Arab Board Pediatrics Clinical Exam cheat sheet

WHO growth standards apply to children 0-5 years; CDC 2000 charts apply from 2 years onward in the US.

Weight doubles by 5 months, triples by 12 months, and quadruples by 2 years.

Length increases ~25 cm in year 1, ~12 cm in year 2, then 5-7 cm/year until puberty.

Head circumference grows ~12 cm in year 1 (35 to 47 cm) and ~10 cm over years 1-3.

Red flags for development: loss of milestones, asymmetry of movement, no social smile by 2 months, no words by 16 months.

Mid-parental height: boys = (father + mother + 13)/2 cm; girls = (father + mother - 13)/2 cm; target range +/- 8.5 cm.

Growth hormone evaluation is indicated for height velocity < 4 cm/year after age 4 or height < -3 SD.

Bone age by left hand/wrist radiograph: delay > 2 years suggests constitutional delay, hypothyroidism, or GH deficiency.

Apgar score is assigned at 1 and 5 minutes; components are heart rate, respiratory effort, muscle tone, reflex irritability, and color.

Surfactant is indicated for RDS with FiO2 > 0.30 and clinical signs; early CPAP reduces need for intubation.

Physiologic jaundice appears after 24 hours; jaundice within 24 hours is always pathologic.

Phototherapy thresholds follow hour-specific bilirubin nomograms; exchange transfusion for levels near 20 mg/dL in term infants or signs of acute bilirubin encephalopathy.

Sepsis risk: maternal GBS colonization, intrapartum fever >= 38 C, rupture of membranes >= 18 hours, or prematurity.

Hypoglycemia in neonates: < 45 mg/dL in first 4 hours warrants feeding and recheck; < 25 mg/dL requires IV dextrose.

Kernicterus risk increases with hemolysis, prematurity, sepsis, and acidosis.

Newborn screening should be drawn after 24 hours of feeding; repeat testing for preterm or sick infants.

Cyanotic congenital heart disease with decreased pulmonary vascularity: tetralogy of Fallot, tricuspid atresia, Ebstein anomaly.

Cyanotic CHD with increased pulmonary vascularity: transposition of great arteries, truncus arteriosus, total anomalous pulmonary venous return.

Hyperoxia test: PaO2 > 250 mmHg on 100% oxygen suggests pulmonary rather than cardiac cause of cyanosis.

Ductal-dependent lesions: prostaglandin E1 infusion at 0.01-0.05 mcg/kg/min maintains patency.

Aortic stenosis murmur: harsh systolic ejection murmur at upper right sternal border radiating to carotids.

VSD murmur: holosystolic at lower left sternal border; small defects may close spontaneously.

Kawasaki disease: fever >= 5 days plus 4 of 5 criteria; treat with IVIG 2 g/kg and high-dose aspirin.

Supraventricular tachycardia in infants: rate typically > 220 bpm; vagal maneuvers then adenosine 0.1 mg/kg IV.

Asthma severity is classified by impairment and risk; controller therapy with inhaled corticosteroids is first-line for persistent disease.

Acute asthma exacerbation: albuterol with ipratropium, systemic corticosteroids, and oxygen to keep SpO2 >= 92%.

Croup: barking cough and inspiratory stridor; treat with dexamethasone 0.15-0.6 mg/kg and nebulized epinephrine for moderate-severe cases.

Epiglottitis: drooling, tripod position, high fever; avoid throat examination and secure airway in operating room.

Bronchiolitis: supportive care; no routine bronchodilators, corticosteroids, or antibiotics.

Cystic fibrosis diagnosis: sweat chloride >= 60 mmol/L on two occasions, or two CF-causing mutations.

Anaphylaxis: intramuscular epinephrine 0.01 mg/kg (max 0.5 mg) into the lateral thigh, repeated every 5-15 minutes as needed.

Allergic rhinitis: intranasal corticosteroids are more effective than oral antihistamines for nasal congestion.

GERD in infants: physiologic reflux peaks at 4 months; treatment reserved for failure to thrive, esophagitis, or respiratory complications.

Pyloric stenosis: nonbilious projectile vomiting at 3-6 weeks; ultrasound shows pyloric thickness > 3 mm and length > 14 mm.

Bilious vomiting in a neonate is a surgical emergency until malrotation with volvulus is excluded.

Celiac disease: tissue transglutaminase IgA with total IgA; duodenal biopsy shows villous atrophy and crypt hyperplasia.

Acute diarrhea: oral rehydration solution is preferred; zinc supplementation reduces duration and severity.

Intussusception: colicky pain, currant-jelly stool, sausage-shaped mass; air enema is diagnostic and therapeutic.

Neonatal cholestasis: conjugated bilirubin > 1 mg/dL or > 20% of total; evaluate for biliary atresia urgently.

Hepatitis B: HBsAg indicates infection; anti-HBs indicates immunity; HBeAg indicates high infectivity.

Type 1 diabetes presents with polyuria, polydipsia, weight loss; DKA criteria include glucose > 200 mg/dL, pH < 7.3, bicarbonate < 15, ketonemia.

Congenital hypothyroidism: newborn screening TSH elevated; treat with levothyroxine 10-15 mcg/kg/day within 2 weeks.

Congenital adrenal hyperplasia: 21-hydroxylase deficiency causes virilization and salt wasting; treat with hydrocortisone and fludrocortisone.

Short stature evaluation: assess growth velocity, bone age, IGF-1, and screen for celiac disease and hypothyroidism.

Precocious puberty: breast or pubic hair before 8 years in girls, 9 years in boys; GnRH stimulation confirms central cause.

Diabetic ketoacidosis fluid resuscitation: isotonic saline bolus 10-20 mL/kg; insulin infusion started after fluids.

Hypocalcemia in neonates: serum calcium < 7 mg/dL; treat with IV calcium gluconate with cardiac monitoring.

Metabolic crisis: consider inborn errors with hypoglycemia, hyperammonemia, and anion gap acidosis; stop feeds and give IV dextrose.

Nephrotic syndrome: edema, proteinuria > 3.5 g/24 h or urine protein/creatinine > 2, hypoalbuminemia, hyperlipidemia.

Minimal change disease is most common in children; responds to corticosteroids in 80-90%.

Hematuria with hypertension and edema suggests acute post-streptococcal glomerulonephritis; low C3 supports diagnosis.

Vesicoureteral reflux grading I-V; low-grade reflux may resolve spontaneously.

Urinary tract infection in infants: obtain urine culture before antibiotics; treat febrile UTI for 7-10 days.

Acute kidney injury: rising creatinine, oliguria; classify by prerenal, renal, and postrenal causes.

Hyponatremia in nephrotic syndrome reflects intravascular volume depletion; restrict fluids and give albumin if symptomatic.

Posterior urethral valves present with poor stream, palpable bladder, and bilateral hydronephrosis in male infants.

Febrile seizures: age 6 months to 5 years, generalized, < 15 minutes; no routine EEG or neuroimaging for simple febrile seizure.

Status epilepticus: benzodiazepine first-line (lorazepam 0.1 mg/kg IV), then phenytoin or levetiracetam.

Infantile spasms: flexor spasms with hypsarrhythmia on EEG; treat with ACTH or vigabatrin.

Meningitis in infants: lumbar puncture after stabilizing; empiric ceftriaxone plus vancomycin, plus ampicillin if < 3 months.

Cerebral palsy: nonprogressive motor impairment from early brain injury; assess for associated seizures, vision, and hearing deficits.

Guillain-Barre syndrome: ascending weakness with areflexia; CSF shows albuminocytologic dissociation.

Migraine vs tension headache: migraine has nausea, photophobia, and pulsating quality; tension headache is bilateral and pressing.

Neonatal seizures: often subtle; treat with phenobarbital first-line.

Fever without source in infants < 3 months: full sepsis workup and empiric antibiotics are indicated.

Kawasaki disease, MIS-C, and toxic shock syndrome should be considered in prolonged fever with mucocutaneous signs.

Primary immunodeficiency red flags: recurrent severe infections, failure to thrive, family history, and unusual organisms.

Measles: Koplik spots, rash starting at hairline; isolate and report; MMR is live vaccine contraindicated in immunodeficiency.

Tuberculosis: tuberculin skin test >= 10 mm positive in children; >= 5 mm in immunocompromised.

HIV in children: maternal antibody persists to 18 months; use virologic testing (DNA PCR) for diagnosis in infants.

Antibiotic choice for community-acquired pneumonia in children > 5 years: amoxicillin is first-line.

Immunization schedule: DTaP, IPV, Hib, PCV, MMR, varicella, hepatitis A and B, and HPV at 11-12 years.

Iron deficiency anemia: microcytic, low ferritin, high TIBC; treat with oral iron 3-6 mg/kg/day elemental iron.

Thalassemia trait: microcytosis with normal ferritin and elevated HbA2.

Sickle cell disease: hydroxyurea reduces crises; penicillin prophylaxis until 5 years; pneumococcal vaccination.

Acute lymphoblastic leukemia is the most common childhood malignancy; presents with pallor, bruising, bone pain, and hepatosplenomegaly.

ITP: isolated thrombocytopenia with petechiae; usually self-limited; IVIG or steroids for significant bleeding.

Hemophilia A: prolonged PTT, normal PT; factor VIII replacement for bleeding.

Wilms tumor: abdominal mass in children 2-5 years; nephrectomy plus chemotherapy.

Neutropenic fever: obtain cultures and start empiric broad-spectrum antibiotics within 1 hour.

Pediatric basic life support: 30 compressions to 2 breaths for single rescuer, 15:2 for two rescuers; compression depth one-third of chest.

Epinephrine in pediatric cardiac arrest: 0.01 mg/kg IV/IO of 1:10,000 solution every 3-5 minutes.

Acetaminophen overdose: N-acetylcysteine is antidote; use Rumack-Matthew nomogram 4 hours after ingestion.

Salicylate toxicity: mixed respiratory alkalosis and metabolic acidosis; treat with sodium bicarbonate and urinary alkalinization.

Organophosphate poisoning: SLUDGE symptoms; treat with atropine and pralidoxime.

Iron poisoning: GI symptoms followed by shock and hepatic failure; treat with deferoxamine.

Fluid resuscitation in shock: 20 mL/kg isotonic crystalloid bolus, reassess after each bolus.

Carbon monoxide poisoning: 100% oxygen; hyperbaric oxygen for severe neurologic or cardiac involvement.

Well-child visits: newborn, 1, 2, 4, 6, 9, 12, 15, 18, 24 months, then annually.

Lead screening at 12 and 24 months in at-risk children; level >= 5 mcg/dL requires follow-up.

Vision screening starts at 3 years; hearing screening at newborn and school entry.

Breastfeeding is recommended exclusively for 6 months, with continued breastfeeding to 12 months and beyond.

Informed consent requires capacity, disclosure, understanding, and voluntariness; assent is sought from minors.

Confidentiality in adolescents: exceptions include danger to self or others, abuse, and certain communicable diseases.

Mandatory reporting of suspected child abuse supersedes parental confidentiality.

Vaccine hesitancy: address with motivational interviewing and clear documentation of discussion.