Pediatrics and Obstetrics/Gynecology
Paediatric questions test normal development and what deviates from it; obstetric questions test the timeline (gestational age, antenatal screening, intrapartum monitoring); gynaecology adds oncology and reproductive endocrinology.
Core rules
- Development: social smile at 2 months, head control 3–4 months, sitting 6–8 months, walking 12–15 months, two-word phrases 18–24 months. Any regression is pathological.
- Japanese immunisation schedule: hepatitis B, Hib, pneumococcal conjugate, and rotavirus from 2 months; BCG at 5–7 months (tuberculin test first); MR first dose at 1 year; varicella at 1 year; Japanese encephalitis from 6 months; influenza from 6 months.
- Neonatal jaundice: physiological peak day 3–5 in term infants; pathological if it appears within 24 h, is direct (conjugated), or rises rapidly.
- Preeclampsia: hypertension ≥140/90 after 20 weeks plus proteinuria or organ dysfunction. Severe features: ≥160/110, platelets <100,000, transaminase rise, pulmonary oedema, headache or visual change. Magnesium sulfate prevents seizures; delivery is definitive.
- Cardiotocography: late decelerations indicate uteroplacental insufficiency; variable decelerations indicate cord compression; prolonged bradycardia requires immediate action.
Worked example
A 33-year-old at 34 weeks has BP 168/112, 3+ proteinuria, headache, and platelets 88,000. Reasoning: preeclampsia with severe features. Admit, start magnesium sulfate, control BP with nifedipine or labetalol, give corticosteroids for fetal lung maturity, and plan delivery after maternal stabilisation - delivery is the only cure.
Traps
- Aspirin for a febrile child (Reye syndrome).
- Applying phototherapy thresholds that do not match the infant's age and risk factors.
- Treating reduced fetal movements with a reassuring single trace instead of continued monitoring and escalation.