Prelims_2.pdf Chapter-01_Pediatrics in Last Minutes.pdf Chapter-02_Pre Neet Pediatric Questions.pdf Chapter-03_Pre Neet Pediatric Answers.pdf Chapter-04_Previous Years Questions of DNB.pdf Pre NEET Pediatrics Taruna Mehra MBBS MD PEDIATRICS (MAMC) ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Panama City • London • Dhaka • Kathmandu ® Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc. 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton SW1H 0HW (UK) Panama City, Panama Phone: +44-2031708910 Phone: +507-301-0496 Fax: +02-03-0086180 Fax: +507-301-0499 Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Shorakhute, Kathmandu Mohammadpur, Dhaka-1207 Nepal Bangladesh Phone: +00977-9841528578 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2013, Jaypee Brothers Medical Publishers All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. Inquiries for bulk sales may be solicited at: [email protected] This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author(s) specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author(s). Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device. Pre NEET Pediatrics First Edition: 2013 ISBN : 978-93-5090-314-8 Printed at Dedication I dedicate my work to my teachers,my parents and most importantly my patients. Preface Why should I change anything in your life till the time you decide to change yourself… Quran With the challenging task ahead in month of November and December with all the major exams within a period of 20 days, the committee has decided to release Pre NEET Pediatrics inclusive of DNB questions and important last minute revision points so that you are confident in attempting maximum questions in all the exams.This book has been written keeping in mind that maximum time taken to revise pediatrics is less than one day. All the best may God help you cross the bridge Taruna Mehra “Do not count the days make the days count” From the Publisher’s Desk We request all the readers to provide us their valuable suggestions/errors (if any) at: [email protected] so as to help us in further improvement of this book in the subsequent edition. Contents 1. Pediatrics in Last Minutes .......................... 1 – 65 2. Pre NEET Pediatric Questions .................... 66 – 77 3. Pre NEET Pediatric Answers....................... 78 – 150 4. Previous Year’s Questions of DNB.............. 151 – 174 PEDIATRICS in Last Minutes Developmental Milestones Age Gross motor Fine motor Language Social 1 mo Momentarily lifts Has tight grasp, Responds to Regards face head when prone follows objects sound of bell intently to midline 2 mo Holds head in No longer Smiles after Recognize midline. Lifts clenches fist being stoked or parent, social chest when prone tightly, follows talked to smile objects past midline Follows moving Coos (produces Reaches for 3 mo Head holding objects in a vowel sounds familiar people achieved circular fashion, in a musical or objects, converges and fashion), laughs anticipates focuses aloud feeding 4-5 mo Rolls over, sits Grasps objects/ Orients to Enjoys looking with support rattle crudely voice/bell around (localizes environment laterlly); "ahgoo", razzes 6 mo Takes foot to Transfers Babbles Stranger mouth, lifts head objects from anxiety, smiles and upper chest one hand to back at mirror with support another image of self Uses pincer Responds to Responds to 9 mo Sits unassisted (8 grasp, probes name, says social play, mo), Crawls, with forefinger, mama/dada plays pat-a- cruises, pulls to holds feeding (non-specific) cake, starts to stand bottle explore environment (9-10 mo) Contd... 2 Pre-NEET Pediatrics Contd... Age Gross motor Fine motor Language Social 10 mo Pulls from supine Understands to to sitting; from some "mama" sitting to standing, stands holding furniture 12 mo Gives hand held Says 'mama, Imitates actions objects to dada' (specific) mother when asked, turns 2-3 pages at a time 15 mo Walks well Uses 3-5 words Temper without support, meaningfully tantrums, Walks backwards separation and sideways anxiety 18 mo Starts to run, Makes a tower About 10 words Copies parents climb stairs with of 3-4 cubes, spoken in tasks, toilet help scribbles including name training started spontaneously, may draw a vertical line 2 yrs Runs well, climbs Makes a tower Points to at Follows 2-step stairs alone; of 6-7 cubes, least one commands walks on tiptoes turns one page named body (30 months) of a book at a part, simple time, may draw 2 word horizontal line sentences (2 words at 2 years) 3 yrs Pedals tricycle, Make a tower of Uses plurals, 3 Dresses and jumps with both 9-10 cubes, word undresses feet off ground, draws (copies) a sentences (3 partially can alternate feet circle word at buttons/ when climbing 3 years) unbuttons stairs 4 yrs Hops, alternates Draws (copies) Knows colours Buttons feet going a Cross clothing fully, downstairs (At 4 plays with other yr hop off the children floor) 5 yrs Jumps on one Draws (copies) Dresses foot, heel to toe a Square without walk supervision Calcification Age at Eruption Age at Shedding Begins At Complete At Maxillary Mandibulaur Maxillary Mandibular Primary Teeth Central incisors 5th fetal mo 18–24 mo 6–8 mo 5–7 mo 7–8 yr 6–7 yr Lateral incisors 5th fetal mo 18–24 mo 8–11 mo 7–10 mo 8–9 yr 7-8 yr Cuspids (canines) 6th fetalmo 30–36 mo 16–20 mo 16–20 mo 11–l2 yr 9–11 yr Firstmolars 5th fetal mo 24–30 mo 10–16 mo 10–16 mo 10–12 yr 10–12 yr Second molars 6th fetal mo 36 mo 20–30 mo 20–30 mo 10–12 yr 11–13 yr Secondary teeth Central incisors 3-4mo 9-10yr 7-8yr 6-7yr Pediatrics inLastMinutes 3 Lateral incisors Max, 10-12 mo 10-11yr 8-9yr 7-8 yr Mand, 3-4 mo Cuspids (canines) 4-5mo 12-15yr 11-l2yr 9-11yr Firstpremolars (biscuspids) 18-21mo 12-13yr 10-11yr 10-12yr Secondmolars (biscuspids) 24-30mo 12-14yr 10-12yr 11-13yr First molars Birth 9-10yr 6-7yr 6-7yr Secondmolars 30-36mo 14-16yr 12-13yr 12-13yr Third molars Max, 7-9 yr 18-25 yr 17-22 yr 17-22 yr Mand, 8-10 yr 4 Pre-NEET Pediatrics • Delayed eruption is usually considered when there are no teeth by approximately 13 months of age. • Causes of delayed eruption – Idiopathic (most common), Trisomy 21, Hypopituitarism, Trisomy 21 (Down syndrome) – Hypothyroidism, – Familial, Hypoparathyroidism, Cleidocranial dysplasia Remember • Central incisors is first to develop in primary dentition. • 1st molar is first to develop in secondary dentition. • Second molar is last to develop in primary dentition. • Third molar is last to develop in secondary dentition. Weight 10% of body weight lost in first few days of life; regained by 2 weeks. Birth weight doubles by 4 months, triples by 12 months, quadruples by 24 months. Height Height is increased by 50% at 1 year of age, doubles at 4 years and triples at 13 years. Head circumference Measured during 1-3 years of life 5 cm growth during age 0-3 months; 4 cm in 3-6 months, 2cm in 6-9 months and 1cm in 9-12 months. (newborn = 35 cm; 3 months = 40 cm, 9 months 45 cm, 3 years =50 cm, 9 years = 55cm. SURVEILLANCE OF GROWHAND DEVELOPMENT Surveillance of growth and development is an important component of the routine anticipatory care of children. The main purpose of growth surveillance is to identify those children who are not growing normally. Surveillance for physical growth can be done in following ways. 1. Weight for age • Measurement of weight and rate of gain in weight are the best single parameters for assessing physical growth. The weight should be carefully repeated at intervals: – Birth - 1 year Monthly – Second year Every two months – 2-5 years Every 3 months Pediatrics in Last Minutes 5 • These measurements when compared with the reference standards of weight of children of same age, the trend of growth becomes obvious. • Weight for age can be used to classify malnutrition and determine its prevalence. • 80 % of the median weight for age of the reference is cut off point below which children should be considered malnourished. 2. Height for age • Height is a stable measurement of growth as opposed to body weight. • Whereas weight reflects only the present health status of the child, height indicates the events in the past also. Low height for age. • This is also known as nutritional stunting or dwarfing. • It reflects past or chronic malnutrition. • The cut off point commonly taken for the diagnosis of stunting is 90 percent of the united states NCHS height for age. 3. Weight for height • Weight in relation to height is now considered more important than weight alone.