Defini ons –

1. Development (Growth and development)- Child development encompasses all aspects of

paediatrics. It applies to all aspects of soma c, psychological, cogni ve growth to behaviour.
The developmental principle is the concept of ongoing change and matura on. Or

2. Moderate dehydra on (dehydra on) - Moderate dehydra on in children refers to a state

where there is a no ceable deficit of fluids in the body, but it has not yet reached a severe
level. Common signs of moderate dehydra on in children may include increased thirst,
decreased urine output, darker urine, dry mucous membranes (such as the inside of the
mouth), and mild irritability or lethargy.

or
3. Malnutri on-It is defined as any disease-promo ng condi on due to either an inadequate or
an excessive exposure to nutrients, i.e. undernutri on or over-nutri on. Common causes of
malnutri on are inadequate calorie consump on, inadequate intake of essen al vitamins
minerals or other micronutrients improper absorp on and distribu on of foods within the
body; overea ng; and intoxica on by nutrient excesses.

4. Neonatal asphyxia-Hypoxia(asphyxia) refers to an arterial concentra on of oxygen that is less

than normal, and ischemia refers to blood flow to cells or organs that is insufficient to
maintain their normal func on. Hypoxic-ischemic encephalopathy is an important cause of
permanent damage to central nervous system cell, which may result in neonatal death or
which may be manifested later as cerebral palsy or mental deficiency.

5. Sexual precocity-Sexual precocity is defined as the appearance of secondary sexual

characteris cs before the lower limit of the normal age for pubertal onset.

6. Mycoplasma pneumonia-Pneumonia caused by the bacteria Mycoplasma is known as

Mycoplasma pneumonia. It is also called atypical pneumonia. It is a cause of symptoma c
pneumonia in older children. Endemic and epidemic infec on can occur. The incuba on
period is long (2-3 weeks) and the onset of symptoms is slow. Although the lung is the
primary infec on site, extra pulmonary symptoms some mes occur. Fever, cough, headache,
malaise are the common symptoms

7. Tetralogy of Fallot (TOF)-

8. Haematuria-The presence of blood in urine is defined as haematuria. It is a common sign of

urinary tract disease. Brown or tea coloured urine may suggest glomerular nephri s,
whereas red coloured urine may suggest post glomerular bleeding.
9. Pathological anaemia-Pathological anaemia in children refers to a condi on where there is a
significant and abnormal decrease in the number of red blood cells, leading to a reduced
capacity of the blood to carry oxygen. Unlike physiological anaemia, which is a normal part of
growth, pathological anaemia in children is caused by underlying health condi ons such as
gene c disorders, chronic illnesses, infec ons, or nutri onal deficiencies. Proper diagnosis
and targeted treatment are essen al to address the specific cause and manage the anaemia
in paediatric pa ents.

10. Head circumference- During infancy head circumference is usually a reliable indicator of
brain growth．At birth，head circumference measures approximately 34 to 35 cm，
increases 11 cm～12cm during the first year，reaching46cm．Subsequently growth slows
down，and in the second year for life the head circumference grows 2cm，reaching 48cm．
A er 2 years ll maturity head circumference grows 6-7cm more．At the age of 5，the
median head circumference is 50cm．At age 0f 15 average head circumference is 54-58cm.
The maximum circumference of the head from the occipital protuberance to the forehead
(through eyebrows)should be recorded．If the head growth exceeds 1 cm in 2 weeks during
the first 3 months，hydrocephalous should be suspected．

or(Head circumference is a measurement of a child's head around its largest area. The
maximum circumference of the head from the occipital protuberance to the forehead
(through eyebrows) should be recorded. During infancy, head circumference is usually a
reliable indicator of brain growth.)

11. Severe dehydra on: - Severe dehydra on is defined as severe decrease in ECF volume and
ssue perfusion, along with decrease in body weight (11%-15%), >4sec perfusion, anuria,
and tachycardia.
12. Obesity- Obesity is an important paediatric public health problem associated with risk of
complica ons in child- hood and increased morbidity and mortality throughout adult life.
A BMI 95th percen le is classified as obese. Obesity is almost always due to an imbalance of
caloric intake and expenditures, Obesity is rarely secondary to gene c or endocrine
condi ons.

13. Long term infant (LGA)- LGA is Large for Gesta onal Age. If the body weight is more than the
90th percen le of the same gesta onal age, it is characterized as LGA. Post term neonate -
GA>42 W

14. External marrow haematopoiesis-In the normal circumstance extramedullary

haematopoiesis does not happen only in condi on of increased requirement of
haematopoiesis such as suffering from infec on and hemo1y c．Extramedullary
haematopoiesis begins to work with enlargement of liver，spleen and lymph nodes，
meanwhile may appear immature red cells and neutrophilia into peripheral blood．We
called them “extramedullary haematopoiesis ” when infec ons and anaemia have been
controlled，extramedullary haematopoiesis disappears．

15. Infec on mononucleosis-The Epstein-Barr virus (EBV) is recognized as the major cause of
heterophil-posi ve and heterophil-nega ve infec ous mononucleosis. The incuba on period
of infec ous mononucleosis syndrome is 30 to 50 days. The clinical syndrome of infec ous
mononucleosis is usually preceded by a -3 to 5-day prodrome of malaise, fa gue, headache,
nausea, or abdominal pain. Over the next 7to 20 days, sore throat and fever gradually
increase. The triad of fever, sore throat, and posterior cervical adenopathy occurs in more
than 80% of pa ents.

16. Rota virus diarrhoea-Rotavirus is the most common cause of acute infec ous diarrhoea
during infan le period in developing and developed countries.
17. Viral myocardi s-

18. Convulsion dura on-

19. HSP (anaphylactoid purpura)- Anaphylactoid purpura (Henoch-Schoenlein Syndrome, HSP) is

a type of dis nct systemic vasculi s syndrome. The main pathological change is small-vessel
vasculi s. It is characterized by skin purpura (the main character), migratory polyarthri s,
bellyache, hemifacial, haematuria, albuminuria.
20. Physiological anaemia- Within the first few days of life, erythrocyte produc on decreases,
and the levels of haemoglobin and haematocrit fall to a nadir at about 2-3 months, known as
physiologic of infancy. Hemoglobins:100g/L (Premature infants:70-80g/L) RBC:3.0x1012/L.

SHORT ANSWERS-

1. General principle of child growth and development (index of child growth and
development MCQ)
Ans- Up to down: for example, a baby raises head first, then sits, then stands, and finally
walks．
*From proximal to distal: an infant moves its extremi es from shoulder joint to elbow
joint to hands, from legs to feet.
*From gross to fine: babies always use their palms as early as fingers when they want
something．
*From elementary to advanced: children o en learn to observe their surroundings at
first, then have their own feelings, remember them, produce their own thoughts, and try
to analyse by themselves．
*From simple to complex: for instances, if a child draws pictures, he can express his
thoughts from lines to circles, and to whole pictures at last.

2. Kawasaki disease and maybe HSP from connec ve ssue disease.

Ans- • The diagnos c criteria include fever for more than 5 days and at least four of the
following features:
• Bilateral, painless, non-exuda ve conju vi s.
• Lips or oral cavity changes (lip cracking, fissuring, strawberry tongue, inflamma on of
the oral mucosa).
• Cervical lymphadenopathy (1.5 cm in diameter, unilateral, non-purulent).
Polymorphus exanthema
• Extremity changes (redness of palm and soles, swelling of hand and feet with
subsequent desquama on)

HSP is a type of dis nct systemic vasculi s syndrome. The main pathological change is
small-vessel vasculi s.
Character:
1. skin purpura (the main character)
2. migratory polyarthri s
3. bellyache, hemafecia,
4. hematuria, albuminuria
3. Acute and chronic complica ons of diabetes mellites (clinical manifesta on and
treatment maybe)

Ans- Type 1 diabetes mellitus also called insulin dependent diabetes mellitus or juvenile
onset diabetes mellitus. It results from immunologic damage insulin producing B cells of
pancreas. The immunologic damage requires a gene c predisposi on, and is probably
influenced by environmental factors like virus, bacteria. It can be caused by gene c
factors. Most common type of diabetes in younger people below 40 years. Associated
with islet cell an bodies, diminished insulin produc on

Acute complica ons-

Hypoglycaemia

Ketonuria

Ketonemia

ketoacidosis

Chronic complica ons-

Renal failure

Loss of vision

Re nal detachment

4. Clinical characteris c of acute glomerulonephri s & nephro c syndrome

5. Characteris c of neonatal pathological jaundice

Ans- 1. Appears earlier (first 24 hours of life).

2 serum bilirubin concentra on in higher than 204~256µmol/L(12~15mg/dl)

3.serum bilirubin concentra on daily increase is more than 85µmol/l(5mg/dl)

4.Jaundice lasts more than 2 week in mature or more than 3-4 weeks in premature

5.Jaundice recurrent

6. Direct bilirubin(conjugated)concentra on is higher than 34µmol/l(2mg/dl)

6. Classifica on of congenital heart disease

7. Lumber puncture and bone marrow puncture (what is the puncture point for these two
opera ons and applicable age) BMP is more important

Ans-
 8. Diagnosis of growth hormone deficiency

Ans- Growth hormone deficiency: is characterized by decreased growth velocity delay skeletal
matura on, absence of other explana on for poor growth, and laboratory test indica ng subnormal
GH secre on
9. CPR for infant and children (how to give CPR to infants)
LARGE QUESTIONS
1. Neonatal and neonatal disease (most probably RDS)

Ans- NRDS the ethiopathogenesis is PS（pulmonary surfactant）deficiency. The

diagnosis include

 Clinical features:

Respiratory distress [Tachypnea, RR>60bpm, cyanosis, pale, nasal flaring. Intercoastal

and

sternal retrac on. Expiratory grun ng. Air limited entry into lung.

Circulatory insufficiency: Hypotension, PDA, Shock.

Intracranial Hemorrhage

 Chest x-ray show symmetric changes : 1.ground glass 2.air bronchogram 3.white
lung

 Gastric fluid oscilla on test

 Blood gas analysis

The treatment of NRDS

 symptoma c treatment

 CPAP、ven lator

 PS subs tu ve therapy

2. How to diagnose & treatment(therapy) of ITP

Ans-
3. Clinical findings and treatment of neonatal HIE

Ans-
4. CSF table (how to differen ate CSF)

Ans-