Master Paediatrics
for FMGE

What the FMGE Tests in Paediatrics

The FMGE Paediatrics section tests your ability to manage common paediatric emergencies, recognise age-specific normal variants, and apply evidence-based guidelines for conditions like neonatal jaundice, acute gastroenteritis, pneumonia, and febrile seizures. You must know WHO IMCI protocols, vaccination schedules (including BCG, OPV, DPT, MMR), and critical cut-offs: bilirubin levels for phototherapy/exchange transfusion, dehydration severity (mild: <5%, moderate: 5-10%, severe: >10%), and fever without focus management in infants under 3 months. Emphasis is on clinical reasoning: choosing first-line antibiotics (e.g., ampicillin + gentamicin for neonatal sepsis), recognising signs of respiratory distress (grunting, chest indrawing, head bobbing), and differentiating rashes (measles, Kawasaki, meningococcaemia). You must also know growth chart interpretation (WHO standards), developmental milestones (e.g., pincer grasp at 9 months, walking alone at 12 months), and management of childhood poisoning (paracetamol, iron).

High-Yield Concepts

• Neonatal Jaundice Management: Use Bhutani nomogram for phototherapy threshold: at 72 hours, term infant with bilirubin >15 mg/dL requires phototherapy; >20 mg/dL consider exchange transfusion. First-line: intensive phototherapy (double/triple surface). If Rh incompatibility, give anti-D immunoglobulin to mother. Kernicterus risk: bilirubin >25 mg/dL.
• Acute Gastroenteritis and Dehydration: Assess dehydration: mild (thirsty, normal eyes/tone), moderate (sunken eyes, reduced skin turgor, irritable), severe (lethargic, very sunken eyes, skin pinch goes back >2 sec). Rehydrate: mild-moderate with ORS (50-100 mL/kg over 4 hours); severe with IV Ringer's lactate 20 mL/kg bolus. Zinc supplementation (10-20 mg/day for 14 days) reduces duration.
• Febrile Seizure Criteria and Management: Simple febrile seizure: generalized, <15 minutes, single in 24h, age 6 months-5 years. No LP needed if alert and no meningeal signs. First-line abortive: rectal diazepam (0.5 mg/kg) or buccal midazolam (0.3 mg/kg). No prophylactic antipyretics to prevent recurrence. EEG not indicated.
• Pneumonia Diagnosis (WHO IMCI): Classify: no pneumonia (cough, no tachypnea), pneumonia (tachypnea: <2 months >60/min, 2-12 months >50/min, 1-5 years >40/min), severe pneumonia (chest indrawing, stridor, or danger signs). First-line antibiotics: amoxicillin 45 mg/kg/day for pneumonia; for severe, IV ampicillin + gentamicin or ceftriaxone.
• Kawasaki Disease Diagnosis: Diagnostic criteria: fever >5 days plus 4 of 5: bilateral conjunctivitis, strawberry tongue/cracked lips, polymorphous rash, cervical lymphadenopathy (>1.5 cm), extremity changes (erythema, desquamation). Treatment: IVIG 2 g/kg single dose + high-dose aspirin (80-100 mg/kg/day) until afebrile, then low-dose (3-5 mg/kg/day) for 6-8 weeks. Echo for coronary aneurysms.
• Developmental Milestones Key Ages: 6 weeks: social smile. 4 months: head control, reaches for objects. 6 months: sits unsupported, transfers objects. 9 months: pincer grasp, crawls. 12 months: walks alone, says 1-2 words. 18 months: runs, uses spoon. 2 years: climbs stairs, 2-word phrases. 3 years: tricycle, copies circle. 4 years: hops on one foot, knows colours. 5 years: skips, ties shoelaces.
• Childhood Immunization Schedule (India): At birth: BCG, OPV-0, HepB-0. 6 weeks: DTwP-1, IPV-1, HepB-1, Hib-1, Rotavirus-1. 10 weeks: DTwP-2, IPV-2, HepB-2, Hib-2, Rotavirus-2. 14 weeks: DTwP-3, IPV-3, HepB-3, Hib-3, Rotavirus-3. 9-12 months: MMR-1, OPV-1. 16-24 months: DTwP booster, OPV-2, MMR-2. 5-6 years: DTwP booster. 10 years: Tdap.
• Neonatal Sepsis Workup and Management: Risk factors: PROM >18h, maternal fever, chorioamnionitis, preterm. Workup: CBC, CRP, blood culture, LP if suspect meningitis. Start empiric antibiotics: ampicillin (50 mg/kg/dose) + gentamicin (4 mg/kg/day) or cefotaxime. If meningitis: add vancomycin. Duration: 7-10 days for bacteremia, 14-21 days for meningitis.

Common Traps in Paediatrics Questions

• Confusing physiological jaundice (appears day 2-3, resolves by day 7-10) with pathological jaundice (appears <24h, bilirubin rising >5 mg/dL/day, or persists >2 weeks).
• Using antipyretics to prevent febrile seizures — they do not reduce recurrence risk; only rescue benzodiazepines are indicated for active seizures.
• Assuming all wheezing in infants is asthma — bronchiolitis (RSV, age <2 years) is far more common and treated with supportive care, not bronchodilators routinely.
• Forgetting to adjust drug doses for weight and age — paediatric doses are mg/kg, and using adult doses or fixed doses is a dangerous error.
• Misinterpreting a bulging fontanelle as only meningitis — also consider hydrocephalus, intracranial bleed, or venous sinus thrombosis.
• Giving IV fluids too rapidly in diabetic ketoacidosis — risk of cerebral oedema; use 0.9% saline at 10-20 mL/kg over 1 hour, then slow deficit replacement over 48 hours.

How to Revise Paediatrics for the FMGE

Focus on high-stakes, time-critical paediatric scenarios: neonatal resuscitation (APGAR, meconium aspiration), sepsis, severe dehydration, and status epilepticus. Questions frequently present a clinical vignette with a single best answer, often requiring you to pick the next step in management (e.g., 'start IV antibiotics' vs 'observe'). Memorise key cut-offs: bilirubin phototherapy thresholds, dehydration percentages, fever without source age-based algorithms (e.g., <28 days: full septic workup; 28-90 days: consider RSV, urinalysis). Practice interpreting growth charts and Denver II milestones. Also, know the IMCI danger signs (convulsions, lethargy, not feeding, vomiting everything, stridor). For therapeutics, commit to memory first-line antibiotics for common infections (pneumonia, UTI, meningitis) and reversal agents (naloxone for opioids, flumazenil for benzodiazepines, but avoid in mixed overdoses).

Practise it: MedLumen has 50 Paediatrics questions for the FMGE, each with a full explanation and references.