Second Edition

Anand Bhatia MBBS, MD (Pediatrics)

Assistant Professor
North DMC Medical College & Hindu Rao Hospital, New Delhi

Senior Residency
Lady Hardinge Medical College and North DMC Medical College &
Hindu Rao Hospital, New Delhi

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 Preface
Hello friends!
First of all, I would like to extend my heartfelt thanks to all of you for reading my book and showering your
blessings. I still remember, when I was doing MBBS, I faced huge difficulty in covering my syllabus. I had
no idea how to study in a proper way and how to crack exams. That day, I promised myself that one day
I will change the whole thought process of teaching and will introduce a different way of learning.
So, here is the result of my day and night efforts. I am introducing to you this book which covers all the
theories and clinical topics for your UG and PG exams. There is one precious message I would like to convey
to all of you: “Never stop believing in your dreams, they were given to you for a reason. Just find the
purpose of your existence in this life and once you find it, spend your whole life cherishing it; because once
you follow your passion, life becomes beautiful.”

Who Can Use This Book?

Anyone who is preparing for UG and PG exams.

How Should I Read This Book?

• If you are a final year student then develop the habit of finishing one chapter in a day. By the end of
the day, call one of your close friends and just teach him/her whatever you read. (You will never forget
that topic in your life). There are 17 chapters in this book, which means your first reading must be
finished in 17 days.
• If you are appearing for PG entrance exam—you must finish this book in 5 days.
• Time for first reading: 4 days
• Time for second reading: 3 days
• Time for third reading: 2 days
• Try to focus on the images, tables and last segment of the book which covers recent MCQs.

Always Remember:
“10 fdrkcksa dks ,d ckj ugha] ,d fdrkc dks 10 ckj i<+ksA”
“Instead of reading 10 books one time, Read one book 10 times.”

“Life is a one-time offer—use it well.”

Social Media Handle:

Instagram: p.e.d.i.a.t.r.i.c.s
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For study group@9354407677

Anand Bhatia
 From Publisher’s Desk
Dear Students,
Let us begin with a power-packed and inspiring quote:
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—Swami Vivekananda
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At CBS Publishers, we take great pride in supporting the healthcare community by offering resources
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 Contents
Preface .................................................................................................................................................................................................. iii

THEORY

1. Growth and Development................................................................................................................................................3

2. Neonatology........................................................................................................................................................................21
3. Respiratory System..........................................................................................................................................................45
4. Pediatric Cardiology........................................................................................................................................................55
5. Behavioral Disorders........................................................................................................................................................68
6. Central Nervous System................................................................................................................................................71
7. Immune System ...............................................................................................................................................................89
8. Breastfeeding......................................................................................................................................................................95
9. Severe Acute Malnutrition............................................................................................................................................98
10. Micronutrients................................................................................................................................................................. 102
11. Vaccines.............................................................................................................................................................................. 108
12. Hematology and Infectious Disease ....................................................................................................................... 114
13. Renal System................................................................................................................................................................... 127
14. Musculoskeletal System................................................................................................................................................ 133
15. GIT/Hepatology.............................................................................................................................................................. 141
16. Inborn Errors of Metabolism..................................................................................................................................... 150
17. 100 Images/Spotters................................................................................................................................................... 161

LATEST QUESTION PAPERS

NEET PG 2024 (Memory-Based)������������������������������������������������������������������������������������������������������������������������������������������������� 181

NEET PG 2023-2021 (Memory-Based)����������������������������������������������������������������������������������������������������������������������������������� 184

INI-CET Nov 2024 (Memory-Based)������������������������������������������������������������������������������������������������������������������������������������������ 190

INI-CET May 2024 (Memory-Based)����������������������������������������������������������������������������������������������������������������������������������������� 192

INI-CET 2023-2021 (Memory-Based)������������������������������������������������������������������������������������������������������������������������������������� 195

FMGE 2023 (July and January) (Memory-Based)���������������������������������������������������������������������������������������������������������������� 204

FMGE 2022 (Memory-Based)�������������������������������������������������������������������������������������������������������������������������������������������������������� 208

UPSC CMS 2024�������������������������������������������������������������������������������������������������������������������������������������������������������������������������� 215

UPSC CMS 2022 (Paper 1)����������������������������������������������������������������������������������������������������������������������������������������������������� 217
UPSC CMS 2022 (Paper 2)����������������������������������������������������������������������������������������������������������������������������������������������������� 220
THEORY
 1 Growth and Development
“If the world was blind, how many people you would have impressed.”

IMPORTANT FACTS Remember

• Neonate: 0–28 days of life Greek Meaning of Pediatrics
• Early neonate: 0–7 days • Pedia = child
• Late neonate: 7–28 days* • iatrics = healer

Periods of Growth
• Ovum: 0–2 weeks
• Embryo: 3–8 weeks
• Fetus: 9 weeks—birth

• Normal weight of a newborn: 2.5–4 kg

• Average Indian baby weight: 3 kg
• Weight doubles by 5 months and triples by 1 year

RATE OF INCREMENT OF WEIGHT

1. 0–2 months: 20-40 g/day
2. 3–12 months: 400 g every month till 1 year
Image 1: Early neonate
3. 2 kg/year for next 7 years
• Infant: 29 days till 1 year 4. After 7 years—3 kg/year
• Toddler: 1–3 years
• Preschool: 3–6 years Remember*
• School: 6–12 years
Weight of a 1-year-old is 10 kg
• Adolescent period:
As the age increases, weight increases in even
○ Early: 10–13 years*
number, that means weight of a 2-year-old will
○ Middle: 14–16 years be 12 kg
○ Late: 17–19 years 3-year-old: 14 kg 4-year-old: 16 kg
○ Normal head circumference (HC) at birth: 5-year-old: 18 kg 6-year-old: 20 kg
33–35 cm
○ Rate of increment: Weech’s Formula for calculating expected weight
9 + x
▪ 0–3 months: 2 cm/month 1. 3–12 months = x ⇒ age in months
2
▪ 3–6 months: 1 cm/month
2. 1–6 years = 2x + 8 x ⇒ age in years
▪ 6–12 months: 0.5 cm/month
7x – 5
3. 7–12 years = x ⇒ age in years
2

Note: * Repeated question

**Multiple times repeated question
4 One Touch Pediatrics by Dr Anand Bhatia

HEIGHT SKIN FOLD THICKNESS

Harpenden Caliper
High-Yield Points
• To know the caloric reserve of the body
• Length of a newborn: 48–50 cm (19–21 inches) • Measured to the nearest of 1 cm
• Length doubles by 4 years and triples by • Normal value
12 years
○ 1–6 years is >10 mm
• Length of a 4-year-old will be 100 cm and
○ If it is <6 mm—malnutrition
12-year-old will be 150 cm
• After 4 years, child gains 6 cm/year height
every year till 12 years
• Length of a 1-year-old is 75 cm (means
from birth till 1 year there is an increment of
25 cm)
• Expected height formula: Age (in years)
multiply by 6 + 77
• <2 years we take the length of baby
• >2 years we take the height

Legal age definitions

Definition of child <18 years

Minimum age of marriage Boy <21 years,

Girl <18 years

Responsibility of crime 12 years

Image 3: Harpenden caliper**
Juvenile criminal 12–18 years

Compulsory free education 6–14 years

MICROCEPHALY AND
Infantometer: To measure the length of 0–2 years
•
MACROCEPHALY
• Stadiometer: To measure the height of >2 years
• Standing height is about 0.7 cm less than the • Microcephaly: Head circumference <–3 SD
recumbent length (standard deviation)
• Macrocephaly: HC >2 SD for the age and sex

A B A B

Images 2A and B: A. Infantometer; B. Stadiometer Images 4A and B: A. Microcephaly; B. Macrocephaly

 THEORY 5

Causes of Microcephaly

Mnemonic Practice Question

There were two babies Rubin and Smith Q. 
What is the common feature about
• Rubin: Rubinstein-Taybi syndrome these syndromes—Galactosemia, Weaver
syndrome, Sotos syndrome and Morquio
• Smith: Smith-Lemli-Opitz syndrome
syndrome?
Their Families were Crying because they want to a. They are causes of Microcephaly
Eat Corn at Pattaya beach b. They are causes of Macrocephaly
• F: Familial c. They are causes of Anemia
• C: Cri du chat syndrome d. They are Nutritional disorders
• E: Edward syndrome Ans. b. They are causes of Macrocephaly
• Corn: Cornelia de Lange syndrome
• Pattaya: Patau syndrome

Rubinstein-Taybi syndrome Cri du chat syndrome Edward syndrome

• GREAT—Great toe deviated • 5p deletion Trisomy 18

• MR—Mental retardation • Microcephaly R: Rocker bottom feet
• MICRO—Microcephaly • High pitch cry resembling O: Overlapping digits
• THUMBS—Thumbs are broad a cat
C: Cardiac defect
• ASD—Atrial septal defect
K: Kidney defect
Y: Microcephaly
M: Mental retardation

UPPER SEGMENT: LOWER SEGMENT RATIO

• Upper segment: Vertex to pubic symphysis High-Yield Points
• Lower segment: Pubic symphysis to heel
• Growth of a child is cephal to caudal and distal
• Normal ratio at birth: 1.7:1
to proximal
• 3 years: 1.3:1
• That means during fetal life, head grows before
• 7–10 years: 1:1 the neck
• Adult: 0.9:1 • Distal parts of the body such as hands increase
in size before the upper arms
6 One Touch Pediatrics by Dr Anand Bhatia

DRUGS CONTRAINDICATED IN PREGNANCY

Maternal intake Defect in the baby

Thalidomide Phocomelia
Antimalarial Deafness
Alcohol Fetal alcohol syndrome/limb abnormalities
Carbamazepine Spina bifida
Carbimazole Scalp defects, choanal atresia, esophageal atresia
Cocaine Microcephaly, LBW, IUGR
Danazol Virilization
Lithium Ebstein anomaly, macrosomia
Misoprostol Moebius syndrome—cranial neuropathies
Phenytoin Fetal hydantoin syndrome, neuroblastoma, bleeding (Vitamin K deficiency)
Quinine Abortion, thrombocytopenia, deafness
Statins VACTERL anomalies
Tetracyclines Teeth pigmentation, cataract
Vitamin D Supravalvular aortic stenosis, hypercalcemia
Warfarin Fetal bleeding, hypoplastic nasal structures
Erythromycin Congenital hypertrophic pyloric stenosis

POTTER SYNDROME
• If the mother is a case of polyhydramnios, we should rule
out trachea esophageal fistula (TEF) in the baby
• If the mother is a case of oligohydramnios, we should rule
out renal agenesis in the baby
Renal agenesis and oligohydramnios are associated with Potter
syndrome
• P: Pulmonary hypoplasia
• O: Oligohydramnios
• T: Twisted skin (wrinkled skin)
• T: Twisted face (potter face)
• E: Extremities defect
Image 5: Potter syndrome
• R: Renal agenesis

Turner syndrome Noonan syndrome Fetal alcohol syndrome

Karyotype 45 X0 Karyotype normal Microcephaly
Infertile due to streak ovaries Fertile but delayed puberty Short palpebral fissure
Only females Males or females Smooth philtrum
Intelligence normal Intellectual disability present Thin upper lip
Heart: Pulmonary stenosis
 THEORY 9

High-Yield Points
• Most common GIT abnormality in Down • Triple bubble sign: Jejunal atresia
syndrome is: Duodenal atresia (X-ray: Double
bubble sign)

• Single bubble sign is seen in: Pyloric stenosis

Most common congenital.

Heart disease in Down syndrome is Endocardial
cushion defect.

For the antenatal screening of down syndrome in 1st trimester: Practice Question
1. Nuchal thickness >3 mm
Q. 
Pulmonary stenosis is most
2. b-hCG and pregnancy-associated plasma protein A (PAPP-A) commonly seen in:

2nd trimester: a. Alagille syndrome

Triple scan AFP, unconjugated estriol, b-hCG b. Noonan syndrome

Quadruple scan: All 3 + inhibin A c. Down syndrome

d. a and b
Ans. d. a and b
IMP PYQs
Q. Which is the syndrome where IQ will not be affected?
Ans. Turner syndrome

AFP Estriol hCG Inhibin A Levels

Down Low Low High High High
Turner Low Low Very high Very high High
Edward Unchanged Low Very low Unchanged HE is low
Patau Increased Normal Normal Normal AFPatau is high
12 One Touch Pediatrics by Dr Anand Bhatia

Mnemonic
Clinical Features of Treacher Collins Syndrome
Gandhi ji’s three monkeys
• “Bura mat dekho/don’t see bad”—coloboma of eyes
• “Bura mat suno/don’t hear bad”—deafness
• “Bura mat bolo/don’t speak bad”—hypoplasia of
cheeks, micrognathia
• Autosomal dominant
• Tcof1 gene mutation
• Intelligence is not affected*

Causes: Macrocephaly: Mnemonic: “ARO Saves My Health”

• A : Anemia (chronic)
• R : Rickets
• O : Osteogenesis imperfecta
• S : Subdural hematoma, Syndromes like—Galactosemia, Weaver syndrome, Sotos syndrome, Morquio
syndrome
• M: Megalencephaly
• H : Hydranencephaly
• H : Hydrocephalus

X-RAY WRIST

Hamate Capitate Trapezoid Trapezium

Medial Lateral

Pisiform Triquetral Lunate Scaphoid

1st carpal bone to appear: Capitate comes by

•
2 months
Mnemonic
• 2nd carpal bone to appear: Hamate comes by 3—3 means 3-year-old will have 3 carpal bones
3 months 4—4 means 4-year-old will have 4 carpal bones
• 3rd—triquetral comes by 3 years 5—5 means 5-year-old will have 5 carpal bones
• 4th lunate comes by 4 years
Age X-ray for bone X-ray is
• 5th scaphoid comes by 5 years
age estimation compared
• Last carpal bone to appear: Pisiform
Newborn Knee joint Greulich and
Pyle atlas
Practice Question
and Tanner-
Whitehouse
Q. X-ray is compared using:
methods
a. Greulich and Pyle atlas Tanner
b. Whitehouse method 3-9 months Shoulder joint
c. Both 1-13 years Wrist joint
d. None 12-14 years Elbow/hip
Ans. c. Both
 THEORY 15

Stage Volume and size of testis Characteristic features

Increase in length of penile shaft, hair begins to

3.
curl and darken

• Increase in girth of penis and glans

• Darkening of scrotum
4.
• Coarse abundant and curly hair

Adult type
5. • Adult size scrotting
• Adult type penis
• Hair spreading to medial side of thigh

CMR stage Features IMP PYQs

Grade 1. Prepubertal, no terminal hair Q. Identify the given
instrument and also write
its function.
Breast bud, sparse straight
2.
hair along the labia

Generalized breast development Ans. Orchidometer.

3.
(extending beyond the areola), The instrument is used for
hair begins to curl testis volume/hypogonadism.

Practice Question
Q. 
CMR staging with
Nipple and areola form a features of Breast bud,
4. second mound over the breast sparse straight hair along
with increase in amount of the labia is:
hair over the entire mons. a. 1
b. 2
Mature adult type c. 3
Nipple projects and areola d. 4
5. receds with adult type pubic e. 5
hair in triangle spreading over
Ans. b. 2
to medial part of thigh.
22 One Touch Pediatrics by Dr Anand Bhatia

PERLMAN SYNDROME Identify The Image

Features Identify the finding in the image.
• Fetal overgrowth disorder present @ birth • Acrocyanosis: ACRO = periphery and cyanosis
• Fetal gigantism = bluish discoloration
• Renal hamartomas • One of the conditions in a newborn which
• It does not cause IUGR. looks abnormal, but is normal

Acrocyanosis

APPROACH TO HIV+ MOTHER

• ART sufficient (>4 weeks): Nevirapine 10 mg
once daily for 6 weeks.
• ART insufficient: (<4 weeks)
○ High-risk of transmission then nevirapine +
Image 31: Perlman syndrome zidovudine for 12 weeks.
○ Low-risk of transmission: Only nevirapine
for 12 weeks.
APPROACH TO HEPATITIS B POSITIVE
MOTHER
APPROACH TO TB+ MOTHER
Hepatitis B immunoglobulin (within 48–72 hours) +
hepatitis B vaccine on alternate thigh to the baby. Isoniazid to the baby 10 mg/kg/day for 6 months.

TYPES OF IUGR

Symmetrical IUGR Asymmetrical IUGR

• Insult to the mother in 1st or early 2nd • Insult in late 2nd or 3rd trimester
trimester • Cause: Maternal anemia, not gaining weight,
• Causes: Chromosomal defect, genetic defects and hypertension, uteroplacental insufficiency
torch infections • Head circumference is normal; rest of body
• HC/WT/length equally affected appears small (due to “Brain-sparing” effect)
Then, multiply by 100 • Ponderal index <2
• Ponderal index (PI) >2 • Good prognosis
• PI >2.5 is seen in term babies Formula:
Weight in grams
Ponderal index = × 100
• Poor prognosis (Length in cm)3
 THEORY 33

NEONATAL RESUSCITATION (LATEST UPDATE)

“Do smart work.”

Image 56: The resuscitation algorithm

Abbreviations: CPAP, continuous positive airway pressure; ETT, endotracheal tube; PPV, positive pressure ventilation;
SpO2, saturation of oxygen
(Adapted with permission from American Academy of Pediatrics 2020)
58 One Touch Pediatrics by Dr Anand Bhatia

• SVR: Systemic vascular resistance decreases Structure Remnant

• Flow of ductus arteriosus: Right to left Ductus arteriosus Ligamentum arteriosum
• IVC blood is more saturated than SVC blood
Umbilical artery Medial umbilical ligament
• Lungs are never working in fetal circulation
Umbilical vein Ligamentum teres (hepatis)
• The placenta is the principal site of gas exchange,
Ductus venosus Ligamentum venosum
excretion and acquisition of nutrients
• Factors causing closure of ductus arteriosus:
Oxygen, bradykinin, cutting of placenta PATENT DUCTUS ARTERIOSUS
• If a patient has single artery-single vein, we
should rule out: Renal agenesis.

Functional Anatomical
closure closure
Ductus venosus After removal 7 days
of placenta/
umbilical cord
clamp
Foramen ovale** During Months –
breastfeeding years
Image 102: Diagramatic presentation of PDA
Ductus arteriosus 10–15 hours 10–21 days
Present with pulmonary artery and descending aorta

Remember
• More common in females and high altitudes
• One syndrome associated with PDA is
congenital rubella syndrome findings:
○ Loud M1
○ Shunt murmur: Machinery murmur
○ S2: Paradoxical split of S2
○ S3: Large shunt

High-Yield Points
• ASD S2—wide fixed split S2
• VSD S2—wide variable split of S2
• PDA S2—paradoxical split in large PDA

Clinical Features
• Hyperdynamic circulation
• Bounding pulses
• Easily palpable dorsalis pedis artery
• Wide pulse pressure >25 mm Hg
• Hyperactive precordium (visible pulsation is >2
rib spaces)
• Ejection systolic murmur
Image 101: PDA • Persistent tachycardia
 THEORY 67

Practice Questions
Q. What is the use of Hypoxia test?
a. To test reduced oxygen levels in a pre-term infant
b. To differentiate hypoxia and dysnoae
c. To confirm cyanosis
d. To rule out the cause of cyanosis
e. To assess SpO2 in a newborn
Ans. d. To rule out the cause of cyanosis.

Q. Full form of CCAM:

a. Congenital Cardiac Anomaly Management
b. Cardiac Conditions Assessment and Management
c. Congenital Cystic Abnormalities and Malformation
d. Congenital Cystic Adenomatoid Malformation
Ans. d. Congenital Cystic Adenomatoid Malformation

Q. Pulmonary stenosis is most commonly seen in:

a. Alagille syndrome b. Noonan syndrome
c. Down syndrome d. a and b
e. a and c
Ans. d. a and b

Q. Which anatomical structure closes during breastfeeding?

a. Ductus arteriosus b. Foramen ovale
c. Ductus venosus d. All of these
Ans. b. Foramen ovale

Quick Revision
• Tetralogy of Fallot (Boot-shaped) components: Right Ventricular Hypertrophy, Ventricular Septal
Defect, Overriding of aorta and Progressive pulmonary stenosis.
• MC Congenital heart disease associated with Lutembacher’s syndrome is Ostium secundum type of
ASD.
• Alagille syndrome—Butterfly-shaped Vertebra.
• Functional closure of ductus arteriosus is 10-15 hours and Anatomical closure is 10-21 days.
• Most common type of Atrial Septal Defect is Ostium secundum.
• Most common congenital heart disease in cardiology is ventricular septal defect.
• Most common congenital heart disease is transposition of Great Arteries.
• Box-shaped heart is seen on Chest X-ray of Ebstein anomaly.
• Figure of 3 appearance is seen in X-ray of Coarctation of Aorta.
• Duct independent congenital heart disease is truncus arteriosus.
76 One Touch Pediatrics by Dr Anand Bhatia

IMP PYQs IMP PYQs

Q. Y
ou are the Doctor in the internal ward at Q. W
 hich of the following agents is likely to cause
Rajagiri Hospital and you meet Mr Bharath. cerebral calcification and hydrocephalus in a
He responds to strong pain and withdraws his newborn whose mother has history of taking
hand, incomprehensible word. His GCS is: spiramycin but was not compliant with
A. 6    B. 7    C. 8    D. 9 therapy?

Ans. C. 8 A. Rubella B. Toxoplasmosis

C. CMV D. Herpes
Ans. B. Toxoplasmosis
TORCH PROFILE
T : Toxoplasmosis Congenital Syphilis
O : Others • Early feature: Syphilitic rhinitis (bloody rhinorrhea)
R : Rubella • Late features: Hutchinson’s triad*
C : CMV (most common) 1. Hutchinson teeth
H : Herpes 2. Interstitial keratitis
• Which is the most common among all?—CMV 3. 8th nerve deafness (sensorineural hearing loss)
• Which one causes recurrent abortions?—Syphilis
Other Features
• Which is the most severe form of intrauterine
infection?—Rubella • Mulberry molars: Multiple rounded rudimentary
• Which is dangerous in first trimester?—Rubella enamel cusps on the permanent first.
• Trimester-wise severity of infection: • Clutton’s joint, painless joint, swelling-knee
○ First trimester: Rubella
○ Second trimester: Parvovirus
○ Third trimester: Syphilis, CMV, toxoplasmosis

Congenital Toxoplasmosis
• Triad
1. Hydrocephalus
2. Intracranial calcification (diffuse)
3. Chorioretinitis* Most common Image 140: Image 141:
Hutchinson teeth Mulberry molars
• Confirmatory test: +ve toxoplasma IgM in serum.
• Maternal RX with spiramycin during pregnancy • Higoumenakis Sign: Thickening of the medial
reduces the risk of transmission significantly. portion of the clavicle
• Diagnosis: IgM-FTA-ABS* NEET

Image 139: Congenital toxoplasmosis

Image 142: Higoumenakis sign
86 One Touch Pediatrics by Dr Anand Bhatia

STATUS EPILEPTICUS—APPROACH SEIZURE IN A NEWBORN—

APPROACH
Definition: Status epilepticus is defined as continuous
or recurrent seizure which lasts for >5 minutes
without regaining consciousness.

*Levetiracetam or lidocaine may be considered a

second-line agent in place of phenytoin

Image 163: Sequential drug therapy in Image 164: Acute management of neonatal seizures
the management of status epilepticus
 THEORY 101

FEEDING IN SEVERE ACUTE IMP PYQs

MALNUTRITION (SAM) Q. When to discharge SAM baby?
Ans. 
WHO recommended F-75 diet F-100 diet
• 15% weight gain from the date of admission.
starter diet in SAM
Calories 75 100 • >5 g/kg/day weight gain for 3 consecutive days.

Protein 0.9 g 2.9 g • M

 other is confident enough to take care of
the baby.
Lactose 1.3 g 4.2 g
• All the micronutrients are given for 14 days.
IMP PYQs • Child is free from infection.
Q. What is failure to respond in SAM? • Antibiotic course has been finished.
Ans.  • Child appetite has returned.
• Failure to regain appetite by day 4 • Immunization is complete.
• Failure to start to lose edema by day 4
• Edema still present by day 10

Practice Questions
Q. Shakir tape:
a. Used by health worker b. Less than 11.5 cm—Severe Malnutrition
c. More than 12.5 cm—Normal d. All of these
Ans. d. All of these

Q. Theory of Adaptation and Dysadaptation is seen respectively in:

a. Marasmus and Kwashiorkor b. Kwashiorkor and Marasmus
c. Only Marasmus d. Only Kwashiorkor
Ans. a. Marasmus and Kwashiorkor

Quick Revision
• WHO defines severe acute malnutrition (SAM) as:
○ Weight-for-height <-3 SD (standard deviation).
○ Mid-upper arm circumference (MUAC) <11.5 cm—edema.
• Chronic malnutrition/stunting: Decrease height for age <-2 SD.
• Parameter changes in acute on chronic malnutrition is weight-for-age.
• Kwashiorkor: Fatty liver (kwashiorkor baby is fatty therefore we will see fatty liver).
• Hypoglycemia cut off: <54 mg/dL.
• Triad of kwashiorkor: Mental changes, edema, apathy.
• Triad of complication of SAM: Hypoglycemia, hypothermia, infection.
• Flaky paint dermatosis is also known as crazy pavement dermatosis.
• Hyperpigmented patches which may peel easily: Kwashiorkor.
• Flag sign: Alternate band of shiny and dull areas in a hair follicle—Kwashiorkor.
 14 Musculoskeletal System
“Thousands of candles can be lighted from a single candle, be the candle.”

OSTEOGENESIS IMPERFECTA (OI) • Easy bruisability

Image 251: Multiple fractures

Image 253: Easy bruisability
Osteogenesis imperfecta (OI) is also known as brittle
bone disease. • Joint laxity
Triad: • Short stature
1. History of blue sclera • Type of OI which is lethal in prenatal period:
Type 2
2. Recurrent fractures
• Baby will be stillborn/die in first year.
3. Early deafness
• Intrauterine fracture/crumpled appearance
Classification • Popcorn appearance of metaphysis

Sillence Classification
• Defect is in the collagen.

Clinical Features
• Hyperextensible joints

Image 252: Hyperextensible joints Image 254: Popcorn appearance of metaphysis

162 One Touch Pediatrics by Dr Anand Bhatia

7. Pfeiffer syndrome 10. Meningomyelocele

11. Craniorachischisis (NTD with worst prognosis)

• Cloverleaf shape skull
• FGFR1 Gene mutation

8. Encephalocele with anencephaly

Worst prognosis
9. Holoprosencephaly
12. Dandy-Walker Malformation

It is not a neural tube defect, it is a forebrain Dandy walker malformation: Cerebellar hypoplasia
anomaly with hydrocephalus
 LATEST QUESTION PAPERS 181

a. 2 years b. 6 years
NEET PG 2024 (Memory-Based)
c. 10 years d. 14 years
“No one is you and that is your power.”
Ans. b. 6 years
1. A 3-month-old baby is brought with
intracranial diffuse calcifications, chorioretinitis
and hydrocephalus. What is the most likely Explanation: Maximum brain growth occurs by
diagnosis? 2 years. Maximum somatic and puberty growth
occurs by 12 years.

4. A 1-month-old baby with olive shape mass

and recurrent vomiting. USG was done which
is shown in the image. What is your diagnosis?

a. Toxoplasmosis b. CMV
c. Zika virus d. Rubella

Ans. a. Toxoplasmosis

Explanation: Diffuse intracranial calcifications

are seen in toxoplasmosis and periventricular a. CHPS
calcifications are seen in cytomegalovirus. b. Intussusception
c. Meckel’s diverticulum
2. At what pressure, pop valve is released in bag d. None of the above
and mask ventilation?
a. 30–40 cm of H2O Ans. a. CHPS
b. 40–50 cm of H2O
c. 50–60 cm of H2O Explanation: Single bubble sign is seen in CHPS.
d. 60–70 cm of H2O The name of the surgery is Ramstedt pyloromy-
otomy.
Ans. a. 30–40 cm of H2O
5. A 1-month-old baby came with complaints
Explanation: The absolute indication of bag and of projectile vomiting with olive shape mass.
mask ventilation is heart rate <100 bpm. X-ray abdomen was done. What is the
diagnosis?
3. Maximum lymphoid growth is seen at what
age?

a. Pyloric stenosis
b. Intestinal obstruction
184 One Touch Pediatrics by Dr Anand Bhatia

19. A child is brought to the hospital with

NEET PG 2023–2021 (Memory-Based)
respiratory distress and biphasic stridor.
16. A newborn presented with chest retractions, The radiograph is shown below. What is the
dyspnea, and lethargy. The pediatrician diagnosis?
diagnosed the baby with respiratory distress
syndrome. This occurs due to the deficiency
of:
a. Dipalmitoyl inositol
b. Lecithin
c. Sphingomyelin
d. Dipalmitoylphosphatidylethanolamine

Ans. b. Lecithin

17. A 10-year-old child weighing 30 kg presents

with a history of loose stools for 2 days. On
examination, there is severe dehydration.
Laboratory investigations are as follows. a. Acute epiglottitis
What is the initial management as per ISPAD b. Acute laryngotracheobronchitis
guidelines? c. Foreign body aspiration
d. Laryngomalacia
RBS 550 mg/dL
pH 7.01 Ans. b. Acute laryngotracheobronchitis

Na+ 158 mEq/L 20. A 3-month-old baby comes with complaints

Urine glucose 3+ of deafness, cataract, and patent ductus
arteriosus. Which of the following is the most
a. Manage ABC, NS 20 mL/kg and start likely diagnosis?
insulin after 1 hour a. Congenital herpes simplex virus infection
b. Manage ABC, NS 20 mL/kg along with b. Congenital toxoplasmosis
insulin 0.1 IU/kg/hr c. Congenital cytomegalovirus infection
c. Manage ABC, NS 10 mL/kg along with d. Congenital rubella syndrome
insulin 0.1 IU/kg/hr
d. Manage ABC, NS 10 mL/kg and start Ans. d. Congenital rubella syndrome
insulin after 1 hour
21. Chloride level in sweat is used in the diagnosis
Ans. a. 
Manage ABC, NS 20 mL/kg and of which disease?
start insulin after 1 hour a. Phenylketonuria
b. Cystic fibrosis
18. Which of the following is the best sign to
c. Gaucher’s disease
indicate adequate growth in an infant with a
birth weight of 2.8 kg? d. Osteogenesis imperfecta
a. Increase in length of 25 cm in the first Ans. b. Cystic fibrosis
year
b. Weight gain of 300 g/month till 1 year 22. A 3-month-old baby presents with jaundice
c. Anterior fontanel closure by 6 months of and clay-colored stools. Lab investigation
age reveals that the baby has conjugated
d. Weight under 75th percentile and height hyperbilirubinemia. The liver biopsy shows
under 25th percentile periductal proliferation. What is the most
likely diagnosis?
Ans. a. 
Increase in length of 25 cm in the a. Crigler-Najjar syndrome
first year b. Rotor syndrome
 LATEST QUESTION PAPERS 217

c. Both parents are carriers of balanced 288. Which of the following are correct in respect
translocation of jaundice?
d. Either parent is a carrier of translocation 1. Patients complain of darkening of urine
between two chromosomes 21 before they notice jaundice
2. Jaundice is usually detectable with a serum
Ans. c. B
 oth parents are carriers of balanced bilirubin level of over 18 mg/dL
translocation
3. In Gilbert syndrome, jaundice is more
noticeable after fasting
285. Consider the following pairs:
Select the correct answer using the code given
Urine color Possible causative agent in a below:
child with suspected poisoning a. 1 and 2 only
1. Pink Cephalosporin b. 2 and 3 only
2. Brown Chloroquine c. 1 and 3 only
d. 1, 2 and 3
3. Greenish blue Phenazopyridine
4. Red-orange Amitriptyline Ans. c. 1 and 3 only

How many of the pairs given above correctly 289. Which of the following are correct in respect
matched? of Myasthenia gravis?
a. Only one pair 1. Symptoms worsen toward the end of the
b. Only two pairs day
c. Only three pairs 2. There may be difficulty in chewing and
d. All four pairs swallowing
3. Acetylcholine receptors in the pre-
Ans. a. Only one pair junctional membrane are involved
4. Penicillamine may precipitate similar
286. If a baby does not begin breathing in response illness
to tactile stimulation, then the baby assumed
Select the correct answer using the code given
to be in:
as follows:
a. Primary apnea
a. 1, 2 and 3 b. 1, 2 and 4
b. Secondary apnea
c. 1 and 3 only d. 2 and 4 only
c. Tertiary apnea
d. Cardiorespiratory arrest Ans. b. 1, 2 and 4

Ans. a. Primary apnea 290. Which of the following statements are correct
regarding short stature?
1. Linear bone growth rates are pituitary
UPSC CMS 2022 (PAPER 1)
dependent
287. An 18-year-old boy got frostbite of left feet 2. Normal bone age in a child with short
after working in a snowy field for 5–6 hours. stature suggests hormonal disorder
He complained of pain, numbness and limited 3. Final height in boys can be estimated by
moment of his tones. The skin appeared adding 6.5 cm to midparental height
white and waxy. Which one of the following is 4. Replacement therapy with recombinant
contradicted as initial treatment? GH restores growth velocity in GH-
a. Rewarming by immersion of feet in water deficient children
bath at 40°–44°C Select the correct answer using the code given
b. Massage as follows:
c. Cleaning of injured area with soap a. 1 and 2 only b. 1, 2 and 4
d. Use of analgesia and sterile dressing c. 1, 3 and 4 d. 3 and 4 only

Ans. b. Massage Ans. c. 1, 3 and 4