Master Pediatrics
for SMLE
Access 50+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Growth & Development: Track using WHO growth charts. Understand developmental milestones (gross motor, fine motor, language, social) and recognize deviations. Nutrition: Breastfeeding, Vit D/iron for infants. Malnutrition (marasmus, kwashiorkor) and obesity are key concerns.
Immunization: Crucial for disease prevention. Adhere to national schedules (e.g., Saudi schedule). Know contraindications (anaphylaxis, severe immunocompromise for live vaccines). Key vaccines (DTaP, MMR, Hep B, etc.) and understanding schedules are vital.
Neonatal Care: APGAR scoring, physiological vs. pathological jaundice (within 24 hrs, high rise, conjugated), common issues like Respiratory Distress Syndrome (RDS), sepsis, and congenital anomalies. Routine screenings.
Common Conditions: Focus on respiratory (asthma, bronchiolitis, pneumonia), GI (gastroenteritis, constipation), GU (UTI), and infectious diseases (febrile seizures, meningitis). Child abuse recognition.
Clinical Presentation
- Gastroenteritis: Vomiting, diarrhea, signs of dehydration (sunken fontanelle/eyes, dry membranes, decreased tears/urine, prolonged CRT, lethargy).
- Bronchiolitis: (Infants <2 yrs) Viral prodrome, cough, tachypnea, retractions, expiratory wheeze, crackles.
- Asthma: Recurrent wheezing, cough (especially nocturnal/exercise-induced), dyspnea, chest tightness.
- Pneumonia: Fever, cough, tachypnea, respiratory distress, localized crackles, decreased breath sounds.
- Urinary Tract Infection (UTI): Infants: fever, irritability, poor feeding. Older children: dysuria, frequency, urgency, enuresis, abdominal/flank pain, fever.
- Febrile Seizure: Seizure with fever (6 months-5 years), generalized tonic-clonic, usually <15 mins, single episode/24 hrs. No underlying CNS infection.
- Meningitis: Infants: fever, irritability, bulging fontanelle. Older: fever, headache, photophobia, neck stiffness, Kernig/Brudzinski signs.
- Child Abuse: Unexplained/inconsistent injuries, injuries incompatible with developmental stage, patterned bruises, spiral fractures, retinal hemorrhages.
Diagnosis (Gold Standard)
Gastroenteritis: Clinical. Stool culture for severe/persistent/bloody diarrhea, travel history.
Bronchiolitis: Clinical based on age and presentation. CXR not routinely recommended.
Asthma: Clinical. Spirometry (>5-6 yrs) with bronchodilator reversibility. Peak flow monitoring.
Pneumonia: Clinical with chest X-ray (infiltrates).
Urinary Tract Infection (UTI): Urine culture (clean catch, catheter specimen, suprapubic aspirate). Dipstick for screening.
Febrile Seizure: Clinical after ruling out CNS infection if indicated (e.g., <6 months).
Meningitis: Lumbar Puncture (LP) for CSF analysis (cell count, protein, glucose, Gram stain, culture) is gold standard.
Developmental Delay: Formal developmental assessment. Further workup based on suspected etiology.
Neonatal Jaundice: Total and conjugated serum bilirubin. Transcutaneous bilirubinometry for screening.
Management (First Line)
Gastroenteritis: Oral Rehydration Therapy (ORT) is cornerstone. Zinc supplementation (SMLE focus) reduces severity/duration. IV fluids for severe dehydration/shock.
Bronchiolitis: Supportive care: humidified oxygen for hypoxia, nasal suctioning, hydration. No routine bronchodilators/steroids/antibiotics.
Asthma Exacerbation: Inhaled short-acting beta-agonists (SABA) via spacer. Oral corticosteroids for moderate-severe. Long-term control with inhaled corticosteroids (ICS).
Pneumonia (CAP): Amoxicillin (oral) for uncomplicated bacterial pneumonia. Hospitalize infants/severe cases. Macrolides for atypicals.
Urinary Tract Infection (UTI): Empirical oral antibiotics (e.g., Cefixime) for 7-10 days, adjusted by culture. Renal US + VCUG for atypical/recurrent UTIs.
Febrile Seizure: Reassurance, antipyretics for comfort. Safety during seizure. No routine anticonvulsants.
Meningitis: Prompt IV empirical antibiotics (Ceftriaxone/Cefotaxime + Vancomycin). Dexamethasone may reduce neurological sequelae.
Anaphylaxis: Immediate intramuscular (IM) adrenaline (0.01 mg/kg, max 0.5mg/0.3mg infant) mid-anterolateral thigh. Repeat as needed.
Exam Red Flags
- Fever in an infant <3 months: Urgent evaluation and full septic workup until proven otherwise.
- Non-blanching rash (petechiae/purpura) + fever: Meningococcemia or serious bacterial infection; immediate antibiotics.
- Severe respiratory distress: Grunting, severe retractions, cyanosis, altered mental status, inability to feed.
- Bulging fontanelle: Raised intracranial pressure (e.g., meningitis, hydrocephalus, bleed).
- Significant dehydration/shock: Lethargy, prolonged capillary refill (>3 secs), weak pulses, hypotension.
- Absent red reflex: Suggests congenital cataract, retinoblastoma, vitreous hemorrhage.
- Neonatal jaundice within first 24 hours of life: Always pathological, requires urgent investigation.
- Inconsistent history/physical findings with injury: High suspicion for non-accidental trauma (child abuse).
- Regression of developmental milestones: Suggests neurological or metabolic disorder, requires urgent investigation.
- Acute scrotum: Testicular torsion is a surgical emergency; differentiate from epididymitis.
Sample Practice Questions
A 5-day-old full-term neonate is brought to the emergency department by his parents due to worsening jaundice, poor feeding, and lethargy. His skin is icteric down to his feet. On examination, he is mildly hypotonic, has a weak cry, and a temperature of 38.1°C. His total bilirubin is 22 mg/dL. What is the most likely underlying diagnosis explaining this overall presentation?
A 3-day-old exclusively breastfed male infant presents with yellowish discoloration of his skin and sclera. He was born at full term via spontaneous vaginal delivery, with no antenatal or perinatal complications. His birth weight was 3.2 kg, and his current weight is 2.9 kg. Physical examination reveals an alert infant with icterus extending to the abdomen. Bilirubin levels are measured at 18 mg/dL (unconjugated). What is the most likely diagnosis?
A 4-year-old child presents with a 6-day history of persistent high-grade fever. Physical examination reveals bilateral conjunctival injection without exudate, cracked red lips, a 'strawberry tongue,' diffuse polymorphous rash on the trunk and extremities, and palpable cervical lymphadenopathy. The child's extremities show erythema and swelling of the hands and feet. Based on these findings, what is the most crucial potential long-term complication to monitor for in this patient?
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