Iraqi Board Pediatrics cheat sheet

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

Expected length at 2 years is half adult height; at 4 years, double birth length.

Head circumference grows ~2 cm/month in first 3 months, 1 cm/month from 4-6 months, 0.5 cm/month in second half of year 1.

Primitive reflexes: Moro disappears by 3-4 months, palmar grasp by 4-6 months, asymmetric tonic neck by 4-6 months, Babinski may persist to 12-24 months.

Developmental milestones: social smile 6 weeks, head control 3 months, sits unsupported 6-8 months, walks alone 12-15 months, 2-word phrases 18-24 months.

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

Growth hormone deficiency suspected when height velocity < 4 cm/year after age 4 or height < -2.5 SD with delayed bone age.

Failure to thrive: weight-for-age < 5th percentile or crossing two major percentile lines; first step is a 3-day food and intake diary with accurate weights.

Apgar score is assigned at 1 and 5 minutes and never guides resuscitation; the decision to resuscitate is made before birth.

Surfactant is indicated for RDS with FiO2 > 0.30-0.40 and signs of respiratory distress; early CPAP is first-line for preterm infants with respiratory distress.

Physiologic jaundice appears after 24 hours; jaundice within 24 hours is always pathologic and requires urgent bilirubin and Coombs testing.

Phototherapy thresholds follow hour-specific bilirubin nomograms; exchange transfusion is considered when bilirubin exceeds exchange thresholds or signs of acute bilirubin encephalopathy appear.

Neonatal sepsis: group B Streptococcus and E. coli predominate in early-onset disease; Listeria is covered by ampicillin plus gentamicin empiric therapy.

Necrotizing enterocolitis presents with feeding intolerance, abdominal distension, bloody stools, and pneumatosis intestinalis; management includes bowel rest, decompression, and antibiotics.

Hypoglycemia in neonates is < 47 mg/dL (2.6 mmol/L) in the first 48 hours; treat with feeding or IV dextrose bolus of 2 mL/kg of D10W followed by continuous infusion.

Retinopathy of prematurity screening is indicated for infants < 30 weeks gestation or < 1500 g birth weight, starting at 4-6 weeks postnatal age.

Fever in infants < 28 days is a full sepsis evaluation with empiric IV antibiotics and admission regardless of appearance.

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

Scarlet fever: group A Streptococcus, sandpaper rash with circumoral pallor and strawberry tongue; treat with penicillin or amoxicillin for 10 days.

Measles: Koplik spots precede a maculopapular rash spreading from the face downward; isolate with airborne precautions and give vitamin A.

Primary immunodeficiency red flags: ≥ 2 pneumonias, ≥ 4 ear infections/year, failure to thrive, family history, or need for IV antibiotics.

HIV in children: diagnose infants < 18 months with virologic HIV DNA/RNA PCR; maternal antibody makes serology unreliable in this age group.

Tuberculosis in children: gastric aspirate or sputum for AFB and culture; IGRA is preferred over tuberculin skin test in BCG-vaccinated children over 2 years.

Meningococcal meningitis prophylaxis: rifampin, ciprofloxacin, or ceftriaxone for close contacts within 24 hours of diagnosis.

Cyanotic congenital heart disease with decreased pulmonary blood flow: Tetralogy of Fallot, tricuspid atresia, pulmonary atresia, Ebstein anomaly.

Cyanotic congenital heart disease with increased pulmonary blood flow: transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous return, single ventricle.

Acyanotic left-to-right shunts: VSD, ASD, PDA; large shunts cause failure to thrive, tachypnea, and recurrent respiratory infections.

Hypercyanotic Tetralogy spell: knee-chest position, supplemental oxygen, morphine, IV fluids, and phenylephrine; avoid isoproterenol.

Ductal-dependent lesions (transposition, critical coarctation, interrupted arch) are maintained with prostaglandin E1 infusion.

Innocent murmur features: systolic, grade ≤ 2/6, no thrill, normal S2, varies with position, no radiation, and asymptomatic child.

Congestive heart failure in infants: tachycardia, tachypnea, hepatomegaly, poor feeding, and sweating; treat with diuretics, ACE inhibitors, and digoxin.

Rheumatic fever Jones criteria: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules plus evidence of preceding streptococcal infection.

Asthma severity in children 5-11: intermittent, mild persistent (symptoms > 2 days/week), moderate persistent (daily), severe persistent (continuous).

Asthma exacerbation: give inhaled short-acting beta-2 agonist every 20 minutes for 3 doses, add ipratropium for severe attacks, and use systemic corticosteroids early.

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

Epiglottitis: drooling, tripod position, muffled voice, high fever; do not inspect the throat, keep child calm, and secure the airway in the operating room.

Bronchiolitis: most common cause is respiratory syncytial virus; treatment is supportive with oxygen and hydration; bronchodilators and steroids are not routinely recommended.

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

Allergic rhinitis: first-line therapy is intranasal corticosteroids; add oral antihistamines for ocular symptoms; allergen avoidance is adjunctive.

Anaphylaxis: intramuscular epinephrine 0.01 mg/kg of 1:1000 (max 0.5 mg) into the anterolateral thigh, repeated every 5-15 minutes as needed.

Acute gastroenteritis: oral rehydration solution 50 mL/kg over 4 hours for mild dehydration and 100 mL/kg over 4 hours for moderate dehydration; continue breastfeeding.

Hypertrophic pyloric stenosis: nonbilious projectile vomiting at 3-6 weeks, visible peristalsis, olive-shaped mass, hypochloremic hypokalemic metabolic alkalosis; treat with pyloromyotomy.

Bilious vomiting in a neonate is a surgical emergency until malrotation with volvulus is excluded by upper GI contrast study.

Celiac disease: anti-tissue transglutaminase IgA with total IgA level; confirm with duodenal biopsy showing villous atrophy and crypt hyperplasia.

Intussusception: colicky pain, currant-jelly stools, sausage-shaped mass; diagnose with ultrasound and reduce with air or contrast enema if no peritonitis.

Hirschsprung disease: delayed meconium passage beyond 48 hours, abdominal distension, and explosive stool after rectal examination; diagnose with rectal biopsy.

Neonatal cholestasis: conjugated bilirubin > 1 mg/dL or > 20% of total; evaluate for biliary atresia with ultrasound, hepatobiliary scan, and liver biopsy.

Vitamin D deficiency rickets: 400 IU/day for infants; treatment of deficiency is 2000 IU/day for 6-12 weeks or a single dose of 50,000 IU.

Febrile seizures: simple if generalized, < 15 minutes, and once in 24 hours; no routine EEG or neuroimaging is indicated.

Status epilepticus: first-line is a benzodiazepine (lorazepam 0.1 mg/kg IV or midazolam 0.2 mg/kg IM); second-line is fosphenytoin or levetiracetam.

Bacterial meningitis in a child > 3 months: ceftriaxone plus vancomycin; add ampicillin for infants < 3 months to cover Listeria.

Headache red flags: waking from sleep, morning vomiting, worsening with Valsalva, focal deficits, or papilledema require neuroimaging.

Cerebral palsy: nonprogressive motor impairment from a perinatal insult; associated findings include seizures, visual and hearing deficits, and intellectual disability.

Guillain-Barré syndrome: ascending symmetric weakness with areflexia and albuminocytologic dissociation; treat with IVIG or plasmapheresis.

Duchenne muscular dystrophy: X-linked, Gowers sign, calf pseudohypertrophy, elevated CK; confirm with genetic testing; steroids slow progression.

Neonatal seizures: most common cause is hypoxic-ischemic encephalopathy; treat with phenobarbital as first-line.

Diabetic ketoacidosis: fluid resuscitation with isotonic saline, insulin infusion 0.05-0.1 units/kg/hour, and monitor for cerebral edema; avoid rapid osmotic shifts.

Congenital hypothyroidism: newborn screening with TSH; treat with levothyroxine 10-15 mcg/kg/day started within 2 weeks of life to prevent intellectual disability.

Type 1 diabetes autoantibodies: GAD65, IA-2, insulin, and ZnT8; check for associated autoimmune thyroid and celiac disease.

Short stature evaluation: bone age, IGF-1, TSH, celiac serology, and karyotype in girls to exclude Turner syndrome.

Precocious puberty: breast or pubic hair before 8 years in girls and 9 years in boys; GnRH stimulation test distinguishes central from peripheral.

Congenital adrenal hyperplasia: 21-hydroxylase deficiency causes salt wasting, ambiguous genitalia in girls, and hyperkalemia with hyponatremia; treat with hydrocortisone and fludrocortisone.

Hypocalcemia in neonates: serum calcium < 7 mg/dL in preterm or < 8 mg/dL in term; treat with IV calcium gluconate with cardiac monitoring.

Obesity screening: BMI percentile ≥ 95th is obesity; screen for dyslipidemia, hypertension, and type 2 diabetes with fasting glucose or HbA1c.

Nephrotic syndrome: heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia; treat with prednisone 60 mg/m²/day for 4-6 weeks then alternate-day therapy.

Acute post-streptococcal glomerulonephritis: cola-colored urine, hypertension, edema, low C3; supportive care; C3 normalizes within 6-8 weeks.

Hemolytic uremic syndrome: microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury after bloody diarrhea; supportive care with dialysis as needed.

Urinary tract infection in infants < 2 months: admit for IV antibiotics; obtain urine culture before starting antibiotics.

Vesicoureteral reflux grading I-V by voiding cystourethrogram; grade V or recurrent febrile UTIs warrant antibiotic prophylaxis.

Hypospadias: do not circumcise; refer for surgical repair at 6-18 months of age.

Acute kidney injury staging by KDIGO uses serum creatinine rise and urine output; first step is fluid assessment and discontinuation of nephrotoxins.

Enuresis: primary nocturnal enuresis in children ≥ 5 years; first-line behavioral therapy with alarm or desmopressin for short-term control.

Iron deficiency anemia: microcytic hypochromic with low ferritin and high TIBC; treat with elemental iron 3-6 mg/kg/day for 3 months after hemoglobin normalizes.

Sickle cell disease: penicillin prophylaxis from 2 months to 5 years, hydroxyurea for frequent crises, and pneumococcal vaccination.

Acute lymphoblastic leukemia: most common childhood malignancy; presents with pallor, bruising, bone pain, and blasts on peripheral smear; diagnose with bone marrow aspiration.

Wilms tumor: abdominal mass in a child 2-5 years; avoid biopsy; treat with nephrectomy and chemotherapy.

Neuroblastoma: median age 22 months, elevated urine catecholamines (VMA, HVA), and bone marrow involvement; risk-stratified therapy.

Immune thrombocytopenia: isolated thrombocytopenia with petechiae and bruising in a well child; treat only if platelets < 20,000 with bleeding or < 10,000.

Hemophilia A: prolonged aPTT with normal PT; treat with factor VIII concentrate; desmopressin for mild disease.

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

Pediatric basic life support: compression-to-ventilation ratio 30:2 for one rescuer and 15:2 for two rescuers; depth one-third of chest diameter.

Anaphylaxis: epinephrine 0.01 mg/kg IM of 1:1000 (max 0.5 mg) into the anterolateral thigh; repeat every 5-15 minutes as needed.

Acetaminophen toxicity: N-acetylcysteine is most effective within 8 hours; use Rumack-Matthew nomogram at 4 hours post-ingestion.

Iron overdose: abdominal pain, vomiting, and GI bleeding; treat with deferoxamine for severe toxicity.

Organophosphate poisoning: SLUDGE syndrome (salivation, lacrimation, urination, diarrhea, GI upset, emesis); treat with atropine and pralidoxime.

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

Carbon monoxide poisoning: measure carboxyhemoglobin; treat with 100% oxygen; hyperbaric oxygen for severe cases or pregnancy.

Pediatric trauma: primary survey ABCDE; hypotension in children is a late sign; treat with 20 mL/kg crystalloid boluses.

Juvenile idiopathic arthritis: arthritis in ≥ 1 joint for ≥ 6 weeks in a child < 16 years; exclude other causes before diagnosis.

Systemic JIA: quotidian fever, evanescent rash, arthritis, hepatosplenomegaly, and serositis; risk of macrophage activation syndrome.

Kawasaki disease is the leading cause of acquired heart disease in children in developed countries; treat with IVIG and aspirin.

Systemic lupus erythematosus: malar rash, arthritis, cytopenias, and renal involvement; ANA and anti-dsDNA are screening tests.

Henoch-Schönlein purpura (IgA vasculitis): palpable purpura on lower extremities, arthritis, abdominal pain, and nephritis; supportive care; monitor urine.

Acute rheumatic fever: Jones criteria with evidence of streptococcal infection; treat with penicillin and anti-inflammatory therapy.

Dermatomyositis: proximal muscle weakness with heliotrope rash and Gottron papules; treat with corticosteroids and methotrexate.

Macrophage activation syndrome: fever, cytopenias, high ferritin, and liver dysfunction in a child with systemic JIA; treat with steroids and cyclosporine.

Down syndrome: trisomy 21; screen for congenital heart disease with echocardiogram, hypothyroidism with TSH, and atlantoaxial instability with cervical spine x-ray.

Turner syndrome: 45,X; short stature, webbed neck, coarctation of the aorta, and ovarian dysgenesis; treat with growth hormone and estrogen replacement.

Fragile X syndrome: most common inherited cause of intellectual disability; CGG repeat expansion in FMR1; associated with macroorchidism and autism.

Autism spectrum disorder: screen with M-CHAT at 18 and 24 months; refer for behavioral therapy and audiology; no single diagnostic test.

ADHD: diagnose with DSM-5 criteria across settings; first-line treatment for children ≥ 6 years is stimulant medication with behavioral therapy.

Klinefelter syndrome: 47,XXY; tall stature, gynecomastia, small testes, and infertility; treat with testosterone replacement.

Newborn screening: phenylketonuria, congenital hypothyroidism, congenital adrenal hyperplasia, galactosemia, and sickle cell disease are standard in many programs.

Failure to thrive in a child with dysmorphic features warrants chromosomal microarray and genetics referral.