Arab Board Pediatrics Final Written cheat sheet

WHO weight-for-age: birth weight doubles by 5 months, triples by 12 months, quadruples by 24 months.

Infant length increases ~50% by 12 months (birth ~50 cm → ~75 cm); head circumference grows ~2 cm/month in first 3 months, then slows.

Developmental milestones: social smile 6 weeks; head control 3 months; sits unsupported 6–8 months; walks 12–15 months; two-word phrases 18–24 months.

Red flags: loss of milestones, persistent primitive reflexes beyond 4–6 months, no babbling by 12 months, no walking by 18 months.

Immunization schedule: BCG and HepB at birth; DTaP, IPV, Hib, PCV, rotavirus at 2, 4, 6 months; MMR and varicella at 12–15 months; boosters at 4–6 years.

Growth chart interpretation: crossing two major percentiles (up or down) warrants evaluation; BMI ≥95th percentile = obesity, 85–94th = overweight.

Newborn screening: heel prick at 24–72 hours of life; repeat at 1–2 weeks for preterm/sick infants; includes congenital hypothyroidism, PKU, CAH, hemoglobinopathies.

Lead screening: universal at 12 and 24 months in high-risk areas; blood lead ≥5 µg/dL requires investigation, ≥45 µg/dL requires chelation.

Hearing screening: universal newborn screening; repeat if failed; audiology by 3 months, intervention by 6 months for congenital hearing loss.

APGAR scored at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; score 0–3 = severe depression, 4–6 = moderate, ≥7 = normal.

NRP: initial steps (warm, dry, stimulate, position airway) for 30 seconds; if HR <100 or apnea, start PPV at 21% O2 (term) or 21–30% (preterm).

Chest compressions in neonate: 3:1 compression-to-ventilation ratio with 100% O2 when HR <60 after effective PPV; increase to 90 compressions/min.

Surfactant indicated for RDS: preterm <30 weeks with FiO2 >0.30 or any infant with RDS requiring mechanical ventilation; early rescue preferred.

Neonatal hypoglycemia: <47 mg/dL (2.6 mmol/L) in first 48 h; treat with IV dextrose 2 mL/kg of D10W bolus then continuous infusion.

Physiologic jaundice appears after 24 h, peaks day 3–5 (term) or day 5–7 (preterm); jaundice <24 h is always pathologic (hemolysis, sepsis, TORCH).

Kernicterus risk: exchange transfusion if total bilirubin exceeds age/hour-specific thresholds on Bhutani nomogram or signs of acute bilirubin encephalopathy.

Necrotizing enterocolitis: preterm, feeding intolerance, bloody stools, pneumatosis intestinalis; stop feeds, NG decompression, IV antibiotics, surgery if perforation.

Retinopathy of prematurity screening: infants ≤30 weeks or ≤1500 g at 4–6 weeks chronological age; laser if type 1 ROP.

Innocent murmur features: systolic, grade ≤2/6, soft, no thrill, normal S2, decreases with standing; pathologic if diastolic, pansystolic, >3/6, or abnormal S2.

Cyanotic congenital heart disease: 5 T's - Truncus arteriosus, Transposition, Tricuspid atresia, Tetralogy of Fallot, Total anomalous pulmonary venous return.

Hypercyanotic spell (Tetralogy): knee-chest position, calm, 100% O2, IV fluids, morphine, propranolol; avoid isoproterenol.

Ductal-dependent lesions: prostaglandin E1 at 0.01–0.05 µg/kg/min for suspected ductal-dependent pulmonary or systemic circulation; monitor for apnea.

Kawasaki disease: fever ≥5 days plus 4/5 criteria (rash, conjunctivitis, oral changes, extremity changes, cervical lymphadenopathy); IVIG 2 g/kg + aspirin.

Rheumatic fever Jones criteria: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules; evidence of preceding GAS plus 2 major or 1 major + 2 minor.

Supraventricular tachycardia in infants: HR >220; vagal maneuvers then adenosine 0.1 mg/kg IV rapid push (max 6 mg first dose).

Long QT syndrome: QTc >0.46 s in children; avoid competitive sports, treat with beta-blocker; syncope with exercise is a red flag.

Eisenmenger syndrome: long-standing left-to-right shunt reverses to right-to-left; cyanosis, clubbing; closure contraindicated once pulmonary vascular disease is fixed.

Asthma severity: mild intermittent = symptoms ≤2 days/week; mild persistent = >2 days/week but not daily; moderate = daily; severe = throughout day.

Asthma step-up: SABA as needed for all; low-dose ICS for persistent; add LABA or increase ICS for uncontrolled; consider biologics for severe.

Acute asthma: oxygen to keep SpO2 ≥92%, inhaled SABA (albuterol) every 20 min ×3, ipratropium, systemic steroids (prednisolone 1–2 mg/kg/day); magnesium sulfate IV for severe.

Cystic fibrosis diagnosis: sweat chloride ≥60 mmol/L on two occasions, or two CF-causing mutations, or abnormal nasal potential difference.

CF pulmonary exacerbation: increased cough, sputum, dyspnea, weight loss; treat with IV anti-pseudomonal antibiotics ×14 days and airway clearance.

Croup: barking cough, stridor, hoarseness; treat with dexamethasone 0.15–0.6 mg/kg single dose; nebulized epinephrine for moderate-severe.

Epiglottitis: drooling, tripod position, high fever, muffled voice; do not examine throat; secure airway in OR with anesthesia.

Foreign body aspiration: sudden choking, unilateral wheeze, decreased breath sounds; rigid bronchoscopy is diagnostic and therapeutic.

Primary ciliary dyskinesia: neonatal respiratory distress, chronic wet cough, situs inversus (Kartagener), low nasal nitric oxide.

GERD in infants: physiologic until 12–18 months; avoid overfeeding, thickened feeds, prone while awake; PPIs only for proven esophagitis or failure to thrive.

Celiac disease: IgA tissue transglutaminase ≥10× upper limit plus positive endomysial antibodies; confirm with duodenal biopsy (villous atrophy, crypt hyperplasia).

Inflammatory bowel disease: ulcerative colitis = continuous colonic inflammation, bloody diarrhea; Crohn = skip lesions, transmural, perianal disease, granulomas.

Acute gastroenteritis: ORS 50 mL/kg over 4 h for mild-moderate dehydration; IV 20 mL/kg NS bolus for severe; zinc 10–20 mg/day ×14 days in deficient areas.

Intussusception: colicky pain, red currant jelly stools, sausage-shaped mass; air or contrast enema is diagnostic and therapeutic if no peritonitis.

Pyloric stenosis: 3–6 weeks, projectile nonbilious vomiting, olive mass, hypochloremic hypokalemic metabolic alkalosis; treat with pyloromyotomy.

Biliary atresia: jaundice beyond 2 weeks with direct bilirubin >1 mg/dL; Kasai portoenterostomy best before 60 days of life.

Neonatal cholestasis: direct bilirubin >1 mg/dL if total <5, or >20% of total; urgent evaluation for biliary atresia, metabolic, infectious causes.

Failure to thrive: weight <3rd percentile or crossing two major percentiles; evaluate caloric intake, absorption (celiac, CF), and increased losses.

Short stature evaluation: bone age, IGF-1, thyroid function; GH stimulation testing if height <−2.5 SD or growth velocity <4 cm/year.

Congenital hypothyroidism: newborn screening TSH elevated; treat with levothyroxine 10–15 µg/kg/day started within 2 weeks to prevent intellectual disability.

Type 1 diabetes: polyuria, polydipsia, weight loss, ketosis; initial management with IV fluids, insulin infusion, and potassium replacement.

Diabetic ketoacidosis: pH <7.3, bicarbonate <15, ketonemia; cerebral edema risk - use isotonic fluids, slow correction, mannitol for suspected edema.

Congenital adrenal hyperplasia (21-hydroxylase deficiency): salt-wasting crisis in males, virilization in females; treat with hydrocortisone and fludrocortisone.

Precocious puberty: breast or testicular enlargement before 8 (girls) or 9 (boys) years; GnRH stimulation test; treat central with GnRH agonist.

Hypocalcemia: total Ca <8.5 mg/dL or ionized <4.5 mg/dL; treat symptomatic with IV calcium gluconate 10% 1–2 mL/kg slow push.

Maple syrup urine disease: sweet-smelling urine, encephalopathy, branched-chain amino acid elevation; emergency diet and dialysis.

Phenylketonuria: newborn screen phenylalanine >120 µmol/L; dietary phenylalanine restriction; avoid aspartame.

Nephrotic syndrome: edema, proteinuria >3+ or >40 mg/m²/h, hypoalbuminemia <2.5 g/dL; first-line prednisone 60 mg/m²/day ×6 weeks then alternate.

Hematuria: >5 RBC/hpf; differentiate glomerular (brown, dysmorphic RBCs, casts) from lower tract (bright red, clots).

Acute post-streptococcal glomerulonephritis: cola-colored urine 1–2 weeks after pharyngitis, hypertension, low C3; supportive care, resolves.

Urinary tract infection: culture-proven growth >100,000 CFU/mL; infants <3 months with fever need full sepsis workup and IV antibiotics.

Vesicoureteral reflux grading I–V; grade I–III with normal kidneys: antibiotic prophylaxis and surveillance; grade IV–V may need surgery.

Hypertension in children: ≥95th percentile for age/sex/height on 3 occasions; first-line lifestyle then ACE inhibitor or calcium channel blocker.

Acute kidney injury: rise in creatinine ≥0.3 mg/dL in 48 h or ≥1.5× baseline; classify by urine output and creatinine (KDIGO).

Posterior urethral valves: male infant, poor stream, palpable bladder, bilateral hydronephrosis; voiding cystourethrogram diagnostic; catheterize and ablate.

Cryptorchidism: undescended testis; orchiopexy by 12–18 months to reduce malignancy and infertility risk.

Febrile seizure: age 6 months–5 years, fever without CNS infection; simple = generalized, <15 min, once in 24 h; no routine EEG or imaging.

Status epilepticus: seizure >5 min or repeated without recovery; give benzodiazepine (lorazepam 0.1 mg/kg IV) then phenytoin/fosphenytoin 20 mg/kg.

Infantile spasms: flexor/extensor spasms, hypsarrhythmia on EEG; treat with ACTH or vigabatrin; poor prognosis if untreated.

Headache red flags: morning vomiting, worsening with Valsalva, focal deficits, papilledema, age <6 years; neuroimaging indicated.

Bacterial meningitis: fever, neck stiffness, altered mental status; empiric ceftriaxone + vancomycin (plus ampicillin for neonates); dexamethasone before first dose.

Cerebral palsy: nonprogressive motor impairment from early brain injury; spastic diplegia most common in preterm; MRI for etiology.

Guillain-Barré syndrome: ascending symmetric weakness, areflexia, albuminocytologic dissociation; IVIG or plasmapheresis; monitor respiratory capacity.

Neural tube defect prevention: folic acid 400 µg/day preconception; 4 mg/day for prior affected pregnancy.

Migraine in children: often bilateral, shorter duration; treat with NSAIDs and triptans; prophylaxis with topiramate or amitriptyline.

Fever without source in infant <3 months: full sepsis evaluation (blood, urine, CSF cultures) and empiric antibiotics; risk stratification with Rochester criteria.

Kawasaki disease is the leading cause of acquired heart disease in children in developed countries; coronary artery aneurysm risk highest if untreated.

Tuberculosis: latent TB treated with isoniazid 10 mg/kg/day ×9 months; active disease with 4-drug regimen (HRZE) for 2 months then HR for 4 months.

HIV: maternal-to-child transmission prevention with maternal ART and infant nevirapine prophylaxis; early infant diagnosis by DNA PCR at 4–6 weeks.

Primary immunodeficiency red flags: ≥2 pneumonias/year, recurrent deep abscesses, failure to thrive, family history, need for IV antibiotics.

Severe combined immunodeficiency: lymphopenia, hypogammaglobulinemia, infections; avoid live vaccines; hematopoietic stem cell transplant curative.

Malaria: Plasmodium falciparum severe disease - IV artesunate; uncomplicated - artemisinin-based combination therapy.

Dengue: warning signs = abdominal pain, vomiting, fluid accumulation, bleeding, lethargy; monitor hematocrit and platelets; avoid NSAIDs.

Measles: Koplik spots, maculopapular rash head-to-toe; vitamin A 200,000 IU daily ×2 days for children with measles.

Anemia in children: microcytic (iron deficiency, thalassemia), normocytic (hemolysis, chronic disease), macrocytic (B12/folate, marrow failure).

Iron deficiency anemia: low ferritin, low MCV, high RDW; treat with elemental iron 3–6 mg/kg/day; response = reticulocytosis in 1–2 weeks.

Sickle cell disease: hydroxyurea for frequent crises; penicillin prophylaxis until 5 years; pneumococcal vaccination; transcranial Doppler screening for stroke risk.

Acute lymphoblastic leukemia: most common childhood malignancy; peak age 2–5 years; bone marrow >25% blasts; treat with multiagent chemotherapy.

Wilms tumor: abdominal mass, hematuria, hypertension; staging with CT; nephrectomy plus chemotherapy; associated with WT1 mutations.

Neuroblastoma: median age 2 years; elevated urinary catecholamines (VMA/HVA); bone marrow and MIBG scan for staging.

Immune thrombocytopenia: isolated thrombocytopenia with petechiae; treat if bleeding or platelets <20,000; IVIG or steroids.

Hemophilia A: factor VIII deficiency; prolonged PTT; treat with factor replacement; desmopressin for mild cases.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; prevent with hydration and allopurinol/rasburicase.

Pediatric assessment triangle: appearance, work of breathing, circulation to skin; used in first 30 seconds.

PALS: start CPR with 2 breaths then 15 compressions (2 rescuers) at 100–120/min; epinephrine 0.01 mg/kg IV/IO every 3–5 min.

Fluid resuscitation: 20 mL/kg isotonic crystalloid bolus for shock; reassess after each bolus; blood products for hemorrhagic shock.

Anaphylaxis: epinephrine 0.01 mg/kg IM (max 0.5 mg) into anterolateral thigh; repeat every 5–15 min; adjuncts H1/H2 blockers and steroids.

Poisoning: activated charcoal 1 g/kg if within 1 hour and airway protected; naloxone for opioid; fomepizole for methanol/ethylene glycol.

Acetaminophen overdose: N-acetylcysteine based on Rumack-Matthew nomogram; start within 8 hours of ingestion.

Salicylate toxicity: mixed respiratory alkalosis and metabolic acidosis; alkalinize urine with sodium bicarbonate; hemodialysis for severe.

Drowning: hypoxia is primary; CPR starting with rescue breaths; do not perform abdominal thrusts; cervical spine precautions if trauma.

Severe traumatic brain injury: maintain normocapnia, head elevation, hypertonic saline or mannitol for herniation; avoid hypotension.

Autism spectrum disorder: deficits in social communication and restricted/repetitive behaviors; screen with M-CHAT at 18 and 24 months; refer for behavioral therapy.

ADHD: symptoms before age 12, in ≥2 settings; first-line for <6 years is behavioral therapy; ≥6 years stimulant (methylphenidate) plus behavioral therapy.

Adolescent depression: screen with PHQ-A; first-line therapy is CBT or SSRI (fluoxetine or escitalopram); monitor for suicidality.

Eating disorders: anorexia nervosa = low BMI, fear of weight gain, amenorrhea; medical stabilization with refeeding; watch for refeeding syndrome.

Substance use screening: use CRAFFT in adolescents; brief intervention and referral for positive screens.

Adolescent confidentiality: discuss limits (suicide, homicide, abuse) before obtaining sensitive history.

Learning disability: discrepancy between ability and achievement; psychoeducational testing; individualized education plan.

Tics/Tourette: multiple motor and one vocal tic for >1 year; behavioral therapy (CBIT) first-line; antipsychotics for severe.

Bullying and school refusal: assess for anxiety, depression, and safety; coordinated school and family intervention.