Paediatrics
What is tested
Paediatrics is weighted toward neonatology, growth and development, nutrition and dehydration, immunization, and acute respiratory illness.
Core rules
- APGAR at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration. It describes the newborn's condition and response to resuscitation; it does not diagnose birth asphyxia or predict outcome.
- Neonatal hypoglycemia: blood glucose <45 mg/dL; treat with early feeding or 10% dextrose 2 mL/kg bolus.
- Dehydration (WHO): Plan A for no dehydration (home ORS plus zinc for 14 days); Plan B for some dehydration - 75 mL/kg low-osmolarity ORS over 4 hours; Plan C for severe dehydration - Ringer lactate 100 mL/kg, with 30 mL/kg in the first hour in infants.
- Low-osmolarity ORS: sodium 75, glucose 75, potassium 20, chloride 65, citrate 10 mmol/L; osmolarity 245 mOsm/L.
- Immunization: BCG, OPV-0 and hepatitis B at birth; pentavalent at 6, 10 and 14 weeks; measles-rubella at 9–12 months.
Worked example
A 10 kg child has diarrhea, sunken eyes, delayed skin pinch and lethargy but is able to drink. Reasoning: at least two signs place him in 'some dehydration', so Plan B applies - 75 × 10 = 750 mL of ORS over 4 hours by spoon or cup, with reassessment at 4 hours. Lethargy with inability to drink would move him to Plan C and intravenous Ringer lactate.
Traps
Using APGAR to diagnose asphyxia; prescribing antibiotics for routine acute diarrhea; and forgetting zinc, which shortens duration and reduces recurrence.