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TOPIC-WISE QUESTION DISTRIBUTION

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Key High-Yield Points to Remember:

1. Social smile = 6 weeks (first social milestone)
2. Pincer grasp = 9-10 months
3. Short stature = height <3rd percentile or <-2 SD
4. SAM = MUAC <11.5 cm OR WFH <-3 SD OR bilateral pitting oedema
5. ORS osmolarity = 245 mOsmol/L (WHO low-osmolarity)
6. Fast breathing in 2-11 months = ≥50/min for pneumonia diagnosis
7. Croup = barking cough, steeple sign; Epiglottitis = drooling, thumb sign
8. Febrile seizure age = 6 months to 5 years
9. Folic acid dose for NTD prevention = 400 mcg/day (5 mg in high risk)
10. Congenital hypothyroidism = most common preventable cause of intellectual disability

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100 MORE PEDIATRICS SAQs — ADVANCED SET

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MONDAY — GROWTH, MILESTONES, SHORT STATURE, IMMUNIZATION

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• Girls: Peak height velocity (PHV) occurs at Tanner stage 2-3, around age 11-12 years; gain of ~8-10 cm/year
• Boys: PHV occurs at Tanner stage 3-4, around age 13-14 years; gain of ~9-11 cm/year
• Boys grow ~12-13 cm at peak year vs girls ~10-11 cm, explaining the final height difference

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• Birth: ~34 cm
• 6 months: ~44 cm (10 cm gain in first 6 months)
• 1 year: ~47 cm (3 cm gain in second 6 months)
• 2 years: ~49 cm
• Adult: ~55 cm Head grows fastest in the first 6 months of life.

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• Persistence of Moro/ATNR beyond 6 months
• No head control by 4 months
• Scissoring of legs (spastic diplegia posture)
• Fisting (thumb-in-palm) beyond 3-4 months
• Asymmetric reach or movement
• Early hand dominance (before 18 months) - suggests hemiplegia
• No independent sitting by 12 months

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• At birth: upper: lower segment = 1.7:1 (head and trunk dominate)
• At 3 years: ~1.3:1
• At 10 years: ~1.0:1 (equalization of segments) An abnormally high ratio in older children suggests skeletal dysplasia or rickets (short limbs).

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• Proportionate short stature: Head, trunk, and limbs reduced equally. Causes: endocrine (GH deficiency, hypothyroidism), malnutrition, chronic systemic disease, Turner syndrome, IUGR.
• Disproportionate short stature: Trunk and limbs not reduced equally. Causes: Skeletal dysplasias - achondroplasia (short limbs, normal trunk), Morquio syndrome (short trunk, normal limbs), rickets.

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• Short limbs (rhizomelic shortening - proximal > distal)
• Normal trunk length
• Macrocephaly with frontal bossing
• Midface hypoplasia
• Lumbar lordosis, trident hand
• Normal intelligence
• X-ray: narrowed interpedicular distance in lumbar spine

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• Stunting: Height-for-age <-2 SD. Reflects chronic/long-standing malnutrition (undernutrition over months to years). Irreversible after age 2.
• Wasting: Weight-for-height <-2 SD. Reflects acute recent malnutrition. Potentially reversible.
• Underweight: Weight-for-age <-2 SD. Composite of both.

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• ≥10 mm: positive in immunocompetent BCG-vaccinated children
• ≥5 mm: positive in immunocompromised/HIV/close TB contacts
• ≥15 mm: positive in healthy low-risk individuals In BCG-vaccinated children, induration >10 mm is suggestive of true TB infection; >15 mm strongly suggests TB.

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• Dose 1 (HepB-0): Within 24 hours of birth - 0.5 mL IM (thigh)
• Dose 2: At 6 weeks (as part of pentavalent)
• Dose 3: At 10 weeks (pentavalent)
• Dose 4: At 14 weeks (pentavalent) If birth dose missed, 3 more doses are given (0, 1, 6 month schedule). For HBsAg-positive mothers, HBIG (0.5 mL) + HepB vaccine within 12 hours of birth.

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• Vaccine reactions: fever, local redness/swelling (most common), febrile seizures (MMR, DPT)
• Programme errors: abscess at injection site (improper technique), transmission of bloodborne infections
• Coincidental: events that would have happened anyway
• Serious AEFI:
• Anaphylaxis (any vaccine, within 30 minutes)
• BCG lymphadenitis/osteitis
• Vaccine-associated polio (OPV)
• Intussusception (rotavirus vaccine - first dose)
• Thrombocytopenia (MMR)

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• SA 14-14-2 (live attenuated) or JENVAC:
• Dose 1: 9 months (with measles)
• Dose 2: 16-24 months (with DPT booster) Given in endemic states: UP, Bihar, Assam, Karnataka, Tamil Nadu, West Bengal, etc.

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TUESDAY — DIARRHOEA, DYSENTERY, ADOLESCENT HEALTH, SAM

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• Hypernatraemic dehydration (Na >150): CNS hyperirritability, "doughy" skin, seizures - treat slowly to avoid cerebral oedema
• Hyponatraemic dehydration (Na <130): lethargy, seizures - if severe symptomatic, use hypertonic saline
• Hypokalaemia: muscle weakness, ileus, cardiac arrhythmias (from stool potassium losses)
• Metabolic acidosis: from bicarbonate loss in stools and poor tissue perfusion

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• Severe dehydration (Plan C): Ringer's Lactate (preferred) or Normal Saline
• Children >1 month: 100 mL/kg over 3 hours (30 mL/kg fast in first 30 min, then 70 mL/kg in 2.5 hours)
• Infants <12 months: 30 mL/kg in first 1 hour, then 70 mL/kg over 5 hours
• Oral route is preferred whenever possible; IV only if cannot drink or in shock

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• Identify and treat specific cause
• Avoid lactose (use low-lactose feeds)
• Increase dietary energy density
• Zinc supplementation
• Treat micronutrient deficiencies (Vitamin A, zinc)
• Probiotics may help

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• Blood in stool (dysentery with severe dehydration)
• Signs of severe dehydration not responding to Plan C
• Persistent vomiting unable to retain ORS
• Abdominal distension/ileus
• Convulsions
• Altered consciousness
• Cholera (rice-water stools + severe dehydration) in epidemic areas

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• Rapid IV rehydration (Plan C - Ringer's Lactate)
• Oral rehydration as soon as able to drink
• Antibiotic: Azithromycin 20 mg/kg single dose (first choice in children) OR Doxycycline (>8 years)
• Zinc supplementation

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• Anorexia Nervosa: BMI <17.5, intense fear of weight gain, distorted body image, self-starvation. Complications: bradycardia, electrolyte disturbances (hypokalaemia), osteoporosis, amenorrhoea, lanugo hair, refeeding syndrome on treatment.
• Bulimia Nervosa: Recurrent binge eating + purging (self-induced vomiting, laxatives). Weight may be normal. Features: parotid enlargement, dental erosion (Russell's sign - calluses on knuckles), hypokalaemia, metabolic alkalosis.

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• Hypoalbuminaemia → reduced oncotic pressure → fluid shift to interstitium
• Increased aldosterone (secondary hyperaldosteronism)
• Increased capillary permeability (aflatoxin theory)
• Free radical damage (kwashiorkor has higher oxidative stress) Key features: oedema (starts feet, progresses), flaky paint skin, sparse reddish hair, fatty liver, immunosuppression.

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• Weight gain: achieving 15-20% of admission weight (or reaching -2 SD WFH) and maintaining for 3 consecutive days
• Good appetite (passes RUTF appetite test)
• No medical complications
• Oedema resolved (if present)
• Good clinical condition: alert, afebrile
• Caregiver trained on home feeding and follow-up

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• Lower sodium (45 mmol/L vs 75 in ORS) - prevents sodium overload in SAM
• Higher potassium (40 mmol/L)
• Higher glucose (125 mmol/L) Given 5-10 mL/kg/hour for 2 hours, then 5-10 mL/kg alternating with F-75 for 4-10 hours. NEVER give IV fluids in SAM unless in shock.

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• If conscious: 50 mL of 10% glucose (or sucrose solution) by mouth/NG
• If unconscious: IV 10% glucose 5 mL/kg stat, then oral/NG glucose feeds
• Immediately start F-75 every 2-3 hours day and night
• Prevent by feeding every 2 hours (do not fast)
• Treat underlying infection

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• Folic acid: 1 mg/day (5 mg on day 1)
• Zinc: 2 mg/kg/day
• Copper: 0.3 mg/kg/day
• Multivitamins including Vitamin A, B-complex, C
• Iron: NOT given in acute phase (promotes bacterial growth, free radical damage); give only in rehabilitation phase once appetite returns

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WEDNESDAY — OBESITY, BEHAVIOURAL DISORDERS, MICRONUTRIENTS

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• Central obesity: Waist circumference ≥90th percentile (mandatory criterion) Plus any 2 of:
• Triglycerides ≥150 mg/dL
• HDL cholesterol <40 mg/dL
• Blood pressure ≥130/85 mmHg
• Fasting glucose ≥100 mg/dL (or known T2DM)

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• Lifestyle modification (cornerstone): Dietary change (reduce caloric density, increase fibre, avoid sugary drinks), physical activity (≥60 min/day moderate-intensity), reduce screen time (<2 hours/day for >5 years, none for <2 years)
• Behavioural therapy: Family-based behavioural intervention
• Pharmacotherapy: Orlistat (FDA-approved for children ≥12 years)
• Bariatric surgery: For adolescents ≥13 years with BMI >40 and severe comorbidities
• Treat comorbidities (HTN, T2DM, dyslipidaemia)

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• Stimulants (first-line): Methylphenidate (Ritalin) - most studied, effective in 70-80%. Amphetamine salts.
• Common side effects: appetite suppression, insomnia, growth deceleration
• Non-stimulants: Atomoxetine (norepinephrine reuptake inhibitor) - used if stimulants contraindicated or substance abuse risk; Guanfacine, Clonidine Medication combined with behavioural therapy is most effective.

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1. Social-emotional reciprocity deficit
2. Nonverbal communicative behaviours deficit
3. Deficits in developing/maintaining relationships

1. Stereotyped/repetitive motor movements or speech
2. Insistence on sameness/routines
3. Highly restricted, fixated interests
4. Hyper/hypo-reactivity to sensory input

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• Nocturnal (bed-wetting, most common): Primary (never achieved night dryness) vs Secondary (relapse after ≥6 months dry)
• Diurnal (daytime wetting): suggests organic cause more often Management:
• Simple measures: fluid restriction in evenings, void before bed, star charts (motivational)
• Enuresis alarm: Most effective long-term treatment (conditioning therapy)
• Desmopressin (DDAVP): Useful for short-term (overnight trips); 0.2-0.4 mg oral at bedtime
• Imipramine (anticholinergic): Less preferred (cardiac side effects)

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• Oral elemental iron: 3-6 mg/kg/day of elemental iron in 2-3 divided doses
• Given on empty stomach with Vitamin C (enhances absorption)
• Duration: 3-6 months (3 months after Hb normalisation to replenish stores)
• Response: Reticulocytosis in 3-5 days (earliest sign of response); Hb rises ~1 g/dL/week
• IV iron dextran: if oral intolerance, malabsorption, non-compliance
• Treat underlying cause (dietary deficiency, hookworm)

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• Dermatitis: Symmetric, sun-exposed areas (Casal's necklace around neck)
• Diarrhoea
• Dementia: Cognitive impairment, confusion, depression
• Death (if untreated) Causes: Maize-based diet (low tryptophan + bound niacin), carcinoid syndrome, Hartnup disease (tryptophan malabsorption), isoniazid therapy. Treatment: Nicotinamide 100-300 mg/day.

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• Dry Beriberi: Peripheral neuropathy (sensory + motor), bilateral, symmetric, ascending
• Wet Beriberi: High-output cardiac failure, oedema, cardiomegaly
• Infantile Beriberi: Occurs in breastfed infants of thiamine-deficient mothers; cardiac (acute cardiac failure, tachycardia, cyanosis) or neurologic (aphonia, ophthalmoplegia)
• Wernicke's Encephalopathy: Confusion, ophthalmoplegia, ataxia (triad) Treatment: Thiamine IV/IM immediately, then oral.

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• Macrocytosis (MCV >100 fL)
• Macro-ovalocytes (oval macrocytes)
• Hypersegmented neutrophils (≥5 lobes in >5% of neutrophils, or any cell with ≥6 lobes) - hallmark
• Low reticulocyte count
• Pancytopenia in severe cases
• Bone marrow: megaloblastic changes (nuclear-cytoplasmic asynchrony)

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• Premature newborns: Haemolytic anaemia, oedema, thrombocytosis (at 1-2 months)
• Older children with cholestasis/malabsorption (e.g., cystic fibrosis, abetalipoproteinaemia): Progressive spinocerebellar ataxia, peripheral neuropathy, ophthalmoplegia, retinitis pigmentosa
• Also: Impaired immune function

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• Fetus: Still birth, congenital anomalies, endemic cretinism (mental retardation, deaf mutism, spastic diplegia)
• Neonate: Neonatal hypothyroidism, goitre
• Child/Adult: Goitre (most visible sign), hypothyroidism, impaired cognition
• Prevention: Universal salt iodisation (mandatory in India - 15 ppm at production, 7 ppm at consumer level). Lugol's iodine or lipiodol injections in severe endemic areas.

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• Nutritional rickets (Vit D deficiency): Vitamin D + calcium (see Q69 in previous set)
• X-linked Hypophosphataemic Rickets (XLH): Most common hereditary rickets. PHEX gene mutation → excess FGF23 → phosphate wasting. Treatment: Oral phosphate supplements + active Vitamin D (calcitriol). Does NOT respond to plain Vitamin D. Burosumab (anti-FGF23 antibody) now available.
• Vitamin D-dependent rickets type 1 (25-OH D to 1,25-OH D conversion defect): Calcitriol (active Vit D)
• Vitamin D-dependent rickets type 2 (receptor defect): High-dose calcitriol

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• Marasmus: Inadequate total calories AND protein (starvation). The body adapts by catabolizing fat and muscle. No oedema because albumin is preserved and hormonal adaptation is maintained.
• Kwashiorkor: Predominantly protein deficiency (often with infection triggering it). Inadequate protein intake → hypoalbuminaemia → oedema. High-carbohydrate diet suppresses fat mobilization, leading to fatty liver. Free radical injury plays a role (aflatoxin, infection → oxidative stress).

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• Normal (Green): ≥12.5 cm
• Moderate Acute Malnutrition / MAM (Yellow): 11.5-12.4 cm
• Severe Acute Malnutrition / SAM (Red): <11.5 cm MUAC is age-independent (usable 6-59 months) and is the single best predictor of mortality risk.

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THURSDAY — ASTHMA, PNEUMONIA, CROUP, BRONCHIOLITIS

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1. Airway inflammation: Eosinophilic predominant, driven by Th2 lymphocytes; mast cells, IgE, IL-4, IL-5, IL-13 → inflammation, mucus hypersecretion
2. Airway hyperresponsiveness (AHR): Exaggerated bronchoconstriction to stimuli
3. Airway remodelling: Chronic changes - subepithelial fibrosis, smooth muscle hypertrophy, goblet cell metaplasia → progressive irreversible obstruction if untreated

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• FEV1/FVC ratio < 0.8 (obstructive pattern) - reduced
• FEV1 reduced (<80% predicted)
• FVC: normal or mildly reduced
• Reversibility: ≥12% AND ≥200 mL improvement in FEV1 after SABA (salbutamol 400 mcg) - diagnostic of asthma
• In children <5 years, spirometry not reliable; use clinical criteria, bronchodilator response trials

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• Step 1: PRN low-dose ICS-formoterol (or SABA only as reliever)
• Step 2: Low-dose ICS daily (controller) + SABA PRN
• Step 3: Low-dose ICS + LABA (or medium-dose ICS alone)
• Step 4: Medium-dose ICS + LABA
• Step 5: High-dose ICS + LABA + add-on therapy (tiotropium, biologics - omalizumab for allergic asthma, mepolizumab for eosinophilic)

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• Silent chest (no wheeze due to no air movement)
• Pulsus paradoxus >20 mmHg
• Inability to speak
• SpO2 <92% despite oxygen
• PCO2 rising (normal PCO2 in severe asthma is ominous - indicates fatigue) Management: ICU, IV magnesium, IV aminophylline, possible NIV or intubation.

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• Lobar/segmental consolidation (air-space opacity): Bacterial (S. pneumoniae most common); air bronchograms common
• Interstitial pattern (bilateral diffuse): Viral, atypical (Mycoplasma, Chlamydia)
• Round pneumonia: S. pneumoniae in young children (unique to <5 years)
• Parapneumonic effusion/empyema: S. pneumoniae, Staph aureus
• Pneumatoceles (thin-walled air cysts): Staphylococcal pneumonia (pathognomonic)

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• Rapid deterioration
• High fever, toxaemia
• Pneumatoceles (pathognomonic on CXR)
• Pyopneumothorax, empyema
• Abscesses Treatment: Cloxacillin 200 mg/kg/day IV + Gentamicin. If MRSA: Vancomycin or Linezolid. Chest drain for pyopneumothorax.

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• Steeple sign (Pencil sign): Seen in Croup (laryngotracheobronchitis). AP neck X-ray shows subglottic narrowing - the tracheal column tapers symmetrically below the glottis, resembling a church steeple.
• Thumb sign: Seen in Epiglottitis. Lateral neck X-ray shows swollen, rounded epiglottis resembling an adult's thumb instead of the normal thin finger-like shadow.

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• Oxygen if SpO2 <90-92%
• High-flow nasal cannula (HFNC) for moderate-severe - reduces need for intubation
• Nasogastric tube feeding if unable to feed
• Hypertonic saline nebulization (3%) may reduce hospital stay modestly
• NOT recommended: bronchodilators (salbutamol, adrenaline), systemic steroids, antibiotics (unless bacterial co-infection), chest physiotherapy, ribavirin (except severe immunocompromised)

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• Premature infants <29 weeks gestation
• Infants with chronic lung disease of prematurity
• Haemodynamically significant congenital heart disease Given monthly IM injections (15 mg/kg) during RSV season (winter/early spring). Does NOT replace immunization.

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FRIDAY — HYPOTHYROIDISM, SEIZURES, NEURAL TUBE DEFECTS

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• Primary: Thyroid gland failure. TSH high, T4/T3 low. (Hashimoto's, post-thyroidectomy, iodine deficiency, congenital dysgenesis)
• Secondary: Pituitary failure → TSH low, T4/T3 low.
• Tertiary: Hypothalamic failure → TRH low → TSH low/normal, T4/T3 low.
• Subclinical: TSH mildly elevated, T4 normal, no symptoms.

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• Blood glucose (immediate - rule out hypoglycaemia)
• Serum electrolytes: Na, Ca, Mg (rule out metabolic causes)
• CBC
• EEG (electroencephalogram) - after acute phase; helps classify epilepsy type
• MRI brain (preferred over CT - better structural detail); indicated if focal seizure, Todd's paresis, abnormal neurology, or EEG abnormality
• LP (if suspected CNS infection - meningitis/encephalitis)
• Metabolic workup if suspected inborn error

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• Infantile spasms (salaam attacks): Sudden flexion of neck, trunk, arms and legs in clusters
• Hypsarrhythmia: Chaotic, high-amplitude slow waves with multifocal spikes on EEG (pathognomonic)
• Developmental regression/arrest Causes: Structural (tuberous sclerosis, Down syndrome, hypoxic-ischaemic injury), metabolic, or unknown. Treatment: ACTH (first-line), Vigabatrin (especially in tuberous sclerosis), Pyridoxine trial.

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• Multiple seizure types: tonic (most characteristic), atonic (drop attacks), atypical absence
• EEG: slow spike-wave (1-2.5 Hz) - characteristic
• Intellectual disability
• Treatment-resistant (often polytherapy needed: Valproate, Clobazam, Lamotrigine, Rufinamide, Dietary therapy - ketogenic diet)

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• Aura (pre-ictal): Sensory/motor/psychic warning (only in focal onset seizures)
• Tonic phase: Sudden loss of consciousness, generalized stiffening, expiratory cry, apnoea, cyanosis, eyes deviated upward (10-30 seconds)
• Clonic phase: Rhythmic jerking of all limbs, salivation, tongue bite, incontinence (1-3 minutes)
• Post-ictal phase: Gradual recovery, confusion, headache, drowsiness, Todd's paresis if focal (minutes to hours)

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• Obstructive hydrocephalus (most common complication of myelomeningocele)
• Cranial nerve palsies (stridor, apnoea, dysphagia)
• Syringomyelia Treatment: VP shunt for hydrocephalus; posterior fossa decompression if symptomatic Chiari.

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• Maternal serum AFP: Markedly elevated (>2.5 MoM) at 15-20 weeks
• Ultrasound: Absence of skull/brain at 10-14 weeks (12 weeks most reliable); "frog-like" face appearance
• Amniotic fluid AFP and acetylcholinesterase: Elevated (confirmatory) Termination of pregnancy offered. Prevention: folic acid periconceptionally.

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• Hairy patch (hypertrichosis), dimple, lipoma, haemangioma, or skin discoloration over lumbar spine
• These may indicate underlying tethered spinal cord - can cause progressive neurological deficits with growth Investigations: MRI spine (to rule out tethered cord). Prophylactic surgery for tethered cord.

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• V - Vertebral defects (spina bifida, hemivertebrae)
• A - Anal atresia (imperforate anus)
• C - Cardiac defects (VSD most common)
• T - Tracheo-Esophageal fistula
• E - Esophageal atresia
• R - Renal anomalies
• L - Limb defects (radial ray defects) When one anomaly is found, screen for others. Vertebral defects and NTDs overlap.

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BONUS QUESTIONS (Q81-Q100) — HIGH-YIELD EXAM TOPICS

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• 7-10: Normal; 4-6: Moderate depression; <4: Severe depression

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• Neuromuscular: Posture, square window, arm recoil, popliteal angle, scarf sign, heel-to-ear
• Physical: Skin, lanugo, plantar surface, breast, eye/ear, genitals Total score correlates with gestational age (range 20-44 weeks).

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• Bilateral non-purulent conjunctival injection
• Changes in lips/oral mucosa (strawberry tongue, cracked lips)
• Polymorphous rash
• Changes in extremities (erythema, oedema, periungual peeling)
• Cervical lymphadenopathy (≥1.5 cm, usually unilateral) Treatment: IVIG 2 g/kg single infusion + Aspirin (anti-inflammatory then antiplatelet dose). IVIG given within 10 days of fever onset prevents coronary artery aneurysms.

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• Meningitis/encephalitis
• Hydrocephalus
• Intracranial haemorrhage
• Lead poisoning
• Vitamin A toxicity (pseudotumor cerebri)
• Space-occupying lesion A sunken fontanelle indicates dehydration.

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• 3 weeks: Infant stays awake more
• 3 months: Holds head up, social smile
• 6 months: Sits with support, transfers objects
• 9 months: Pincer grasp, stands with support
• 12 months: Walks with support, 2-3 words (Better known: head control at 3 months, sits at 6 months, stands at 9 months, walks at 12 months - quarter-year milestones)

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• Alpha-fetoprotein (AFP): Elevated in NTDs, gastroschisis; Reduced in Down syndrome
• hCG: Elevated in Down syndrome; Reduced in trisomy 18
• Unconjugated Estriol (uE3): Reduced in Down syndrome and trisomy 18 Raised AFP alone (>2.5 MoM) with normal hCG and uE3 suggests NTD (open spina bifida or anencephaly). Confirmed by detailed USS and amniocentesis (amniotic AFP + AChE).

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• Infants: Bulging fontanelle, increasing head circumference, dilated scalp veins, sunset sign (downward deviation of eyes), irritability, vomiting, poor feeding, high-pitched cry
• Older children: Headache (worse in morning, worsened by bending/coughing), vomiting (projectile, not related to feeding), papilloedema, sixth nerve palsy (diplopia), Cushing's triad (bradycardia, hypertension, irregular breathing) - a late, ominous sign

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• Phase 1: Abduction and extension of arms with opening of hands
• Phase 2: Adduction of arms across chest (embrace)
• Associated: Cry Present from birth, disappears at 4-6 months. Asymmetric Moro suggests brachial plexus injury (Erb's palsy - absent on affected side) or hemiplegia. Absent Moro bilaterally suggests severe brain injury.

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• Low risk of epilepsy (1-2%)
• Side effects of AEDs outweigh benefit
• Does not prevent subsequent febrile seizures effectively Exceptions (consider prophylaxis):
• Complex febrile seizures with recurrence
• Underlying neurological abnormality
• Very high parental anxiety If given: Sodium valproate or Phenobarbitone. Intermittent oral/rectal diazepam at onset of fever is an alternative but has CNS side effects.

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• Cretinism (Endemic cretinism): Due to severe iodine deficiency during fetal/neonatal period. Features: Intellectual disability, deaf-mutism, spastic diplegia (neurological type) OR hypothyroid symptoms (myxoedematous type). A public health/preventable condition.
• Congenital hypothyroidism: Due to thyroid dysgenesis or dyshormonogenesis (not iodine deficiency). Detected by neonatal screening; treated with levothyroxine to prevent intellectual disability. Key difference: Endemic cretinism is iodine deficiency-related; congenital hypothyroidism is structural/genetic.

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• Congenital hypothyroidism (TSH/T4) - most important
• Phenylketonuria (PKU) - Phenylalanine elevated
• Congenital adrenal hyperplasia (17-OHP)
• Haemoglobinopathies (sickle cell)
• MCAD deficiency (medium-chain acyl-CoA dehydrogenase)
• Cystic fibrosis (IRT) India's RBSK (Rashtriya Bal Swasthya Karyakram) screens for 30 conditions.

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1. Not able to drink or breastfeed
2. Vomits everything
3. Convulsing now (or convulsed in this illness)
4. Lethargic or unconscious Additionally in young infants (<2 months):

• Fast breathing (≥60/min)
• Severe chest indrawing
• Nasal flaring
• Grunting
• Bulging fontanelle
• Fever or hypothermia Any ONE danger sign = refer urgently.

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• DQ (Developmental Quotient): Used in infants/young children. DQ = (Developmental Age / Chronological Age) × 100. Normal = 85-115. Assessed by Denver, Griffiths, Bayley scales. Measures development, not intelligence.
• IQ (Intelligence Quotient): Mental Age / Chronological Age × 100. Used in children >5 years. Assessed by Wechsler scales (WISC), Stanford-Binet.
• Intellectual Disability (ID) classification:
• Mild: IQ 50-70
• Moderate: IQ 35-49
• Severe: IQ 20-34
• Profound: IQ <20

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QUICK REVISION TABLE - Must-Know Facts