General Pediatrics
What to master
Know well-child visits and anticipatory guidance by age-nutrition, safety, sleep, and development. Understand common childhood illnesses: otitis media, pharyngitis, bronchiolitis, gastroenteritis, and rashes. Master fever management and the difference between antipyretic use and treating the underlying cause. Know immunization catch-up principles. Understand child abuse recognition-injury patterns inconsistent with history, delay in seeking care, and sentinel injuries.
Concepts that recur
Acute otitis media diagnosis requires bulging tympanic membrane or otorrhea, not just redness. Streptococcal pharyngitis is uncommon under 3 years and requires testing before antibiotics. Gastroenteritis management is oral rehydration; antiemetics may help but antibiotics are rarely indicated. Rashes: know the difference between maculopapular viral exanthems, vesicular lesions (varicella, hand-foot-mouth), and petechial rashes (meningococcemia). Failure to thrive requires growth chart review and a systematic approach. Sudden infant death syndrome prevention includes supine sleep and avoiding soft bedding.
Traps
Examiners test antibiotic overuse-viral illnesses do not need antibiotics. Another trap is missing serious bacterial infection in a febrile child with a benign-looking rash. Beware normal variant questions-e.g., physiologic bowing, benign murmurs, and positional plagiocephaly.
Rule of thumb
For any child with a petechial rash and fever, assume meningococcemia and start antibiotics immediately. For common colds, the correct answer is usually supportive care.
Emergency, Critical Care and Social/Community Pediatrics
What to master
Know the primary survey (ABCDE) and the differences between adult and pediatric resuscitation-airway size, respiratory rate, and compensatory mechanisms. Master shock recognition: compensated (tachycardia, normal BP) versus decompensated (hypotension is late in children). Understand anaphylaxis management-intramuscular epinephrine first, then adjuncts. Know poisoning principles: decontamination, antidotes, and toxidromes. Understand drowning, burns, and trauma initial management. Know social determinants of health, screening for abuse and neglect, and the role of community resources.
Concepts that recur
Pediatric vital signs change with age-know normal ranges. Fluid resuscitation in shock uses isotonic crystalloid boluses. Cerebral edema in DKA is a critical care emergency. Status asthmaticus management includes oxygen, bronchodilators, steroids, and consideration of magnesium. Sepsis requires early antibiotics and fluids. Child protection questions test mandatory reporting and documentation. Immunization programs and breastfeeding promotion are community pediatrics staples.
Traps
Examiners test hypotension as a late sign-do not wait for it to diagnose shock. Another trap is epinephrine delay in anaphylaxis-give IM epinephrine before antihistamines or steroids. Beware poisoning questions that suggest inducing vomiting-do not. Finally, social questions often have a "safest" answer: report suspected abuse, involve social services, and document.
Rule of thumb
In pediatric shock, treat before the blood pressure falls. In anaphylaxis, IM epinephrine is the first and most important drug-adjuncts do not replace it.