Pediatrics
Paediatric items test integrated case management: dehydration, pneumonia, neonatal care, growth and nutrition, and the national immunisation schedule. Answers usually hinge on classification and the correct first-line step.
Core rules
- Diarrhoea: classify dehydration. Plan A at home with ORS and zinc; Plan B some dehydration - 75 mL/kg low-osmolarity ORS over 4 hours; Plan C severe dehydration - 100 mL/kg Ringer lactate (30 mL/kg in the first hour, 70 mL/kg over 5 hours for infants under 12 months; 30 minutes and 2.5 hours for older children).
- Zinc: 10 mg daily for infants under 6 months, 20 mg daily for 14 days in older children.
- Pneumonia: fast breathing is the key sign; treat with oral amoxicillin, and refer if there is chest indrawing or danger signs.
- Neonatal resuscitation: warm, dry, stimulate, position, clear the airway if needed, then positive pressure ventilation with a bag and mask at 40–60 breaths per minute.
- Immunisation: BCG, OPV and hepatitis B at birth; pentavalent, OPV and PCV at 6, 10 and 14 weeks; measles-rubella at 9 and 15 months.
Worked example
A one-year-old has three days of watery stools, sunken eyes, a slow skin pinch and drinks eagerly. This is some dehydration, not severe. Give 75 mL/kg ORS over 4 hours, continue breastfeeding, add zinc for 14 days, and reassess; antibiotics are not indicated for watery diarrhoea.
Traps
- Prescribing antibiotics for acute watery diarrhoea.
- Forgetting zinc, which shortens the episode.
- Using adult-strength ORS sachets.
- Missing severe acute malnutrition when weight-for-height is low with oedema.