Membership of the Royal College of Paediatrics and Child Health (MRCPCH) General Paediatrics and Systems Medicine Syllabus

General Paediatrics and Systems Medicine syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for General Paediatrics and Systems Medicine in Membership of the Royal College of Paediatrics and Child Health (MRCPCH), not a summary of it.

1. 1

   Respiratory Medicine

   6 topics

   • Asthma and viral wheeze
     • Acute exacerbation management
     • Chronic control and inhaler technique
   • Bronchiolitis and croup
   • Pneumonia and empyema
   • Cystic fibrosis
     • Diagnosis, sweat test and modulator therapy
     • Pulmonary and nutritional complications
   • Sleep-disordered breathing and apnoea
   • Chronic cough and recurrent infection
2. 2

   Cardiology

   6 topics

   • Evaluation of murmurs and cyanosis
   • Acyanotic congenital heart disease
     • VSD, ASD, PDA and coarctation
   • Cyanotic congenital heart disease
     • Tetralogy of Fallot and transposition
     • Duct-dependent lesions and prostaglandin use
   • Heart failure in children
   • Arrhythmias and supraventricular tachycardia
   • Rheumatic fever and Kawasaki disease
3. 3

   Gastroenterology, Hepatology and Nutrition

   6 topics

   • Gastro-oesophageal reflux and vomiting
   • Acute and chronic diarrhoea
     • Coeliac disease
     • Inflammatory bowel disease
   • Constipation and soiling
   • Abdominal pain and recurrent presentations
   • Liver disease and jaundice beyond the neonatal period
   • Food allergy and intolerance
4. 4

   Nephrology and Urology

   6 topics

   • Urinary tract infection and reflux
   • Nephrotic and nephritic syndromes
   • Acute kidney injury and chronic kidney disease
   • Hypertension in children
   • Enuresis and bladder dysfunction
   • Haematuria and proteinuria evaluation
5. 5

   Endocrinology and Metabolic Medicine

   6 topics

   • Diabetes mellitus and DKA
     • Insulin regimens and monitoring
     • Diabetic ketoacidosis management
   • Thyroid disorders
   • Disorders of growth and short stature
   • Puberty: precocious and delayed
   • Adrenal disorders and congenital adrenal hyperplasia
   • Inborn errors of metabolism
6. 6

   Haematology and Oncology

   5 topics

   • Anaemias
     • Iron deficiency and haemolytic anaemias
     • Sickle cell disease and thalassaemia
   • Bleeding and clotting disorders
   • Leukaemias and lymphomas
   • Solid tumours of childhood
   • Lymphadenopathy and the child with a mass
7. 7

   Infectious Diseases and Immunology

   6 topics

   • The febrile child and sepsis pathways
   • Meningitis and encephalitis
   • Common childhood exanthems
   • Tuberculosis and HIV in children
   • Immunisation schedule and vaccine science
   • Primary immunodeficiency

General Paediatrics and Systems Medicine flashcards for Membership of the Royal College of Paediatrics and Child Health (MRCPCH)

19 of 64 cards from the General Paediatrics and Systems Medicine deck — real questions with worked answers.

1. In acute asthma in a child, what threshold of $\text{SpO}_2$ on air, plus other features, defines a LIFE-THREATENING attack?

   $\text{SpO}_2 < 92\%$ PLUS any of: silent chest, poor respiratory effort, cyanosis, exhaustion, hypotension, confusion/agitation, or a PEF $< 33\%$ of best/predicted.

2. How are viral-induced wheeze and asthma classically distinguished in a preschool child?

   Viral wheeze occurs only with viral URTIs with symptom-free intervals and no interval/atopic features; asthma has interval symptoms, atopy (eczema, allergic rhinitis), a family history, and responds to preventer therapy.

3. What is the typical causative organism, age, and hallmark clinical sign of acute bronchiolitis?

   RSV is the commonest cause, usually in infants $<12$ months (peak $3$–$6$ months); hallmarks are coryza progressing to a wheezy/crackly chest with fine end-inspiratory crackles and hyperinflation.

4. Differentiate viral croup from acute epiglottitis on clinical grounds.

   Croup (parainfluenza): gradual onset, barking cough, stridor, low fever, child can drink. Epiglottitis (Hib): rapid onset, high fever, drooling, soft stridor, muffled voice, toxic and sitting forward — NO cough, do not examine throat.

5. What is the first-line treatment for moderate-to-severe croup, and the agent for severe airway obstruction?

   Oral dexamethasone $0.15$–$0.6\,\text{mg/kg}$ (single dose) for all severities; nebulised adrenaline (epinephrine) for severe obstruction giving temporary relief while steroid takes effect.

6. What are the commonest bacterial causes of community-acquired pneumonia in children by age?

   Newborns: Group B Strep, Gram-negatives. Infants/young children: Strep pneumoniae (commonest overall), RSV. School age: Strep pneumoniae and Mycoplasma pneumoniae/Chlamydophila (atypicals).

7. What is empyema, and how is its presence suggested and confirmed in childhood pneumonia?

   Empyema is pus in the pleural space. Suggested by persistent fever/illness despite antibiotics with a pleural effusion; confirmed by ultrasound-guided pleural aspiration showing pus, low pH/glucose and high LDH; treated with chest drain $\pm$ fibrinolytics.

8. What is the genetic basis of cystic fibrosis and the commonest mutation?

   Autosomal recessive mutation in the CFTR gene (chromosome 7) encoding a chloride channel; the commonest mutation is $\Delta F508$ (Phe508del).

9. What is the diagnostic gold-standard test for cystic fibrosis and its abnormal cut-off?

   The sweat test: sweat chloride $\geq 60\,\text{mmol/L}$ is diagnostic (40–59 intermediate). Newborn screening uses raised immunoreactive trypsinogen (IRT) followed by CFTR mutation analysis.

10. List the cardinal polysomnographic and clinical features of obstructive sleep apnoea (OSA) in children.

    Snoring, witnessed apnoeas, restless sleep, mouth breathing; daytime behavioural problems/hyperactivity. Commonest cause is adenotonsillar hypertrophy; diagnosis by polysomnography (apnoea–hypopnoea index), treatment is adenotonsillectomy.

11. Define an Apparent Life-Threatening Event (now BRUE) and key red flags requiring admission.

    BRUE = Brief Resolved Unexplained Event in an infant $<1$ yr: a brief episode of altered colour, tone, breathing or responsiveness, now resolved. Higher-risk: age $<2$ months, prematurity, $>1$ event, or event $>1$ min.

12. List key 'red flag' causes to exclude in a child with chronic wet cough and recurrent infections.

    Cystic fibrosis, primary ciliary dyskinesia, immunodeficiency, retained foreign body, recurrent aspiration (GORD/swallowing dysfunction), TB, and bronchiectasis. Persistent wet cough $>8$ weeks warrants investigation.

13. What features distinguish an innocent murmur from a pathological murmur in a child?

    Innocent (the 7 S's): Soft, Systolic, aSymptomatic, left Sternal edge, Small area, normal heart Sounds, Stands/Sits (varies with posture). Pathological: diastolic, pansystolic, loud ($\geq 3/6$), thrill, abnormal $S_2$, or symptoms.

14. Differentiate central from peripheral cyanosis and give the deoxygenated Hb threshold for clinical cyanosis.

    Central cyanosis (tongue/mucosae blue) indicates arterial desaturation/right-to-left shunt; peripheral (acrocyanosis) is benign in neonates from sluggish circulation. Clinically visible at deoxygenated $\text{Hb} > 50\,\text{g/L}$ (5 g/dL).

15. What is the hyperoxia (nitrogen washout) test used for, and how is it interpreted?

    To distinguish cardiac from respiratory cyanosis: give $100\%$ $\text{O}_2$ for 10 min. If $\text{PaO}_2$ rises $>20\,\text{kPa}$ it is likely respiratory; if it remains low ($<15\,\text{kPa}$) it suggests cyanotic congenital heart disease with right-to-left shunt.

16. List the acyanotic congenital heart defects and the commonest one.

    Left-to-right shunts/obstructive lesions: ventricular septal defect (VSD — commonest CHD overall), atrial septal defect (ASD), patent ductus arteriosus (PDA), atrioventricular septal defect, plus aortic stenosis, pulmonary stenosis and coarctation of the aorta.

17. Describe the characteristic murmur and ECG of an ostium secundum ASD.

    Ejection systolic murmur at the upper left sternal edge (increased pulmonary flow) with a FIXED, widely split second heart sound. ECG shows right axis deviation and partial RBBB (right ventricular volume overload).

18. Name the 5 cyanotic congenital heart defects (the '5 Ts').

    Tetralogy of Fallot, Transposition of the great arteries, Truncus arteriosus, Tricuspid atresia, and Total anomalous pulmonary venous return (TAPVR/connection).

19. List the four anatomical components of Tetralogy of Fallot.

    (1) Large VSD, (2) overriding aorta, (3) right ventricular outflow tract obstruction / pulmonary stenosis, and (4) right ventricular hypertrophy. CXR shows a 'boot-shaped' heart.

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