Master Pediatrics
for DHA

What the DHA Tests in Pediatrics

The DHA Pediatrics exam tests the ability to manage common acute and chronic paediatric conditions across all age groups, with emphasis on evidence-based guidelines, emergency triage, and developmental milestones. Candidates must demonstrate knowledge of neonatal resuscitation (APGAR, NRP), growth charts (WHO/CDC), immunisation schedules (UAE/HAAD), and management of febrile illness (NICE traffic light system). Key presentations include respiratory distress (bronchiolitis, asthma, pneumonia), dehydration (WHO classification), seizures (febrile vs. epilepsy), and congenital heart disease (duct-dependent lesions). You will be expected to calculate fluid requirements, drug doses (e.g., paracetamol 15 mg/kg), and recognise red flags for serious bacterial infection (meningitis, sepsis). The exam also covers paediatric endocrinology (DKA management, growth hormone deficiency), nephrology (UTI prophylaxis, nephrotic syndrome), and safeguarding (non-accidental injury).

High-Yield Concepts

• Febrile Seizure Criteria: Simple febrile seizure: generalised, <15 minutes, single in 24h, age 6 months–5 years. Lumbar puncture indicated if <12 months with incomplete immunisations or meningeal signs. First-line for prolonged seizure (>5 min): rectal diazepam 0.5 mg/kg or buccal midazolam 0.3 mg/kg.
• Bronchiolitis Management (NICE/NASPGHAN): Diagnosis: first episode of wheeze in <12 months, RSV season. Supportive care: nasal suction, oxygen if SpO2 <90%, IV fluids if unable to feed. No routine bronchodilators, steroids, or chest physiotherapy. Palivizumab prophylaxis for high-risk infants (ex-prem, CHD).
• Paediatric Dehydration Classification (WHO): No dehydration: <5% loss, normal condition, drinks well. Some dehydration: 5-10% loss, irritable, sunken eyes, skin pinch slow. Severe dehydration: >10% loss, lethargic, very sunken eyes, skin pinch goes back very slowly. Plan A: home ORS. Plan B: 75 mL/kg ORS over 4h. Plan C: 20 mL/kg IV bolus of RL/NS, repeat if needed.
• Paediatric Diabetic Ketoacidosis (ISPAD Guidelines): Fluid resuscitation: 10-20 mL/kg NS over 1h if shock, then deficit correction over 48h. Insulin: 0.1 U/kg/h IV (start after fluids). Do not give bicarbonate unless pH <6.9. Monitor for cerebral oedema: treat with mannitol 0.5-1 g/kg or 3% NaCl 5 mL/kg if neurological deterioration.
• NICE Traffic Light System for Fever: Green: no features of serious illness, manage at home. Amber: intermediate risk (pallor, tachycardia, tachypnoea, fever >5 days, etc.) – consider urine culture, FBC, CRP, CXR. Red: high risk (meningeal signs, non-blanching rash, lethargy, grunting) – urgent paediatric assessment, IV antibiotics (ceftriaxone 80 mg/kg).
• Neonatal Resuscitation (NRP Algorithm): APGAR <3 at 5 minutes: initiate PPV with 21% O2, reassess. If HR <60 despite 30 seconds of effective ventilation, start chest compressions (3:1 ratio). Consider IV epinephrine 0.01-0.03 mg/kg (0.1-0.3 mL/kg of 1:10,000). Therapeutic hypothermia (33.5°C for 72h) if moderate-severe HIE.
• Congenital Heart Disease: Duct-Dependent Lesions: PGE1 (alprostadil) 0.05-0.1 mcg/kg/min IV for ductal patency in critical coarctation, hypoplastic left heart, pulmonary atresia. Classic triad: cyanosis, respiratory distress, diminished femoral pulses. Echo is diagnostic; start PGE1 before transfer.
• Nephrotic Syndrome Management: First episode: prednisolone 60 mg/m2/day (max 80 mg) for 4 weeks, then 40 mg/m2 alternate days for 4 weeks. Salt restriction, fluid balance, no routine albumin. Indications for renal biopsy: age <1 year or >12 years, steroid resistance (no remission by 4 weeks), gross haematuria, low C3.

Common Traps in Pediatrics Questions

• Confusing simple febrile seizure with complex (focal, prolonged, multiple) – the latter requires EEG and neurological workup.
• Giving bronchodilators for bronchiolitis in infants <6 months – they are not effective and may cause tachycardia.
• Using hypotonic fluids (e.g., 0.45% NaCl) for maintenance in children with DKA – risk of cerebral oedema; use isotonic fluids.
• Assuming all febrile infants <3 months need a full septic workup – NICE recommends urine culture and bloods but LP only if risk factors present.
• Forgetting to calculate weight-based doses in mg/kg – many errors come from using adult fixed doses (e.g., paracetamol 500 mg in a 10 kg child).
• Misinterpreting a non-blanching rash as always meningococcal – it can be viral (e.g., enterovirus) but still requires urgent antibiotics until proven otherwise.

How to Revise Pediatrics for the DHA

Prioritise high-stakes presentations: febrile child, respiratory distress, dehydration, and neonatal emergencies. Questions are often scenario-based with a single best answer, focusing on next step in management (e.g., 'what is the most appropriate fluid?') or diagnostic red flags. Memorise key cut-offs: fever >38°C in <3 months is high risk; respiratory rate thresholds by age; systolic BP <70 + (2 x age in years) indicates shock. Practise weight-based calculations for fluids, drugs, and resuscitation. Use the NICE fever traffic light system and WHO dehydration chart as mental frameworks. Review UAE immunisation schedule (e.g., hexavalent at 2,4,6 months; MMR at 12 months). Expect one or two questions on child protection (bruising patterns, fractures in non-mobile infants). Do not over-study rare syndromes; focus on common conditions like asthma, UTI, and gastroenteritis.

Practise it: MedLumen has 90 Pediatrics questions for the DHA, each with a full explanation and references.