Pediatrics
What this domain tests
The Pediatrics domain tests whether a practicing clinician can deliver primary care to infants, children, and adolescents at a level beyond entry to practice: growth and development, preventive care, common acute and chronic illness, and family-centered communication. Items are usually case vignettes, so what is measured is applying a rule to a specific age, weight, and history - not reciting the rule back.
Core rules
- Everything is age-banded. Vital signs, milestones, screening intervals, and many drug doses change with age. A heart rate that is normal for a school-age child may be bradycardia in a neonate.
- Weight-based dosing, four steps: calculate mg/kg/day, divide by the number of doses, check the maximum adult dose, then convert to volume using the actual suspension concentration.
- Development: surveillance at every well visit; standardized autism screening at 18 and 24 months.
- Dehydration: oral rehydration is first-line for mild-to-moderate dehydration; reserve IV fluids for severe dehydration, shock, or ileus.
- Young infants with fever are a separate pathway - under roughly 3 months, lower the threshold for full evaluation and empiric treatment.
- Bronchiolitis is supportive care: oxygen, hydration, suctioning. Bronchodilators, steroids, and antibiotics are not routine.
Worked example
An 18 kg child has acute otitis media. High-dose amoxicillin is 80–90 mg/kg/day divided twice daily: 80 × 18 = 1,440 mg/day, so 720 mg per dose. Using 400 mg/5 mL suspension, that is 9 mL twice daily; at 90 mg/kg it would be 810 mg per dose, about 10 mL. Before finalizing, check penicillin allergy, amoxicillin in the past 30 days, and concurrent purulent conjunctivitis - any of these pushes you to amoxicillin-clavulanate.
Traps
- Applying adult vital-sign ranges and calling sinus tachycardia "normal" in a toddler.
- Stopping at the mg/kg number without checking the maximum or the suspension concentration.
- Reaching for IV fluids in an alert child who is drinking.
- Managing a 6-week-old with fever as an outpatient.