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🏥 NEET PG PEDIATRICS - HIGH YIELD REVISION NOTES

Target: Under 5000 Rank | Subject Weightage: ~10 Questions

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📋 MENTOR'S STRATEGY

• 60% weightage = Neonatology + Growth & Development + Congenital Heart Disease
• Memorize NUMBERS - every cutoff, every age, every score is exam gold
• Buzzwords = diagnosis - question stem mein ek word se answer aaega
• Revise Kawasaki + Nephrotic + IEM + vaccines separately - guaranteed 2-3 Qs

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SECTION 1: NEONATOLOGY 🍼

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1.1 APGAR SCORE

Heart rate | Respiration | Muscle tone | Reflex | Color

• Score 7-10 = Normal
• Score 4-6 = Moderate depression (PPV needed)
• Score 0-3 = Severe depression (full resuscitation)
• Calculated at: 1, 5, 10 minutes

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1.2 NEONATAL RESUSCITATION (NRP Guidelines)

Warmth → Dry/Stimulate → Assess (HR, Breathing, Color)
        ↓
HR < 100 or Apnea → PPV (40-60 breaths/min)
        ↓
HR < 60 after 30 sec PPV → Chest compressions (3:1 ratio)
        ↓
HR still < 60 → Epinephrine IV (1:10,000)

• PPV rate = 40-60 breaths/min
• Compression:Ventilation = 3:1 (neonates) vs 15:2 (pediatric 2-rescuer)
• Room air (21%) for term neonates (NOT 100% O2 - reduces mortality!)
• Preterm <35 weeks: start with 21-30% O2
• Epinephrine dose: 0.01-0.03 mg/kg IV (1:10,000 solution)
• ET tube size = (gestational age/10) + 1 OR weight in kg + 6 for oral depth

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1.3 BIRTH WEIGHT DEFINITIONS

• Preterm: <37 weeks
• Term: 37-42 weeks
• Post-term: >42 weeks
• Late preterm: 34-37 weeks (most common preterm category in NEET Qs)

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1.4 NEONATAL JAUNDICE ⭐⭐⭐

Physiological vs Pathological Jaundice

Causes by Time

• <24 hours: Hemolysis (Rh/ABO incompatibility), G6PD deficiency, congenital infection (TORCH)
• 24-72 hours: Physiological, polycythemia, cephalhematoma
• >2 weeks: Hypothyroidism, biliary atresia, breast milk jaundice, infection

Investigations of Choice

• Direct Coombs Test (DCT) = Rh incompatibility investigation of choice
• G6PD assay = G6PD deficiency
• TORCH titres = Congenital infection
• USG abdomen = Biliary atresia (triangular cord sign)
• Hepatobiliary scintigraphy (HIDA scan) = Biliary atresia confirmation

Buzzwords

• "Brass"/"Bronze baby" = Complication of phototherapy when direct bilirubin is elevated
• Kernicterus = Bilirubin encephalopathy; opisthotonus, high-pitched cry
• Exchange transfusion indication = Bilirubin >20 mg/dL (term) or as per nomogram
• Phototherapy = 430-490 nm wavelength (blue light), distance 15-20 cm

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1.5 NEONATAL SEPSIS ⭐⭐

Classification

Clinical Features - Buzzwords

• "Not doing well" - earliest sign
• Temperature instability (hypothermia MORE common than fever in neonates)
• Poor feeding, lethargy, hypotonia
• Abdominal distension
• Petechiae/purpura (meningococcemia)
• Bulging fontanelle = Meningitis

Investigations

• Blood culture = Gold standard (do BEFORE antibiotics)
• CBC: WBC <5000 OR >30,000 = abnormal; I:T ratio >0.2 = infection
• CRP = best screening marker; rises at 6-8 hours
• Procalcitonin = rises faster (3-6 hours), more specific
• CSF: always do LP if meningitis suspected
• Sepsis screen = TLC + I:T ratio + CRP + blood culture

Treatment

• EOS: Ampicillin + Gentamicin
• LOS/Nosocomial: Vancomycin + Aminoglycoside (CONS coverage)
• Meningitis: extend treatment to 21 days

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1.6 RESPIRATORY DISTRESS SYNDROME (RDS / HMD) ⭐⭐

• Also called: Hyaline Membrane Disease (HMD)
• Due to: Surfactant deficiency
• Who: Preterm neonates (especially <28 weeks), Infant of diabetic mother
• Surfactant produced by: Type II pneumocytes from 24 weeks, adequate by 36 weeks
• Lecithin:Sphingomyelin (L:S) ratio >2 = lung maturity

• Antenatal steroids (Betamethasone) given to mother at 24-34 weeks = reduces incidence

• CXR = Ground glass opacity (diagnosis)
• Gastric aspirate shake test = Foam stability test (Clements test)
• L:S ratio <1.5 = high risk

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1.7 NECROTIZING ENTEROCOLITIS (NEC)

• Characteristic X-ray: Pneumatosis intestinalis (intramural gas = PATHOGNOMONIC)
• Free air = pneumoperitoneum = perforation (surgical emergency)
• Bell's staging: Stage I (suspected), Stage II (confirmed), Stage III (advanced)
• Treatment: NPO + NG decompression + antibiotics; surgery for Stage III

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1.8 TRANSIENT TACHYPNEA OF NEWBORN (TTN)

• "Wet lung disease"
• Common in: Term/near-term, C-section babies (fluid not squeezed out)
• CXR: Fluid in horizontal fissure + cardiomegaly + streaky perihilar markings
• Self-limiting, resolves in 72 hours
• Treatment: Supportive O2, NOT surfactant

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1.9 MECONIUM ASPIRATION SYNDROME (MAS)

• Post-term babies (>42 weeks) most common
• CXR: Hyperinflation + coarse patchy infiltrates + areas of atelectasis
• Complication: Persistent Pulmonary Hypertension (PPHN)
• PPHN treatment: iNO (inhaled Nitric Oxide) = drug of choice

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SECTION 2: GROWTH & DEVELOPMENT 📏

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2.1 KEY DEVELOPMENTAL MILESTONES ⭐⭐⭐

Important Reflexes

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2.2 GROWTH PARAMETERS ⭐⭐

Weight

• Birth weight: 2.8-3.2 kg (average 3 kg)
• Physiological weight loss: 5-10% in first week, regained by 10-14 days
• Doubles by: 5 months (trick: "5 pe 5" = 5 months mein 5+5=10... nahi, double = 6 kg)
  • Actually: Doubles by 5 months, Triples by 1 year, Quadruples by 2 years
• Formula: Weight (1-6 years) = Age (years) × 2 + 8 kg
• Formula: Weight (7-12 years) = Age (years) × 3 - 3 kg (or 7×age/2 + 5)

Height

• Birth: 50 cm
• 1 year: 75 cm (1.5x birth)
• 2 years: 87 cm
• 4 years: Double birth height (100 cm)
• Formula (2-12 years): Age × 6 + 77 cm

Head Circumference (HC)

• Birth: 34 cm
• 3 months: 40 cm
• 6 months: 43 cm
• 1 year: 46-47 cm
• HC = Chest circumference at 6 months (both ~43 cm)
• After 1 year: HC < Chest circumference

Fontanelle

• Anterior fontanelle: Closes at 9-18 months (most commonly asked: 18 months)
• Posterior fontanelle: Closes at 6-8 weeks (2 months)
• Large anterior fontanelle: Hypothyroidism, hydrocephalus, rickets, Down syndrome
• Sunken fontanelle: Dehydration
• Bulging fontanelle: Meningitis, raised ICP

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2.3 DENTITION

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SECTION 3: NUTRITION & FEEDING 🥛

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3.1 BREASTFEEDING ⭐⭐

• Exclusive breastfeeding: 6 months (WHO recommendation)
• Continue with complementary foods: up to 2 years or beyond
• Colostrum = First milk, yellowish, richest in SIgA (secretory IgA) + vitamins + protein
• Breast milk > formula in: IgA, lactoferrin, lysozyme, bifidus factor, lipase
• Witch's milk = Neonatal gynecomastia due to maternal hormones (benign, no treatment)
• Lactobacillus bifidus = Growth promoted by breast milk (protects against GI infections)

• Mother: HIV (in developed countries), active TB (start after 2 weeks of treatment), chemotherapy, galactosemia
• Baby: Galactosemia, phenylketonuria (can breastfeed partially), maple syrup urine disease

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3.2 PROTEIN ENERGY MALNUTRITION (PEM) ⭐⭐⭐

Complications of PEM

• Hypothermia, hypoglycemia, infections
• Refeeding syndrome - dangerous complication when feeding restarted (hypophosphatemia)
• Treatment: WHO 10 steps; F-75 (stabilization) → F-100 (catch-up growth)

MUAC (Mid Upper Arm Circumference)

• <11.5 cm = Severe Acute Malnutrition (SAM)
• 11.5-12.5 cm = Moderate Acute Malnutrition (MAM)

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3.3 RICKETS ⭐⭐

• Craniotabes (earliest sign in infants)
• Rachitic rosary (costochondral junction enlargement)
• Harrison's sulcus (horizontal groove on lower chest)
• Bowing of legs (Genu varum) in toddlers
• Looser's zones (pseudofractures) on X-ray
• Wrist widening, delayed fontanelle closure

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SECTION 4: CONGENITAL HEART DISEASES (CHD) ❤️

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4.1 OVERVIEW: ACYANOTIC vs CYANOTIC ⭐⭐⭐

• Acyanotic = "VAS" = VSD, ASD, PDA, PS, AS, Coarctation (L→R shunt initially)
• Cyanotic = "4T + TGA" = TOF, TGA, Truncus, Tricuspid atresia, TAPVC

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4.2 ACYANOTIC CHDs

VSD (Ventricular Septal Defect) - MOST COMMON CHD

• Pansystolic murmur at left sternal border, 3rd-4th ICS
• L→R shunt; Pulmonary hypertension if large/untreated → Eisenmenger
• Most common type: Perimembranous (80%)
• Spontaneous closure: Muscular type most likely to close
• ECG: Biventricular hypertrophy

ASD (Atrial Septal Defect)

• Most common in adults (often missed in childhood)
• Types: Ostium secundum (75%, most common), Ostium primum (associated with AV canal defects/Down syndrome), Sinus venosus
• Murmur: Fixed wide split S2 + ejection systolic murmur at pulmonary area
• Ostium primum ASD = associated with Down syndrome, cleft mitral valve

PDA (Patent Ductus Arteriosus)

• Most common CHD in premature infants
• Murmur: Continuous "machinery" murmur at left infraclavicular area
• Collapsing/Waterhammer pulse (wide pulse pressure)
• Treatment: Indomethacin (closes PDA, COX inhibitor) in premature; Surgical ligation in term
• Rubella = most common cause of isolated PDA

Coarctation of Aorta

• Radio-femoral pulse delay (HIGH BP arms, LOW BP legs)
• Associated with: Turner syndrome (most common cardiac defect), bicuspid aortic valve
• CXR: "3" sign (notching on aorta) + Rib notching (from collaterals)
• Treatment: Surgical repair / balloon angioplasty

Pulmonary Stenosis

• Ejection click at pulmonary area; systolic ejection murmur
• Noonan syndrome association
• Treatment: Balloon valvuloplasty

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4.3 CYANOTIC CHDs ⭐⭐⭐

TOF (Tetralogy of Fallot) - MOST COMMON CYANOTIC CHD ⭐⭐⭐

1. Pulmonary stenosis (MOST important, causes cyanosis)
2. Right ventricular hypertrophy
3. Overiding aorta
4. VSD (perimembranous)

• Boot-shaped heart (coeur en sabot) on CXR - due to RVH + pulmonary artery hypoplasia
• Right aortic arch in 25%
• ECG: Right axis deviation + RVH
• Cyanosis worsens with crying/exertion
• Tet spells = Hypercyanotic spells, worse in morning/after feeding
• Child adopts squatting position (increases SVR, reduces R→L shunt)
• "Pink TOF" = mild PS, no cyanosis at rest

• Knee-chest position (squatting equivalent)
• Morphine (reduces hyperpnea)
• IV fluids
• Propranolol (IV, relaxes RV outflow tract spasm)
• Phenylephrine (increases SVR)
• Sodium bicarbonate (if acidosis)

TGA (Transposition of Great Arteries)

• Most common cyanotic CHD in neonates (first week of life)
• Aorta from RV, Pulmonary artery from LV (complete reversal)
• Egg on string/side appearance on CXR (narrow mediastinum)
• Survival depends on mixing (ASD, VSD, PDA)
• Emergency: Prostaglandin E1 (keeps PDA open) + Balloon atrial septostomy (Rashkind procedure)
• Definitive: Arterial Switch Operation (Jatene procedure) - within first 2 weeks

Tricuspid Atresia

• Left axis deviation on ECG (RVH absent = distinctive)
• No tricuspid valve; blood must go through ASD/PDA
• CXR: decreased pulmonary vascular markings

TAPVC (Total Anomalous Pulmonary Venous Connection)

• All pulmonary veins drain to right side
• "Snowman/Figure-8" appearance on CXR = supracardiac type
• Obstructed TAPVC = emergency (pulmonary edema in newborn)

Truncus Arteriosus

• Single great vessel; associated with DiGeorge syndrome (22q11 deletion)
• Increased pulmonary blood flow, early heart failure

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4.4 EISENMENGER SYNDROME

• Reversal of L→R to R→L shunt due to pulmonary hypertension
• Cyanosis appears LATE in acyanotic CHDs
• Differential cyanosis = PDA with Eisenmenger (lower body blue, upper body pink)
• Contraindication: pregnancy, surgery
• Treatment: Bosentan (endothelin receptor antagonist)

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SECTION 5: NEONATAL/CHILDHOOD INFECTIONS 🦠

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5.1 CONGENITAL INFECTIONS (TORCH) ⭐⭐

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5.2 KAWASAKI DISEASE ⭐⭐⭐

1. Conjunctival injection (bilateral, non-purulent)
2. Rash (polymorphous)
3. Adenopathy cervical (>1.5 cm, unilateral, non-tender)
4. Strawberry tongue / Stomatis (red cracked lips, oral changes)
5. Hand/foot changes (erythema → desquamation in convalescent phase)

• Investigate with: Echocardiography (repeat at diagnosis, 2 weeks, 6-8 weeks)
• Z-score ≥2.5 = abnormal coronary artery

• Sterile pyuria (70%)
• Mild anterior uveitis (80%)
• Elevated hepatic aminotransferases (50%)
• CSF pleocytosis (40%) - can mimic meningitis
• Hydrops of gallbladder (<10%)
• Fink sign = desquamation in groin in acute phase
• BCG scar inflammation = supportive of KD diagnosis

• Especially in infants <6 months = high risk, often missed

1. IVIG 2 g/kg (single dose) = reduces coronary aneurysm risk
2. Aspirin high dose (30-50 mg/kg/day) during acute phase → low dose (3-5 mg/kg/day) after fever subsides, continue for 6-8 weeks
3. If IVIG resistant: Infliximab or repeat IVIG or corticosteroids

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5.3 MENINGITIS IN CHILDREN ⭐⭐

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SECTION 6: GENETIC & CHROMOSOMAL DISORDERS 🧬

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6.1 DOWN SYNDROME (Trisomy 21) ⭐⭐⭐

• Most common chromosomal disorder
• Commonest cause of intellectual disability (preventable)
• Most common type: Non-disjunction (95%), Translocation (4%), Mosaicism (1%)
• Advanced maternal age = risk factor for non-disjunction

• Flat face, flat nasal bridge
• Upslanting palpebral fissures (Mongoloid slant)
• Brushfield spots (iris)
• Single palmar crease (Simian crease)
• Hypotonia
• Wide sandal gap (between 1st and 2nd toes)
• Short stature, small ears
• Epicanthal folds

• Cardiac: AVSD/AV canal defect (40%), VSD, ASD - endocardial cushion defect
• GI: Duodenal atresia ("double bubble" sign), Hirschsprung, Tracheoesophageal fistula
• Hematological: Transient myeloproliferative disorder (newborn), ALL (later), AML (M7)
• Hypothyroidism (25%)
• Alzheimer disease by age 40 (amyloid precursor protein on chr 21)
• Atlantoaxial instability (neck pain/instability)

• 1st trimester: NT (Nuchal Translucency) + PAPP-A + beta-hCG (increased NT, low PAPP-A, high beta-hCG)
• 2nd trimester: Triple test: Low AFP, High hCG, Low Estriol; Quad screen + Inhibin A
• Diagnostic: Karyotype (amniocentesis, CVS)

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6.2 OTHER CHROMOSOMAL SYNDROMES

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SECTION 7: INBORN ERRORS OF METABOLISM (IEM) 🧪

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7.1 HIGH YIELD IEMs ⭐⭐⭐

• Marfan = UP and OUT (Superotemporal)
• Homocystinuria = DOWN (Inferonasal)
• "Marfan UPAR, Homo NEECHE"

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SECTION 8: RESPIRATORY DISORDERS ⛑️

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8.1 PNEUMONIA IN CHILDREN ⭐⭐

• Most common cause of bronchiolitis in infants <2 years
• Hyperinflation + peribronchial thickening on CXR
• Treatment: Supportive (O2, hydration)
• Prophylaxis for high-risk premature infants: Palivizumab (monthly IM)

• Rapid progression, pneumatoceles (thin-walled cysts), empyema
• X-ray: Multiple cavities, pneumatocele (pathognomonic for staph)
• Treatment: Vancomycin / Cloxacillin

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8.2 CROUP vs EPIGLOTTITIS ⭐⭐

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8.3 ASTHMA IN CHILDREN

• PEFR or FEV1 improves >12% with bronchodilator

• Mild intermittent: <2 days/week, PEFR >80%
• Mild persistent: >2 days/week but not daily
• Moderate persistent: Daily symptoms, PEFR 60-80%
• Severe persistent: Continuous symptoms, PEFR <60%

• SABA + Ipratropium + Systemic steroids
• IV Magnesium sulfate = rescue therapy
• Heliox (helium-oxygen) = reduces work of breathing

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SECTION 9: RENAL DISORDERS 🫘

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9.1 NEPHROTIC SYNDROME ⭐⭐⭐

• Age: 2-6 years, boys > girls
• Periorbital edema (morning, first noticed by parents)
• Frothy urine
• Anasarca, ascites
• Hypertension uncommon (unlike nephritic syndrome)
• Complications: Infection (especially pneumococcal peritonitis), thrombosis, hyperlipidemia

• Urinalysis: 3+/4+ proteinuria (dipstick), oval fat bodies
• 24-hr urine protein OR protein:creatinine ratio
• Serum albumin: <2.5 g/dL
• Serum cholesterol: HIGH (hyperlipidemia = compensatory liver synthesis)
• Renal biopsy: Normal on light microscopy, effacement of foot processes on EM

• Prednisolone (first line): 2 mg/kg/day for 4-6 weeks → taper
• Steroid responsive: 80-90% of MCD children
• Steroid resistant: Cyclosporine, Tacrolimus, Cyclophosphamide

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9.2 NEPHRITIC SYNDROME ⭐⭐

• Follows throat infection (10-14 days) or skin infection (3-6 weeks)
• Organism: Group A beta-hemolytic Streptococcus (GABHS)
• "Rusty/cola-colored urine"
• Subepithelial humps on EM (pathognomonic)
• Low C3, normal C4 (alternate pathway activation)
• Anti-streptolysin O (ASO) titre elevated
• Self-limiting; prognosis excellent

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9.3 HEMOLYTIC UREMIC SYNDROME (HUS)

• Follows bloody diarrhea by 5-10 days
• NOT to give antibiotics (increases Shiga toxin release!)

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SECTION 10: HEMATOLOGICAL DISORDERS 🩸

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10.1 ANEMIA IN CHILDREN ⭐⭐

• Neonates: 14-20 g/dL (high)
• 2-3 months: Physiological nadir (9-10 g/dL = physiological anemia of infancy)
• Children: 11-14 g/dL

Iron Deficiency Anemia (IDA) - Most Common Anemia in Children

• Most common at 6 months - 2 years (rapid growth + low iron stores)
• CBC: Microcytic, hypochromic, low MCV, low MCH, low MCHC
• Serum ferritin = BEST single indicator of iron stores (earliest to fall)
• TIBC: High; Serum Iron: Low
• Peripheral smear: Pencil cells, anisocytosis, poikilocytosis

Thalassemia ⭐⭐

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10.2 SICKLE CELL DISEASE ⭐⭐

• Hand-foot syndrome (dactylitis) = first manifestation (6 months - 2 years)
• Acute chest syndrome
• Neurological (stroke)
• Dactylitis + Painful vaso-occlusive crises

• Autosplenectomy by age 5-6 years → susceptible to encapsulated bacteria (Pneumococcus, H. influenzae, Meningococcus)
• Prophylactic penicillin from 2 months to 5 years
• Parvovirus B19 → aplastic crisis (most dangerous acute event)
• Stroke: Exchange transfusion; prevention: Hydroxyurea

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10.3 HEMOPHILIA ⭐⭐

• PT: Normal
• aPTT: Prolonged
• Platelet count: Normal
• Bleeding time: Normal (Hemophilia A/B), Prolonged (vWD)

• Hemophilia A: Factor VIII concentrate (or recombinant Factor VIII)
• Hemophilia B: Factor IX concentrate
• Mild Hemophilia A/vWD: DDAVP (Desmopressin) - releases stored vWF from endothelium

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SECTION 11: NEUROLOGICAL DISORDERS 🧠

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11.1 FEBRILE SEIZURES ⭐⭐⭐

• Acute: Rectal diazepam / IV lorazepam
• No routine prophylactic antiepileptics for simple FS
• Antipyretics do NOT prevent recurrence

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11.2 CEREBRAL PALSY (CP) ⭐⭐

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11.3 MENINGITIS (see Section 5.3)

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11.4 NEURAL TUBE DEFECTS ⭐

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SECTION 12: GASTROINTESTINAL DISORDERS 🫃

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12.1 PYLORIC STENOSIS ⭐⭐

• Non-bilious, projectile vomiting in first-born male infant at 3-6 weeks
• Male: Female = 4:1
• Palpable "olive-shaped mass" in right upper quadrant
• Hypochloremic, hypokalemic metabolic alkalosis (vomiting of HCl)
• String sign on barium meal (narrow pyloric canal)
• Ultrasound = investigation of choice (pyloric thickness >3mm, length >14mm)
• Treatment: Ramstedt pyloromyotomy

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12.2 INTUSSUSCEPTION ⭐⭐

• Age: 3 months - 3 years (most common 6-9 months)
• Classically: Ileocolic (most common)
• Colicky abdominal pain + "Currant jelly stools" (blood + mucus) + Sausage-shaped mass (right side)
• Child draws up legs, screams, then becomes still (intermittent)
• "Dance's sign" = emptiness in RIF

• USG abdomen = doughnut/target sign (investigation of choice)
• Barium enema = both diagnostic and therapeutic (hydroststic reduction)

• Reduction with air/hydrostatic enema (non-surgical, first choice if no peritonitis)
• Surgery if failed reduction or perforation

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12.3 HIRSCHSPRUNG DISEASE (Congenital Megacolon) ⭐⭐

• Due to absence of ganglion cells (Meissner + Auerbach plexus) in distal colon
• Rectum always involved (extends proximally)
• Failure to pass meconium in first 24 hours (delayed passage = suspect!)
• Presentation: Chronic constipation + abdominal distension + failure to thrive
• Explosive passage of stool on rectal examination = "Blast" sign

• Barium enema: Narrow segment (aganglionic) + dilated proximal colon + "Transition zone"
• Rectal biopsy: Absence of ganglion cells + hypertrophied nerve trunks = GOLD STANDARD
• Anorectal manometry: Absent rectoanal inhibitory reflex

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12.4 BILIARY ATRESIA ⭐

• Conjugated (direct) jaundice in neonate
• Dark urine, pale stools, hepatomegaly
• Triangular cord sign on USG = highly specific
• HIDA scan (hepatobiliary scintigraphy): No excretion into bowel
• Liver biopsy: Bile duct proliferation + fibrosis = confirmatory
• Treatment: Kasai procedure (hepatoportoenterostomy) = do before 60 days of age!
• Late presentation → liver transplantation

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SECTION 13: VACCINATION/IMMUNIZATION 💉

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13.1 NATIONAL IMMUNIZATION SCHEDULE (India) ⭐⭐⭐

Key Vaccine Facts:

• BCG: given intradermally, left deltoid region; NEVER to immunocompromised
• OPV: Live attenuated; complication = Vaccine-Associated Paralytic Polio (VAPP)
• IPV: Killed; safer, no VAPP; Sabin = OPV (Sabin = Swallowable), Salk = IPV (Salk = Shot)
• Measles: MMR at 9 months and 15 months; Do not give to pregnant, immunocompromised
• Varicella: Live vaccine; 2 doses; contraindicated in immunocompromised
• Hep B: Recombinant; 3 doses; response measured by Anti-HBs titre

Contraindications:

• Live vaccines (BCG, OPV, MMR, Varicella, Yellow fever) = CONTRAINDICATED in: HIV, immunocompromised, pregnancy
• Exception: HIV-infected children who are NOT severely immunocompromised can receive MMR and Varicella

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SECTION 14: PUBERTY & ENDOCRINE ⭐⭐

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14.1 NORMAL PUBERTY

• First sign: Breast development (Thelarche) → Pubic hair → Growth spurt → Menarche
• Growth spurt: Earlier (10-12 years), just after thelarche
• Menarche: Average 12.5 years (2 years after thelarche)

• First sign: Testicular enlargement (>4 mL or >2.5 cm)
• Testicular volume → Pubic hair → Growth spurt → Voice change
• Growth spurt: Later than females (12-14 years)

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14.2 PRECOCIOUS PUBERTY ⭐⭐

• Bone age (X-ray wrist/hand) = Advanced in PP
• GnRH stimulation test = LH >5 IU/L = central PP
• MRI brain = for central causes

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14.3 CONGENITAL HYPOTHYROIDISM ⭐⭐⭐

• Prolonged neonatal jaundice
• Hoarse cry, macroglossia, large fontanelle
• Constipation, hypothermia, poor feeding
• Umbilical hernia (pathognomonic)
• Myxedema, dry skin, coarse hair

• Neonatal screening: TSH (heel prick, done at 48-72 hours of age)
• Confirmatory: Serum T4 (low) + TSH (high)
• Bone age: Delayed (epiphyseal dysgenesis)

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14.4 CONGENITAL ADRENAL HYPERPLASIA (CAH) ⭐⭐

1. Salt-wasting (Classic, severe): Low cortisol + Low aldosterone → Hyponatremia, Hyperkalemia, hypotension, virilization in females (ambiguous genitalia)
2. Simple virilizing: Low cortisol only, no salt-wasting; Virilization
3. Non-classic (NCAH): Late-onset, mild symptoms; hyperandrogenism

• 17-Hydroxyprogesterone elevated = marker of 21-hydroxylase deficiency
• ACTH stimulation test: confirms diagnosis
• Karyotype: to determine sex of virilized females

• Hydrocortisone (glucocorticoid replacement)
• Fludrocortisone (mineralocorticoid) in salt-wasting
• Salt supplementation

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SECTION 15: BEHAVIORAL/DEVELOPMENTAL DISORDERS

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15.1 AUTISM SPECTRUM DISORDER (ASD) ⭐

1. Deficits in social communication and interaction
2. Restricted, repetitive behaviors

• No pointing by 12 months
• No single words by 16 months
• No 2-word phrases by 24 months
• Loss of language = biggest RED FLAG (regression at any age = refer immediately)

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15.2 ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

• First line (6+ years): Methylphenidate (Ritalin) or Amphetamines
• <6 years: Behavioral therapy first
• Atomoxetine (non-stimulant, preferred if comorbid tic or substance abuse)

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SECTION 16: IMPORTANT SYNDROMES/VASCULITIC DISORDERS

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16.1 HENOCH-SCHONLEIN PURPURA (HSP/IgA Vasculitis) ⭐⭐

1. Palpable purpura (non-thrombocytopenic, on buttocks/lower extremities)
2. Arthritis/Arthralgia
3. Abdominal pain (colicky, can cause intussusception)
4. Renal involvement (IgA nephropathy = hematuria/proteinuria)

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16.2 JUVENILE IDIOPATHIC ARTHRITIS (JIA) ⭐⭐

• Quotidian fever (spikes daily, returns to normal)
• Salmon-colored evanescent rash (appears with fever, disappears when afebrile)
• Serum ferritin >500 (often >10,000 in MAS complication)
• Macrophage Activation Syndrome (MAS) = life-threatening complication (pancytopenia + coagulopathy)

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16.3 KAWASAKI DISEASE (see Section 5.2)

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SECTION 17: QUICK REFERENCE - HIGHEST YIELD SINGLE LINERS ⭐⭐⭐

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• First sign of puberty in females = Breast development
• First sign of puberty in males = Testicular enlargement
• First bone to ossify = Clavicle
• First tooth to erupt (deciduous) = Lower central incisor (6 months)
• First tooth to erupt (permanent) = First molar (6 years)

• Most common CHD = VSD
• Most common cyanotic CHD = TOF
• Most common cyanotic CHD in newborn = TGA
• Most common cause of neonatal sepsis (EOS) = GBS
• Most common cause of meningitis in neonates = GBS
• Most common cause of meningitis in children = Neisseria meningitidis
• Most common chromosomal disorder = Down syndrome
• Most common inborn error = PKU
• Most common cause of bronchiolitis = RSV
• Most common cause of croup = Parainfluenza virus
• Most common cause of epiglottitis = H. influenzae b
• Most common renal tumor in children = Wilms tumor (Nephroblastoma)
• Most common brain tumor in children = Medulloblastoma (posterior fossa)
• Most common leukemia in children = ALL (75-80%)
• Most common cause of AKI in children = HUS
• Most common vasculitis in children = Kawasaki disease

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17.1 WILMS TUMOR (NEPHROBLASTOMA) ⭐⭐

• Age: 3-4 years (most common renal tumor in children)
• Presents as painless abdominal mass (don't palpate aggressively!)
• Never crosses midline (vs neuroblastoma which does)
• Associated: WAGR syndrome (Wilms + Aniridia + Genitourinary anomalies + mental Retardation), Beckwith-Wiedemann syndrome, Hemihypertrophy
• WT1 gene deletion (chromosome 11p13)
• USG/CT abdomen = diagnosis; intrarenal mass
• Mets: Lung most common (cannonball metastases)
• Treatment: Surgery + Chemotherapy (Actinomycin D + Vincristine) ± Radiotherapy

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17.2 NEUROBLASTOMA ⭐⭐

• Most common solid extracranial tumor in children
• Arises from neural crest cells (adrenal medulla, sympathetic ganglia)
• Adrenal medulla most common site (65%)
• Crosses midline (unlike Wilms)
• Age: <5 years
• Symptoms: Abdominal mass + hypertension + raccoon eyes (periorbital ecchymoses) + Horner syndrome
• Urinary catecholamines (VMA, HVA) = investigation of choice (elevated)
• MIBG scan = most specific imaging
• N-MYC amplification = poor prognosis
• Opsoclonus-myoclonus-ataxia (dancing eyes, dancing feet) = paraneoplastic, GOOD prognosis

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17.3 ALL (ACUTE LYMPHOBLASTIC LEUKEMIA) ⭐⭐

• Most common cancer in children, peak age 2-5 years
• Pre-B cell ALL (most common)
• B symptoms: Fever, night sweats, weight loss
• Bone pain + limping (most common presenting complaint in children)
• Lymphadenopathy, hepatosplenomegaly
• CNS involvement: Headache, cranial nerve palsy, fundal hemorrhages
• Mediastinal mass: T-cell ALL (anterior mediastinum)
• Hyperleukocytosis + Blast cells in smear

• Age 1-9 years
• WBC <50,000
• B-cell lineage
• Hyperdiploidy (>50 chromosomes)
• Rapid response to treatment

• CNS prophylaxis: IT methotrexate (replaced cranial radiation)

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SECTION 18: HIGH YIELD PYQ BANK ❓

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1. APGAR score component most predictive = 5-min APGAR (NOT 1-min)
2. Earliest sign of birth asphyxia = Fetal heart rate change
3. Surfactant is made by = Type II pneumocytes
4. L:S ratio for lung maturity = >2
5. Most common cause of neonatal death in India = Prematurity (then sepsis, asphyxia)
6. Vitamin K is given at birth to prevent = Hemorrhagic Disease of Newborn
7. Breast vs cow milk difference = Breast has more lactoferrin, IgA, oligosaccharides; cow milk has more protein/casein
8. Physiological weight loss - regained by = 10-14 days

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SECTION 19: SUBJECT-WISE TRICKS FOR EXAM DAY 🎯

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EMERGENCY TRICKS TO REMEMBER

• APGAR: 7-10 normal, 4-6 moderate, 0-3 severe
• Birth weight doubles at 5 months, triples at 1 year
• Cephalic (HC) = 34 birth, 46 at 1 year
• Dentition: first tooth at 6 months

• <24hr = PATHOLOGICAL
• 24hr-2 weeks = may be physiological

• 2 weeks = PATHOLOGICAL again

• Responds = MCD (90% in children)
• Resists = FSGS, Membranous

• Down syndrome = AVSD
• Turner = Coarctation
• Williams = Supravalvular AS
• Noonan = Pulmonary stenosis
• 22q11 = Truncus/TOF

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MENTOR'S FINAL TIPS 🎓

1. Pediatrics has ~10 questions in NEET PG. Getting 8-9 correct can push your rank by 200-300 places.
2. Priority order for study:
   • Neonatology (3-4 Qs guaranteed)
   • CHD (1-2 Qs guaranteed)
   • Growth milestones (1 Q)
   • Kawasaki, Nephrotic, Thalassemia (1 Q each)
3. Trap questions: They always ask about "exceptions" - e.g., which vaccine CAN be given to HIV patients (answer: MMR and Varicella if not severely immunocompromised).
4. Clinical stem questions: Read the AGE first - it narrows diagnosis immediately (e.g., 3-6 weeks + projectile vomiting = pyloric stenosis; 6-9 months + colicky pain + blood in stool = intussusception).
5. Labs to memorize cold:
   • Ferritin low = earliest iron store depletion
   • C3 low + C4 normal = APSGN
   • C3 low + C4 low = SLE nephritis
   • 17-OHP high = CAH
   • Ceruloplasmin low = Wilson's

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Next Subject: Surgery, Medicine, OBG, Ophthalmology, ENT, Orthopedics, Radiology, Pathology, Microbiology, Pharmacology, Physiology, Biochemistry, Anatomy, PSM/Community Medicine, Psychiatry, Dermatology, Anesthesia, FMT - tell me which one to tackle next!

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