Child and Adolescent Health (Pediatrics)
This domain covers growth, development, immunisation, common acute childhood illness and adolescent care in the clinic. Questions test whether you act on age-specific risk rather than on how well the child looks.
Core rules
- Growth: plot weight, length/height, head circumference and BMI on the correct chart. A single point means little; the trajectory is the finding. Crossing centiles downward over time is faltering growth and needs a cause.
- Development: not sitting by 9 months, not walking by 18 months, no single words by 18 months, no two-word phrases by 24 months, or loss of previously acquired skills are red flags for referral.
- Fever in the young infant: any infant under 3 months with ≥38.0 °C needs a full sepsis screen including lumbar puncture and empirical intravenous antibiotics, regardless of appearance.
- Bronchiolitis is supportive: oxygen if saturations fall below 90-92%, feeding support, and no routine bronchodilator, steroid or antibiotic.
- Acute otitis media: immediate antibiotics if under 2 years, bilateral, severe pain or otorrhoea; otherwise analgesia and a 48-72 hour review.
- Gastroenteritis: oral rehydration solution 75 mL/kg over 4 hours for some dehydration, plus zinc; continue breastfeeding.
- Immunisation follows the current Omani national schedule, which differs from UK/US timing for BCG, MMR and HPV - use the national table, not memory.
Worked example
A 6-week-old has a temperature of 38.2 °C, is feeding and looks well. Reasoning: age is the risk factor, not appearance. Full septic screen with lumbar puncture, admission and intravenous antibiotics; do not send home with antipyretics.
Traps that cost marks
Reassurance based on a well appearance in early infancy; treating viral wheeze with antibiotics; missing weight loss on re-weighing; forgetting the adolescent HEADSS assessment.