PMDC National Licensing Examination Paediatrics Syllabus

Paediatrics syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Paediatrics in PMDC National Licensing Examination, not a summary of it.

1. 1

   Neonatology

   4 topics

   • Neonatal Resuscitation
   • Neonatal Jaundice
   • Prematurity and Low Birth Weight
   • Neonatal Sepsis
2. 2

   Growth, Development and Nutrition

   3 topics

   • Developmental Milestones
   • Malnutrition and Failure to Thrive
   • Micronutrient Deficiencies
3. 3

   Common Paediatric Infections

   3 topics

   • Acute Respiratory Infections
   • Diarrhea and Dehydration
   • Vaccine-Preventable Diseases
4. 4

   Paediatric Systemic Disorders

   4 topics

   • Congenital Heart Disease
   • Nephrotic Syndrome
   • Asthma in Children
   • Seizure Disorders
5. 5

   Paediatric Emergencies and Genetics

   2 topics

   • Shock and Fluid Management in Children
   • Common Genetic Syndromes

Paediatrics flashcards for PMDC National Licensing Examination

22 of 54 cards from the Paediatrics deck — real questions with worked answers.

1. During neonatal resuscitation, what are the initial steps performed within the first 30 seconds (the 'golden minute' starts here)?

   Provide warmth, position the airway (slight extension/sniffing position), clear secretions if needed, dry the baby, and stimulate. Then assess breathing, heart rate, and tone.

2. In neonatal resuscitation, what heart rate threshold indicates the need to start positive pressure ventilation (PPV)?

   Heart rate below 100 beats per minute (or apnoea/gasping) after the initial steps indicates the need for PPV.

3. At what heart rate during neonatal resuscitation should chest compressions be started, and at what ratio with ventilation?

   Start chest compressions when heart rate remains below 60 bpm despite 30 seconds of effective PPV. Use a 3:1 ratio (3 compressions to 1 breath), giving 90 compressions and 30 breaths per minute.

4. What is the dose and route of adrenaline (epinephrine) in neonatal resuscitation?

   IV/intraosseous adrenaline 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000 solution). It is given when heart rate stays below 60 bpm despite adequate ventilation and chest compressions.

5. What oxygen concentration should be used to initiate resuscitation of a term newborn versus a preterm newborn?

   Term newborns: start with 21% oxygen (room air). Preterm (<35 weeks): start with 21–30% oxygen, titrated to target preductal SpO2.

6. What are the 5 components of the APGAR score?

   Appearance (colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. Each scored 0–2, assessed at 1 and 5 minutes.

7. What is physiological neonatal jaundice — its timing and cause?

   Unconjugated hyperbilirubinaemia appearing after 24 hours of life, peaking around day 3–5, resolving by 1–2 weeks. Caused by increased RBC breakdown plus immature hepatic conjugation (low UDP-glucuronosyltransferase).

8. Why is jaundice appearing within the first 24 hours of life always pathological, and what causes it?

   It is always pathological because it usually reflects haemolysis. Common causes: Rh or ABO incompatibility, G6PD deficiency, hereditary spherocytosis, and congenital infections.

9. What is kernicterus and which type of bilirubin causes it?

   Kernicterus is bilirubin-induced brain damage (deposition in basal ganglia) caused by unconjugated (indirect) bilirubin crossing the blood-brain barrier. It causes lethargy, hypertonia, opisthotonus, high-pitched cry, and later choreoathetoid cerebral palsy, deafness, and gaze palsy.

10. What are the two main treatments for neonatal unconjugated hyperbilirubinaemia?

    Phototherapy (blue light converts bilirubin to water-soluble isomers for excretion) and exchange transfusion (for severe/rapidly rising bilirubin to prevent kernicterus).

11. How is conjugated (direct) hyperbilirubinaemia defined in a neonate and why is it always pathological?

    Direct bilirubin >1 mg/dL or >20% of total bilirubin. It is always pathological and suggests biliary atresia, neonatal hepatitis, or metabolic/infective causes — requires urgent evaluation.

12. How is prematurity defined by gestational age, including the subcategories?

    Premature = birth before 37 completed weeks. Extremely preterm <28 weeks, very preterm 28 to <32 weeks, moderate to late preterm 32 to <37 weeks.

13. Define low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW).

    LBW <2500 g, VLBW <1500 g, ELBW <1000 g (regardless of gestational age).

14. What is the pathophysiology and key cause of respiratory distress syndrome (RDS) in preterm infants?

    Surfactant deficiency from immature type II pneumocytes causes alveolar collapse, decreased compliance, and hypoxaemia. Risk increases with decreasing gestational age.

15. What antenatal intervention reduces the risk of neonatal RDS, and how does it work?

    Antenatal corticosteroids (betamethasone or dexamethasone) given to the mother accelerate fetal lung maturity and surfactant production, reducing RDS, IVH, and mortality.

16. Name four major complications of prematurity affecting different organ systems.

    Respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity (also patent ductus arteriosus, apnoea of prematurity, and hypothermia).

17. What distinguishes early-onset from late-onset neonatal sepsis by timing and typical source?

    Early-onset: ≤72 hours (some say ≤7 days) of life, acquired from maternal/vertical transmission. Late-onset: >72 hours, usually nosocomial or community-acquired.

18. What are the three most common organisms causing early-onset neonatal sepsis?

    Group B Streptococcus (S. agalactiae), Escherichia coli, and Listeria monocytogenes.

19. What is the typical empirical antibiotic regimen for early-onset neonatal sepsis?

    Ampicillin plus an aminoglycoside (gentamicin). A third-generation cephalosporin (e.g., cefotaxime) is added if meningitis is suspected.

20. List five clinical signs that should raise suspicion of neonatal sepsis.

    Temperature instability (fever or hypothermia), poor feeding/lethargy, respiratory distress/apnoea, tachycardia or bradycardia, and jaundice. Others: hypotension, hypo/hyperglycaemia, seizures, and abdominal distension.

21. What intrapartum strategy prevents Group B Streptococcus early-onset sepsis?

    Intrapartum antibiotic prophylaxis (IV penicillin or ampicillin) given to mothers who are GBS-positive on screening or who have risk factors (preterm labour, prolonged rupture of membranes, intrapartum fever).

22. At what age does a child typically achieve social smiling, and what domain does it assess?

    Social smile appears by 6 weeks (around 6–8 weeks). It assesses the social/emotional developmental domain.

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