Professional and Linguistic Assessments Board (PLAB) Paediatrics and Child Health Syllabus

Paediatrics and Child Health syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Paediatrics and Child Health in Professional and Linguistic Assessments Board (PLAB), not a summary of it.

1. 1

   Neonatology and Newborn Care

   4 topics

   • Newborn Assessment
     • APGAR scoring and newborn examination
     • Newborn blood spot screening
   • Neonatal Jaundice
     • Physiological vs pathological jaundice
     • Phototherapy and exchange transfusion thresholds
   • Prematurity and Respiratory Distress
     • Respiratory distress syndrome
     • Neonatal sepsis
   • Congenital Conditions
     • Congenital heart disease screening
     • Common congenital anomalies
2. 2

   Acute Paediatric Presentations

   4 topics

   • Fever and Infection
     • NICE traffic light system
     • Meningococcal disease
     • Urinary tract infection in children
   • Respiratory Emergencies
     • Bronchiolitis
     • Croup and epiglottitis
     • Acute asthma in children
   • Gastrointestinal Presentations
     • Gastroenteritis and dehydration assessment
     • Intussusception and pyloric stenosis
   • Paediatric Resuscitation
     • APLS principles
     • Recognition of the sick child
3. 3

   Growth, Development and Chronic Conditions

   4 topics

   • Growth and Nutrition
     • Growth charts and failure to thrive
     • Faltering growth assessment
   • Developmental Milestones
     • Normal development domains
     • Developmental delay and autism
   • Childhood Chronic Disease
     • Childhood diabetes
     • Cystic fibrosis and chronic respiratory disease
   • Immunisation
     • UK childhood immunisation schedule
     • Contraindications and counselling
4. 4

   Child Protection and Genetics

   4 topics

   • Safeguarding Children
     • Recognising non-accidental injury
     • Referral pathways and documentation
   • Common Genetic Conditions
     • Down syndrome
     • Inherited conditions counselling
   • Childhood Cancers
     • Leukaemia presentation
     • Red flag symptoms
   • Adolescent Health
     • Consent and confidentiality
     • Risk behaviours and HEADSS assessment

Paediatrics and Child Health flashcards for Professional and Linguistic Assessments Board (PLAB)

18 of 50 cards from the Paediatrics and Child Health deck — real questions with worked answers.

1. What are the five components of the APGAR score used in newborn assessment, and at what time points is it measured?

   Appearance (colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. It is measured at 1 and 5 minutes after birth (and 10 minutes if abnormal). Each component scores 0-2, giving a total of 0-10.

2. In the newborn (NIPE) examination, what are the two manoeuvres used to screen for developmental dysplasia of the hip?

   The Barlow manoeuvre (adduct the flexed hip while applying posterior pressure to dislocate an unstable hip) and the Ortolani manoeuvre (abduct the flexed hip with anterior pressure to relocate a dislocated hip).

3. What is the cut-off age that distinguishes physiological from pathological neonatal jaundice in a term baby?

   Jaundice appearing within the first 24 hours of life is always pathological. Physiological jaundice typically appears after 24 hours, peaks around days 3-5, and resolves by day 14 (or day 21 in preterm infants).

4. Which type of bilirubin causes kernicterus, and why does it cross the blood-brain barrier?

   Unconjugated (indirect) bilirubin, because it is lipid-soluble (fat-soluble) and unbound to albumin, so it crosses the blood-brain barrier and deposits in the basal ganglia, causing bilirubin encephalopathy (kernicterus).

5. What is the first-line treatment for significant neonatal unconjugated hyperbilirubinaemia, and what is used when levels approach the exchange threshold?

   Phototherapy (blue light ~450 nm converts bilirubin to water-soluble isomers) is first-line. Exchange transfusion is used when bilirubin reaches the exchange-transfusion threshold or there are signs of acute bilirubin encephalopathy.

6. How is prematurity defined by gestational age, and what are the WHO subcategories?

   Prematurity is birth before 37 completed weeks of gestation. Subcategories: extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate-to-late preterm (32 to <37 weeks).

7. What is the underlying cause of neonatal respiratory distress syndrome (RDS) in premature infants, and what antenatal intervention reduces its risk?

   Deficiency of pulmonary surfactant (produced by type II pneumocytes), leading to alveolar collapse and reduced lung compliance. Antenatal maternal corticosteroids (e.g. dexamethasone/betamethasone) accelerate fetal lung maturation and reduce RDS risk.

8. What is the classic chest X-ray appearance of neonatal respiratory distress syndrome?

   A diffuse 'ground-glass' (reticulogranular) appearance of the lungs with air bronchograms and low lung volumes.

9. What are the four cardinal features of Tetralogy of Fallot?

   (1) Ventricular septal defect (VSD), (2) overriding aorta, (3) right ventricular outflow tract obstruction (pulmonary stenosis), and (4) right ventricular hypertrophy. The chest X-ray classically shows a 'boot-shaped' heart.

10. What is the difference between cyanotic and acyanotic congenital heart disease, with examples of each?

    Cyanotic lesions cause right-to-left shunting and central cyanosis (e.g. Tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, truncus arteriosus). Acyanotic lesions cause left-to-right shunting or obstruction without cyanosis (e.g. VSD, ASD, PDA, coarctation of the aorta).

11. What medication keeps the ductus arteriosus open in a duct-dependent congenital heart lesion, and what is used to close a patent ductus arteriosus?

    Prostaglandin E1 (alprostadil) is infused to keep the duct open in duct-dependent lesions. A prostaglandin synthesis inhibitor such as indometacin or ibuprofen is used to close a patent ductus arteriosus.

12. In a febrile child, list the NICE traffic-light 'red' (high-risk) features that mandate urgent assessment.

    Pale/mottled/blue skin, no response to social cues, appears ill, does not wake or stay awake, weak/high-pitched/continuous cry, grunting, tachypnoea >60/min, moderate-severe chest indrawing, reduced skin turgor, age <3 months with temperature ≥38°C, non-blanching rash, bulging fontanelle, neck stiffness, status epilepticus, focal neurology/seizures.

13. What temperature threshold defines fever in an infant under 3 months that mandates a full septic screen, and which empirical antibiotic class is typically used?

    A temperature ≥38°C in an infant <3 months old is treated as serious until proven otherwise, requiring a full septic screen. Empirical IV broad-spectrum antibiotics are given, classically a third-generation cephalosporin (e.g. cefotaxime/ceftriaxone), with amoxicillin added in neonates to cover Listeria.

14. What is the characteristic rash of meningococcal septicaemia, and what bedside test confirms it?

    A non-blanching petechial or purpuric rash. The 'glass/tumbler test' confirms it: the rash does not fade (does not blanch) when pressed under a glass tumbler.

15. Differentiate croup from epiglottitis by causative organism and clinical features.

    Croup (laryngotracheobronchitis) is usually viral (parainfluenza), with a barking/seal-like cough, stridor, and hoarse voice, child usually not toxic. Epiglottitis is bacterial (classically Haemophilus influenzae type b), with rapid onset, high fever, drooling, muffled 'hot potato' voice, tripod positioning, and a toxic-looking child; do NOT examine the throat.

16. What is the first-line treatment for moderate croup, and what is given for severe croup with significant stridor?

    A single dose of oral dexamethasone (0.15 mg/kg) is first-line for croup of any severity. For severe croup, add nebulised adrenaline (epinephrine) for rapid temporary relief, alongside oxygen.

17. Which organism most commonly causes bronchiolitis, in which age group, and what is the mainstay of management?

    Respiratory syncytial virus (RSV) is the commonest cause, typically in infants <2 years (peak 3-6 months). Management is supportive: oxygen, fluids/feeding support, and minimal handling; bronchodilators and steroids are not routinely effective.

18. What is the typical presentation of pyloric stenosis, including the metabolic abnormality and examination finding?

    Projectile non-bilious vomiting in an infant typically 2-8 weeks old (commoner in firstborn males). It causes a hypochloraemic, hypokalaemic metabolic alkalosis. Examination may reveal a palpable 'olive-shaped' mass in the right upper quadrant and visible gastric peristalsis. Treated with Ramstedt pyloromyotomy after fluid correction.

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