Summary of "Exam Recall Series (INI-CET May '23) - Paediatrics"

Summary of “Exam Recall Series (INI-CET May ‘23) - Paediatrics” by Dr. Singaram

This video is a detailed review of pediatric questions from the INI-CET May 2023 exam, focusing on clinical concepts, diagnostic criteria, and management guidelines. Dr. Singaram explains each question with relevant clinical reasoning, emphasizing important pediatric topics frequently encountered in exams.

Main Ideas, Concepts, and Lessons

1. Nadas Criteria for Congenital Heart Disease (CHD)

Used clinically to suspect CHD based on physical findings.
Major criteria:
- Systolic murmur ≥ grade 3
- Any diastolic murmur
- Presence of central cyanosis
- Features of congestive heart failure
Minor criteria:
- Systolic murmur < grade 3
- Abnormal second heart sound
- Abnormal blood pressure
- Abnormal chest X-ray or ECG
Diagnosis requires at least one major or two minor criteria.
Next step after clinical suspicion: Echocardiography (definitive diagnosis).

2. Differential Diagnosis of Child with Acute Watery Diarrhea and Altered Sensorium

Important differentials include:

Severe dehydration (most common)
Cerebral venous thrombosis (due to dehydration-induced hypercoagulability)
Electrolyte abnormalities (especially hyponatremia)

Other considerations:

Hemolytic uremic syndrome (HUS) is unlikely here (typically post-diarrheal with bloody diarrhea).
Hypoglycemia, encephalitis/meningitis, febrile seizures.

3. Parvovirus B19 and Its Clinical Associations

Causes erythema infectiosum (“slapped cheek” rash).
Associated disorders:
- Pure red cell aplasia (especially in chronic hemolytic anemia like sickle cell disease)
- Arthralgia/arthropathy (in older children/adolescents)
- Hydrops fetalis (if infected in utero)
- Hemophagocytic syndrome (in immunocompromised)
Tropism for erythroid progenitor cells via P blood group antigen.

4. Perinatal Transmission of Infections

Herpes simplex virus (HSV), cytomegalovirus (CMV), and hepatitis B can be transmitted perinatally.
Rubella is primarily transmitted intrauterine (highest risk in first trimester), not perinatally.

5. Cystic Fibrosis (CF)

Clinical features: chronic cough, recurrent pneumonia, malabsorption (steatorrhea, foul-smelling stools).
Diagnosis:
- Sweat chloride test (>60 mEq/L)
- CFTR gene mutation analysis (best diagnostic test)
- Nasal potential difference test (abnormal in CF)
Genetics: autosomal recessive inheritance.
Most common mutation: ΔF508 (deletion of phenylalanine at position 508).
CFTR codes for a chloride ion channel.

6. Kawasaki Disease

Classic presentation: fever ≥5 days plus ≥4 of the following (mnemonic CREAM):
- C: Conjunctivitis (bilateral, non-purulent)
- R: Rash (maculopapular)
- E: Edema of extremities (including periungual desquamation)
- A: Adenopathy (cervical lymphadenopathy)
- M: Mucosal changes (strawberry tongue, cracked lips)
Echocardiography may show coronary artery aneurysms.
First-line treatment: Intravenous Immunoglobulin (IVIG) 2 g/kg.
Aspirin is used as adjunct for anti-inflammatory effect but is not first-line.

7. Neonatal Resuscitation in Meconium-Stained Liquor

Distinguish between vigorous and non-vigorous babies:
- Vigorous: good breathing, normal tone → gentle suction of mouth/nose, keep with mother.
- Non-vigorous: poor/no breathing, decreased tone → follow neonatal resuscitation protocol (initial steps: positioning, suction, stimulation, warming).
Routine tracheal suctioning is NOT recommended even in non-vigorous babies.
Intrapartum suctioning before delivery of shoulder is contraindicated.

8. Hydrops Fetalis and Parvovirus B19 Infection

Parvovirus B19 infection in utero causes:
- Severe anemia due to erythroid precursor destruction
- Hydrops fetalis (generalized fetal edema)
- Myocarditis, high-output cardiac failure, ascites
Other TORCH infections (CMV, toxoplasmosis, syphilis) have different characteristic features.

9. Genetic Disorders and Enzyme Deficiencies

Trisomy 18: Edwards syndrome
Trisomy 13: Patau syndrome
Huntington disease: trinucleotide repeat disorder (CAG repeats)
Sickle cell anemia: point mutation in beta-globin gene (glutamate → valine)
Pompe disease: glycogen storage disease type II, deficiency of acid alpha-glucosidase
- Affects skeletal and cardiac muscles
- Enzyme replacement therapy (ERT) available
Other muscle glycogen storage diseases:
- Tarui disease (phosphofructokinase deficiency)
- McArdle disease (myophosphorylase deficiency)
GSD type I (von Gierke disease): glucose-6-phosphatase deficiency (liver).

Methodologies and Lists Presented

Nadas Criteria for CHD Diagnosis: Major criteria (≥1) or minor criteria (≥2) needed to suspect CHD.
Differential Diagnosis for Diarrhea + Altered Sensorium:
- Severe dehydration
- Electrolyte abnormalities (hyponatremia/hypernatremia)
- Cerebral venous thrombosis
Kawasaki Disease Diagnostic Criteria (Mnemonic CREAM): Conjunctivitis, Rash, Edema, Adenopathy, Mucosal changes.
Neonatal Resuscitation in Meconium-Stained Liquor:
- Vigorous baby: gentle suction only.
- Non-vigorous baby: follow full resuscitation, no routine tracheal suction.
Pompe Disease Enzyme Deficiency and Therapy:
- Deficiency: acid alpha-glucosidase
- Treatment: enzyme replacement therapy.

Speakers / Sources Featured

Dr. Singaram – Pediatrics faculty at Marrow Education (main and sole speaker throughout the video).

This summary encapsulates the key pediatric exam points discussed in the video, providing a concise but thorough review of clinical criteria, diagnostic approaches, and management principles relevant for postgraduate medical exams.