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منشورات القناة
بالنسبة للي يسألون عن مصادر المذاكره لقسم الأطفال:
١. ملف د. مهدي المصحح (للاسف فيه كم خطأ مثال سؤال 177 جوابه A + سؤال 204 جوابه B)
٢. MG
٣. توب جيز (اعتمدوا الاجابات الاخيره لان بعض الاسئله يغيرون اجابتهم)
AA: ما فتحت ملفات د. صفدر ابدًا
AH: فتحتها كبدايه مذاكرتي للاختبار في جولاي ولو رجع فيني الزمن ماذكرت ملف د.صفدر لانه دسم وياخذ وقت طويل
الافضل من وجهه نظري مذاكره الاسئله اليوميه بعد ملف مهدي.
المراجعه قبل الاختبار: الاسئله الصعبه الي تحددونها من الاسئله اليوميه + MG + المايلستون والفاكسين تبع شهر اختباركم.
| 2 | ☝🏻كفو والله ❤️🔥 أحب الصنف هذا من البشر 🌹🫡 | 1 019 |
| 3 | Pediatric_100%.pdf | 1 021 |
| 4 | السلام عليكم ورحمة الله وبركاته،
احنا طالب وطالبة من جامعة الملك فيصل الحمدالله حصلنا على درجة 100 في قسم الأطفال في اختبار نوفمبر.
حبينا نسوي ملف نجمع فيها الاسئلة اللى جاتنا ونرسلها لكم.
وهذه المبادره بإذن الله راح تستمر لسنوات عديده بحيث كل سنة يمسكون القناة الي جابوا ١٠٠٪ بقسم الاطفال.
واي شخص جاب ١٠٠٪ بقسم الاطفال، اكتب لنا حسابك بالتلقرام بحيث نجمع اكبر عدد ممكن من الاشخاص الي جابوا ١٠٠٪ بقسم الاطفال.
Telegram: @SMLE_pediatric
وبالتوفيق يا رب 🙏 | 1 040 |
| 5 | ☝🏻من هنا أول رسالة في قناة البيديا | 940 |
| 6 | ☝🏻Beginning of SMLE Notes (Pedia) | 866 |
| 7 |  Tanner Stages | 1 532 |
| 8 |  #Milestones | 1 396 |
| 9 |  لا يوجد نص... | 1 115 |
| 10 | Osgood schlatter disease 🦵
• Traction apophysitis
• Age 9-14 yo
• Sx: Tender lump over tibial tuberosity
• Self-limiting
Infantile Colic
• In 3-6 months old babies
• Dx: crying lasts for >=3 hr/d, >=3 d/week, for >=3 weeks
• Mx: behavioral change
Sudden Infant Death Syndrome SIDS
• RF: prematurity, prone sleeping, smoking, family hx of SIDS
• Prevention:
- Sleep in supine position
- Use pacifier during sleep
- Firm mattress, no pillows/blankets/stuffed animals🛏️
- In the first 6 mo: sleeping in the same room w/o bed-sharing
- Smoke-free🚭🙅♀️
- Avoid overheating
- Breastfeeding 🤱 until at least 4 mo
- Placing an infant prone while they’re awake
Primary protein-energy malnutrition
Main types:
Marasmus:
- Sx: Muscle wasting, loss of subcutaneous fat, no edema
- Deficiency: All major nutrients
Kwashiorkor:
- Sx: Bilateral pitting edema, distended abdomen, hepatomegaly
- Deficiency: Protein
Infantile Beriberi
• Caused by vitamin B1 deficiency
• Sx: anorexia, edema, aphonia
Scurvy (Vitamin C Deficiency)
• Sx: Follicular hyperkeratosis, gingivial hypertrophy, enlarged bluish purple friable gums
Common cause of vomiting in infants -> UTIs
Maternal phenobarbital consumption causes low vitamin K in fetus -> Prenatal 1 mg vitamin K1 | 904 |
| 11 | #Fluid_Management 💦
Indications for IV fluid:
1) Resuscitation
2) Replacement
3) Maintenance
1) Resuscitation (in shock)
10-20 cc/kg over 20-60 min
2) Replacement
- Dehydration % x wt (kg) x 10
- Bolus given to moderate-severe dehydration
^Degree of dehydration:
Mild: 5% (<2 yo), 3% (>2 yo)
Pulse: N
BP: N
Urine output: Decreased
Oral mucosa: Slightly dry
Ant fontanelle: N
Eyes: N
Skin turgor: N
CR: N (<2 s)
Moderate: 10% (<2 yo), 6% (>2 yo)
Pulse: Rapid
BP: N to decreased
Urine output: Markedly Decreased
Oral mucosa: Dry
Ant fontanelle: Sunken
Eyes: Sunken
Skin turgor: Decreased
CR: N to increased
Severe: 15% (<2 yo), 9% (>2 yo):
Pulse: Rapid, weak
BP: Decreased in shock
Urine output: Anuria
Oral mucosa: Parched
Ant fontanelle: Markedly Sunken
Eyes: Markedly Sunken
Skin turgor: tenting
CR: Increased
3) Maintenance
Holliday-Segar Method: 100:50:20 rule (24 hr)
First 10 kg: 100 cc/kg
Second 10 kg: 50 cc/kg
Remaining kilos: 20 cc/kg | 684 |
| 12 | #Toxicology 💊
Toxicity agents & their antidotes:
Paracetamol: N-acetylcystine
TCA: Sodium bicarbonate
Aspirin: Sodium bicarbonate
Narcotics: Naloxone
Iron: Deferoxanine
Lead: D-penicillamine
Copper: D-penicillamine
Organophosphates: Atropine
Acetaminophen Toxicity Phases
Phase 1
• 0.5-24 hours after ingestion
• Sx: asymptomatic or report anorexia, nausea or vomiting, and malaise
• PE: reveal pallor, diaphoresis, malaise, and fatigue
Phase 2
• 18-72 h after ingestion
• Sx: right upper quadrant abdominal pain, anorexia, nausea, and vomiting
• PE: Right upper quadrant tenderness, Tachycardia and hypotension
Phase 3: Hepatic phase
• 72-96 h after ingestion
• Sx: continued nausea and vomiting, abdominal pain, and a tender hepatic edge, jaundice, coagulopathy, hypoglycemia, and hepatic encephalopathy
• Acute kidney injury
Phase 4: Recovery phase
• 4 d to 3 wk after ingestion
• Patients who survive critical illness in phase 3 have complete resolution of symptoms | 639 |
| 13 | #Rheumatology 🦴
Transient Synovitis vs Septic Arthritis
• Sx:
Transient: Well-appearing, Afebrile
Septic: ill-appearing, febrile🤒, non-wt bearing
• Dx:
Septic: synovial fluid WBCs >=50,000
• Tx
Transient: conservative
Septic: drainage & Abx
Juvenile Idiopathic Arthritis JIA
• Dx:
Persistent arthritis lasting for >6 w
• Females > Males
• All 4 types have negative RF, except in Seropositive Polyarticular JIA
• Uveitis screening:👁️
+ANA: every 3-6 mo (in <7 yo), every 6 mo (in >=7 yo)
-ANA: every 6 mo
Systemic JRA: every 12 mo
• Types:
Oligoarticular JIA (Most common)
• Arthritis: <=4 joints, asymmetrical, large joints
• Extra-articular sx: Anterior uveitis👁️
• Tx: NSAIDs💊
Seronegative polyarticular JIA
• Arthritis: >=5 joints
• Tx: MTX and NSAIDs💊
Seropostive polyarticular JIA
• Arthritis: >=5 joints, symmetrical
• Extra-articular sx: Rheumatoid nodules
• Dx: RF positive
• Tx: MTX and NSAIDs💊
Systemic JIA (Still’s disease)
• Arthritis: >=1 joint AND intermittent fever🤒 AND extra-articular sx
• Extra-articular sx:
- Transient migratory salmon-pink rash🍣
- Generalized lymphadenopathy
• Dx: Anemia, leukocytosis, thrombocytosis
Henoch-Schonlein Purpura HSP
• Most common vasculitis in children👧
• Often has Hx of URTI 1-3 w before sx onset
• Sx:
IgA deposits in small vessels of skin, joints, GI, and kidney
- Palpable purpura (buttocks, LL)
- Arthritis/arthralgia
- Abdominal pain, Intussusception
- Renal disease
• Dx:
Normal Plt
⬆️Cr, Hematuria🩸
• Tx
- Hydration & NSAIDs
- Severe: Systemic CS
Kawasaki Disease
• 90% age <5
• Diagnostic criteria:
Fever >=5 d + >=4 of the following:
- Conjunctivitis (bilateral👁️👁️, nonexudative)
- Mucositis: fissured lips/pharynx, strawberry tongue👅🍓
- Rash (erythematous generalized)
- Erythema and edema of hands/feet✋️🦶
• Tx: Aspirin & IVIG
• Cx: coronary artery aneurysms, MI🫀
• Poor prognostic factors (Kobayashi score):
- Na <=133
- CRP >=10 mg/dL (>=100 mg/L)
- Neutrophils >=80%
Juvenile Dermatomyositis
• Sx: muscle weakness, cutaneous features (Helitrope rash)
• Dx: High CK, ANA | 644 |
| 14 | #Immunology
Wiskott-Aldrich Syndrome WAS
• Genetic condition characterized by impaired T cell function and thrombocytopenia
• Mutation in WAS gene 🧬 (X-linked recessive)
• Common in boys 👦
• Sx: Triad of:
1. Thrombocytopenia
2. Eczema
3. Recurrent bacterial infections
• Dx:
⬆️IgA & IgE
X-linked (Bruton) Agammaglobulinemia
• X-linked recessive disease causes a complete deficiency of mature B lymphocytes 🧬
• Common in boys👦
• Sx: starts at 3-6 mo after materal IgG starts to decline:
- Recurrent severe sinopulmobary and GI infections
- Small/absent lymphoid tissues (Tonils, adenoids, LNs)
• Dx: Low B Cells (CD19)
• Tx: IV immunoglobulins (IVIG)💉 | 593 |
| 15 | #Dermatology 🧴
Atopic Dermtitis
• Sx:
- Infants (<2 y): Itchy, red, scaly, crusted lesions on extensor surfaces, trunk, cheeks, and scalp
- Child/adult: lichenified plaques in flexural creases
• Mx: topic emollients, steroids
• Cx:
- Bacterial like S. Aureus (grape-like pattern🍇)
- Viral like HSV/eczema herpticup
Impetigo
Nonbullous
• Pathogen:
1. S. Aureus
2. GAS (S. Pyogenes)
• Sx: Honey-crusted lesions🍯
• A pt w imptigo 1-2 w with low complement -> Post-strept GN
Bullous
• Pathogen: S. Aureus
• Sx: Rapidly enlarging flaccid bullae w yellow fluid🟡
Tx for Impetigo:
- Limited to skin: Topic Abx (Mupirocin)
- Extensive: PO Abx (cephalexin or clindamycin)
Cat Scratch Disease🐈😼
• Pathogen: Bartonella Henselae
• Sx: enlarged LNs
• Mx: Macrolides Abx (Azithromycin) | 581 |
| 16 | #Endocrinology 🍰🍭
T1DM:
• Autoimmune
• Screen for celiac disease at diagnosis, every 2 y
• Screen for microvascular cx: after 5 y
• Tx: Full bolus insulin regimen w once-daily insulin glargine
- Honeymoon period: hypoglycemia attacks when the pt first start insulin
DKA
• Diagnostic Criteria:
- Glucose >200 mg (11.1 mmol)
- pH 7.3
- Ketones in urine or serum
• Mx:
- Fluid & electrolyte tx💦
- Gradual decline in glucose (to minimize the risk of cerebral edema)💦🧠
- Potassium repletion:
Hyperkalemia -> K not given
Normokalemia -> Give K w insulin
Hypokalemia -> Give K before insulin⚠️
- Insulin: regular insulin, continuous infusion of 0.1 U/kg/hr
Normal Puberty
Female: Onset 8-13 yo
1. Thelarche
2. Pubarche
3. Growth spurt
4. Menarche (mean: 12.5 yo)
Male: Onset 9-14 yo
1. Testicular enlargement
2. Penile enlargement
3. Pubarche
4. Growth spurt
Approach to precocious puberty
Early secondary sexual development: (F <8 yo, M <9 yo)
Bone age: 🦴
1. Advanced Bone Age:
• Low basal LH -> GnRH stimulation test:
- Low LH: Peripheral precocious puberty
- High LH: Central precocious puberty (Brain MRI)🧠
• High basal LH: Central precocious puberty (Brain MRI)🧠
2. Normal bone age
• Isolated breast development: Premature thelarche (Pelvic US)
• Isolated pubic hair development: Premature adrenarche (test DHEA) 💉
Nutritional Rickets (Vit D def)
• RF: exclusive breastfeeding 🤱, inadequate sun exposure☀️
• Sx:
- Craniotabes (ping-pong skull)
- Widening of wrists
- Delayed fontanel closure
- Frontal bossing
- Costochondral joints hypertrophy (Rachitic rosary)
- Femoral & tibial bowing
• Dx: Labs and Xray
Labs:
⬇️Ca, P, Vit D
⬆️Alk Phos, PTH
• Mx: Vit D & Ca suppl
Familial Short Stature vs Constitutional Growth Delay
Family hx
Familial: Short stature
Constitutional: Delayed puberty
Bone age
Familial: Normal
Constitutional: Less than chronological age | 629 |
| 17 | #Nephrology
UTI
• RF:
- Females
- Uncircumcised boys
- Fever >=39
- Nitrate
- Age <12 mo
- Duration >=48 hr
- Vesicouretral reflux
- Constipation
• Sx: Fever, poor feeding, dec urine output
• Tx:
Mild sx (cystitis):
- Oral amoxicillin
- TMP/SMX
- Nitrofurantoin
Unstable UTI or Pyelonephritis:
- Inability to tolerate oral -> IV Ceftriaxone, Cefepime, or Ceftaxime
• Indications for Imaging:
Renal US
- First febrile UTI in <2 yo
- Recurrent febrile UTI
- UTI + Family hx of renal disease, poor growth, or HTN
- Not responsive to Abx
Voiding Cystourethrogram (look for vesicuretral reflux)
- Child <6 mo w recurrent UTI, atypical UTI, or UTI + US showing hydronephrosis
- Child 6 mo - 3 yo w atypical UTI or US showing hydronephrosis
Renal Scintiography (DMSA scan)
- To detect acute pyelonephritis and renal scarring
Glomerular Diseases
Nephrotic vs Nephritic syndrome
Sx:
• Nephrotic: generalized edema and peri-orbital edema
• Nephritic: HTN
Dx:
• Protein in 24 h urine:
- Nephrotic >3.5 gm
- Nephritic <3.5 gm
• Urine cast:
- Nephrotic: Fatty cast🟡
- Nephrtitic: RBCs cast🔴
• Hyperlipidemia and hypoalbuminemia
- Nephrotic: Yes
- Nephritic: No
Diseases in Pediatrics
Nephrotic Syndrome:
Minimal change disease
- Common in children👧
- Tx: steroid
- Confirm remission -> Urine dipstick negative or trace for 3 consecutive days
Nephritic Sybdrome:
Post-streptococcal glomerulonephritis PSGN
- 10 d after the infection
- Has Low C3
IgA nephropathy/Burger’s disease
- Presents within 3 d of URTI🤧
Alport syndrome
- Hearing loss👂❌, ocular :
findings👁️, +family hx of ESRD
- Cause: defect in collagen type 4
Primary Nocturnal Enuresis
• Urinary incontinence in >5 yo
• Caused by destrusor overactivity/instability
• Dx: >2 times per week for 3 mo in >5 yo patient
- Urinalysis to R/O other causes
• Mx:
- Lifestyle changes (minimize fluid intake before bed, void before bed, reward system like gold star chart)
- Enuresis alarm ⏰
- Desmopressin tx
• Bed-wetting is Normal behavior until 6 yo
Prevent progression of Nephrotic Syndrome -> Enalapril
Steroid resistant nephrotic syndrome is the Inability to induce a remission within 4 weeks of daily steroid therapy | 595 |
| 18 | #Hematology 🩸
IDA
• Screening for anemia:
- W/o risk factors -> At 12 mo
- W risk factors (Prematurity, LBW) -> At birth and 4 mo
• Primary causes of IDA in pediatrics -> Dietary issues
• Exclusively breastfeeding 🤱-> Iron supplements should be given from 4 mo
• No cow milk 🐮 in the first year of life
• Physiologic anemia:
- Term: 2-3 mo
- Preterm: 1-2 mo
Sickle Cell Anemia
• AR, Hallmarks in SCD is Vaso-occlusive phenomena, Hemolytic anemia
• Dx:
- Markers of hemolysis: high indirect hyperbilirubinemia, LDH, AST, reticulocyte
- Peripheral boold film: Sickle cell, Howell-Jolly body, Target cell
- Confirm: Hb electrophoresis
• Mx:
- Hydroxyurea: prevent cx (vaso-occlusive crises) by inc HbF
- Vaccines: pneumococcal, meningococcal, Hemophilus influenza type b
- Daily pencillin prophylaxis (until 5 y)
• Cx:
Acute:
Painful episode
- Triggered by: inf, dehydration, cold weather, high altitude
- Site: legs, arms, back
- Mx: Regydration & Pain management, If fever: Abx
Acute Chest Syndrome ACS
- Sx: fever, chest pain, hypoxemia, wheezing, cough, new pulmonary infiltrate
- Mx: broad spectrum Abx, Transfusion
Aplastic crisis
- Arrest of erythropoiesis
- Dx: dec reticulocytes, Acute drop of Hb
- Organism: Parovirus B-19
Splenic Squestration Crisis
- Life-threatening
- Dx: Acute drop of Hb typically two below baseline, reticulocytosis
Chronic:
- Stroke
- Renal impairment & HTN
- Pigmented gallstones
Hereditary Spherocytosis
- AD
- Family hx of gallbladder stone/Splenectomy
- Can presents as neonatal jaundice
Dx:
- Blood film: Spherocytes
- Gold standard: Erosin 5 Malemide (EMA) binding test
- Osmotic fragility test
- To differentiate from AHA: Coombs test (negative)
Tx:
- EPO, iron and folate
- Splenectomy (curative)
Hemophilia (A&B)
• A: Vlll, B: lX, X-linked
• Sx:
- Hemarthrosis (knee)
- Intracranial bleeding
- IM/Retroperitoneal hematoma
- Hematuria, hemospermia
• Dx:
- Prolonged aPTT
- Normal PT, thrombin time, bleeding time
Infantile Vitamin K-Deficient Bleeding
• Sx: presents at 2-7 d of life, easy bruising, umbilical/mucosal/GI bleeding, Intracranial hemorrhage
• Dx: prolonged PT
• Tx:
- IV vit K
- Unstavle -> FFP
• Prevention: IM vit K at birth
• Vit K dependent factors: II, VII, IX, X (2,7,9,10)
Immune Thrombocytopenia Purpra ITP
- Superficial bleeding, can be preceded by viral inf
- Dx: isolated thrombocytopenia (<100,000)
- Tx:
Cutaneous sx only -> Observe
Bleeding -> CS, IVIG, or Anti-D
- Tx in adults:
No bleeding, Plt 50,000-30,000 -> No tx
Minor bleeding, Plt 50,000-30,000 -> CS (prendnisone)
Severe bleeding or Plt less than 10,000 -> IVIG or Anti-Rho (anti-D)
Recurrent/Failed -> Splenectomy
Thrombotic Thrombocytopenic Purpura TTP
• Severe deficiency in ADAMTS13
• Sx: fever, neurological sx
• Dx:
CBC:
- Thrombocytopenia
- Low Hb
- Film: schistocytes (Microangiopathic hemolytic anemia)
Hemolysis:
- High reticulocytes
- High LDH
- Low Haptoglobin
Coagulation profile
- Normal/mildly prolonged PT, aPTT
- Normal/mildly elevated D-dimer
Liver chemistry
- High indirect bilirubin
BMP
- High BUN, Cr
Urinalysis
- Hematuria, proteinuria
• Tx: Plasma Exchange
Hemolytic Uremic Syndrome HUS
• Causes: E. Coli (O157:H7, O104:H4)
• Sx: Renal impairment
• Dx:
- Thrombocytopenia
- Film: schistocytes (Microangiopathic hemolytic anemia)
- AKI: ⬆️BUN and Cr
• Tx:
- Typical HUS > Supportive
- Atypical HUS > Eculizumab (causes fulminant meningococcal inf, screen for vaccin.)
⚠️Abx are C/I -> Injury to bacterial wall releasing large anounts of toxins! | 626 |
| 19 | #Neurology 🧠
Febrile Siezure🤒
• Siezure + Fever (>=38) in 6 mo-5 yo
• Simple vs Complex
- Simple (one of the following):
<15 min
Generalized tonic-clonic
No recurrence in 24 hr
- Complex (one of the following):
>15 min
Focal onset
Recur in 24 hr
• Mx:
- If >=5 min: Abortive tx (IV lorazepam)
- Antipyretics
- Reassurance
Rolandic Epilepsy (Benign Epilepsy w Centrotemporal Spikes)
• Most common form of benign epilepsy in children
• Sx: usually during sleep 😴, facial twitching and numbness
• Dx: EEG: Centrotemporal Spikes
• Mx:
- Anticonvulsants are only recommended in high frequency/severity
Infantile Spasms (West Syndrome)
• Sx: Multiple neck flexion followed by neck extension
• EEG: Very heterogeneous, hypsarrhythmia
Tx: ACTH, Steroid
Status Epilepticus
• Mx:
1. IV lorazepam (given again if no response) or IV/Rectal diazepam or Buccal midazolam
2. IV phenytoin (recurrent in ER > Fosphenytoin)
3. General anesthesia
• Absence seizure > Ethosuximide
• Generalized epilepsy > Sodium valporate
Guillian Barre Syndrome GBS
• Sx:
- Acute ascending areflexic paralysis and parasthesia
- Hx of URTI/GI inf (Cambylobacter jeujeni)
• Dx: clinically
• Mx: 1. IVIG or 2. Plasma exchange
• Excellent prognosis w full recovery ❤️🩹
• To monitor ventilatory impairment🫁 -> Bedside measurement of vital capacity
Cerebral Palsy
• Heterogeneous group of disorders affecting muscle tone and the development of movement and posture, non-progressive
• RF:
- Birth wt <1.5 kg
- Prematurity⚠️
- TORCH infection
• Red flags
🚩 Definite hand preference before 1 yo
🚩Persistent moro reflex (>6 mo)
• Types:
- Spastic (75%): Can result in hemiplagia (one side of the body), diplegia (both legs 🦵), quadriplegia (all limbs)
- Dyskinetic/Athentoid (Basal ganglia affected, maybe associated w kernicterus)
- Ataxic
Duchenne Muscular Dystrophy
• Type of Progressive Muscular Dystrophies
• X-linked recessive disorder
• Screening: Creatinine kinase
• Sx: Calf pseudohypertrophy, Grower maneuver (pt supports himself on his thighs and uses his hands to walk up his body until he’s standing) | 568 |
| 20 | #GI 🍜
Celiac Disease
• Autoimmune disease causing malabsorption
• Sx: Diarrhea, Steatorrhea, Abdominal bloating, N&V, Loss of subcutaneous fat, Dermatological (Dermtitis herpetiformis)
• Dx:
- Serology: IgA Tissue Transglutaminase Antibody (tTG IgA), or Anti-endomysial antibody (2nd line)
- Confirmatory > EGD w Small Intestine Biopsy
Eosinophilic Esophagitis
• Chronic immune-mediated esophageal inflammation
• Associated w Atopy (Asthma, rhinitis, atopic dermtitis)
• Sx: Dysphagia (compensated by excessive chewing), reflux, chest pain
• Dx: Endoscopy & biopsy
• Mx:
- First line: PPIs
- Second: Topical steroids
- Dietary modifications
Sandifer Syndrome
• Movement disorder characterized by torticollis & arching of the spine
• Associated w GERD & Hiatal hernia
Lactose intolerance
• Dx -> Hydrogen breath test | 535 |
