DHA Pediatrician Exam – Quick Reference

1. Core Pediatric Clinical Knowledge Domains

• A. Growth and Development, Adolescent Health, and Behavior: 
  • Normal Growth Patterns & Use of Growth Charts:
    • Core Concept: Monitor growth using standardized charts (WHO 0-2 yrs, CDC >2 yrs). Key charts: Length/Height-for-age, Weight-for-age, Weight-for-length/height, BMI-for-age, Head Circumference (up to 2-3 yrs).
    • Interpretation: Assess patterns, not single points. Crossing >2 major percentiles, BMI >85th/>95th, or Weight-for-length/height <-2 or >+2 SDs warrants investigation.
    • Tools: Calculate Mid-Parental Height (MPH) to estimate genetic potential.
  • Developmental Milestones (Infancy, Childhood, Adolescence):
    • Domains: Track Gross Motor, Fine Motor, Language (Expressive/Receptive), Social-Emotional/Cognitive milestones.
    • Key Ages: Know average ages for major milestones (e.g., social smile ~2mo, sitting ~6mo, walking ~12-15mo, first words ~12mo, 2-word phrases ~24mo).
    • Screening: Use validated tools (ASQ, PEDS, M-CHAT for autism) at well-child visits to detect delays early. Refer if concerns arise.
  • Puberty and Related Issues:
    • Staging: Use Tanner stages (I-V) for breast/pubic hair (girls) and genital/pubic hair (boys) development.
    • Timing: Normal onset ~8-13 yrs (girls), ~9-14 yrs (boys). Sequence: Thelarche/Testicular enlargement first usually.
    • Abnormalities: Precocious = before 8 (girls)/9 (boys). Delayed = no signs by 13 (girls)/14 (boys). Requires endocrine workup (LH, FSH, Estradiol/Testosterone, Bone Age).
  • Behavioral Disorders:
    • ADHD: Core symptoms: Inattention, Hyperactivity, Impulsivity (DSM-5). Requires impairment in ≥2 settings. Management: Behavior therapy + Stimulants (first-line meds) or non-stimulants. Screen with Vanderbilt/Conners.
    • ASD: Core deficits: Social communication/interaction & Restricted/repetitive behaviors. Screen toddlers with M-CHAT. Diagnosis is clinical +/- ADOS/ADI-R. Management: Early intensive behavioral intervention (ABA).
    • Others: Recognize ODD (negativistic, defiant), Conduct Disorder (violates rights/rules), Anxiety, Depression – often comorbid.
  • Adolescent Health Concerns:
    • Screening: Use HEEADSSS (Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, Safety) framework. Confidentiality is key (with limits).
    • Key Issues: Mental Health (Depression/Anxiety screening), Substance Use (SBIRT approach), Sexual Health (STI/pregnancy prevention), Eating Disorders (SCOFF screen), Safety (driving, violence).
    • Transition: Prepare adolescents with chronic conditions for transfer to adult healthcare system.
• B. Gastroenterology: 
  • Common GI Disorders:
    • GERD: Infants: Reflux common, GERD if complications (FTT, esophagitis). Older children: Heartburn. Mgmt: Lifestyle (infants: positioning/thickening; older: avoid triggers), PPIs if severe/erosive.
    • Constipation: Often functional. Use Rome IV criteria. Mgmt: Disimpaction (if needed), Maintenance (PEG 3350 often first-line), Diet (fiber/fluids), Behavior (scheduled toileting). Rule out organic causes (Hirschsprung’s, thyroid, celiac).
    • Diarrhea: Acute (<14d, usually infectious) vs Chronic (>14d). Focus on hydration status. Chronic needs workup (infection, allergy, IBD, celiac, toddler’s diarrhea).
  • Infectious Gastroenteritis:
    • Etiology: Viral (Rota, Noro) most common. Bacterial (Salmonella, Shigella, Campy, E. coli O157:H7) less common but can be severe (dysentery).
    • Mgmt: Oral Rehydration Therapy (ORT) is cornerstone. Assess dehydration clinically. IV fluids if severe dehydration or ORT failure. Antibiotics rarely needed (indicated for Shigella, C. diff, sepsis, specific hosts). Antidiarrheals generally avoided.
  • Inflammatory Bowel Disease (IBD):
    • Types: Crohn’s (CD – transmural, skip lesions, anywhere mouth to anus, granulomas) vs Ulcerative Colitis (UC – mucosal, continuous, colon only, no granulomas).
    • Presentation: Abdo pain, diarrhea (bloody in UC), weight loss, fever, fatigue, extraintestinal manifestations (arthritis, uveitis, skin).
    • Dx: Labs (CRP/ESR, fecal calprotectin), Endoscopy + Biopsy essential, Imaging (MRE).
    • Mgmt: Induce remission (steroids, biologics), Maintain remission (immunomodulators, biologics). Nutrition support vital.
  • Celiac Disease:
    • Patho: Immune reaction to gluten (wheat, barley, rye) in genetically susceptible individuals (HLA-DQ2/DQ8). Leads to small bowel villous atrophy.
    • Presentation: GI (diarrhea, FTT, abdo pain) or extraintestinal (anemia, dermatitis herpetiformis, short stature, delayed puberty).
    • Dx: IgA Tissue Transglutaminase (TTG) Ab + Total IgA. Confirm with duodenal biopsy showing villous atrophy before starting gluten-free diet (GFD).
    • Mgmt: Lifelong strict GFD. Monitor TTG levels. Nutritional counseling.
  • Nutritional Deficiencies:
    • Iron: Most common. Screen high-risk infants/toddlers. Treat with oral iron.
    • Vitamin D: Rickets risk if inadequate sun/diet/supplementation. Supplement infants (400 IU/day). Treat deficiency with higher doses.
    • Others: B12 (vegan diets), Zinc (chronic diarrhea), Calcium (low dairy intake). Assess diet, consider supplements if deficient.
  • Pediatric Liver Diseases:
    • Neonatal Cholestasis: Jaundice + elevated conjugated bilirubin (>1 mg/dL or >20% total). URGENT workup needed to rule out Biliary Atresia (needs Kasai procedure <60 days age). Other causes: infections, metabolic, genetic.
    • Acute Liver Failure: Rare but serious. Causes: Drugs (Acetaminophen), Viruses (Hepatitis A/B, EBV), Metabolic (Wilson’s), Autoimmune. Needs PICU, transplant evaluation.
    • LFT Interpretation: AST/ALT = hepatocellular injury. Alk Phos/GGT = cholestasis. Bilirubin (conj vs unconj). Albumin/PT = synthetic function.
• C. Acute Care (ER, PICU, NICU): 
  • Neonatal and Pediatric Resuscitation (NRP/PALS Principles):
    • NRP: Focus on Term? Tone? Breathing/Crying? Initial steps (Warm, Dry, Stimulate, Position Airway, Suction if needed). Assess HR & Resp effort -> PPV -> Chest Compressions -> Epinephrine/Volume if needed.
    • PALS: Systematic approach: Recognize -> Intervene -> Prevent arrest. Assess (Appearance, Breathing, Circulation – PAT triangle), Evaluate (ABCDE), Identify (Resp distress/failure, Shock type, Cardiac arrest), Intervene (Manage airway, O2, Fluids, Meds based on algorithms). High-quality CPR is key.
  • Management of Shock and Sepsis:
    • Recognition: Tachycardia (early!), Tachypnea, Altered mental status, Weak pulses, Delayed cap refill (>2s), Hypotension (late!). Compensated vs Decompensated.
    • Types: Hypovolemic (fluids!), Distributive (septic – fluids + vasopressors + antibiotics!), Cardiogenic (inotropes, cautious fluids), Obstructive (treat cause e.g., tension pneumo, tamponade).
    • Sepsis: Recognize early (qSOFA/SIRS adaptation). Act fast: Blood cultures -> Broad-spectrum IV antibiotics (<1 hr) -> IV fluid boluses (20ml/kg up to 60ml/kg in 1st hr, reassess frequently) -> Vasopressors (Norepi/Epi) if fluid-refractory. Target normalizing perfusion.
  • Respiratory Distress Management:
    • Signs: Tachypnea, Retractions (subcostal, intercostal, supraclavicular), Nasal flaring, Grunting, Head bobbing, Cyanosis, Altered mental status.
    • Causes: Upper airway (Croup, FBA), Lower airway (Asthma, Bronchiolitis), Parenchymal (Pneumonia), Non-pulmonary (DKA, sepsis, cardiac).
    • Mgmt: O2 to maintain SpO2 >94%. Non-invasive (CPAP/BiPAP) if increasing work/hypoxia. Intubation/Mechanical ventilation if respiratory failure (severe hypoxia, hypercapnia, exhaustion). Treat underlying cause.
  • Status Epilepticus/Seizure Management:
    • Definition: Seizure >5 min OR ≥2 seizures without recovery between.
    • Mgmt Algorithm: ABCs, O2, Check glucose. 1st line: IV/IM/Rectal Benzodiazepine (Lorazepam, Diazepam, Midazolam). If no cessation: 2nd line: IV Fosphenytoin, Valproic acid, Levetiracetam, or Phenobarbital. Consider underlying cause (fever, infection, metabolic, toxin, structural). Continuous EEG if refractory.
  • Diabetic Ketoacidosis (DKA) Management:
    • Dx Triad: Hyperglycemia (>200 mg/dL), Ketosis (urine/serum), Acidosis (pH <7.3 or Bicarb <15).
    • Patho: Insulin deficiency -> Hyperglycemia, Lipolysis -> Ketones -> Acidosis + Osmotic diuresis -> Dehydration, Electrolyte loss (K+ total body depleted despite serum level).
    • Mgmt: 1) Fluids: NS bolus (10-20ml/kg over 1hr), then slower deficit replacement over 48hrs (avoid rapid osmolality changes -> cerebral edema risk). 2) Insulin: Start after initial fluids (0.05-0.1 U/kg/hr IV infusion). 3) Electrolytes: Add K+ to IV fluids once urine output established and K+ <5.5. Monitor glucose, electrolytes, neuro status closely. Transition to SC insulin when acidosis resolved, patient eating.
  • Pediatric Trauma Principles:
    • Primary Survey (ABCDE): Airway (maintain C-spine prn), Breathing (assess/manage pneumo/hemothorax), Circulation (control hemorrhage, IV access, fluids/blood), Disability (GCS/AVPU, pupils, neuro exam), Exposure (undress, prevent hypothermia).
    • Secondary Survey: Head-to-toe exam, history (AMPLE), reassess vitals.
    • Peds Specifics: Airway smaller, head larger (C-spine injury risk), faster heat loss, different physiological response to shock (compensate longer then crash). High index of suspicion for non-accidental trauma (NAT).
  • Common Pediatric Emergencies:
    • Foreign Body Aspiration (FBA): Sudden onset cough/choke/gag. Unilateral wheeze/decreased breath sounds. CXR (may show hyperinflation, atelectasis, object). Rigid bronchoscopy for diagnosis/removal.
    • Poisoning: Identify toxin if possible (history, toxidrome). ABCs. Decontamination (Activated Charcoal if appropriate/timely). Specific antidotes (e.g., N-acetylcysteine for acetaminophen, Naloxone for opioids). Contact Poison Control.
    • Anaphylaxis: Rapid onset multi-system allergic reaction. IM Epinephrine is first-line, life-saving treatment. Airway support, O2, IV fluids, Antihistamines/Steroids (adjunctive).
    • Acute Abdomen: Appendicitis (periumbilical -> RLQ pain, fever, anorexia), Intussusception (colicky pain, currant jelly stool, sausage mass – US dx, air/contrast enema reduction), Volvulus (bilious emesis – surgical emergency).
• D. Metabolic and Endocrine Disorders: 
  • Diabetes Mellitus (Type 1 & Type 2):
    • T1DM: Autoimmune destruction of beta cells -> absolute insulin deficiency. Presentation: Polydipsia, Polyuria, Polyphagia, Weight loss, DKA possible. Mgmt: Insulin (basal-bolus MDI or pump), Carb counting, Glucose monitoring (CGM), Complication screening (retinopathy, nephropathy, neuropathy).
    • T2DM: Insulin resistance + relative deficiency. Risk factors: Obesity, Family Hx, Ethnicity, PCOS. Presentation: Often insidious, Acanthosis nigricans. Mgmt: Lifestyle (diet/exercise), Metformin, Insulin if needed.
  • Thyroid Disorders:
    • Congenital Hypothyroidism: Usually detected by Newborn Screen. Cause: Dysgenesis, Dyshormonogenesis. Presentation if missed: Lethargy, poor feeding, constipation, prolonged jaundice, coarse features. URGENT treatment with Levothyroxine prevents severe neurodevelopmental impairment.
    • Acquired Hypo (Hashimoto’s): Autoimmune. Presentation: Growth failure, fatigue, cold intolerance, constipation, goiter. Dx: High TSH, Low Free T4, +Anti-TPO Ab. Tx: Levothyroxine.
    • Hyper (Graves’): Autoimmune (TSH receptor Ab). Presentation: Weight loss, heat intolerance, anxiety, tachycardia, goiter, exophthalmos. Dx: Low TSH, High Free T4/T3, +TRAb. Tx: Methimazole, PTU, Radioiodine, Surgery.
  • Growth Hormone Deficiency & Other Growth Disorders:
    • Short Stature Workup: Accurate measurements, Growth velocity (<4-6cm/yr concerning), MPH, Bone age X-ray. Screen for systemic disease (celiac, IBD, renal, thyroid).
    • GHD: Consider if growth velocity low +/- low IGF-1/IGFBP-3. Dx confirmed with GH stimulation tests. Tx: Recombinant hGH injections.
    • Others: Turner Syndrome (XO – need karyotype), Skeletal dysplasias (Achondroplasia – disproportionate), IUGR/SGA (catch-up growth?), Chronic illness.
  • Inborn Errors of Metabolism (IEM):
    • Presentation: Often non-specific: Neonatal encephalopathy, sepsis-like picture, vomiting, FTT, developmental delay, acidosis, hypoglycemia, hyperammonemia.
    • Screening: Newborn screening (NBS) vital for early detection (PKU, Galactosemia, MCADD etc.).
    • Mgmt Principles: Acute: Stop offending substrate (protein, fats), provide IV glucose/fluids, remove toxins (dialysis). Chronic: Dietary restriction (PKU low-Phe diet), Cofactor supplementation (Biotinidase def). Specialist (Metabolic Genetics) input essential.
  • Adrenal Gland Disorders:
    • CAH (21-hydroxylase deficiency most common): Ambiguous genitalia (females), Salt wasting crisis (vomiting, dehydration, shock ~1-2 wks age). Dx: High 17-OH Progesterone (NBS). Tx: Glucocorticoids (Hydrocortisone) + Mineralocorticoids (Fludrocortisone if salt-wasting). Stress dose steroids for illness.
    • Adrenal Insufficiency (Addison’s): Weakness, fatigue, weight loss, hyperpigmentation, hypotension, hypoglycemia, electrolyte issues (low Na, high K). Dx: Low AM cortisol, High ACTH, ACTH stim test non-responsive. Tx: Glucocorticoid/Mineralocorticoid replacement. Stress dosing crucial.
    • Cushing’s: Excess cortisol (exogenous steroids most common cause, or pituitary/adrenal tumor). Features: Weight gain (central), moon facies, striae, hypertension, growth failure. Dx: 24hr urine free cortisol, Dexamethasone suppression test. Tx: Address cause (taper steroids, surgery).
  • Calcium and Phosphorus Metabolism Disorders:
    • Rickets: Defective bone mineralization. Nutritional (Vit D def most common) or Genetic. Features: Bowed legs, delayed fontanelle closure, rachitic rosary, bone pain, fractures. Dx: Low/normal Ca, Low Phos, High Alk Phos, High PTH, Low 25-OH Vit D (in nutritional). X-rays show cupping/fraying of metaphyses. Tx: Vit D + Calcium supplementation.
    • Hypo/Hypercalcemia: Multiple causes (PTH disorders, Vit D issues, renal failure, malignancy). Need Ionized Ca. Check PTH, Phos, Vit D levels. Treat underlying cause + specific Ca management.
• E. Allergy, Immunology, and Infectious Diseases: 
  • Common Allergic Conditions:
    • Asthma: See Respiratory. Chronic airway inflammation, reversible bronchoconstriction.
    • Allergic Rhinitis: IgE-mediated nasal inflammation. Sneezing, rhinorrhea, itchy nose/eyes. Mgmt: Allergen avoidance, Antihistamines, Intranasal steroids (most effective).
    • Atopic Dermatitis (Eczema): Chronic itchy skin inflammation. “Itch that rashes”. Associated with other atopy. Mgmt: Emollients (barrier repair), Topical steroids (flares), Avoid triggers, Antihistamines (itch), Wet wraps.
    • Food Allergies: IgE-mediated (rapid onset urticaria, angioedema, anaphylaxis) or Non-IgE (delayed GI symptoms). Dx: History + Skin Prick Test (SPT) / Specific IgE (sIgE). Oral Food Challenge (OFC) is gold standard. Mgmt: Strict avoidance, Epinephrine auto-injector for IgE-mediated, Food ladder for baked milk/egg introduction sometimes.
  • Anaphylaxis Recognition and Management:
    • Recognition: Acute onset illness with skin/mucosal involvement PLUS Respiratory compromise OR Hypotension OR GI symptoms OR Reduced muscle tone (infants).
    • Mgmt: IM Epinephrine (0.01 mg/kg, max 0.3-0.5mg) in anterolateral thigh ASAP. Repeat q5-15min prn. Secure airway, High-flow O2, IV fluids (bolus if hypotensive). Adjuncts: H1/H2 blockers, Glucocorticoids (prevent biphasic reaction). Observe 4-6+ hrs. Prescribe Epi auto-injector x2 + Action Plan.
  • Primary and Secondary Immunodeficiency Syndromes:
    • PIDs: Suspect if recurrent/severe/unusual infections, FTT, specific features. Warning signs (Jeffrey Modell Foundation). Examples: SCID (T-cell defect, emergency), CVID (low IgG/IgA/IgM), XLA (B-cell defect, low Ig’s), DiGeorge (22q11 del, T-cell defect + cardiac/facial/hypoCa), CGD (phagocyte defect, specific infections). Workup: CBC+diff, Immunoglobulins, Vaccine titers, Lymphocyte subsets, Complement assays, specific gene tests.
    • Secondary: More common. Causes: HIV, Malnutrition, Drugs (steroids, chemo), Malignancy, Protein-losing states.
  • Common Viral and Bacterial Infections:
    • Viral: URI (rhinovirus), Flu (fever, cough, myalgia – Tamiflu if indicated), Measles (cough, coryza, conjunctivitis -> rash), Varicella (itchy vesicular rash), RSV (bronchiolitis).
    • Bacterial: Otitis Media (Strep pneumo, H flu, M cat – Amox first line), Strep Pharyngitis (GAS – Centor criteria, Rapid test/culture – Penicillin/Amox), Pneumonia (see Resp), UTI (see Renal). Fever in infant <3 mo requires sepsis workup.
    • Stewardship: Use antibiotics judiciously based on likely pathogen and host.
  • Tuberculosis (TB) in Children:
    • Risk: Higher risk of progression from LTBI to active disease, and higher risk of disseminated/meningeal TB. Often paucibacillary (smear neg).
    • Screening: TST or IGRA for exposure/risk factors.
    • Dx: LTBI = +TST/IGRA, normal CXR, asymptomatic. Active TB = Symptoms + abnormal CXR +/- positive culture/smear (often hard in kids). Use clinical + CXR + exposure Hx. Gastric aspirates may help.
    • Tx: LTBI = Isoniazid (INH) x 9mo or other regimens. Active TB = Multi-drug therapy (e.g., RIPE – Rif, INH, PZA, EMB) x 6+ months. Reportable disease.
  • HIV Infection in Children:
    • Transmission: Primarily vertical (mother-to-child). PMTCT protocols dramatically reduce risk (ART for mother, infant prophylaxis).
    • Dx: HIV DNA/RNA PCR needed in infants <18mo (maternal Ab persist). Antibody test >18mo.
    • Presentation: FTT, recurrent infections, developmental delay, specific opportunistic infections (PJP, Candida).
    • Mgmt: Early combination Antiretroviral Therapy (ART) essential. Monitor CD4 count, Viral Load. Prophylaxis for OIs (e.g., Bactrim for PJP). Specialist care needed.
  • Vaccination Schedules and Principles (Immunization):
    • UAE Schedule: MUST know the current national schedule provided by DHA/MOHAP. Includes BCG, HepB, DTaP, IPV/OPV, Hib, PCV, MMR, Varicella, Rotavirus, Meningococcal, HPV, Influenza.
    • Principles: Active immunity (vaccine stimulates immune system) vs Passive (antibodies given – e.g., IVIG, maternal Ab). Live attenuated (MMR, Var, Rota, OPV – caution in immunocompromised) vs Inactivated (DTaP, IPV, HepB, PCV, Hib, Flu shot).
    • Practice: Adhere to schedule, understand contraindications (true allergy, encephalopathy post-DTaP, severe immunodeficiency for live vaccines) vs precautions. Manage mild side effects. Address vaccine hesitancy with evidence/empathy.
• F. Respiratory System: 
  • Pneumonia (Viral, Bacterial, Atypical):
    • Etiology: Viral commonest overall (RSV, Flu). Bacterial: Strep pneumo most common bacterial cause, esp lobar PNA. Atypical: Mycoplasma, Chlamydia (esp school-age/adolescents).
    • Presentation: Fever, cough, tachypnea, crackles, decreased breath sounds. Viral often with wheeze.
    • Dx: Clinical + CXR (infiltrates, consolidation, effusion). Labs (CBC, CRP) may help differentiate.
    • Mgmt: Supportive care (O2, fluids). Antibiotics if bacterial suspected: Amoxicillin (or Augmentin) for typical outpatient. Macrolide (Azithromycin) if atypical suspected. Hospitalize if hypoxic, dehydrated, severe distress.
  • Bronchiolitis:
    • Etiology: Usually RSV (<2 yrs age). Viral infection -> airway inflammation, edema, mucus -> wheezing, crackles, resp distress.
    • Presentation: URI prodrome then lower resp symptoms (tachypnea, wheeze, crackles, cough). Peaks day 3-5.
    • Mgmt: SUPPORTIVE. Nasal suctioning, Hydration (oral/NG/IV), Oxygen if SpO2 <90-92%. NO routine use of bronchodilators, steroids, antibiotics. Hospitalize for hypoxia, dehydration, apnea. Palivizumab prophylaxis for high-risk (preemie, CHD, CLD).
  • Croup (Laryngotracheobronchitis) and Epiglottitis:
    • Croup: Viral (Parainfluenza). Subglottic inflammation. Presentation: Barking cough, inspiratory stridor, hoarseness. Worse at night. Dx: Clinical +/- Steeple sign on neck X-ray. Mgmt: Mild: supportive. Mod/Severe: Dexamethasone (oral/IM) + Nebulized Epinephrine (for stridor at rest/distress).
    • Epiglottitis: Bacterial (Hib reduced incidence, now Strep/Staph). Supraglottic inflammation. MEDICAL EMERGENCY. Presentation: Rapid onset high fever, sore throat, dysphagia, drooling, tripod position, muffled voice, distress. Dx: Clinical suspicion. DO NOT examine throat if suspected. Secure airway in OR/PICU (intubation). IV antibiotics (Ceftriaxone). Thumb sign on lateral neck X-ray (if stable enough).
  • Asthma Diagnosis and Management:
    • Dx: Recurrent symptoms (wheeze, cough, SOB, chest tightness), often worse at night/early AM, triggered (viral, allergens, exercise). Spirometry (>5-6 yrs): Obstruction (low FEV1/FVC) + Reversibility (>12% FEV1 increase post-bronchodilator).
    • Mgmt (GINA Guidelines): Stepwise approach based on control. All pts need SABA (Short-Acting Beta-Agonist) for relief. Persistent asthma needs daily Controller: Low-dose ICS (Inhaled Corticosteroid) is preferred first-line controller. Step up if needed (add LABA, LTRA, increase ICS dose). Check inhaler technique & adherence. Written Asthma Action Plan essential.
    • Exacerbations: Assess severity (speech, RR, HR, O2 sat, accessory muscle use). Tx: O2, repeated SABA (nebs/MDI+spacer), Oral/IV Corticosteroids. Add Ipratropium for severe. Mg Sulfate IV for very severe. PICU if impending failure.
  • Cystic Fibrosis (CF):
    • Genetics/Patho: Autosomal Recessive, CFTR gene mutation -> defective Cl- transport -> thick secretions in lungs, pancreas, etc.
    • Presentation: Neonatal (Meconium ileus), Resp (chronic cough, recurrent PNA, bronchiectasis), GI (Pancreatic insufficiency -> malabsorption, FTT, steatorrhea), Salt loss syndromes, Infertility (males).
    • Dx: Newborn screen (IRT). Confirmed by Sweat Chloride Test (>60 mmol/L) +/- CFTR genetic testing.
    • Mgmt: Multidisciplinary team. Airway clearance (physio, devices), Nebulized meds (DNase, hypertonic saline), Treat infections (inhaled/IV antibiotics), Pancreatic Enzyme Replacement Therapy (PERT), High-calorie/fat diet + Vitamins (ADEK), CFTR Modulator drugs (target specific mutations).
  • Bronchopulmonary Dysplasia (BPD):
    • Definition: Chronic lung disease of prematurity. Need for O2 at 36 wks postmenstrual age (PMA) or 28 days postnatal age.
    • Risk Factors: Extreme prematurity, Low birth weight, Prolonged mech ventilation, High O2 exposure, Infection.
    • Patho: Impaired alveolar/vascular development. Fewer, larger alveoli. Airway inflammation/fibrosis.
    • Mgmt: Minimize lung injury (gentle ventilation, avoid high O2), Oxygen therapy, Diuretics (for fluid overload), Nutritional support (high calories), Bronchodilators sometimes used. Prevent infections (RSV prophylaxis). Long-term resp issues common.
• G. Cardiovascular System: 
  • Congenital Heart Defects (CHD):
    • Acyanotic: Left-to-right shunt (VSD, ASD, PDA) -> Pulmonary overcirculation -> HF symptoms (tachypnea, poor feeding, FTT), Murmur. Obstructive (Coarctation, AS, PS) -> Pressure load -> Murmur, decreased pulses (CoA), exercise intolerance.
    • Cyanotic: Right-to-left shunt (ToF, TGA) or Complex mixing -> Cyanosis (low SpO2), Murmur. ToF = VSD + Overriding Aorta + RV outflow tract obstruction (PS) + RVH. TGA = Aorta from RV, PA from LV (parallel circulation, needs mixing via ASD/VSD/PDA).
    • Critical CHD: Ductal-dependent lesions (severe CoA, HLHS, TGA, critical PS/AS). Need Prostaglandin E1 (PGE1) infusion to keep ductus arteriosus open until surgery. Screen newborns with pulse oximetry.
  • Acquired Heart Diseases:
    • Rheumatic Fever (ARF): Post-Group A Strep (GAS) pharyngitis. Immune mediated. Jones Criteria (Major: Carditis, Polyarthritis, Chorea, Erythema Marginatum, Subcutaneous Nodules; Minor: Fever, Arthralgia, high ESR/CRP, prolonged PR). Requires evidence of preceding GAS infection (ASO titre). Tx: Penicillin (eradicate GAS) + Aspirin/Steroids (inflammation). Long-term Penicillin prophylaxis prevents recurrence/Rheumatic Heart Disease (RHD).
    • Kawasaki Disease (KD): Vasculitis, unknown cause. Primarily <5 yrs. Diagnostic Criteria: Fever ≥5 days + ≥4 of 5: Conjunctivitis (bilateral, non-exudative), Rash (polymorphous), Adenopathy (cervical, >1.5cm), Strawberry tongue/lip changes, Hand/Foot edema/erythema/desquamation. Risk of Coronary Artery Aneurysms. Tx: High-dose IVIG + High-dose Aspirin (acute phase), then low-dose Aspirin. Echo needed at baseline and follow-up.
  • Pediatric Arrhythmias:
    • SVT (Supraventricular Tachycardia): Most common symptomatic arrhythmia. Narrow complex tachycardia, regular, rate >220 (infants)/>180 (children). Often re-entrant circuit. Tx: Vagal maneuvers (ice to face, Valsalva). If unsuccessful: Adenosine IV (rapid push). Long term: Meds (beta-blocker, flecainide) or Ablation.
    • Bradycardia: Can be sinus brady or AV block. Concerning if symptomatic (syncope, poor perfusion). Needs ECG, Holter. May require pacing.
  • Pediatric Hypertension:
    • Definition: BP ≥95th percentile for age/sex/height on ≥3 occasions. Stage 1 (95th-99th + 5mmHg), Stage 2 (>99th + 5mmHg). Pre-HTN (90-95th).
    • Etiology: Younger kids = likely Secondary cause (Renal – parenchymal/vascular; Coarctation; Endocrine). Adolescents = increasingly Primary/Essential HTN (esp if obese, family hx).
    • Workup: Based on age/severity. Renal US, Urinalysis, electrolytes, lipids, glucose. Echo. Consider endocrine tests if indicated.
    • Mgmt: Lifestyle (weight loss, diet, exercise). Meds (ACEi, ARB, CCB, diuretics) if Stage 2, symptomatic, end-organ damage, or persistent Stage 1 despite lifestyle changes.
  • Cardiomyopathies:
    • Types: Dilated (DCM – LV dilation, systolic dysfunction – most common, often viral/idiopathic/genetic), Hypertrophic (HCM – LV hypertrophy, often genetic, diastolic dysfunction, outflow obstruction risk, sudden death risk), Restrictive (RCM – impaired diastolic filling, rare).
    • Presentation: Heart failure symptoms (dyspnea, edema, fatigue), arrhythmias, chest pain, syncope. HCM may present with sudden death.
    • Mgmt: Treat HF (diuretics, ACEi, beta-blockers). Specifics: Beta-blockers/CCBs for HCM (avoid dehydration/excess exertion), Anticoagulation if thrombus risk (DCM, RCM). Transplant evaluation for end-stage disease. ICD for high-risk HCM.
• H. Hematology and Oncology: 
  • Anemia:
    • Iron Deficiency: Microcytic, Hypochromic (low MCV, MCH). Low Ferritin is key. Causes: Diet (low intake – toddlers on excess milk), Blood loss (GI). Tx: Oral Ferrous Sulfate. Counsel on diet.
    • Thalassemia: Microcytic, Hypochromic. Normal/High Ferritin. Dx: Hb Electrophoresis (shows abnormal Hb – e.g., high HbA2 in Beta Thal trait). Beta Thal Major = severe anemia, needs transfusions + iron chelation. Alpha Thal varies by # gene deletions.
    • Sickle Cell: Normocytic (initially), Hemolytic anemia. Sickled cells on smear. Dx: Hb Electrophoresis (HbS). Mgmt: Prevent crises (Hydroxyurea increases HbF, hydration, avoid triggers), Pain mgmt, Treat complications (Acute Chest Syndrome – O2, antibiotics, exchange transfusion; Stroke prevention – TCD screening, transfusions), Penicillin prophylaxis (<5yrs), Vaccinations (Pneumococcal, Meningococcal, Hib, Flu).
  • Bleeding and Clotting Disorders:
    • ITP: Immune destruction of platelets -> isolated thrombocytopenia (<100k). Often post-viral. Petechiae, bruising, mucosal bleeding. Dx: Clinical, exclude other causes. Mgmt: Observation if mild. IVIG/Steroids/Anti-D if severe bleeding or very low count (<10-20k). Usually resolves spontaneously in kids. Chronic ITP possible.
    • Hemophilia: X-linked recessive. A=Factor VIII def, B=Factor IX def. Spontaneous bleeding (joints – hemarthrosis, muscles). Prolonged PTT (normal PT/platelets). Dx: Factor assays. Tx: Factor replacement (prophylactic or on-demand).
    • Von Willebrand Disease (vWD): Most common inherited bleeding disorder. Defective vWF -> impaired platelet adhesion + low FVIII carrier. Type 1 (mild quantitative), Type 2 (qualitative), Type 3 (severe quantitative). Presentation: Mucocutaneous bleeding (epistaxis, menorrhagia, post-op). Prolonged PTT possible (if FVIII low), abnormal platelet function tests. Dx: vWF antigen, vWF activity (Ristocetin cofactor), Factor VIII level. Tx: DDAVP (desmopressin – releases stored vWF, for Type 1), vWF-containing concentrates.
  • Childhood Leukemia and Lymphoma:
    • Leukemia (ALL/AML): Malignant proliferation of blasts in bone marrow. Presentation: Bone marrow failure (Anemia – fatigue/pallor; Thrombocytopenia – bruising/bleeding; Neutropenia – fever/infection), Bone pain, Lymphadenopathy, Hepatosplenomegaly. Dx: CBC (blasts on smear?), Bone Marrow Aspirate/Biopsy essential (shows >20% blasts, immunophenotyping). Tx: Multi-agent Chemotherapy based on type/risk stratification. CNS prophylaxis needed. Specialist care (Pediatric Oncology).
    • Lymphoma (Hodgkin/NHL): Malignancy of lymphocytes in lymph nodes/tissue. HL: Reed-Sternberg cells, often presents with painless cervical/supraclavicular LAD, B symptoms (fever, night sweats, weight loss). NHL: More aggressive, diverse types (Burkitt – abdominal mass, jaw; Lymphoblastic – mediastinal mass, looks like ALL; Large cell). Dx: Lymph Node Biopsy essential (excisional preferred). Staging (imaging – CT/PET). Tx: Chemo +/- Radiation based on type/stage.
  • Common Solid Tumors:
    • Brain Tumors: Most common solid tumor. Presentation varies by location/age. Infants: ↑Head circ, vomiting. Older: ↑ICP signs (headache, vomiting, papilledema), focal neuro deficits, seizures, ataxia (cerebellar). Dx: MRI Brain + Spine. Tx: Surgery +/- Radiation +/- Chemo (depends on type/location/age – avoid radiation <3yrs). Medulloblastoma (cerebellum), Astrocytoma (various grades), Ependymoma (ventricles).
    • Neuroblastoma: Tumor of sympathetic nervous system (adrenal medulla or paraspinal ganglia). Usually <5 yrs. Presentation: Abdominal mass (most common), bone pain (mets), Horner syndrome, Opsoclonus-myoclonus syndrome (“dancing eyes/feet”), periorbital ecchymoses (“raccoon eyes”). Dx: Urine Catecholamines (VMA/HVA), MIBG scan (specific), Biopsy. Tx: Based on risk stratification (age, stage, biology – N-myc amplification). Surgery, Chemo, Radiation, Immunotherapy.
    • Wilms Tumor: Kidney tumor. Usually <5 yrs. Presentation: Asymptomatic abdominal mass found by parent/MD, +/- hematuria, hypertension. Associated with syndromes (WAGR, Beckwith-Wiedemann). Dx: Abdominal US then CT/MRI. DO NOT biopsy pre-op usually (risk of rupture/upstaging). Tx: Nephrectomy + Chemo +/- Radiation based on stage/histology. Good prognosis overall.
• I. Neurology: 
  • Seizures and Epilepsy Syndromes:
    • Types: Focal (one hemisphere, +/- awareness impaired, motor/sensory/autonomic) vs Generalized (both hemispheres, motor – tonic-clonic, absence, myoclonic, atonic; non-motor – absence).
    • Febrile Seizures: 6mo-5yrs age. Associated with fever (>38C). Simple (<15min, generalized, one in 24h) vs Complex (>15min, focal, multiple in 24h). Usually benign, low epilepsy risk if simple. No routine AEDs needed. Parental education vital.
    • Syndromes: Infantile Spasms (West Syndrome – spasms, hypsarrhythmia on EEG, delay – treat urgently ACTH/Vigabatrin), Absence Epilepsy (childhood onset, brief staring spells, 3Hz spike-wave EEG – Ethosuximide), Lennox-Gastaut (multiple seizure types, slow spike-wave EEG, cognitive impairment – difficult to treat), Benign Rolandic (focal seizures face/arm, often nocturnal, centrotemporal spikes EEG – often outgrown).
    • Mgmt: Treat underlying cause if identified. Antiepileptic Drugs (AEDs) if recurrent unprovoked seizures (epilepsy). Choose AED based on seizure type/syndrome/side effects. Monotherapy preferred. Consider ketogenic diet, VNS, surgery for refractory epilepsy.
  • Headache Evaluation and Management:
    • Primary: Migraine (unilateral/bilateral, pulsating, N/V, photo/phonophobia, +/- aura) & Tension-type (bilateral, non-pulsating, pressure).
    • Red Flags (Need Imaging/Urgent Eval): Worst headache ever, Worsening pattern, Focal neuro signs, Papilledema, Awakens from sleep, <5 yrs age, Personality change, Seizure, Systemic symptoms (fever, stiff neck), Occipital location.
    • Mgmt: Lifestyle (sleep, hydration, trigger avoidance). Acute: NSAIDs, Triptans (migraine). Prophylaxis if frequent/disabling (Topiramate, Amitriptyline, Propranolol).
  • Meningitis and Encephalitis:
    • Meningitis: Inflammation of meninges. Bacterial (Neisseria meningitidis, Strep pneumo, GBS/E.coli in neonates) or Viral (Enterovirus). Presentation: Fever, headache, neck stiffness, photophobia, altered mental status. Kernig/Brudzinski signs. Dx: Lumbar Puncture (LP) – CSF analysis (WBC, protein, glucose, Gram stain, culture, PCR). Bacterial = high WBC (PMNs), high protein, low glucose. Viral = mod high WBC (lymphocytes), normal/slight high protein, normal glucose. Tx: Bacterial = EMPIRIC IV Antibiotics (Ceftriaxone + Vancomycin +/- Ampicillin for neonates) ASAP after LP. Viral = supportive.
    • Encephalitis: Inflammation of brain parenchyma. Usually Viral (HSV, Enterovirus, Arbovirus). Presentation: Fever, headache, altered mental status, seizures, focal neuro deficits. Dx: LP (similar CSF to viral meningitis, but may have RBCs if HSV), MRI brain, EEG. Tx: Supportive + IV Acyclovir (for possible HSV) until ruled out.
  • Cerebral Palsy (CP):
    • Definition: Group of permanent, non-progressive motor disorders causing activity limitation, attributed to disturbances in fetal/infant brain development.
    • Types: Spastic (most common – increased tone, hyperreflexia; diplegia, hemiplegia, quadriplegia), Dyskinetic (athetoid/choreiform/dystonic movements), Ataxic (cerebellar signs – balance/coordination issues), Mixed. Classified by GMFCS level (I-V).
    • Etiology: Prenatal (infection, stroke), Perinatal (HIE, prematurity), Postnatal (infection, trauma).
    • Mgmt: Multidisciplinary: Physio/Occupational/Speech therapy, Orthotics, Meds for spasticity (Baclofen, Botox), Seizure management, Nutrition support, Orthopedic surgery. Focus on maximizing function/independence.
  • Developmental Delays and Assessment:
    • Global Delay (GDD): Significant delay (≥2 SD below mean) in ≥2 developmental domains in child <5 yrs.
    • Intellectual Disability (ID): Significant limitations in intellectual functioning AND adaptive behavior, onset before 18 yrs (used >5 yrs age).
    • Workup: Thorough Hx/Exam, Hearing/Vision screen, Formal developmental testing, Consider: Genetics (Microarray, Fragile X), MRI Brain, Metabolic screen, Lead level, Thyroid function.
    • Mgmt: Early Intervention services are critical. Address specific medical issues. Family support.
  • Neuromuscular Disorders:
    • Presentation: Often hypotonia (“floppy infant”), muscle weakness (proximal > distal often), delayed motor milestones, feeding difficulties, respiratory insufficiency.
    • Examples: Spinal Muscular Atrophy (SMA – Autosomal Recessive, SMN1 gene deletion, progressive loss of anterior horn cells -> weakness/atrophy. Newborn screening available. Disease-modifying therapies exist). Duchenne Muscular Dystrophy (DMD – X-linked Recessive, Dystrophin gene mutation, progressive muscle degeneration -> weakness, Gower sign, calf pseudohypertrophy, cardiomyopathy. High CK level. Tx: Steroids slow progression, supportive care).
    • Dx: Clinical exam, CK level, EMG/NCS, Genetic testing, Muscle biopsy sometimes needed.
• J. Renal and Musculoskeletal Systems: 
  • Urinary Tract Infections (UTIs):
    • Presentation: Infants: Fever, irritability, poor feeding, vomiting. Older kids: Dysuria, frequency, urgency, incontinence, abdo/flank pain, fever.
    • Dx: Urinalysis (UA): +Leukocyte esterase, +Nitrites, WBCs. Urine Culture (clean catch, catheterized, or SPA): ≥50k CFU/mL (cath/SPA) or ≥100k (clean catch) of single pathogen (usually E. coli).
    • Mgmt: Oral antibiotics (Cephalosporin, Bactrim) for cystitis/mild pyelonephritis. IV antibiotics (Ceftriaxone, Gentamicin) if toxic, vomiting, <2mo, or severe pyelo. Duration 7-14 days.
    • Imaging: Renal/Bladder Ultrasound (RBUS) for all infants 2-24mo with first febrile UTI. Consider VCUG if RBUS abnormal, recurrent febrile UTIs, or other risk factors (evaluates for Vesicoureteral Reflux – VUR).
  • Glomerulonephritis (GN) and Nephrotic Syndrome (NS):
    • GN: Immune-mediated glomerular INFLAMMATION. Presentation: Hematuria (RBC casts, dysmorphic RBCs), Edema, Hypertension, Oliguria, Proteinuria (usually non-nephrotic range). Example: Post-Streptococcal GN (PSGN – occurs weeks after GAS infection, low C3). Others: IgA Nephropathy, HSP nephritis, Lupus nephritis. Dx: UA, Urine protein/Cr ratio, Renal function, C3/C4, ASO titre (for PSGN), Renal biopsy sometimes needed. Mgmt: Supportive (manage HTN/edema with diuretics, salt restriction), treat underlying cause.
    • Nephrotic Syndrome: Podocyte injury -> massive PROTEINURIA (>3.5g/day or Urine Pr/Cr >2). Presentation: Generalized Edema, Hypoalbuminemia (<2.5 g/dL), Hyperlipidemia. Hematuria/HTN less common than GN. Minimal Change Disease (MCD) most common cause in kids (normal biopsy on light microscopy). Others: FSGS, Membranous. Dx: UA, Urine Pr/Cr, Albumin, Lipids. Renal biopsy if atypical features or steroid-resistant. Mgmt: Corticosteroids (most MCD respond well). Manage edema (diuretics, salt restriction), Albumin infusion if severe hypoalbuminemia/volume depletion. Prevent complications (infection – vaccinate!, thrombosis).
  • Congenital Anomalies of the Kidney and Urinary Tract (CAKUT):
    • Spectrum: Includes Renal agenesis/dysplasia/hypoplasia, Hydronephrosis (obstruction – UPJ/UVJ stenosis, Posterior Urethral Valves-PUV in boys), VUR, Duplex systems.
    • Presentation: Often found on prenatal US. Postnatal: UTI, abdominal mass, FTT, renal insufficiency. PUV -> bladder outlet obstruction -> severe hydronephrosis, poor urine stream, renal failure.
    • Mgmt: Depends on anomaly. Observation for mild hydronephrosis. Surgical correction for significant obstruction (pyeloplasty for UPJ, valve ablation for PUV). Prophylactic antibiotics sometimes used for VUR/hydronephrosis. Long term renal function monitoring.
  • Common Pediatric Fractures and Dislocations:
    • Peds Bone: More porous, less dense, thicker periosteum (limits displacement, aids healing), Presence of Physis (growth plate – weaker area prone to injury).
    • Fractures: Buckle/Torus (incomplete compression fx), Greenstick (incomplete fx with bending), Clavicle (common birth/fall injury), Supracondylar (elbow – high risk neurovascular injury – brachial artery, median/radial nerve), Distal Radius. Salter-Harris Classification for Physeal Injuries (I-V, higher number = worse prognosis, esp III-V involving epiphysis/joint).
    • Dislocations: Nursemaid’s Elbow (radial head subluxation – pull injury, child holds arm pronated/flexed – reduce by supination/flexion). Shoulder/Patellar dislocations more common in adolescents.
    • Mgmt: Reduction (if displaced/angulated), Immobilization (cast/splint). Ortho referral often needed, esp for physeal, displaced, or complex fractures. Check neurovascular status! Consider Non-Accidental Trauma (NAT) if injury pattern inconsistent with history (spiral femur fx in non-walker, posterior rib fxs, multiple fxs in different healing stages).
  • Musculoskeletal Infections:
    • Osteomyelitis: Bone infection. Usually hematogenous spread (Staph aureus most common). Presentation: Fever, localized bone pain/tenderness, refusal to bear weight/use limb. Dx: High ESR/CRP, WBC maybe elevated. X-ray may be normal early, shows periosteal reaction/lysis later. MRI is sensitive early. Bone scan can localize. Blood culture often positive. Bone aspiration/biopsy for culture needed if blood culture neg or empiric tx fails. Tx: IV antibiotics (target Staph initially – e.g., Oxacillin/Nafcillin or Clindamycin/Vancomycin if MRSA risk) then transition to PO. Duration weeks. Surgery if abscess/sequestrum.
    • Septic Arthritis: Joint infection. Hematogenous spread (Staph aureus, Strep, Kingella kingae in toddlers). MEDICAL EMERGENCY (cartilage destruction). Presentation: Fever, severe joint pain, swelling, warmth, erythema, markedly decreased range of motion (pseudoparalysis). Hip common in infants/toddlers. Knee common overall. Dx: High ESR/CRP, WBC. Ultrasound may show effusion. Arthrocentesis (joint aspiration) is diagnostic: Synovial fluid shows high WBC (>50k, mostly PMNs), low glucose, +Gram stain/culture. Tx: Surgical drainage/washout + IV antibiotics (similar coverage to osteo).
  • Juvenile Idiopathic Arthritis (JIA):
    • Definition: Arthritis (joint swelling or limitation + pain/warmth) of unknown cause, onset <16 yrs, duration ≥6 weeks. Exclusion diagnosis.
    • Subtypes: Oligoarticular (<5 joints in first 6 mo – most common, high risk uveitis), Polyarticular (≥5 joints, RF+ or RF-), Systemic (sJIA – arthritis + fever, rash, organomegaly – high inflammation), Enthesitis-related, Psoriatic.
    • Presentation: Joint pain, stiffness (esp AM), swelling, limp. Uveitis risk (esp Oligo/Poly RF-), regular eye screening needed. sJIA presents with spiking fevers, salmon-pink rash, serositis, LAD, HSM.
    • Dx: Clinical. Labs (ESR/CRP elevated, ANA often + in Oligo/Poly RF-, RF/Anti-CCP for Poly RF+). Imaging shows joint effusion/damage later.
    • Mgmt: Multidisciplinary (Rheum, Physio, Ophtho). NSAIDs (symptom relief). DMARDs (Methotrexate first-line for Poly/persistent Oligo). Biologics (TNF inhibitors – Etanercept, Adalimumab; IL-1/IL-6 inhibitors for sJIA – Anakinra, Tocilizumab). Intra-articular steroid injections. Goal: control inflammation, preserve function, prevent damage.

1. Foundational Medical Sciences (Pediatric Relevance)

• Anatomy: Key Peds Differences: Airway (larger tongue/occiput, floppy epiglottis, narrowest at cricoid), Fontanelles (assessment, closure times), Growth Plates (injury risk), Smaller organ size, Different body proportions (larger head).
• Physiology: Age-related changes: Higher basal metabolic rate/O2 consumption, Immature renal function (GFR lower in neonates), Higher fluid requirements per kg, Cardiovascular transition at birth, Thermoregulation challenges (large surface area/volume ratio).
• Pathology: Understand basic disease mechanisms in context: Inflammation (asthma, IBD, JIA), Infection (viral vs bacterial pathogenesis), Neoplasia (common pediatric tumor biology), Genetic basis of many pediatric disorders (CF, Sickle Cell, Thal, DMD, Syndromes), Metabolic pathway defects (IEMs).
• Pharmacology:
  • Dosing: CRITICAL. Usually weight-based (mg/kg). Use ideal body weight for some obesity dosing. Double-check calculations! Utilize pediatric formularies. BSA dosing for chemo.
  • PK/PD Differences: Absorption varies (gastric pH, skin permeability), Distribution (higher total body water), Metabolism (immature liver enzymes – glucuronidation poor in neonates), Excretion (lower GFR in neonates). Affects drug choice/dosing/intervals.
  • Common Meds: Know indications/doses/side effects of common antibiotics, analgesics (Acetaminophen, Ibuprofen – avoid Aspirin Reye’s), asthma meds, anticonvulsants, etc. used in pediatrics.
• Microbiology: Key Pathogens by Age/Syndrome: Neonatal sepsis (GBS, E. coli, Listeria), Meningitis (add Strep pneumo, N. meningitidis later), Pneumonia (RSV, Strep pneumo), Otitis (Strep pneumo, H flu, M cat), UTI (E. coli). Understand diagnostic tests (culture, Gram stain, PCR, antigen tests). Antimicrobial resistance patterns.
• Radiology: Basic Interpretation: CXR (pneumonia patterns, cardiomegaly, atelectasis, pneumothorax, FBA signs), Abdo X-ray (bowel gas pattern, obstruction signs – dilated loops/air-fluid levels, constipation), Skeletal X-ray (fracture types, Salter-Harris, rickets signs, bone age), Ultrasound (appendicitis, intussusception, pyloric stenosis, renal/bladder assessment, cranial US in neonates), Basic Head CT (blood, midline shift, hydrocephalus).

III. Professionalism, Ethics, and Patient Safety

• A. Professionalism and Ethics:
  • Core Principles: Beneficence (Do Good), Non-maleficence (Do No Harm), Autonomy (Respect choices – Parent/Guardian consent, Child assent when capable), Justice (Fairness). Apply these to clinical dilemmas.
  • Consent/Assent: Informed Consent mandatory from legal guardian. Assent should be sought from child if developmentally capable (e.g., >7 yrs), explaining in age-appropriate terms. Document process. Understand exceptions (emergencies).
  • Confidentiality: Protect patient information. Limits apply (risk of harm to self/others, suspected abuse/neglect – mandatory reporting, specific communicable diseases). Adolescent confidentiality important but has legal limits.
  • Conduct: Maintain boundaries, professionalism in interactions. Honesty/transparency. Avoid conflicts of interest. Teamwork and respectful communication.
  • Communication: Build rapport with child/family. Use clear, simple language. Active listening. Elicit concerns. Explain options. Check understanding. Age-appropriate communication with child. Empathetic delivery of bad news. Effective handovers (SBAR).
  • Cultural Sensitivity: Be aware of/respect diverse beliefs/practices affecting health (diet, traditional remedies, decision-making roles). Avoid assumptions. Use interpreters when needed. Provide culturally competent care. Essential in Dubai.
• B. Patient Safety:
  • Medication Safety: HUGE in Peds due to weight-based dosing. Use 5 Rights. Double-check calculations, esp high-risk meds (insulin, chemo, electrolytes). Use standard concentrations. Limit abbreviations. Barcode scanning helps. Medication reconciliation.
  • Infection Control: HAND HYGIENE is paramount. Standard precautions for all patients. Transmission-based precautions (Contact, Droplet, Airborne) as indicated. Aseptic technique for procedures. Promote vaccinations (staff/patients). Environmental cleaning.
  • Error Prevention: Standardize processes (checklists – surgical/procedural). Improve communication (handoffs, read-backs). Avoid interruptions during critical tasks (med admin). Encourage reporting culture (non-punitive). Learn from errors (Root Cause Analysis – RCA).
  • Adverse Event Reporting: Know local hospital/DHA system for reporting errors/near misses. Essential for system improvement. Disclose significant errors to patients/families (Transparency).
  • Risk Management: Identify high-risk situations (e.g., complex patients, new procedures, communication failures). Implement strategies to reduce risk. Follow protocols/guidelines.

1. UAE / Dubai Healthcare Context

• Healthcare Regulations: Understand DHA licensing requirements/renewal. Scope of practice for Pediatricians. Mandatory reporting laws (child abuse – vital!, specific infectious diseases – check DHA list, adverse drug reactions). Patient rights regulations in UAE. Medical record standards.
• System Structure: Know DHA’s role (regulator/provider). Understand public vs private sectors, insurance systems (e.g., SAADA, ENAYA). Referral pathways between levels of care. Role of MOHAP and other Emirates’ health authorities if relevant.
• Local Initiatives/Guidelines: CRITICAL: Check DHA website/circulars for specific guidelines (e.g., UAE National Immunization Schedule, antibiotic stewardship programs, newborn screening panel, specific disease management protocols, patient safety campaigns). Be aware of local health priorities/disease prevalence if possible.

1. General Exam Themes

• Application of Clinical Knowledge: Expect case vignettes requiring you to integrate history, exam, investigations to reach a diagnosis, formulate a management plan, and anticipate complications. Think step-by-step. Prioritize actions in emergencies.
• Professional Skills: Questions may assess ethical decision-making, communication strategies (how would you explain X to a parent?), understanding of consent/confidentiality, teamwork aspects.
• Guidelines & Protocols: Demonstrate knowledge of evidence-based guidelines (PALS, GINA etc.) and awareness of the importance of adhering to local (DHA) protocols where they exist.
• Language Proficiency: Clear, accurate medical English is required to understand questions and (if applicable) formulate responses.

Final Note: This is a rapid overview. Depth of knowledge is required for the exam. Use this as a checklist and guide for focused study using comprehensive resources. Always verify information against the latest guidelines and DHA requirements. Good luck!