Czech Paediatrics Board Examination cheat sheet

Apgar score is assessed at 1 and 5 minutes (and every 5 minutes up to 20 if <7): five components - appearance (colour), pulse, grimace (reflex irritability), activity (muscle tone), respiration - each scored 0–2. The 1-minute score reflects need for resuscitation, not prognosis.

Surfactant is indicated for respiratory distress syndrome (RDS) in preterm infants, especially <30 weeks, ideally given as early rescue therapy; repeated doses are given at intervals (commonly 6–12 h) if oxygen requirement remains high.

Physiological jaundice appears after 24 h of life, peaks at day 3–5 (later in preterm), and is unconjugated. Jaundice within the first 24 h, a rise >85 µmol/L/day (5 mg/dL/day), or conjugated hyperbilirubinaemia is always pathological.

Exchange transfusion thresholds in newborns depend on birth weight, postnatal age, and risk factors; in very low birth weight infants thresholds are lower. Phototherapy is first-line; exchange transfusion is reserved for severe or rapidly rising bilirubin or signs of acute bilirubin encephalopathy.

Newborn screening in the Czech Republic uses a heel-prick dried blood spot (typically 48–72 h of life) for congenital hypothyroidism (TSH), congenital adrenal hyperplasia (17-OHP), phenylketonuria, cystic fibrosis, and other inherited metabolic disorders.

Neonatal sepsis: early-onset (<72 h) is usually caused by group B streptococci or E. coli from the maternal genital tract; late-onset is often staphylococcal or nosocomial. Empiric therapy is usually ampicillin plus gentamicin (early-onset) and adjusted to local resistance.

Necrotising enterocolitis (NEC) presents with feeding intolerance, abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray (Bell staging). Treatment: nil by mouth, parenteral nutrition, antibiotics, and surgery for perforation.

The ductus arteriosus closes functionally within 24–48 h and anatomically over weeks. In preterm infants, a persistent patent ductus arteriosus can cause a systolic murmur, bounding pulses, and pulmonary overcirculation; treatment options include ibuprofen, paracetamol, or surgical ligation.

Hypoxic-ischaemic encephalopathy (HIE) is staged by Sarnat criteria. Therapeutic hypothermia (33.5 °C for 72 h) started within 6 h of birth improves outcome in moderate-to-severe HIE in term infants.

Growth charts: WHO growth standards are used for children 0–5 years (breastfed reference); Czech national growth references are used from 5 years. Length is measured lying down <2 years, standing height thereafter.

Expected growth velocity: ~25 cm in the first year, ~10–12 cm in the second, ~5–7 cm/year from age 3 to puberty, with a pubertal growth spurt of ~8–10 cm/year.

Developmental milestones: social smile at 6 weeks; head control at 3 months; sitting unsupported at 6–8 months; walking independently at 12–15 months; two-word phrases at 18–24 months; three-word sentences at 3 years.

Red flags for developmental delay: no head control by 4 months, no sitting by 9 months, no walking by 18 months, no words by 18 months, or loss of any previously acquired skill (regression always requires investigation).

Preventive examinations in the Czech Republic are scheduled at defined ages (e.g., within the first week, at 1, 3, 4, 6, 8, 10, 12, 18 months, then at 3, 5, 7, 9, 11, 13, 15, 17 years). Each includes growth measurement, developmental assessment, and sensory screening.

Vaccination schedule (Czech Republic): hexavalent vaccine (DTPa-HBV-IPV-Hib) at 2, 3, 4, and 11–12 months; MMR at 13–15 months and 5–6 years; varicella (since 2018) at 15–18 months and 5–6 years; HPV at 13–14 years.

Universal newborn hearing screening uses otoacoustic emissions or automated auditory brainstem response; positive results are confirmed by diagnostic ABR.

Body mass index (BMI) is used for overweight/obesity assessment from 2 years; BMI ≥90th percentile is overweight, ≥97th percentile is obesity (Czech national reference).

Vitamin D supplementation: 400 IU/day for all infants from birth (or within the first weeks) through at least 12 months, continued in at-risk groups; vitamin K is given at birth (1 mg IM) to prevent haemorrhagic disease of the newborn.

Exanthematous infections: measles (Koplik spots, descending rash), rubella (postauricular lymphadenopathy, rash spreads from face), scarlet fever (sandpaper rash, strawberry tongue, perioral pallor, caused by group A streptococcus), varicella (vesicles in crops), and parvovirus B19 (slapped-cheek rash).

Antibiotic choice for common infections: amoxicillin for acute otitis media and community-acquired pneumonia (typical); amoxicillin-clavulanate for sinusitis or treatment failure; macrolides only for atypical pathogens (Mycoplasma, Chlamydia) or penicillin allergy.

Primary immunodeficiencies: suspect in recurrent severe infections, failure to thrive, chronic diarrhoea, or family history. First-line tests include complete blood count with differential, immunoglobulin levels (IgG, IgA, IgM, IgE), and complement.

Severe combined immunodeficiency (SCID) presents with severe infections, chronic diarrhoea, failure to thrive, and absent thymic shadow; live vaccines are contraindicated. Treatment is haematopoietic stem cell transplantation.

Meningococcal disease: purpura fulminans, rapid progression, and high mortality. Immediate parenteral benzylpenicillin or ceftriaxone; chemoprophylaxis (rifampicin or ciprofloxacin) for close contacts.

Tuberculosis: diagnosis in children relies on history of contact, tuberculin skin test (Mantoux), IGRA (from 2 years), chest X-ray, and gastric aspirate culture. Latent TB is treated with isoniazid for 6–9 months.

Lyme borreliosis: erythema migrans is clinical and treated with amoxicillin (children) or doxycycline (from 8 years); neuroborreliosis requires ceftriaxone or cefotaxime.

HIV: vertical transmission is prevented by antenatal antiretroviral therapy, caesarean section if indicated, and neonatal prophylaxis; diagnosis in infants uses PCR (viral RNA/DNA), not antibody tests (maternal antibodies persist up to 18 months).

Congenital heart disease: acyanotic lesions (VSD, ASD, PDA, coarctation) and cyanotic lesions (tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, total anomalous pulmonary venous return, Ebstein anomaly). Ductal-dependent lesions require prostaglandin E1 infusion to maintain ductal patency.

Tetralogy of Fallot: VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta. Hypercyanotic (tet) spells are treated with knee-chest position, oxygen, morphine, and beta-blockers (or phenylephrine).

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, mucosal changes, extremity changes, rash, and cervical lymphadenopathy. Risk of coronary artery aneurysms; treatment is IVIG 2 g/kg plus aspirin.

Acute rheumatic fever: Jones criteria (carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules) plus evidence of preceding group A streptococcal infection; treatment is penicillin and anti-inflammatory therapy.

Asthma: diagnosis in children ≥5–6 years by spirometry showing reversible airflow obstruction (FEV1 increase ≥12% after bronchodilator). In younger children, diagnosis is clinical and based on response to treatment.

Acute asthma exacerbation: salbutamol (inhaled or nebulised), ipratropium for severe cases, systemic corticosteroids (prednisolone 1–2 mg/kg/day for 3–5 days), oxygen to maintain SpO2 ≥94%, and magnesium sulphate for severe unresponsive cases.

Cystic fibrosis: diagnosis by sweat chloride test (≥60 mmol/L diagnostic, 30–59 intermediate), genetic testing, or newborn screening (immunoreactive trypsinogen). Management includes airway clearance, pancreatic enzymes, and CFTR modulators.

Pneumonia in children: most common cause is viral in infants and Streptococcus pneumoniae in older children. Chest X-ray is not routinely required for outpatient management; amoxicillin is first-line for suspected bacterial pneumonia.

Croup (laryngotracheobronchitis): barking cough, inspiratory stridor, hoarseness; treatment is a single dose of dexamethasone (0.15–0.6 mg/kg) and nebulised adrenaline for moderate-to-severe cases.

Acute gastroenteritis: oral rehydration solution (ORS) is first-line; rehydration is calculated as 50–100 mL/kg over 3–4 h for mild-to-moderate dehydration. Ondansetron can be used for persistent vomiting. Antibiotics are not routinely indicated.

Gastro-oesophageal reflux disease (GERD): physiological reflux is common in infants; treatment (PPI) is reserved for complications such as oesophagitis, failure to thrive, or respiratory symptoms.

Coeliac disease: screening with tissue transglutaminase IgA and total IgA; diagnosis confirmed by duodenal biopsy (villous atrophy, crypt hyperplasia, intraepithelial lymphocytosis). A no-biopsy pathway is possible with high titres and positive EMA/genetic testing.

Inflammatory bowel disease: Crohn disease (transmural, skip lesions, granulomas, perianal involvement) vs ulcerative colitis (continuous mucosal inflammation from the rectum). Diagnosis by ileocolonoscopy with biopsies.

Pyloric stenosis: projectile non-bilious vomiting at 3–6 weeks, visible peristalsis, olive-shaped mass; diagnosis by ultrasound (pyloric muscle thickness >3 mm, length >15 mm); treatment is pyloromyotomy.

Biliary atresia: conjugated hyperbilirubinaemia in the first weeks of life, pale stools, dark urine; diagnosis by ultrasound, HIDA scan, and liver biopsy; Kasai portoenterostomy is performed ideally before 60 days of life.

Nutrition: exclusive breastfeeding is recommended for the first 6 months; complementary feeding starts at 6 months. Cow's milk protein allergy presents with gastrointestinal, skin, or respiratory symptoms; treatment is extensively hydrolysed or amino-acid formula.

Wilson disease: liver disease plus neuropsychiatric symptoms; low ceruloplasmin, elevated urinary copper, Kayser-Fleischer rings; treatment is chelation (penicillamine) or zinc.

Failure to thrive: defined as weight below the 3rd percentile or crossing two major percentile lines; evaluation includes dietary history, growth chart review, and screening for organic causes.

Short stature: evaluate with growth chart, bone age, IGF-1, and thyroid function. Growth hormone deficiency is diagnosed by provocation tests (clonidine, insulin, arginine) with peak GH <10 mIU/L. Treatment is recombinant GH.

Congenital hypothyroidism: newborn screening (TSH); treatment with levothyroxine should start within 2 weeks of life to prevent intellectual disability.

Type 1 diabetes: diagnosis by fasting glucose ≥7.0 mmol/L, random glucose ≥11.1 mmol/L with symptoms, or HbA1c ≥48 mmol/mol (6.5%). Diabetic ketoacidosis is treated with IV fluids, insulin infusion, and careful monitoring for cerebral oedema.

Diabetic ketoacidosis (DKA) in children: fluid resuscitation with isotonic saline, insulin infusion 0.05–0.1 U/kg/h started after 1 h of fluids, and potassium replacement. Cerebral oedema is the leading cause of death; treat with mannitol or hypertonic saline.

Congenital adrenal hyperplasia (21-hydroxylase deficiency): salt-wasting crisis in the second week of life with hyponatraemia, hyperkalaemia, and hypotension; treatment is hydrocortisone and fludrocortisone.

Precocious puberty: onset before 8 years in girls and 9 years in boys; central precocious puberty is treated with GnRH agonists.

Turner syndrome: short stature and gonadal dysgenesis (45,X); associated with coarctation of the aorta, bicuspid aortic valve, and horseshoe kidney. Treatment includes growth hormone and oestrogen replacement.

Phenylketonuria (PKU): newborn screening; treatment is a low-phenylalanine diet with a phenylalanine-free amino acid supplement. Untreated, it causes intellectual disability and seizures.

Obesity and metabolic syndrome: BMI ≥97th percentile; screen for dyslipidaemia, hypertension, and impaired glucose tolerance (OGTT) in obese children.

Urinary tract infection (UTI): diagnosis by urine culture (catheter or midstream); treatment is antibiotics guided by local resistance (commonly cephalosporins or amoxicillin-clavulanate). Imaging (ultrasound) is indicated for febrile UTI in infants and for recurrent UTIs.

Vesicoureteral reflux (VUR): graded I–V; management includes antibiotic prophylaxis for high grades and surgical correction for recurrent infections or renal scarring.

Nephrotic syndrome: triad of proteinuria (>3.5 g/day/1.73 m² or urine protein/creatinine ratio >200 mg/mmol), hypoalbuminaemia (<25 g/L), and oedema. Minimal change disease is the most common cause in children; treatment is corticosteroids.

Acute glomerulonephritis: post-streptococcal glomerulonephritis presents with haematuria, oedema, hypertension, and low complement C3; treatment is supportive.

Haemolytic uraemic syndrome (HUS): triad of microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury; most commonly caused by Shiga toxin-producing E. coli (STEC). Treatment is supportive; antibiotics and antimotility drugs are avoided.

Acute kidney injury (AKI): staged by KDIGO criteria (creatinine rise and urine output). Management includes fluid and electrolyte balance, avoidance of nephrotoxins, and dialysis for refractory hyperkalaemia, fluid overload, or uraemia.

Hypertension in children: defined as ≥95th percentile for age, sex, and height on three occasions; first-line evaluation includes renal ultrasound, urinalysis, and echocardiography.

Cryptorchidism: undescended testis should be treated (orchiopexy) by 12–18 months of age to reduce risk of infertility and malignancy.

Enuresis: primary nocturnal enuresis is common; treatment includes behavioural measures, desmopressin, and enuresis alarm. Daytime symptoms or secondary enuresis require urological evaluation.

Febrile seizures: simple (generalised, <15 min, once in 24 h) vs complex (focal, >15 min, recurrent in 24 h). Simple febrile seizures do not require routine EEG or neuroimaging; treatment is antipyretics and reassurance.

Epilepsy: diagnosis requires ≥2 unprovoked seizures >24 h apart. First-line treatment for focal seizures is carbamazepine or levetiracetam; for generalised tonic-clonic seizures, valproate (avoid in girls of childbearing age) or levetiracetam.

Status epilepticus: benzodiazepines first-line (IV lorazepam or diazepam, or buccal midazolam), followed by phenytoin/fosphenytoin, levetiracetam, or valproate; then anaesthesia (midazolam, propofol, thiopental) for refractory cases.

Cerebral palsy: non-progressive motor disorder due to early brain injury; classified by tone (spastic, dyskinetic, ataxic) and distribution. Associated problems include epilepsy, visual/hearing impairment, and intellectual disability.

Meningitis: bacterial meningitis in children presents with fever, headache, neck stiffness, and altered consciousness; treatment is immediate IV ceftriaxone (plus ampicillin in neonates for Listeria) and dexamethasone before or with the first antibiotic dose.

Neural tube defects: prevention with folic acid (400 µg/day) before conception and in early pregnancy; spina bifida occulta vs aperta; hydrocephalus requires shunt or ETV.

Attention-deficit/hyperactivity disorder (ADHD): diagnosis by DSM-5 criteria (inattention and/or hyperactivity-impulsivity for ≥6 months, in ≥2 settings); treatment includes behavioural therapy and stimulants (methylphenidate).

Autism spectrum disorder: impaired social communication and restricted/repetitive behaviours; early screening (M-CHAT) and multidisciplinary assessment; early intervention improves outcome.

Head trauma: indications for CT (PECARN criteria) include altered mental status, skull fracture signs, vomiting, and severe mechanism. Minor head injury without risk factors can be observed.

Anaemia: microcytic (iron deficiency, thalassaemia), normocytic (acute blood loss, chronic disease, haemolysis), macrocytic (B12/folate deficiency). Iron deficiency is the most common cause in children; treatment is oral iron for 3 months after normalisation.

Haemolytic anaemia: signs include jaundice, splenomegaly, reticulocytosis, and low haptoglobin. Causes include hereditary spherocytosis, G6PD deficiency, and autoimmune haemolytic anaemia (positive direct Coombs test).

Thalassaemia: beta-thalassaemia major presents with severe anaemia after 6 months; treatment is regular transfusions with iron chelation. Alpha-thalassaemia has a spectrum from silent carrier to Hb Bart's hydrops fetalis.

Haemophilia: X-linked; haemophilia A (factor VIII) and B (factor IX). Treatment is factor replacement; desmopressin is used for mild haemophilia A.

Immune thrombocytopenia (ITP): isolated thrombocytopenia with petechiae/ecchymoses in an otherwise well child; treatment is observation or IVIG/corticosteroids for significant bleeding.

Acute lymphoblastic leukaemia (ALL): most common childhood malignancy; presents with pallor, fatigue, fever, bone pain, lymphadenopathy, and hepatosplenomegaly; diagnosis by bone marrow aspirate (≥20% blasts). Treatment is multi-agent chemotherapy with CNS prophylaxis.

Brain tumours: most common solid tumour in children; presenting signs include headache, vomiting, ataxia, and cranial nerve palsies. Medulloblastoma and pilocytic astrocytoma are common types.

Wilms tumour (nephroblastoma): abdominal mass in children 2–5 years; treatment is nephrectomy plus chemotherapy (and radiotherapy for advanced stages).

Neuroblastoma: derived from neural crest; elevated catecholamines (VMA/HVA) in urine; treatment depends on risk stratification (surgery, chemotherapy, stem cell transplant).

Juvenile idiopathic arthritis (JIA): arthritis in ≥1 joint for ≥6 weeks in a child <16 years; subtypes include oligoarticular, polyarticular, systemic, and enthesitis-related. Treatment is NSAIDs, intra-articular steroids, and methotrexate; biologics for refractory disease.

Systemic JIA: fever, rash, arthritis, and serositis; risk of macrophage activation syndrome (MAS) - a life-threatening complication with cytopenias, elevated ferritin, and liver dysfunction.

Kawasaki disease: see cardiology; IVIG plus aspirin prevents coronary artery aneurysms.

Henoch-Schönlein purpura (IgA vasculitis): palpable purpura on lower extremities, abdominal pain, arthritis, and renal involvement (haematuria/proteinuria); treatment is supportive, corticosteroids for severe abdominal or renal disease.

Anaphylaxis: immediate IM adrenaline (0.01 mg/kg, max 0.5 mg) into the anterolateral thigh; adjuncts include oxygen, IV fluids, and antihistamines (not first-line). Observation for 4–6 h for biphasic reactions.

Food allergy: diagnosis by history, skin prick test, or specific IgE; oral food challenge is the gold standard. Treatment is avoidance and an adrenaline auto-injector for severe reactions.

Asthma and allergic rhinitis: allergic rhinitis is treated with intranasal corticosteroids and antihistamines; asthma control is assessed by symptom frequency and lung function.

Immunodeficiency: see infectious diseases; recurrent infections, failure to thrive, and family history warrant immunological evaluation.

Paediatric basic life support: 5 rescue breaths, then 15 chest compressions to 2 breaths (ratio 15:2) for two rescuers; compression depth is one-third of chest diameter at a rate of 100–120/min.

Paediatric advanced life support: adrenaline 10 µg/kg IV/IO (0.1 mL/kg of 1:10,000) every 3–5 min; defibrillation 4 J/kg for shockable rhythms.

Fluid resuscitation in children: 20 mL/kg isotonic crystalloid bolus, repeated as needed; reassess for fluid overload.

Anaphylaxis: IM adrenaline 0.01 mg/kg (max 0.5 mg) into the anterolateral thigh; repeat every 5–15 min if needed.

Status epilepticus: see neurology; benzodiazepines first-line, then second-line antiepileptics, then anaesthesia.

Sepsis: recognition (fever, tachycardia, tachypnoea, altered mental status, prolonged capillary refill), blood cultures, and early broad-spectrum antibiotics within 1 h; fluid resuscitation 20 mL/kg.

Trauma: primary survey (ABCDE), cervical spine immobilisation, and early imaging based on mechanism and findings; paediatric trauma centres improve outcomes.

Anaesthesia: fasting guidelines (clear fluids 2 h, breast milk 4 h, formula/solid food 6 h); premedication with midazolam; monitoring includes pulse oximetry, capnography, and ECG.

Poisoning: activated charcoal within 1 h for appropriate ingestions; specific antidotes (N-acetylcysteine for paracetamol, naloxone for opioids, flumazenil for benzodiazepines - use with caution).

Child abuse and neglect: recognition of physical, emotional, and sexual abuse; mandatory reporting to authorities (in the Czech Republic, to the police and social services).

Vaccination legislation: in the Czech Republic, vaccination is mandatory for certain diseases (diphtheria, tetanus, pertussis, polio, Hib, hepatitis B, measles, mumps, rubella, and others); exemptions exist for medical contraindications.

Informed consent: in the Czech Republic, a minor aged 15–18 can consent to certain medical procedures; for younger children, consent is given by the legal guardian. Emergency treatment can be provided without consent if life-threatening.

Confidentiality: medical information is protected; disclosure is permitted with patient/guardian consent or when required by law (e.g., reporting of infectious diseases, child abuse).

Health care organisation: primary care paediatricians (praktický lékař pro děti a dorost) provide preventive care and vaccination; specialist care is by referral. Emergency services are accessed via 155 (ambulance) or 112 (integrated emergency).

Preventive examinations: see growth and development; they are covered by public health insurance and are a condition for certain benefits.

Social paediatrics: screening for social determinants (poverty, neglect, domestic violence) and referral to social services; collaboration with schools and social workers.

Ethical principles: beneficence, non-maleficence, autonomy, and justice; in paediatrics, the best interests of the child are paramount.

Legislation: the Convention on the Rights of the Child (UN) and Czech law (e.g., Act on Health Care Services) govern paediatric care; the Ombudsman for Children's Rights exists in the Czech Republic.