Assessment, Diagnosis, and Management of Common Pediatric Acute Conditions
This domain tests pattern recognition plus disciplined management of common acute illnesses: otitis media, pharyngitis, bronchiolitis, croup, gastroenteritis, UTI, and the febrile young infant.
Core rules
- Acute otitis media requires a bulging tympanic membrane or new otorrhea plus acute signs; redness alone is not enough. First-line is high-dose amoxicillin 80–90 mg/kg/day divided twice daily. Observation is an option for selected nonsevere cases (for example, 6–23 months with unilateral nonsevere disease), with a reliable follow-up plan.
- Group A streptococcal pharyngitis is uncommon under age 3; confirm with rapid antigen test or culture before antibiotics. Penicillin V or amoxicillin is first-line.
- Bronchiolitis is supportive care: hydration, nasal suction, oxygen for hypoxemia. Do not routinely use albuterol, steroids, or antibiotics.
- Croup gets a single dose of dexamethasone (0.15–0.6 mg/kg); nebulized epinephrine for moderate to severe stridor.
- Gastroenteritis is managed with oral rehydration; ondansetron can facilitate oral intake. Assess dehydration and red flags.
- Febrile infants need age-based risk stratification; a febrile infant 28 days or younger generally requires a full sepsis evaluation and hospitalization.
Worked example
A 20-month-old has fever, ear pain, and a bulging, opaque right tympanic membrane with reduced mobility. Weight is 12 kg. Reasoning: this meets acute otitis media criteria, and age plus severity warrants antibiotics. Amoxicillin 90 mg/kg/day = 1080 mg/day = 540 mg twice daily; using 400 mg/5 mL suspension, give 6.75 mL twice daily. Add analgesia and a follow-up plan.
Traps
Prescribing antibiotics for a viral upper respiratory infection; diagnosing otitis media on redness alone; giving steroids for bronchiolitis; missing dehydration or respiratory distress; under-evaluating the youngest febrile infants.