Pediatrics
What Pediatrics tests
Pediatrics in Part I covers common, high-frequency and high-mortality problems: neonatal jaundice, dehydration and oral rehydration, acute respiratory illness, febrile seizures, growth and immunisation. Questions usually ask for the next step in a child who looks well versus one who looks ill, so severity assessment matters more than naming a rare syndrome.
Core rules
- Neonatal jaundice: measure bilirubin, plot against age in hours, and treat by phototherapy threshold rather than a single fixed number. Pathological features include onset within 24 hours, a rise above 0.2 mg/dL per hour, direct hyperbilirubinaemia, and jaundice persisting beyond 14 days.
- Dehydration: WHO Plan A at home with oral rehydration salts; Plan B with supervised oral rehydration at 75 mL/kg over 4 hours; Plan C with IV Ringer lactate at 100 mL/kg for severe dehydration or shock.
- Bronchiolitis: supportive care only - oxygen, fluids, nasal suction. No routine bronchodilators, corticosteroids, antibiotics or chest physiotherapy.
- Croup: a single dose of oral dexamethasone 0.15–0.6 mg/kg; nebulised adrenaline for stridor at rest.
Worked example
A 4-month-old has 2 days of coryza, wheeze, respiratory rate 60, oxygen saturation 88% and poor feeding. Reason: this is bronchiolitis. Give oxygen to keep saturation above 90–92%, maintain hydration (nasogastric if oral intake fails), and admit because of young age and hypoxia. Antibiotics are not indicated without evidence of secondary bacterial infection, and a trial of salbutamol is not recommended.
Traps
Treating bronchiolitis wheeze with bronchodilators or steroids; using aspirin in children because of Reye syndrome; missing sepsis in a neonate who presents with hypothermia and poor feeding rather than fever; performing a lumbar puncture in a well child with a simple febrile seizure.