High-Yield Paediatrics for Medical Exams: Revision Guide

Paediatrics questions test the same diseases as adult medicine plus things unique to children: growth, development, congenital disease, neonatal problems and safeguarding. Children also decompensate quickly, so "next step" questions reward recognising the seriously ill child. This guide is exam revision.

Developmental milestones (red flags)

Milestones vary between children; exams tend to use widely quoted ages and red flags.

Red flags: not smiling by about 8 weeks, not sitting unsupported by about 9 months, not walking by about 18 months, no words by 18 months, loss of previously acquired skills at any age, and hand preference before about 12 months (possible weakness on the other side).

The febrile child

UK guidance uses a traffic-light system (colour, activity, breathing, circulation and hydration, other signs) to classify risk.

• High-risk features: pale, mottled or blue colour; no response to social cues; weak, high-pitched or continuous cry; grunting; respiratory rate above 60 per minute; reduced skin turgor; non-blanching rash; bulging fontanelle; neck stiffness; focal seizures.
• Age matters: fever of 38 °C or more in an infant under 3 months is treated as high risk.
• Non-blanching rash with fever: treat as meningococcal disease until proven otherwise; give parenteral antibiotics immediately.

Febrile seizures

Typically between 6 months and 5 years, with fever, and no CNS infection. Simple febrile seizures are generalised, last under 15 minutes and do not recur within 24 hours. Most children do not develop epilepsy. Look for the source of fever and exclude meningitis when features suggest it.

Respiratory illnesses

Neonatal jaundice

Phototherapy and exchange transfusion are based on bilirubin thresholds plotted against age in hours. Trap: pale stools with prolonged conjugated jaundice suggest biliary atresia; early surgery improves outcomes.

Dehydration and gastroenteritis

• Assess with clinical features: reduced urine output, dry mucous membranes, sunken eyes, tachycardia, reduced skin turgor, prolonged capillary refill.
• Oral rehydration solution is first line for most children without shock.
• Intravenous fluids for shock or if oral or nasogastric rehydration fails.
• Bloody diarrhoea with reduced urine output after a few days: consider haemolytic uraemic syndrome.

Surgical conditions in children

Trap: bilious vomiting in a newborn is malrotation with volvulus until proven otherwise.

Rashes and infections

Congenital heart disease

Genetics and syndromes

• Down syndrome: learning disability, flat facial profile, AV septal defect, duodenal atresia, hypothyroidism, leukaemia risk.
• Turner syndrome (45,X): short stature, coarctation, primary ovarian insufficiency.
• Klinefelter syndrome (47,XXY): tall, small testes, infertility.
• Cystic fibrosis: meconium ileus, failure to thrive, recurrent chest infections.

Immunisation

Exams test principles rather than one country's schedule: live vaccines (MMR, varicella, BCG, oral rotavirus) are generally avoided in significant immunosuppression; a mild illness without fever is not a reason to delay vaccination; egg allergy is rarely a contraindication to MMR. Check your exam's national schedule, as WHO and national programmes differ.

Safeguarding

Features that should raise concern: delay in presentation, inconsistent or changing history, injuries not matching the developmental stage (bruising in a non-mobile infant), patterned bruises, burns in unusual sites, posterior rib or metaphyseal fractures, and torn frenulum in infants. The expected exam action is to follow local child protection procedures, involve senior paediatricians and document carefully; ethics questions often ask about sharing information in the child's interest. See high-yield medical ethics and law.

Common exam traps

• Treating fever in an infant under 3 months as low risk.
• Examining the throat in suspected epiglottitis.
• Giving bronchodilators or antibiotics routinely in bronchiolitis.
• Dismissing jaundice in the first 24 hours.
• Missing biliary atresia in prolonged jaundice with pale stools.
• Ignoring bilious vomiting in a neonate.
• Missing Kawasaki disease in prolonged fever with mucosal changes.

How to revise

Make a one-page milestone grid and quiz yourself until you can place any skill. Then do mixed paediatric vignettes. MediFlow Exam Prep includes paediatrics questions with explanations. Pair this with high-yield obstetrics and gynaecology and high-yield infectious diseases.

Summary

• Know milestone red flags, not every skill.
• Fever: recognise high-risk features and age-related risk.
• Croup, bronchiolitis and epiglottitis are separated by age and appearance.
• Early or prolonged neonatal jaundice needs investigation.
• Safeguarding answers follow local procedures and senior involvement.