Acute and Chronic Illness Management
This domain tests evidence-based management of common pediatric conditions and the coordination of long-term care.
Core rules
- Bronchiolitis: supportive care - suction, hydration, oxygen for saturations below 90%. Bronchodilators, steroids, and antibiotics are not routinely indicated.
- Asthma: assess severity, give short-acting beta-agonist, add ipratropium and systemic steroids for moderate-to-severe exacerbations, and provide a written action plan.
- Croup: dexamethasone 0.15–0.6 mg/kg once; nebulized racemic epinephrine for stridor at rest or increased work of breathing.
- Acute otitis media: high-dose amoxicillin 80–90 mg/kg/day as first line.
- Sickle cell pain crisis: prompt analgesia, hydration, and evaluation for acute chest syndrome and infection.
- Diabetes: DKA requires isotonic fluid resuscitation, insulin infusion only after fluids, and close potassium monitoring.
- Chronic conditions: medical home, care coordination, school 504 plan or IEP, and planned transition to adult care in adolescence.
Worked example
A 3-year-old with wheeze, retractions, and a history of asthma is given albuterol. After three treatments the retractions persist and speech is broken. This is a moderate-to-severe exacerbation: add ipratropium, give oral dexamethasone or prednisolone, apply continuous pulse oximetry, and prepare for continuous nebulization. Bronchiolitis management would look different - in a wheezing infant under 12 months with coryza and no atopy, bronchodilators are not routinely given.
Traps
- Prescribing antibiotics for viral illness or giving cough and cold products under age 4.
- Aspirin in a febrile child - Reye syndrome risk.
- Using albuterol routinely for bronchiolitis.
- Discharging asthma without an action plan or inhaler technique check.