The 1st Semester of 2022-2023 Academic Year in Nantong

University, Final Exam of Pediatrics (Paper A)

Name - MAHDIA MOHAMED SIKIEH

Student ID - 1816130203
1. (10 points) What is the cause of vitamin D deficiency? What’s

the diagnostic criteria for rickets of vitamin D deficiency?

Rickets, a deformative disease that occurs among children, are characterized by deficient
mineralization of the bone matrix as a result of deficiencies of calcium or phosphorus or both.
Rickets are caused by defective mineralization at the growth plate and osteomalacia at the
corticoendosteal level.
Among very low birth weight infants or newborns who need prolonged parenteral nutrition,
osteopenia is primarily the result of calcium or phosphate deficiency and, to a limited extent,
vitamin D deficiency. Among older children, isolated dietary calcium deficiency or
hypercaleiuriahas resulted in rickets.
Vitamin D deficiency still occurs in otherwise normal populations, particularly among
dark-skinned infants and children who stay indoors with little exposure to daylight, who wear
clothing that shields the entire body from sunlight, and who ingest a diet low in vitamin D
(breast milk from a vegetarian or poorly nourished mother or little or no milk, meat, eggs, or
fish). Among patients with celiac diseases, biliary obstruction, gastric resection, pancreatic
insufficiency, orothermalabsorption syndromes, vitamin D is poorly absorbed. Anticonvulsant
drugs (eg, phenytoin) accelerate the catabolism of vitamin D to water-soluble metabolites,
hastening their urinary loss.
Clinical Finding
Clinical findings include craniotabes, rachitie rosary, pigeon breast, bowed legs, delayed
eruption of teeth and enamel defects, Harrison groove, scoliosis, kyphosis, dwarfism, painful
bones, fractures, anorexia, and weakness. Radiographic findings include cupping, fraying, and
flaring of metaphyses.
The loss of sharp definition ofbone trabeculae accounts for the general decrease in skeletal
radiodensity. The diagnosis is supported by characteristic radiologie abnormalities of the
skeleton, low serum phosphorus, high serum alkaline phosphatase, and high serum PTH. The
diagnosis can be confirmed be a low level of serum 25-hvdroxveholecalciferol.
Serum concentrations of calcidiol are low inpatients deprived of vitamin D, whereas caleitriol
values can be high, normal, or low.

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 2. (10 points) Male, 5 years old, double eyelid dropsy 2 days, cough

two weeks ago. Which laboratory examinations were needed for

the diagnosis of nephrotic syndrome? Please discuss the

complications of the disease which we need to prevent?

Complications which need to prevent
Possible complications of nephrotic syndrome include:
Blood clots. The inability of the glomeruli to filter blood properly can lead to loss of blood
proteins that help prevent clotting. This increases your risk of developing a blood clot in your
veins.
High blood cholesterol and elevated blood triglycerides. When the level of the protein
albumin in your blood falls, your liver makes more albumin. At the same time, your liver
releases more cholesterol and triglycerides.
Poor nutrition. Loss of too much blood protein can result in malnutrition. This can lead to
weight loss, which can be masked by edema. You may also have too few red blood cells
(anemia), low blood protein levels and low levels of vitamin D.
High blood pressure. Damage to your glomeruli and the resulting buildup of excess body
fluid can raise your blood pressure.
Acute kidney injury. If your kidneys lose their ability to filter blood due to damage to the
glomeruli, waste products can buildup quickly in your blood. If this happens, you might need
emergency dialysis - an artificial means of removing extra fluids and waste from your blood -
typically with an artificial kidney machine (dialyzer).
Chronic kidney disease. Nephrotic syndrome can cause your kidneys to lose their function
overtime. If kidney function falls low enough, you might need dialysis or a kidney transplant.
Infections. People with nephrotic syndrome have an increased risk of infections

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 3. (10 points) The differences of CSF (cerebrospinal fluid) among

bacterial、viral 、tuberculosis meningitis and normal CSF.

4. (10 points) How to diagnose Kawasaki disease? Please discuss

the treatment of Kawasaki disease.

Diagnosis of Kawasaki disease
 The diagnostic criteria include fever for more than 5 days and atleast four of the
following features:
 Bilateral, painless, non-exudative conjutivitis.
 Lips or oral cavity changes (lip cracking, fissuring, strawberry tongue,
inflammation of the oral mucosa).
 Cervical lymphadenopathy (1.5 cm in diameter, unilateral, non-purulent).
Polymorphus exanthema
 Extremity changes (redness of palm and soles, swelling of hand and feet with
subsequent Desquamation)
The 2 main treatments for Kawasaki disease are:
 aspirin
 intravenous immunoglobulin

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 5. (10 points) TOM ，male ，11 years old ，cough 5 days ，ahigh fever 3 days.
PE: Moist ralescan be heard in both lungs. Blood routine ： WBC
24.2*109/L，N 80%，L 15%，HB 114g/L，PLT 319.0*109/L.CRP 45mg/L;
His X-ray was below.

Please discuss the diagnosis and analyze the diagnostic basis, discuss the
complication of this disease
Right Hilar region of lung is more prominent (radio opaque) and a little bit at the
left.
No pleural effusion seen on either side.
Normal cardiac shadow.
Normal tracheal shadow and in the mid line.
No bony cage abnormality seen.
Chances of Hilarpneumonitis.
General supportive care for viral pneumonia does not differ from that for bacterial
pneumonia. Patients can be quite ill and should be hospitalized according to the level
of their illness. Because bacterial disease often cannot be definitively excluded,
antibioties maybe indicated.
Patients at risk for life-threatening RSV infections (eg, those with
bronchopulmonary dysplasia or other severe pulmonary conditions, congenital heart
disease, or significant immunocompromise) should be hospitalized and given ribavirin.
Rapid viral diagnostic tests mav be a useful guide for such therapy (see Bronchiolitis
section regarding prevention). These high-risk patients should be immunized annualv
against intimenza and B vis Despite immunization, however, influenza can still occur.
When available epidemiologic dala indicate an active minenza infection in the
community, rimantadine, amantadine hydrochloride, oroseltamiir phosphate should be
considered early for high-risk infants and children who appear to be infected. Children
with suspected viral pneumonia should be placed in respiratory isolation

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 6. (10 points) October 23, A 2-year-old girl presents with a history

of passing 10-15 waterstools for 5 days, and has vomited atleast

four times in the last 24 hours. She appears lethargy, her limbs

are cold, and the skin is dry, she cries but no tear, anuria for

about 12 hours. Her weight is 12kg before sick.

The nurse informs you that her weight is 10.5kg, pulse is 136

beats/minute, temperature 37.9℃ and blood pressure 65/40mmHg.

Serum sodium 136mmol/l.

Please discuss the diagnosis and management of this child.

Diagnosis - Severe diarrhea:

Most of the cases are infectious diarrhea (rotavirus, shigella )
Frequency of stool often more than 10 times/day
Watery stool, plenty of mucus.
General condition is poor, usually accompany with vomiting and fever, dehydration and
electrolyte disturbance
Management of Child –
1. Feeding
Continue feeding the child
Give as much as the child want
Give small frequent feeds
Encourage anorexic child to eat
Continue breast feeding as usual during and after diarrhea and rehydration therapy
2. Drugs –
Antimicrobial agents
Antiparasitics
Probiotics: lactobacilli, Bifidobacteria
Antidiarrheal agents: absorbants and mucous membrane protectors: SMECTA
3. Fluid Therapy –
ORS ( oral rehydration salt )Therapy in mild to moderate dehydration
ORS is the preferred treatment for fluid and electrolyte losses caused by diarrhea
in children who have mild to moderate dehydration
50-100ml/kg ORS to be given over a 4-hour period

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 WHO recommended ORS High sodium content 90mmol/l

7. (20 points) A boy, aged 50min, gestational age of 30+3 weeks,

with the birth weight 1100g, presents with tachypnea, retraction,

flaring of the nosal alae, grunting and cyanosis shortly after

birth. PE: Hr 134 bpm, R 70 bpm,

transcutaneous oxygen saturation 88%, retraction, flaring of

the nosal alae, there was no rale in the lung. Chest x-ray

demonstrates diffuse bilateral atelectasis, causing a ground-

glass appearance.

Please discuss the diagnosis and diagnostic basis. What is the next

management of this child?

NRDS the ethiopathogenesis is PS（pulmonary surfactant）deficiency. The
diagnosis include
 Clinical features:
Respiratory distress [Tachypnea, RR>60bpm, cyanosis, pale, nasal flaring.
Intercoastal and sternal retraction. Expiratory grunting. Air limited entry into lung.
Circulatory insufficiency: Hypotension, PDA, Shock.
Intracranial Hemorrhage
 Chest x-ray show symmetric changes : 1.ground glass 2.air bronchogram
3.white lung
 Gastric fluid oscillation test
 Blood gas analysis
The treatment of NRDS
 symptomatic treatment
 CPAP 、ventilator
 PS substitutive therapy

8. (20 points) A 10 years old boy, Abdominal pain for 3 weeks.

Additional signs and symptoms included increased appetite,

fatigue, weight loss, shortness of breath, increased thirst,

increased urine frequency, and leg cramps. His grandmother

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 had a history of type 1 diabetes mellitus 10 years ago.

PE:T 37.5℃; P 98/min;R 16/min; BP 115/68 mmHg; H 150 cm;W

35.5 kg;BMI 15.8kg/m2. Abdomen was soft and nontender with

normal active bowel sounds, no rebound tenderness or guarding was

present, no palpable hepatosplenomegaly.

Which laboratory examinations were first needed. Please discuss

the most likely diagnosis. Please discuss the treatment of this child.
There are several blood tests for type 1 diabetes in children. These tests are used
to diagnose diabetes and to monitor diabetes management:
Random blood sugar test. This is the primary screening test for type 1 diabetes. A
blood sample is taken at a random time. A blood sugar level of 200 milligrams per
deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher, along with
symptoms, suggests diabetes.
Glycated hemoglobin (A1C) test. This test indicates your child's average blood
sugar level for the past 3 months. An A1C level of 6.5% or higher on two separate tests
indicates diabetes.
Fasting blood sugar test. A blood sample is taken after your child hasn't eaten
(fasted) for at least 8 hours or overnight. A fasting blood sugar level of 126 mg/dL (7.0
mmol/L) or higher suggests type 1 diabetes.
If blood sugar testing indicates diabetes, your healthcare provider may recommend
additional tests to distinguish between type 1 diabetes and type 2 diabetes because
treatment strategies differ by type. Additional tests include blood tests to check for
antibodies that are common in type 1 diabetes.
Treatment for type 1 diabetes includes:

 Taking insulin
 Monitoring blood sugar
 Eating healthy foods
 Exercising regularly