Master Paediatrics
for FMGE
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Paediatrics focuses on comprehensive care from birth to adolescence. Key areas for FMGE include:
- Growth & Development: Monitor using WHO charts (<5 years) and CDC charts (>5 years). Milestones (e.g., social smile by 3mo, head control by 4mo, sitting by 6-8mo, walking by 12-18mo, first words by 12-18mo). Red flags for developmental delay are critical.
- Immunization: Adhere to the National Immunization Schedule/IAP guidelines. Key vaccines: BCG, OPV, Hep B (Birth), DPT, Hib, Rotavirus, PCV (6, 10, 14 weeks), Measles/MR, Vit A (9 months), DPT & OPV boosters (16-24 months & 5-6 years).
- Nutrition: Exclusive breastfeeding for 6 months, complementary feeding from 6 months. Common deficiencies: Iron (anaemia), Vitamin D (rickets), Vitamin A (xerophthalmia).
- Fluid & Electrolyte: Assessment of dehydration (mild, moderate, severe). ORS is cornerstone for mild-moderate. IV fluids (Ringer Lactate) for severe dehydration. Maintenance fluid calculation: 4-2-1 rule.
- Neonatal Care: APGAR scoring, thermoregulation, cord care, screening for congenital hypothyroidism and G6PD deficiency (if regional). Physiologic vs. Pathologic Jaundice differentiation.
Clinical Presentation
- Fever: Most common symptom. Crucial to differentiate benign viral fever from serious bacterial infection (SBI), especially in infants <3 months. Febrile seizures (generalized tonic-clonic, 6mo-5yr, short duration, no focal signs, single episode/24hr).
- Respiratory Distress: Tachypnoea, nasal flaring, grunting, chest indrawing, stridor, wheezing. Common causes: Bronchiolitis (infants, wheezing), Croup (barking cough, inspiratory stridor), Pneumonia (cough, fever, tachypnoea, crackles/reduced breath sounds).
- Diarrhea & Vomiting: Assess dehydration (sunken eyes, poor skin turgor, lethargy, decreased urine output). Persistent projectile non-bilious vomiting (pyloric stenosis), bilious vomiting (intestinal obstruction).
- Rashes: Common exanthems (Measles, Rubella, Varicella). Non-blanching rash (petechiae/purpura) is an emergency.
- Jaundice: Neonatal jaundice (physiological after 24h, peaks day 3-5, resolves by 1-2 weeks; pathological within 24h, high rates of rise, prolonged).
- Seizures: Differentiate types (febrile, epilepsy, metabolic). Status epilepticus defined as seizure >5 min or recurrent without recovery of consciousness.
Diagnosis (Gold Standard)
Key diagnostic approaches often involve clinical assessment and targeted investigations:
- Meningitis: Lumbar Puncture (CSF analysis: cell count, protein, glucose, Gram stain, culture).
- Urinary Tract Infection (UTI): Urine culture (suprapubic aspiration or catheter specimen for definitive diagnosis in infants/young children).
- Congenital Hypothyroidism: Newborn screening (TSH and T4 levels).
- Hirschsprung's Disease: Rectal biopsy demonstrating absence of ganglion cells.
- Pyloric Stenosis: Abdominal Ultrasound (identifying thickened pyloric muscle and elongated canal).
- Intussusception: Ultrasound with "target sign" or "pseudokidney sign."
- Growth Faltering/Failure to Thrive: Serial plot of weight, height, head circumference on age/sex-appropriate growth charts.
Management (First Line)
First-line management for common paediatric conditions:
- Dehydration (Diarrhea/Vomiting): ORS (WHO Plan A, B) for mild-moderate. IV Ringer's Lactate for severe dehydration/shock (Plan C).
- Fever: Antipyretics (Paracetamol 10-15mg/kg/dose, Ibuprofen 5-10mg/kg/dose). Treat underlying cause.
- Acute Asthma Exacerbation: Nebulized Salbutamol (SABA). Systemic corticosteroids (oral Prednisolone) for moderate-severe.
- Community Acquired Pneumonia: Oral Amoxicillin (first-line for non-severe). Oxygen therapy for hypoxemia.
- Status Epilepticus: Maintain airway (ABC). First-line: IV Lorazepam/Diazepam or buccal Midazolam.
- Severe Acute Malnutrition (SAM): F-75 milk (stabilization phase) followed by F-100 milk (catch-up growth phase).
- Neonatal Jaundice (Pathological): Phototherapy based on age and bilirubin levels. Exchange transfusion for severe hyperbilirubinemia.
- Anaphylaxis: Intramuscular Adrenaline (epinephrine) is the first-line treatment.
Exam Red Flags
- Fever in an infant <3 months: Always consider serious bacterial infection; requires admission, sepsis workup, and empiric IV antibiotics until sepsis is ruled out.
- Non-blanching rash (petechiae/purpura): Suggests meningococcemia or other severe sepsis/vasculitis. MEDICAL EMERGENCY.
- Stridor at rest, severe respiratory distress with cyanosis: Imminent airway compromise; requires urgent intervention.
- Red currant jelly stools with colicky abdominal pain & palpable mass: Classic triad for Intussusception.
- Absent red reflex / Leukocoria (white pupil): Suspect Retinoblastoma or congenital cataract.
- Projectile, non-bilious vomiting (2-6 weeks age): Highly suggestive of Pyloric Stenosis.
- Regression of previously attained milestones: Indicates serious neurological or metabolic disorder; demands urgent investigation.
- Multiple fractures of varying ages, specific patterns of bruising/burns: Strong indicators of non-accidental injury/child abuse.
- Fever >5 days with conjunctivitis, rash, cracked lips, lymphadenopathy: Kawasaki disease (risk of coronary artery aneurysms).
Sample Practice Questions
A 15-month-old boy presents to the emergency department with a first episode of generalized tonic-clonic seizure, lasting for approximately 3 minutes. His mother reports he had a fever of 39.5°C earlier in the day and had been irritable. There is no prior history of seizures or neurological problems. On arrival, the child is post-ictal but responsive, and his temperature is 38.8°C. Meningeal signs are absent.
A 7-day-old exclusively breastfed term infant presents with lethargy, poor feeding, and jaundice extending to the abdomen and soles. On examination, the infant is irritable, has a high-pitched cry, and an anterior fontanelle that feels slightly tense. Sepsis workup is negative. Total bilirubin is 28 mg/dL with direct bilirubin 1.2 mg/dL. The infant's mother is O positive, and the infant is A positive. What is the most appropriate initial intervention?
A 6-year-old girl is brought to the clinic by her parents due to concerns about her short stature. She is consistently in the 3rd percentile for height, while her weight is in the 25th percentile. Her birth history was unremarkable, and her growth velocity has been consistently below the 25th percentile since age 2. Physical examination reveals normal proportions, no dysmorphic features, and Tanner stage 1 breast development. Bone age assessment shows a bone age of 4 years. Her father is 5'4" (163 cm) and her mother is 4'10" (147 cm). Which of the following is the most likely diagnosis?
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