PMDC National Licensing Examination Paediatrics Syllabus

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).

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.

By what age should a child sit without support, and what is the average age?

Sits without support by around 6 months (average), with a red-flag limit of 9 months.

What gross motor milestone is expected at around 12 months of age?

Walking independently (walks alone). Average is about 12 months; the limit age (red flag) for walking is 18 months.

What are the typical first words and two-word phrases ages in speech development?

First meaningful words around 12 months; two-word phrases/sentences around 18–24 months. A vocabulary explosion occurs around 2 years.

At what age can a child typically build a tower of 6 cubes and a tower of 3 cubes?

Tower of 3 cubes at about 18 months; tower of 6 cubes at about 2 years (24 months).

What is the World Health Organisation (WHO) definition of severe acute malnutrition (SAM) in children 6–59 months?

Weight-for-height/length below −3 SD (severe wasting), and/or MUAC <11.5 cm, and/or bilateral pitting oedema (nutritional oedema).

What are the clinical features that differentiate marasmus from kwashiorkor?

Marasmus: severe wasting, no oedema, 'old man' face, marked weight loss (<60% expected weight) from total calorie deficiency. Kwashiorkor: oedema, hepatomegaly (fatty liver), skin/hair changes, irritability, from protein deficiency with relatively preserved calories.

What is failure to thrive (FTT) and how is it commonly defined?

Inadequate physical growth: weight (or weight-for-height) falling below the 3rd–5th percentile, or crossing down two major percentile lines. Causes are inadequate intake, malabsorption, or increased metabolic demand.

What is the first step in managing the acute (stabilisation) phase of severe acute malnutrition?

Treat/prevent hypoglycaemia, hypothermia, and dehydration; correct electrolytes; treat infection; and begin cautious feeding with F-75 formula. Iron is withheld during the stabilisation phase.

What is refeeding syndrome and which electrolyte abnormality is its hallmark?

A potentially fatal shift in fluids/electrolytes when feeding is reintroduced in malnourished patients. Hallmark is hypophosphataemia (also hypokalaemia and hypomagnesaemia), which can cause cardiac and respiratory failure.

What are the classic features of vitamin A deficiency?

Night blindness (earliest), xerophthalmia, Bitot's spots, corneal xerosis/keratomalacia (can cause blindness), increased infection risk, and follicular hyperkeratosis.

What deficiency causes rickets, and what are its key clinical and biochemical findings?

Vitamin D deficiency. Clinical: bowing of legs, rachitic rosary, frontal bossing, wide wrists, delayed fontanelle closure. Biochemistry: low/normal calcium, low phosphate, high alkaline phosphatase, high PTH.

What are the deficiency states of vitamin B1 (thiamine) and vitamin C?

Thiamine deficiency causes beriberi (wet: cardiac failure; dry: peripheral neuropathy). Vitamin C deficiency causes scurvy (bleeding gums, perifollicular haemorrhage, poor wound healing, painful bones).

What are the consequences of iodine deficiency in children?

Goitre, hypothyroidism, and in severe congenital deficiency, cretinism (intellectual disability, deafness, short stature). Iodine deficiency is the most common preventable cause of intellectual disability worldwide.

What is the most common cause of anaemia in children worldwide and its peripheral blood picture?

Iron deficiency anaemia. Blood picture: microcytic hypochromic anaemia with low ferritin, low serum iron, high TIBC, and low transferrin saturation.

According to WHO/IMCI, what clinical sign defines pneumonia in a child with cough, and what defines severe pneumonia?

Pneumonia: fast breathing for age. Severe pneumonia: any general danger sign or chest indrawing (lower chest wall indrawing) or stridor in a calm child.

What are the WHO age-specific fast breathing (tachypnoea) thresholds used to diagnose pneumonia?

<2 months: ≥60 breaths/min; 2–11 months: ≥50 breaths/min; 12 months–5 years: ≥40 breaths/min.

What is the most common cause of bronchiolitis and the typical age group affected?

Respiratory syncytial virus (RSV) is the most common cause; it typically affects infants under 2 years, peaking at 2–6 months. Presents with wheeze, crackles, and respiratory distress.

What is the first-line antibiotic for non-severe community-acquired pneumonia in children per WHO?

Oral amoxicillin. Severe pneumonia is treated with injectable antibiotics such as ampicillin/penicillin plus gentamicin.

How do you clinically assess the degree of dehydration as 'no/some/severe' dehydration in a child (IMCI)?

Some dehydration: ≥2 of — restless/irritable, sunken eyes, drinks eagerly/thirsty, skin pinch goes back slowly. Severe dehydration: ≥2 of — lethargic/unconscious, sunken eyes, unable to drink or drinks poorly, skin pinch goes back very slowly (≥2 sec).

What is the composition rationale of WHO low-osmolarity oral rehydration solution (ORS)?

Reduced osmolarity (245 mOsm/L) with sodium 75, glucose 75 mmol/L (1:1 sodium-to-glucose ratio) to exploit sodium-glucose co-transport for water absorption, reducing stool output and vomiting compared to old ORS.

Describe WHO Plan C for severe dehydration: the IV fluid and amounts.

IV Ringer's lactate (or normal saline): for children ≥12 months give 100 mL/kg as 30 mL/kg over 30 min then 70 mL/kg over 2.5 hours; for infants <12 months give 30 mL/kg over 1 hour then 70 mL/kg over 5 hours.

What is the role of zinc supplementation in childhood diarrhoea, and the dosing?

Zinc reduces duration and severity of diarrhoea and prevents future episodes. Dose: 10 mg/day for infants <6 months and 20 mg/day for children ≥6 months, given for 10–14 days.

What is the most common cause of acute watery diarrhoea in young children worldwide, and what vaccine prevents it?

Rotavirus. The oral rotavirus vaccine prevents it and is included in many national immunisation schedules.

What are the classic three Cs of measles and the pathognomonic oral sign?

Cough, Coryza, and Conjunctivitis (the three Cs), plus Koplik spots (white spots on buccal mucosa) which are pathognomonic and precede the maculopapular rash.

What organism causes pertussis (whooping cough) and what are its three classic stages?

Bordetella pertussis. Stages: catarrhal (cold-like, most infectious), paroxysmal (paroxysmal cough with inspiratory whoop, post-tussive vomiting), and convalescent (gradual recovery).

What are the complications of mumps and rubella that make their vaccines important?

Mumps: orchitis, meningitis, pancreatitis, deafness. Rubella: congenital rubella syndrome (cataracts, deafness, PDA/congenital heart disease) if infection occurs in early pregnancy.

Which vaccine prevents tuberculosis, when is it given, and what immunity does it provide?

BCG vaccine, given at birth in endemic countries (Pakistan EPI). It protects mainly against severe forms — miliary TB and TB meningitis — in children.

What are the four classic features (tetralogy) of Tetralogy of Fallot?

Ventricular septal defect (VSD), pulmonary stenosis (right ventricular outflow obstruction), overriding aorta, and right ventricular hypertrophy. It is the most common cyanotic congenital heart disease beyond infancy.

How are congenital heart diseases classified into cyanotic versus acyanotic, with examples?

Acyanotic (left-to-right shunt or obstructive): VSD, ASD, PDA, coarctation, aortic/pulmonary stenosis. Cyanotic (right-to-left shunt): Tetralogy of Fallot, transposition of great arteries, tricuspid atresia, TAPVC, truncus arteriosus (the '5 Ts').

What is the most common congenital heart defect overall, and its classic murmur?

Ventricular septal defect (VSD). Classic murmur: harsh pansystolic (holosystolic) murmur best heard at the left lower sternal border.

What is the tetrad defining nephrotic syndrome?

Heavy proteinuria (>40 mg/m²/hour or protein:creatinine ratio >200 mg/mmol), hypoalbuminaemia (<25 g/L), oedema, and hyperlipidaemia.

What is the most common cause of nephrotic syndrome in children and its first-line treatment?

Minimal change disease (most common, ~80–90% of childhood cases). First-line treatment is oral corticosteroids (prednisolone), to which most patients respond.