Pediatric Respiratory and Allergy
Domain focus
Pediatric Respiratory and Allergy tests asthma, bronchiolitis, croup, pneumonia and anaphylaxis. Management questions focus on severity assessment and avoiding low-value therapy.
Core rules
- Asthma is clinical; spirometry supports diagnosis after age 5. Persistent symptoms need inhaled corticosteroid controller therapy, with a spacer and written action plan.
- Acute asthma: give oxygen to keep SpO2 94–98%, repeated inhaled salbutamol, ipratropium for severe cases, systemic corticosteroids, and IV magnesium for severe or life-threatening attacks.
- Bronchiolitis is supportive: oxygen, fluids and suction. Do not routinely give antibiotics, bronchodilators, steroids or cough medicines.
- Croup: dexamethasone for all severities; nebulised adrenaline for severe stridor at rest.
- Anaphylaxis: intramuscular adrenaline 0.01 mg/kg (max 0.5 mg) into the lateral thigh, repeated after 5 minutes if needed.
Worked example
A 5-year-old with wheeze has retractions and SpO2 89% after one salbutamol nebuliser. This is a severe asthma attack. Give oxygen, repeated salbutamol with ipratropium, oral prednisolone and IV magnesium, then admit. Do not start antibiotics unless there is focal pneumonia or another bacterial source.
Traps
Giving antibiotics for bronchiolitis; sedating a child with respiratory distress; delaying adrenaline in anaphylaxis; prescribing oral salbutamol without a spacer; missing hypoxia because the child is not cyanosed.