Rapid Revision Reignite Pediatrics: Question-Answer Format

Growth/ Development/ Puberty

Big Question 1: Define short stature.

Broad Answer: Short stature is defined as “the height of a child is <3rd percentile or <-2 Z score of expected according to the age and sex of the child.”

Detailed Questions

Q1.1: What are the etiologies of proportionate short stature?

Answer:

Q1.2: What is the difference between acute and chronic malnutrition in terms of their effect on a child's growth? 

Answer: Acute malnutrition affects the weight of the child, while Chronic malnutrition affects the height of the child.

Q1.3: A 7-year-old otherwise well child presents with short stature. His weight is appropriate as per his age. His age is less than his chronological age. The height of his parents is normal. What is the diagnosis?

Answer: Height of parents normal - rules out familial short stature. Bone age < chronological age- delay in bone maturation- points towards constitutional delay in growth and puberty (CDGP).

Q1.4: Which X-ray sites are used to assess bone age in infants, children, and older children?

Answer:

• Infants: X-ray of knees
• Children: X-ray left hand and wrist
• Older children: X-ray of shoulders

Q1.5: What are the differences between Constitutional Delay of Growth and Puberty (CDGP) and Familial Short Stature?

Answer:

Q1.6: What does the growth pattern shown in the height chart indicate, and in which condition is such a pattern typically seen?

Answer:

• In the above image, stature/height is plotted
• During childhood, the child's height runs almost parallel to the 3rd percentile line, but ultimately, a catch-up growth happens, and the final height achieved is normal
• Seen in CDGP

Neonatology

Big Question 2: What are common neonatal conditions that do not require treatment, and how can they be differentiated from pathological conditions?

Broad Answer: Certain neonatal conditions like erythema toxicum, milia, Mongolian spots, stork bites, subconjunctival haemorrhage, mastitis neonatorum, hymenal tags, vaginal bleeding, and physiological phimosis or weight loss are self-limiting and benign. They are often due to maternal hormone withdrawal, minor vascular or skin changes, or immature skin structures. These conditions resolve spontaneously, requiring no specific treatment except reassurance.

Detailed Questions

Q2.1: Describe the benign skin conditions of the skin and mucosa seen in neonates that do not require treatment.

Answer:

• Erythema toxicum:
  • Reddish maculopapular lesions present mainly on the trunk
    • Usually present in 1st week of life
    • Sterile eosinophil-filled lesions
• Milia: Colourless papules due to the plugging of sweat ducts
• Mongolian spots: Bluish black areas of discolouration mainly on the lower back, buttocks, and back of the thigh
• Stork bites: Capillary hemangiomas- seen in between the brows, nape of the neck
• Subconjunctival hemorrhage

Q2.2: Explain mastitis neonatorum and its clinical significance.

Answer:

• B/l breast engorgement in both males and females due to the effect of maternal hormones
  • Milk output can also sometimes be seen
  • Vaginal bleeding in females: Due to the withdrawal of maternal hormones
  • Hymenal tags in females
  • Physiological phimosis in males
  • Physiological weight loss

Q2.3 What is physiological weight loss in neonates, and when is it regained?

Answer:

Q2.4 Differentiate between Cephalhematoma and Caput Succedaneum

Answer:

Q2.5 What are the various neonatal primitive reflexes, and when you they appear and disappear?

Answer:

Nutrition and Malnutrition

Big Question 3: Write briefly about malnutrition and its causes.

Broad Answer:

• Malnutrition is an imbalance in energy or nutrient intake, leading to undernutrition or overnutrition
• Causes:
  • Inadequate dietary intake
  • Poor absorption or increased loss
  • Increased requirements
  • Chronic illnesses
  • Overeating or an unhealthy diet

Detailed Questions

Q3.1: What are the best indicators for acute and chronic malnutrition?

Answer:

• The best indicator of Acute Malnutrition: Decrease in weight for height (Wasting)
• The best indicator of Chronic Malnutrition: Decrease in Height for age (Stunting)

Q3.2: According to the WHO classification, how are wasting and stunting defined in children?

Answer:

• WHO classification is based on weight for height, height for age & oedema
• If oedema is present, add 'edematous' to the category

Q3.3: Elaborate on the differences between Kwashiorkor & Marasmus.

Answer:

Q3.4: What are the findings noted in the images below?

Answer: Severely malnourished without oedema - Marasmus

Flaky paint dermatosis

Flag sign: Alternate band of pigmented and hypopigmented hairs

Q3.5: What is the WHO definition of Severe Acute Malnutrition (SAM), and what are the findings in it?

Answer:

• Definition: In a child between 6 months to 5 years of age, the presence of any 1 or more of the following Findings:
  • Weight for height <-3 Z score or < 70% of expected or
  • Mid arm circumference <11.5 cm or
  • Symmetrical bipedal oedema of nutritional origin

Vasculitis Disorders In Children/Immunization

Big Question 5: What is the National Immunization Schedule (NIS) of India, and what does it aim to provide?

Broad Answer: The National Immunization Schedule (NIS) of India provides free vaccination to all children and pregnant women. It includes vaccines against major diseases such as tuberculosis, polio, diphtheria, pertussis, tetanus, measles, hepatitis B, and rotavirus, given at specific ages to ensure maximum protection and reduce childhood morbidity and mortality.

Detailed Questions

Q5.1: What is the latest National Immunization Schedule (NIS) of India?

Answer:

Q5.2: What is the latest recommendation for administering the Hepatitis B vaccine?

Answer:

Hepatitis B is now recommended to be given along with Vitamin K in the delivery room immediately after birth.

Q5.3: What does the pentavalent vaccine contain?

Answer:

• Pentavalent vaccine - A Combination of 5 vaccines
  • DPT + Hep-B + Hib

Q5.4: What are the recommended injection sites and routes of administration for different vaccines in the National Immunization Schedule?

Answer:

• Oral
  • Polio vaccine
  • Rotavirus vaccine 
  • Vitamin A
• Left upper arm
  • BCG (intradermal)
  • Japanese encephalitis (Subcutaneous)
• Anterolateral side of thigh - Left
  • Hepatitis B (At birth)
  • Penta
  • DPT booster
• Right upper arm 
  • IPV (Intradermal)
  • Measles or MR (Subcutaneous)
• Anterolateral side of thigh - Right
  • PCV vaccine
  • Given at
    • 6 weeks
    • 14 weeks
    • 9 months 

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