Pediatrics
Pediatric questions are age-weighted: the younger the child, the lower the threshold for investigation. Expect febrile infants, bronchiolitis, dehydration, neonatal jaundice, growth and immunization schedules, and developmental milestones.
Core rules
- Fever in an infant under three months: full sepsis evaluation including lumbar puncture, admission and empirical intravenous ampicillin plus gentamicin (cefotaxime where meningitis is suspected). "Well-appearing" does not exclude serious bacterial infection at this age.
- Bronchiolitis: supportive care - oxygen if saturations fall below 90–92%, fluids, suction. No routine bronchodilators, steroids or antibiotics.
- Dehydration: assess clinically; oral rehydration solution first, 20 mL/kg isotonic bolus if shocked.
- Neonatal jaundice: plot bilirubin against age in hours on a nomogram; treat with phototherapy by threshold and risk factors; exchange transfusion for severe cases.
- Every drug dose is per kilogram, with a stated maximum.
Worked example
A six-week-old baby has a rectal temperature of 38.3 °C, feeds reasonably and has no focus of infection. Reasoning: age under three months overrides appearance. Blood, urine and cerebrospinal fluid cultures, full blood count, inflammatory markers, admission, and empirical antibiotics after cultures. Consider the HSV risk (maternal history, vesicles, seizures) and add acyclovir if suspected. The trap is discharging the baby because he "looks well" or because a sibling has a cold.
Traps that cost marks
- Antipyretics masking fever without addressing the underlying cause.
- Prescribing adult-strength doses or forgetting weight-based maxima.
- Missing non-accidental injury in an infant with bruising, a metaphyseal fracture or unexplained vomiting.
- Ignoring parental concern - often the most sensitive sign in pediatrics.