Summary of "Exam Recall Series (INI-CET Nov '24) - Paediatrics"

Summary of “Exam Recall Series (INI-CET Nov ‘24) - Paediatrics”

This video features Dr. Singaram, a Pediatrics faculty member, discussing recall questions from the Pediatrics section of the INI-CET November 2024 exam. The discussion covers key clinical topics frequently tested, clarifies diagnostic criteria, and explains important clinical concepts with references to standard textbooks like Nelson’s Textbook of Pediatrics.

Main Ideas, Concepts, and Lessons Conveyed

1. Exam Pattern and Focus

The Pediatrics questions followed a standard INI-CET pattern.
More direct questions and fewer lengthy clinical scenarios than previous years.
Emphasis on important and commonly tested topics such as:
- Developmental milestones
- Congenital heart disease
- Severe acute malnutrition (SAM)
- Common pediatric syndromes

2. Developmental Milestones (Age 4 years)

Milestones typically seen at 4 years include copying a cross, telling stories, and toileting independently.

Key domains at 4 years:

Motor: Hopping on one foot, descending stairs with alternate feet
Fine motor: Imitating a gate with cubes, copying a cross
Language: Counting four pennies, storytelling
Social: Interactive play, role play, toilet independence

3. Severe Acute Malnutrition (SAM) Diagnostic Criteria

Included criteria:
- Weight-for-height < -3 SD
- Mid-upper arm circumference (MUAC) < 11.5 cm
- Presence of bilateral pedal edema
Height-for-age is not a criterion (it indicates chronic malnutrition).
Diagnosis of SAM requires any one of the included criteria.

4. Factor XIII Deficiency (Clot Stabilizing Factor Deficiency)

Presents with bleeding manifestations such as epistaxis, rectal bleeding, and umbilical stump bleeding.
Normal PT, aPTT, platelet count, and function.
Diagnosed by a positive clot solubility test.
Factor XIII stabilizes fibrin clot after formation; hence normal coagulation tests.
Autosomal recessive inheritance.
Treatment: Factor XIII concentrate replacement.

5. Primary Failure of Recovery in SAM Treatment

Criteria indicating failure to respond during the stabilization phase:

Failure to regain appetite by day 4
Failure to start losing edema by day 4
Edema persisting beyond day 10
Weight gain < 5 g/kg/day by day 10 (not day 20)

Common cause: Untreated or unrecognized infection.

6. Breast Milk Jaundice

Benign, transient jaundice seen in 3-4% of exclusively breastfed infants.
Total serum bilirubin > 10 mg/dL after 3-4 weeks of life.
Caused by substances like beta-glucuronidase in breast milk that deconjugate bilirubin.
Breastfeeding should not be stopped.
Usually no treatment required.

7. Cystic Fibrosis (CF) Features

Common features:
- Nasal polyps
- Meconium ileus
- Bleeding diathesis (due to vitamin K deficiency from pancreatic insufficiency)
Not a feature: Central cyanosis.
CF involves pancreatic insufficiency leading to fat malabsorption and fat-soluble vitamin deficiencies.

8. Nadas Criteria for Congenital Heart Disease Diagnosis

Major criteria:
- Systolic murmur grade ≥ 3
- Any diastolic murmur
- Cyanosis
- Congestive cardiac failure
Minor criteria:
- Murmur < grade 3
- Abnormal ECG
- Abnormal chest X-ray
- Abnormal blood pressure
Diagnosis requires either one major or two minor criteria.
Troponin T (cardiac biomarker) is not part of Nadas criteria.

9. Guillain-Barré Syndrome (GBS)

Ascending polyneuropathy following infection (commonly Campylobacter jejuni).
Absent or decreased deep tendon reflexes are diagnostic.
CSF shows albuminocytological dissociation (high protein, normal cell count).
Treatment:
- IV immunoglobulin (IVIG) first line
- Plasma exchange (plasmapheresis) if refractory
Steroids are not effective for weakness but may help with pain.

10. Croup (Laryngotracheobronchitis)

Common in children 6 months to 3 years.
Characterized by barking cough, stridor, low-grade fever.
Most common cause: Parainfluenza virus (if not an option, influenza virus is next common).
X-ray shows “steeple sign” indicating subglottic narrowing.

11. Closure of Ductus Arteriosus

Main factor: Increase in oxygen concentration after birth.
Secondary factor: Decrease in prostaglandins (especially prostaglandin E).
Closure due to smooth muscle constriction in ductus arteriosus wall.

12. Pediatric Cardiopulmonary Resuscitation (CPR)

Compression rate: 100-120/min.
Compression depth: At least 1/3 of the anteroposterior (AP) diameter of the chest (~4 cm in infants, 5 cm in children).
Single rescuer compression:ventilation ratio = 30:2.
Two rescuers compression:ventilation ratio = 15:2.
Allow full chest recoil after each compression.
Adrenaline dose: 0.01 mg/kg IV/IO, diluted to 1:10,000 concentration (not 1:1,000).
Repeat adrenaline every 3-5 minutes if needed.
Adenosine is not used in CPR; it is used for supraventricular tachycardia.

Detailed Methodologies and Instructions

Diagnosing Severe Acute Malnutrition (SAM)

Use weight-for-height < -3 SD, MUAC < 11.5 cm, or bilateral pedal edema.
Height-for-age is not used for SAM diagnosis.

Primary Failure of Recovery in SAM Treatment

Monitor appetite and edema daily.
Criteria for failure:
- No appetite regained by day 4
- No edema reduction by day 4
- Edema still present on day 10
- Weight gain < 5 g/kg/day by day 10

Factor XIII Deficiency Diagnosis

Suspect in bleeding with normal PT, aPTT, and platelet studies.
Perform clot solubility test.
Treat with Factor XIII concentrate.

Management of Guillain-Barré Syndrome

Confirm diagnosis with absent reflexes and albuminocytological dissociation on CSF.
Start IVIG early.
Use plasmapheresis if IVIG is ineffective.
Steroids not recommended for weakness.

Pediatric CPR Guidelines

Compression rate: 100-120/min.
Compression depth: 1/3 AP diameter of chest.
Single rescuer ratio: 30 compressions : 2 breaths.
Two rescuer ratio: 15 compressions : 2 breaths.
Adrenaline dose: 0.01 mg/kg IV/IO, diluted 1:10,000.
Repeat adrenaline every 3-5 min if necessary.
Allow full chest recoil after each compression.

Speakers and Sources Featured

Dr. Singaram – Pediatrics faculty and primary speaker throughout the video.
References made to:
- Nelson Textbook of Pediatrics – for developmental milestones and other pediatric knowledge.
- OP Textbook (likely “Oxford Pediatrics” or similar) – referenced for breast milk jaundice.

This summary encapsulates the core teaching points, clinical pearls, and exam-focused facts delivered by Dr. Singaram in the video, useful for INI-CET and other pediatric examinations.