ orig? largo aorta

(rica Mantestatons
+ Oranosis due to ght let shunting across VSD and docreased Pumonary ow
+ rpc,
+ pohrortenia,
+ squatting spots
+ CHE does rot occur except when there is associated ansomia, endocarditis,
hypertension
# Toyo spals erode cyanosis and lat ~ caused by increase in RV ation tact
resistance, increasing the R—+ L shunt. Las mines lo hours, may resolve or
to coat
Examination:

Helpline: O98 10608460, Vist us at www afme co in, Femail: [email protected]
a

24. aan AFMG
Academy for Foreign Medical Gradu
+ cube,
+ RV eave fet,
+ S2le ingle,
+ Systll election murmur in L upper sternum due to RV outlow obstruction
X-Ray boot shaped heart or cor-en-sabot appearance
ECG ~shows RA dlation, RV hypentooty
Complications: wortering of stenosis with age, irfocivo endocardts, hemiplegia, brain
abscess, severo bronchopreumonia
Treatment
"Cyan spets'- Rx by decreasing R — Lshuntng, by creasing systemic
vascular resistance, and deo pulm vascular resistance
Supplemental 02, merphine suifoleknee-chest positon, sodum bicarbonate, propranolol for
prophytais) methoxamine.
‘Surgery required in mos of the patents
Paltatve surgeries:
“+ Blalock bush shunt puimonary artery and subclavian artery
+ Potts shunt PA wth desconding aorta à
+ Watersie'sshunt-PA with ascending aria
“Truncus Arterlosus
Single atrial vessel, therefore compete mixing of systemic and pumonic blood usualy has
enter septal defect
(Gina Mantostatons
Moderate Cyanosis, CHF develops in weeks
Treatment: Antcongestion = digoxin & recs
‘Surgical pair Close VSD, and make conduit bn both aorta and pul artery

d-Transposion of Great Arteries
‘eta arses from RV, Pulmonary A. arises from LV = operates In Parallel. Ana Is anterior and to
ho pulmonary artery (normal itis poster ant ight)

GA is a corected TGA (aortas tothe lft of PA)

most common cyanai HO presenting in neonates whe may have intact vontiular soptum

ASD, VSD, or PDA that allows mii required for survival

Cincel Mantestons

(Cranosi present ram bith and CHF

Right ventuarhyperrophy seen, right nis deviation on ECG, Egg-shaped heat on Xray
(Treatment: PGE, lo koo PDA open In eco wih Ita soptum and then emergency Rashkind
balon arial soptostomy

‘Surgical repair = arterial switch aten) or Au srch(Wsard)

Total Anomalous Pulmonary Venous Connection(TAPVC)

Rare sion, where all pulmonary venovs return is recto fo the Right Atrium

Hein: 0981060840, Vit usa: ang coin, Eat afmg@ relma ay
2

25. aa AFMG
Academy for Foreign Medical Graduates
May be Supracardiac (most commen), Cardio Inracardia cr Mixed
única! Marifestations: cyanosis and CHF
OR fo o eight or snownan appearance
ECG howe right axis deviaen and Right Venticulr Hypertophy
Treatment Rx of CHF
‘Surgical edrec vessol nt Left Atrium Nocossery in 1% month of Lie

TrieuspkdAtroela
No connection bin RA and RV, leds to hypoplasia or absence of Right vento, 60% have VSD dis
lows blood to tov om ele verre to bot the Pulm A. & Anna

‘Most so have puimorie stenosis

‘The only way for syatomio cod to got to the Left side and therfore the Pulm A. and Aorta ie
trough a Patent Foramen Ovalo or ASD

Cia Manifestations Oyarosis is severe, poo foeding,tachypnea over rst 2 weeks of Me

‘£06 superior axis and Left Ventricular Hypertrophy.

‘Treatment PGE; to keep PDA open lo maintain Pulmonary low and balon atrial sepiostony, Mf aa
elec not suffit Block Taussig Shunt

Ebstein's Anomaly
Extremely rar, where leaflets are diplaced Into RV cavity. Resuts In hypoplasia of RV, ticas
Fur ander stenosis. 80% have Patent Foramon Oval, with R — L shunt

Massively diated RA

Cinica Monfestatona

(yanotis and CHF in fst tow days of

heart blocks commen

CHR = MASSIVE cardiomegaly wih enlarged RA

Treatment: PGE, to keep PDA open to mantain Pulmonary flow, CHE therapy wäh Digesin and
dr

Surgical ropaı Tcusplvavo x

Hypopiastic Left Heart Syndrome (HLHS)
Most common cause of death from congerital HO ding 1% month

Syndrome wih: Hypoplaia of LV and Aorta lading 1 reduced fow tough the Left ido

Casos L +R shut at Atal Jove! & RL shunt at Duclus Artero

(tical Menfestavons: As ductus cose —» CHF, moderate cyanosl,tachypnea, pulmonary rales and
hepatomegaly

Poor or absent peripheral puss

Treatment: PGE; keep PDA open to maintain low 1 the Aorta from right side and plano

Helpline: 09810608410, Vist us at: www af coin, E mall afmg@redifimallcom
2 Mees!

wi

26. wi

ms AFMG
Academy for Foreign Medical Graduates
Coarataion ofthe Rorta
‘Conctition of sota, usvaly desconcng ainsi st of dct
Cries Mantostatone
‘Weak femoral pulses relative to upper
Systolic ejecson murmus at Apex colateral formation round scapula und lower border of ibs lading
teaching fs
systemic hypertension
Intermittent claudication, pain and waskness
Bractilemoral day
roatnent: Batoon argiostaty rzurical end to end anastomosis
ol stonosis
+ let vonsestarhypervophy
+ istry of angina on eo
+ supravakalor ao stenosis (Wilame syndrome) la associatod with En facies, menta
‘retardation, detal abnommalis, idlopatichypercalcaemia
Fleonmengor syndrome: occur in patents wit Increased pulmonary Bioodlow. Over tine
pulmonary pressures incase asa ru or damage to pulmonary vessel.
Increased pulmonary toodtow-—> pulmonary iyperiesion—> Ireversbio pulmonary vassal
changes ght venta hyperropy-—> gt ot shunt
"The hear csease i inoptrt once Esanmengar syndrome occurs
Congestive heart failure:
‘Sausas:Ifone-congoritl hart ico, myocar, ayuno, hypocalocomia
ter chan thoumañe fever, heumat heart sense, myocardial disease, hypertension
Treatment: Frusemide, ACE ill, Digoia
‘Acute theumatc fever:
+. soenin the age group 5 015 years
+ cased by group Abeta hamolfisretococol
+ agnosis by Jones citi: two major or one mapr with two minor ln the presence of
= essonta tera
+ major ctra: Candis, miratory polaris, subcujaneous nodules, Chorea, enema.
morra
+ minor ctor: ver, artalga, raise acute phate reactants, increased PR interval
essential rei: need ASLO, postive treat autre, recent scarlet fever
estiment suppresshe agents aspin or sro for otal of 12 weeks. Steroids prefered i
aris presont (a dose for reo weeks folowed by tapering)
three wealy injections of Bertin peril lielong for prophy ie
Hypertension:
arterial ood pressure above OSthpercentle with reference to age, sox and height. Mos
causes secondary to renal parenchyma dsvases.

27. wi

mou AFMG
Academy for Foreign Medical Graduates

NEPHROLOGY

bevdapnen

+ ny oan ar a en nos topa cr beeen
201098 vet rd hole mba on ma y is

+ ome alo st o was foma

+ ren fura mesma 70 a 00 mem! rec, 20 1400
mot

+ renal function matures by two years of age

Common inc yen fa dee code hot, out an yi
Ema tcs by lg primi momia portal fen a ir ger
Forn cia cis ln Gomorra bt ft I on mens css. Mos
connor cause nées poses Done.

sta ia dut moe

tando

Unico Hama nore a ve RS I ig San ore
than 10 leucocytes/ HPF abnormal, Proteinuria- < 100 mg/m'r- normal; 109-1000 mai
mid to moderate; >1000 mg/m"itr- heavy or nephrotic range.

U tr. a mori mé steam soplo bos. Cony ext > 10000 ten
un. 1000 aan mama paro. y rn ptt urn
pe

+ dt durs 20165 atin, 0.100

Rage rang, NP

= Radon scan: ttm blé USA DTPA, MAG. MEA. ans; DTPA
Anden M0 bt

Act slender
Chartres by autors nora. ki cana agents
rois:
paa
+ Doors hos gehen: yes bp or como acia ange
+ Onur Bm Seip A ba Py ruca ton paty 1104
weis itogano sae, 12.48
+ Orca re ce ui, na, pn, cl alae rn, Thr ie
tt poi Sood tes cee may bo ee
+ Selo nt o sica tc pn plete wih han
SO ond sane ro dr gr. Sum ln 6 cc
ini en.

28. ©

ua AFMG
Academy for Foreign Medical Graduates
Prognosis is excellent Resolution slats In rat wock and wi two wooks mast of ie

‘sympoms disappear Hypertension may aho longer o subside

Rapidly progressive glomerulonephrtis
# thee i rap oes ofrenal funcion
+ stlogical features presence of crescents in more than 50% glomerul
+ chances of chromic fomenudonephris are ah
+ Treatment le early Írrivonous sterids folowed by oral predniakne and
‘opdophoephamice.
Henoch Schonlin Purpura
+ Corimon vasciits in chidren characterised by palpable purpur rash, arthralgia, abdominal
- palnandrenalinvolvement
+ Rash la usually on extensor aspects of lower remis and buttocks
«Renal inlvement ls usually mid with microscopic hematia and mid proteins rarely
"opere or nephrotic syndrome can our. Mast patents recover spomtancousy,raraly
chrome damage occur.
+ Managemen’ le supporivo. Predriclone may bo ed in somo cocos.
Hasmolylo uremio syndrome
+ common cause of acute renal fallo incre ess than 2103 yours ”
+ characterised by hemalyis,thrombocyopenia, acute renal fature
+ Dr group: procedod by dirrhoea mainly caused by E. coll 0157; HZ; |, SHIGELLA
DYSENTERY TYPE I (most common in India D- group: ot preceded by darthoea,
+ Folowng an episode of acute diarhoea or dysentery, patents show sudcen pallor and
guia, Blood pressure may be high
+ Peripheral smear wil show fetes of haomalyais, high rlleJccio counts, and
Urumboopenia Blood urea nx creating are elevated
+ Treatments management of renal falure and correction of anaemia. Peritoneal dass may
be necessary. Residual renal damage can occur in somo eases

GA nephropathy
+ commony causes recurrent episodes of gross hematuria lasting for 210 5 days
+ preceded by URI
+ botwoon episodes mid proteinuria or meroscopic hematurie may peris
+ Rarely neptro or nephroi syndrome can occur. Some patents may have chron renal

+ Cause: greater tran 00%, opa; Other causes amyloidosis, SLE, vasulis, heat
"alpine: 8810608460, Vitus at ww arg coin, mal atma@rediimaliepm,
= ;

29. mon AFMG
Academy tor Foreign Medical Graduates

+ based on histlogy there are two main groups — minimal change nephrotic syndrome and
ptr syndrome wah siniicant lesions

+ > Minimal charge disease: — most common cause In chiéran. Onset generally 2 to 6 yeas
nica! featur inode goneraend codoma and ogra. Hematuia and hypertension aro
rare. Laboratory features of nopal syndrome are present, Hood urea nd creatinine ls
"sal normal and C3 levels are norma. Response to steroids ls charackerstiaiy good.
Long tem prognosis ls good wth le chances of chronic renal damage. The cours Is
(characterised by frequent relapses that gonoraly stop by socend decada. Troatmect le
slrois. Prednisolone is commonly used and the response la good. Direlc are used Hf
required ACE nhlblors are prefered as anthypertomaes as they also decrease prot,
Patents not responting 10 prednisolone or frequent rlapsers may require levarisol,
‘eylonhosphamide or cyclosporine. Common compleatons include infection: Proumoccccus,
¡ram negative, varcal; real vein trombosis; auto renal fale; rod tot.

+ Nommininal change nephrotic syndrome or naphro syndrome with nice lesions:
Includes mesangoproteratve gomerdonephris, focal segmental gomerdoscleross, and
‘membranous glomentonephits. This consutes 10 to 15% of chldren win nopivolo
syndrome. Hypertension and hematuria commonly occur and response to prednisolone ls
{general poor. Long-term prognosis isnot very good and many patents progress to chronic
gomonionephis.

Urinary tract Infection
(Common in chléren and in smaller children, is frequent associated with vsicourtmi roux (VUR).
In lefancy incidence In boys fe same as ge. Later: gle> boys. Causes: most common E. Cal.
ters: Kibseta, Proteus, Psoudomonss, Enterococces. Predisposing faciore— vesicourterc
refux, obstuctvo uropathÿ, neurogenic bladder. nical features include fever, frequent micurion
and aysuna.

Une microscopy shows > 10 WAC! cu mm. Urine cutie fe dlagnostc. >10° organisms perm
postive in a mid team clean catch sample; >10 wih eymolome; evprapubi, any growth. Treatment
la wäh appropriate antibiotics and after treating the episode, evaluation of unary tract needs to be
‘done. Utasound is done nal cases. MCU and renal scan are recommended in chien less than
‘wo years of age

Reflux nephropathy and Vesicouretari reflux (VUR)
+ retrograde Bow of une from the bladder to upper winery tract occurs leading to renal
damage
+ VUR I prosnt in 3010 35% al eidren wi febrile UTI
+ Diagnosis is by MCU which can bo dane wth radio cotas or raionacio agents
+ VUR fs graced from Ito V (ref ito wrote, fx up o real pes,
eier, IVsatalon of renal pelvis als, massive datation of welers aná pelvis)

Helpline: 09810608468, Visit us at: www amg co.n, E-mal: afmg@redifimaitcom
a MBBSHi

30. zou AFMG
Academy for Foreign Medical Graduates
"Anti propinas for prevention of repeated UTTs is given VUR l present and In most
cases VUR rsoives win age.
“+ Indication for surgeryrocurert breaktwough urinary act Infections, poor
comploncofntlerance, appearance of now scare percstonce of grade 4 and 5 VUR alar
vo yours of age. Surgkal procedure done is ureteric e-inplaration.

‘Renal tubutar acidosis

+ There is defect in acificalcn ef wine wit sun hyperchiotemie melabote-ackosc, wih a
igh wine pH. Kidney funtion tots are normal.

+ Type sta: detective secretion of Ht ln dal tubule. inca features Include fature 10 te,
poyura, polyps, ypokzlemi and its. Investitions show s}siémic acidosis, hypokalemia
and Urne pH. Treatments oa sodium bicarbonala.

‘Typ I (proximal: Its due to reduced proximal tubular roabeorpton of bearbenato Acidos lo
loza severe as the deal mechanisms ar hic. is usualy a part of global tubular ysfuncton
caled Fencon's syndrome when accompamirg patera, gucosuda, phospharura, uicosua
ere aho present.

Iaiopathi hyperealeluria
‘Common in children. Manifested as microscope or gross haomauia and renal calcul. Urne calcium
tw creatinine rao greater han 0.2 is agnostic. Serum calcium is usualy normal Treatment includes
sal restrcon and ido direis

Heine: 09810608460, Vis us at: Www aME.C ln, Email [email protected] _
Ei Wer

CA

31. un AFMG
Academy for Foreign Medical Graduates
CHILDHOOD MALIGNANCIES
Most common: lukaomia (30%)
Second mest common: ban tumours (20%)
‘Third most commer: yrnphoma (12%)
leutaemies
+ clonal protteratin of sbnormalhomatopook cats
Acute hmptobastic leukaemias most common
+" risk factors: syndromes Ike Downs syndrome, Kinefeters syndrome, blooms syndrome,
“taa onglets fancon syndrome: exposure toning radiation; chemotherapy
‘Acute lymphoblastic leukemia
+ sua age: 3107 years
+ LA ype mostcommon
Poor prognestcndicators
age of onset <1 yor >40 ys
Ron il etal loco count (550.000)
Drop
922 end 411 aiocaton
response to strld veatment
(nic features: rap increasing palr, fever, ending mantas. Examination usualy reveal,
Imphadenopathy and hepatsplenemegely. Peripheral smear wil show the abnorml cale and bono.
‘manow examination is conmatoy,
Trestment: response lo chemo therapy I gerealy ood. Chemotherapy ls given in twee phases
imduston phase, consolidation phase and maintenance phase. Usual drugs Used Include vrestine,
recono, meihotexate, Cyciophosphamide and L'Asparagnase. Most common causo of
‘eaten faire is relapse. Common ses of relap ar bone marrow, contr nervous eye ena
mt.
ACUTE MYELOBLASTIC LEUKEMIA
+ Prognose ot as good ALL.
+ Morphotoglcaly aves Int ht yes: 4010147
+ congentallucomia1S GENERALLY M7 AML
+ disseminated intravascular coagulation e a common feature of M3 AML
+ gum hyporplasia may be seen in M4 and MS subsets
‘+ coronas ae locals colectons of malignant cals seen in bones tke eb, central nervous
system, skin and other stos
+ mylodysplastic syceme isa prolonged pre-oukoemic phases of AML.
NEUROBLASTOMA,
+ malignant tumour ol autonomie nervous sytem derived rom neural rest

pling 09810608460, Vs us a wor ating. E mal ame Ge dima com
2

32. am AFMG
Academy for Foreign Medic
= most commen intrabdominal sold tumeur chldron
+ most common tumour fancy
+ moet common tumour wih skeletal metastases
# monty soon In children less than two years and almost al cases occur by five years
+ Common años aro adrenal gland, paraveriebra, reo peritoneal, postrer mediastinal and
pets
te matinant mass may produce caecholamines leading o sytem features I fever,
aruity, sweating, lanhoes, hypetenson. urinary catecholamines may bo loved
‘wiLars TUMOUR
+ most common malignant tumour o Kidney,
+ mosty in ehieren tess than vo years : S
+ most common presentation is asymptomatic abdominal mass. Homatura, over hypertension,
abdominal ain may be present.
+ Assccialons: hemihypervopty, ansia, geriouriary anomalies, beckewih wiedeman
smarome.
BRAIN TUMOURS.
+ ancon most common amourinchléron
+ around two tés are lala!
‘+ most common are medutoblastomas flowed y cerebolar astroctomas.
RETINOBLASTOMA
“+ most common primary ocular tumour
+ mostyin citron less than fe years
‘+ lateral disease is common
+ autosomal dominant inherlance, 10% may have famiy history of relnablastoma
caries sign is Loukocaria
HISTIOCYTOSIS X (langerhans call hstocytosis)
+ nitration of tissues by abnormal Hsticyles , Imphocytes osinoghds and nomma

water

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au AFMG
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ion

Energy requirement: 10 kao forthe es 10 gs. Between 10120 kg roqutemant I 100 ca

280 a per kg add ftw weight above 10 kg. Fer wagt mare thn 20 ks, 20 eae aed

151500 al state the requirement

Proton equtement

los than moni ~2 gay

‘to 12 months 16 hot

A1 your 20 ger dy, E

4100 yor 90 por dy,

188 yrs 4 por dy aná

nero 0170 per da.

Exchisive breastfeeding should be done til six months of age. Aer six months complementary
feeding should bo stared and brosifonding continued and encouraged up o 2 years

aloutldoniundernutton
Indicators of malnutrition

Indianer Interpretation

Underweight low weight for age both acute and crore malrurtion
String low hal forage chrone matron

Wostng Le weight or hight acute malrtrtion,

WHO classification

“The use fZ sero or standard dein score i recommended.
Standard deviation score (SOS)= (observed valuemedian reference valaoJeiandard deviation. A
007 01-210-3 iles moderato malnutiion and a secre of +2 o +3 Indicates averneigh A score
less than inticates severe malnurlion and a score of more han +9 indicates obesty.

WHO classification

odorata mali ‘sere malito
[Syrmeticaloedima [no "Yer (Edomatous malaria]
Weight Tor hat ‘BD sere between Exa)
Taig Tora ‘SO score betwoen210-3 a)

"Helpline: 09810608460, ist us at: worw.afmg.co.n, mall: afmg@redifmaiLcom
a

Mas

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IAP classification:
“Tho standard used for reference populaton was the 60th conto of Harvard standards, This scheme
ls used i the 108 programme.

[Grada of mainutrion | weight for age of the standard (5 |
Fama >50

Trost Ti- (mid malen)

Grade STO adore meinen)
Grado 55-60 (cavers maton)
Grade =D very severe manner)

Mid arm circumference. It is an age independent index of manutiion. Miam creumference
remains sao betwoon 1 to 8 ar at a value of 1610 17 om

Lose than 1.5 indcates mation

Less than 11.5 indicate severe malin

Marsamın Kwashlorkor
EL ese common, more savers
En regalo Fine
EN EEE Poor appetie win mental apathy
Hepaiomegaly | negaivo. May bo present
Prognosis — | Bator early recovery poor view of prolonged recovery and more
infections)
TRepearance | monkey facies ‘sna baby appearance
baggy pants appearance, skin changes (pigmentation, flaky paint
matosis) mainly on butocks, perheum and
= upper thigh
‘tag sign in air and has easy pluckabe
‘Treatment of malnutrition
+ manage complications: hypoglycaemia, hypolhormia, dehydration, elecriye Imbalance and
infections

‘+ nuitional rekablitation: Mid to moderate malnurion- 160 kcal perky per day and Proteins 3
gay.
‘Sovere malnuron- 200 kealkglday and proton: 41 0 g/day

35. amet AFMG

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Diarios
Most common causes in cren are rtavtus and Ecol.
Dehydration statis ls assessed and casse as no dehydration, some dehydration or severe
hyéralion according to WHO crt

‘Wo dehydration [some dehydration | severo dehydration

Gordon aa Tests able age ol
unconscious

EN roma E Vera

Tears Good ‘evant ‘Feat

cod Wit By Cora

Thiet ‘inks nora nok AE

Us ink, Es
Sin ping CAN CL CO CA]
(Ocal hydration therapy (ORT):

‘Oral rohr therapy incudes ORS, sugar sal olution, lemon water, coconut wer, soup, co
ar, dl water Glucose water without sl and his lke tea and flo are not ORT.

Composition of ORS
Tow onlay ORS new) | Standard WHO ORS Cou

Sm 75 ©

Polar E ©

‘Cine = gl

nis 0 10

Gee 75 mr

Dane Eu

‘atin wii no dora replace Do ose wi oral vehydraon era
Patients wih some dehyraton: 7 mig ORS inte fest four hours

Patients wih severo dehyraton: 100 mig of IV Mic preferably ringers lactate given over 3 10 6
hours.

"ZINC te be given o al chan wih laca In the flowing osos:

Inlata < 8 montis: 10 moldy, rest 20 mala for 14 dys

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Down's syndrome

Most common hvomosomal disorder occuring in on in 800 to 1000 babies.
‘Caused by tisomy 21 in 04%, translocation in 6% and mosale in 1%.

High matemal age as been found to bean importara sk factor

‘the risk of recurence is more wih vanslocaton especialy when they ae charted rom the
moon

Features Inude mental aid physicel retardation, fat facies, mongelok slant, opicanthal
{eld smad nse ard fat nasal. edge with Tow set dar. Hypotonia i seen. These children
have a small brachyemphal skull win a fat oocput. They may have cinodaciyy, Simian
creas, sand gap. x :

“The con have cardiac defec most commonly Endocardial Cushion defects. Hrschsprunge
(disease ls also seen. Heacing los is common. Hypothyroidism is common. They ae more
‘Prone to develop leukaemia,

Turner's syndrome

4870.

Phenctypcaly females
at bit dedema of dorsum ofthe hands and feet may be present wth a short neck

Later charactrsed by short stature, delayed puberty, shield like chest with widely spaced
niple, ubitus vals, and hypothyroidism.

Lehe cardiac lesions (AS, COA, MVP), horseshoe Kidney, hearing deci.

{aiment includes growth hormone therapy and ovarian hormone replacement

Ktneteltar syndrome
urom

Phenotypic malos.
Hypogonadiam with small testes and no secondary sexual characters delayed puberty
“These boya aro tall and underweight wih elongated logs. Gynecomastia or exypiorhisism
may bo presen. They may have mental retardation.

“Helpline: 09810608460, Visit us et: www.afmg.co.in, E-mail [email protected]
2 :
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