Pediatrics Flashcards
Rules of growth
Cont process, cephalocaudal, unique in each individual, each tiss- unique growth pattern
Weight doubles and triples by
5m, 1 yr
Height doubles by, and triples by
4y and 12 yrs
Hc at birth
33-34
Hc increased by
First 3m 2cm/month
4-6 1cm/m
6-12 0.5cm/m
Sequence of puberty in females
Telarche, pubarche, menarche
Sequence of puberty in males
Testicular enlargement, pubarche/pubical growth/manly changes
Best marker of pubertal status
LH and FSH
Taners staging for male
Grade 111
Coarsening and curling of pubic hair
Increased length of penis
Test vol -10 ml
Taners staging 4
Increase in penile width
Growth spurt(9-11cm/yr
Taners stage five for adult male
Tv >20 ml 25
Scrottal reddening ? Which stage
Scrottal darkening?? Which stage
Reddening-TS 2
Darkening -TS 4
Breast bud app
Ts 2
Growth spurt of female
Ts 3
Menarche occurs in
Ts 4
Ts 5 female
Pubic hair
Medial thight+
Assessment of growth-age dependent
Weight for age
Height for age
Bmi for age
Age independent
Muac
Skin fold thickness
Weight for length
Height vs length
Standing height-stadiometer->2year
Length measured by
Infantometer
Muac measured by
Shakirs tape
Muac
<11.5cm sam red
11.5-12.5 border line
Yellow
>12.5 N green
Skin fold thickness m/c sites
Triceps, biceps, scapula
>10mm -n
<6 mm-malnourished
Skinfold thickness measured by
Harpendens calliper
Hc:cc
At birth hc >cc
9m-12m Hc=cc
>1y cc>hc
Us:ls
Birth 1.7:1
3y:1.3:1
10 y1:1
Adult 0.9:1
Arm spn
At birth length>as
10-11 yr L= as
Adult as>length~ 1cm /2cm
Body surface area
√ ht (m)xwt(kg)÷ 3600
Growth charts
Indian
IAP(>5y)
KN aggarval
International
NCHs
CDC
WHO
MGRS
SD
3rd centile -2sd
15 centile -1sd
50th centile 0sd
85th centile +1sd
97 th +2 sd
Short stature
H/A <-2 SD or 3rd centile
Short stature types
Physiological
Familial
Constitutional delay in growth and puberty
Pathological
Proportionate ss US:LS maintained
Dis proportionate US:LS not maintained
Familial short stature
<3rd centile
Equal to genetic pottential
Familial sd
Mph for boys
Ht(f)+ht(m)÷2+6.5
Familial ss for girls
Ht(m)+ht(f)÷2-6.5
In familial ss
Bone age=chronological age
Cgdp
Final height=adult height
Delay in puberty
Bone age<chronological age
Pathological short stature proportionate eg
Us:ls ratio maintained
Eg:malnutrition, ckd, torch, GH def, turner
Dispropotionate short stature 2 type
Inc us Ls ratio: short dwarfism
Rickets, osteogenesis I’m, achondroplasia, cong hypothyroidism
Dec Us:Ls ratio
Short trunk dwarfism
Pots spine
Spondo epiphysial dysplasia
Mps
Level 1 inv of short stature
Routine
Level 2 inv ss
Thyroid function test
Celiac serology
Karyotyping
Level 3 inv for ss
Gh provocation test
Mri brain
Igf 1/2
Igf binding protein level
In all path ss bone age <chronological age except
Precocious puberty
Gh replacement ind
Gh def
Turner
Prader willi synd
Ckd
Post chemo
Pm radiotherapy
Microcephaly
<-3sd for that age
Macrocephaly
Hc >+2sd for that age
Causes of microcephaly
Gen: down
End: cong hypothyroidism
Torch inf ,Zika
Teratogens -eg alcohol
Inborn error of metabolism
neural tube defect
Structural anomaly
Causes of macrocephaly
Inc skull thickness - any chronic hemolytic anemia eg thalasemia
Accumulation of blood or pus+ hemorrhage
Hydrocephalus
Hydroencephaly
Lsd, leukodystrophism, NC dyndrome
Sotos
What is sotos
Over growth syndrome
AD, NSD 2,inc HC , inc limb size
Ataxia
Mild intellectual disability
Plagiocephaly
Abn flattening of one side of skull
Craniosynostosis
Premature sutural fusion
Craniosyntosis eg:
Dolichocephaly,brachycephaly,trigonocephaly,torrycephaly
Dolichocephaly
Premature fusion of sagittal suture
Increased ap diameter
Brachycephaly
Premature fusion of coronal suture
Trigonocephaly
Premature suture of metopic suture
Triangular shaped skull
Turricephaly
Multiple sutural fusion
Tower shaped skull
Craniosyntosis syndromes
Crouzen syndrome ,apert sundrome
Craniosyndosis syndrome
Crouzen
Apert
Crouzon syndrome
AD
Fgfr 2 mutatn
Proptosis
Midline hyperplasia
Boxshaped skull
Apert
Fgfr2
Cleft palate
Syndactyly(mitten hands)
Turicephali
Rules of development
Cont process
Cephalocaudal dirn
Proximal to distal
Sequences always preserved
Primitive neonatal reflex need to be lost
Domains of development
Gross motor
Fine motor
Language
Social
Special domains . Vision and hearing
Rolls over
5 month
Sit with support
6 month
Sit without support
8 month
Stand with support
9 months
Tripod
9 month
Creeping
10 m
Walk with support which month???
15 months
Walk without support??
15 m
Run
18 m
Up and down stairs 2feet/steps
24 months/2 yr
Upstairs one feet at step/down stairs 2 feet / step
Tricycle
3y
Upstairs and down stairs 2feet/step
4 yr
Skipping
5 yr
Brings hand in the mid line
3 months
Bidextrous grasp (but overshoots)
4 m
Bidextrous grasp but not overshoot
5 m
Unidextrous grasp(ulnar grasp)
6 m
Radial grasp and transpher of object
7 m
Immature pincer grasp
9m
Mature pincer grasp
12 m
Scribbling
15 m
Draw a straight line
2 yr
Circle
3 yr
Crosss
4 year
Rectangle and square
4.5 yr
Triangle
5 year
Diamond
6-7 yr
Cylinder
9yr
Box
11 yr
Tower of 2 cubes
15 m
Tower of 3 cube
18 m
Tower of 6 cube
2 years
Tower of 9 cube
3 years
Train
2y
Train with chimmney
2 1/2 yr
3 cube bridge
4 yrs
5 cube bridge
5 yrs
Bridge with steps
6 years
Child imitate a circle?
Child copy a circle??
Imitate 2 1/2 yr
Copy 3 yr
Child undress with help
2 yr
Dress with help
3 yr
Unbutton without help??
3 yrs
Dress with without help
5 yrs
Social smile
2 months
Recognises mother
3 months
Mirror play
6 m
Stranger anxiety
7 m
Waves,
9 m
15 m 2 p
Point towards object
Point towards wet pants
15 m 2 p
Point towards object
Point towards wet pants
Domestic mimicry
Dry at day
18m
Parallel play
2 yrs
Play each other, cooperative play
3 years
Role play or group play
4 yrs
Language -coo
3 m
Mono syllable
6 m
Bi syllable
9 m
1-2 word with meaning
12 m
Jargon speech
15 m
8-10 words, picture naming
18 m
2 word sentences
24 m
Name, age, gender
3yrs
Past tense , poem, story
4 yrs
Future tense
Ask meaning of word
8-10 word sentences
5 y
Right and left diff
4y
Handedness
3y
Binocular vision
4m
Fixation of
Mother, object, moving object, fast moving object??
1m, 3m, 6m, 12m
