Master Paediatrics
for PMDC NLE Step 1

Core Concepts

Paediatrics focuses on the growth, development, and health of children from birth to adolescence. Key principles include understanding normal developmental milestones (gross motor, fine motor, language, social-adaptive), recognizing deviations, and providing preventative care. Immunization is paramount in preventing common childhood diseases; adherence to national schedules (e.g., EPI program) is critical. Neonatal screening programs for conditions like Congenital Hypothyroidism and Phenylketonuria (PKU) are vital for early detection and intervention to prevent irreversible complications. Growth is monitored via growth charts (WHO for 0-5 years, CDC for >5 years); Failure to Thrive (FTT) is defined as weight <3rd/5th percentile or a drop >2 major percentiles. Apgar score (0-10 at 1 and 5 minutes) assesses newborn vitality.

Clinical Presentation

• **Neonatal Jaundice:** Yellow skin/sclera, cephalocaudal progression. Pathological if within 24h, prolonged, rapid rise, or with other illness.
• **Respiratory Distress in Infants:** Tachypnea, nasal flaring, grunting, retractions, cyanosis. Causes: RDS (preterm), TTN, Meconium Aspiration, Sepsis, Bronchiolitis.
• **Bronchiolitis:** (RSV most common, <2yrs) Rhinorrhea, cough, wheezing, tachypnea, crackles.
• **Croup (Laryngotracheobronchitis):** (Viral, Parainfluenza) Barking cough, inspiratory stridor, hoarseness, often worse at night.
• **Asthma:** Recurrent episodes of wheezing, cough (nocturnal/exercise-induced), shortness of breath.
• **Bacterial Meningitis:** (Infants) Irritability, lethargy, poor feeding, bulging fontanelle, seizures, fever. (Older) Fever, headache, neck stiffness, photophobia.
• **Urinary Tract Infection (UTI):** (Infants) Unexplained fever, poor feeding, vomiting. (Older) Dysuria, frequency, urgency, suprapubic pain.
• **Pyloric Stenosis:** Non-bilious, projectile vomiting (2-8 weeks old), infant remains hungry. May palpate "olive" mass.
• **Intussusception:** Colicky abdominal pain, "red currant jelly" stools, vomiting, palpable "sausage-shaped" mass (RUQ). (3 months - 3 years).
• **Hirschsprung Disease:** Delayed passage of meconium (>48h), chronic constipation, abdominal distention.
• **Congenital Heart Disease (CHD):** (Cyanotic) Cyanosis, clubbing, poor feeding, FTT. (Acyanotic) FTT, recurrent chest infections, murmur.
• **Nephrotic Syndrome:** Generalized edema, massive proteinuria, hypoalbuminemia, hyperlipidemia. (Minimal Change Disease most common in children).
• **Congenital Hypothyroidism:** Lethargy, poor feeding, constipation, prolonged jaundice, large fontanelles, umbilical hernia, macroglossia, dry skin.
• **Febrile Seizures:** Seizure with fever (6 months - 5 years), no CNS infection or prior afebrile seizures.

Diagnosis (Gold Standard)

**Neonatal Sepsis/Bacterial Meningitis:** Blood culture, CSF analysis (Lumbar Puncture).
**Pyloric Stenosis:** Abdominal ultrasound (target sign, thickened pyloric muscle).
**Intussusception:** Abdominal ultrasound (target/doughnut sign); Air or saline enema (diagnostic & therapeutic).
**Hirschsprung Disease:** Rectal suction biopsy (absence of ganglion cells).
**Cystic Fibrosis:** Sweat chloride test (chloride >60 mmol/L).
**Urinary Tract Infection:** Urine culture (clean catch or catheter specimen).
**Congenital Hypothyroidism:** Elevated TSH and low T4 on heel prick screen, confirmed by venous blood test.

Management (First Line)

**Neonatal Jaundice (Pathological):** Phototherapy. Exchange transfusion for severe cases.
**Neonatal Sepsis:** Empirical broad-spectrum IV antibiotics (e.g., Ampicillin + Gentamicin or Cefotaxime).
**Bronchiolitis:** Supportive care: hydration, oxygen, nasal suctioning. No role for bronchodilators/steroids.
**Croup:** Dexamethasone (oral single dose), nebulized epinephrine for moderate/severe stridor.
**Acute Asthma Exacerbation:** Short-acting beta-agonists (SABA) via nebulizer/spacer, systemic corticosteroids.
**Bacterial Meningitis:** Empirical IV antibiotics (e.g., Ceftriaxone + Vancomycin), Dexamethasone (adjunctive).
**Pyloric Stenosis:** Pyloromyotomy (surgical correction) after fluid/electrolyte resuscitation.
**Intussusception:** Air/saline enema reduction. Surgical reduction if enema fails.
**Hirschsprung Disease:** Surgical resection of aganglionic segment.
**Nephrotic Syndrome (Minimal Change Disease):** Oral corticosteroids (prednisolone).
**Congenital Hypothyroidism:** Oral levothyroxine (lifelong).
**Febrile Seizures:** Reassurance, manage fever with antipyretics (no chronic antiepileptics).
**Anaphylaxis:** IM Epinephrine (0.01 mg/kg, max 0.5 mg, 1:1000 solution), ABCs, oxygen.

Exam Red Flags