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

What is the defibrillation energy dose and the standard IV/IO adrenaline dose used in paediatric advanced life support cardiac arrest?

Defibrillation is 4 J/kg for shockable rhythms (VF/pulseless VT). Adrenaline is 10 micrograms/kg (0.1 mL/kg of 1:10,000) IV/IO, repeated every 3-5 minutes (alternate cycles).

How are paediatric weight (for resuscitation) and endotracheal tube internal diameter estimated by age?

Estimated weight (1-5 yr): $\text{weight (kg)} = 2 \times (\text{age} + 4)$. Uncuffed ETT internal diameter: $\text{size (mm)} = \frac{\text{age}}{4} + 4$ (use $\frac{\text{age}}{4} + 3.5$ for cuffed tubes).

How is a child's expected weight related to age changes in the first year of life?

Birth weight is regained by ~10-14 days, doubles by ~5 months, triples by ~1 year, and quadruples by ~2 years. Infants may lose up to 10% of birth weight in the first week.

Give the Holliday-Segar '4-2-1' formula for calculating a child's hourly maintenance fluid requirement.

$$4 \text{ mL/kg/hr for the first } 10\text{ kg} + 2 \text{ mL/kg/hr for the next } 10\text{ kg} + 1 \text{ mL/kg/hr for each kg above } 20\text{ kg}.$$ For example, a 25 kg child needs $40 + 20 + 5 = 65$ mL/hr.

What is the formula for calculating a child's percentage weight loss in dehydration, and what does 5% vs 10% loss represent clinically?

$$\%\text{ loss} = \frac{\text{usual weight} - \text{current weight}}{\text{usual weight}} \times 100.$$ Around 5% loss indicates clinical dehydration; ~10% loss indicates clinical shock (decompensated dehydration).

State the WHO definitions of stunting, wasting, and underweight in childhood malnutrition.

Stunting = low height-for-age (chronic malnutrition), defined as height-for-age z-score below −2. Wasting = low weight-for-height (acute malnutrition), weight-for-height z-score below −2. Underweight = low weight-for-age z-score below −2.

Compare marasmus and kwashiorkor.

Marasmus is severe deficiency of total calories (energy), causing severe wasting, marked weight loss (<60% expected), and an emaciated 'old man' appearance without oedema. Kwashiorkor is predominantly protein deficiency with adequate calories, causing oedema, ascites, fatty liver (hepatomegaly), skin/hair changes, and a distended abdomen.

List the median ages for the key gross motor developmental milestones from head control to running.

Head control ~3-4 months; sits without support ~6-8 months; crawls ~9 months; pulls to stand/cruises ~10-12 months; walks unsupported ~12-15 months (red flag if not walking by 18 months); runs ~2 years; climbs stairs (one foot per step) ~3-4 years.

What are the expected language/speech milestones at 6 months, 12 months, 2 years, and 3 years?

6 months: babbling (consonant sounds). 12 months: 1-2 words with meaning, understands name. 2 years: ~50 words, two-word phrases. 3 years: short sentences (3-4 words), understandable to strangers, knows name and age.

At what ages do the social smile, stranger anxiety, and symbolic/pretend play typically appear?

Social smile ~6 weeks (red flag if absent by 8-10 weeks). Stranger anxiety ~6-9 months. Symbolic/pretend play and waving 'bye-bye' ~12-18 months. Parallel play ~2 years; cooperative/interactive play ~3-4 years.

What is the most common chronic disease of childhood, and what are the components of a personalised asthma management plan?

Asthma is the most common chronic childhood disease. A management plan includes a SABA reliever (e.g. salbutamol), an inhaled corticosteroid preventer, recognition of worsening symptoms (peak flow/symptoms), an action plan for exacerbations, and inhaler technique/spacer education with regular review.

How is type 1 diabetes mellitus typically diagnosed in a child, and what are the cardinal presenting symptoms?

Diagnosed by symptoms of hyperglycaemia plus a random plasma glucose ≥11.1 mmol/L (or fasting ≥7.0 mmol/L). Cardinal symptoms: polyuria, polydipsia, weight loss, and lethargy (the classic 'osmotic symptoms'), often presenting in diabetic ketoacidosis.

List the biochemical criteria for diagnosing diabetic ketoacidosis (DKA) in a child.

(1) Hyperglycaemia: blood glucose >11 mmol/L; (2) Ketonaemia: blood ketones >3 mmol/L (or significant ketonuria); and (3) Acidosis: blood pH <7.3 and/or bicarbonate <15 mmol/L.

What is the UK routine childhood immunisation schedule at 8, 12, and 16 weeks of age?

8 weeks: 6-in-1 (DTaP/IPV/Hib/HepB), rotavirus, MenB. 12 weeks: 6-in-1, pneumococcal (PCV), rotavirus. 16 weeks: 6-in-1, MenB.

When are the MMR vaccine doses given in the UK childhood schedule?

The first MMR dose is given at 1 year (12 months), and the second dose is given at 3 years 4 months (pre-school booster), alongside the 4-in-1 pre-school booster (DTaP/IPV).

Which vaccine is given at 1 year to protect against meningitis, and which vaccines are offered to teenagers in the UK schedule?

At 1 year: Hib/MenC booster, PCV booster, and MMR. Teenagers receive: HPV vaccine (year 8, ~12-13 years), and at ~14 years the 3-in-1 teenage booster (Td/IPV) plus MenACWY.

Name the four classic categories of child maltreatment recognised in safeguarding.

Physical abuse, emotional (psychological) abuse, sexual abuse, and neglect. Fabricated or induced illness (FII) is also recognised.

Which fracture patterns and injuries are highly suggestive of non-accidental injury (physical abuse) in a child?

Posterior rib fractures, metaphyseal 'corner/bucket-handle' fractures, multiple fractures of different ages, spiral fractures of long bones in non-mobile infants, fractures in a child not yet walking, retinal haemorrhages with subdural haematoma (suggesting shaking), cigarette burns, and bruising in non-mobile babies.

What does the acronym TEN-4 (bruising) and the principle 'those who don't cruise rarely bruise' indicate in safeguarding?

Bruising to the Torso, Ears, or Neck in a child ≤4 years, or ANY bruising in an infant <4 months, is concerning for abuse (TEN-4). 'Those who don't cruise rarely bruise' means bruising in a non-mobile (non-cruising) infant is a red flag for non-accidental injury and warrants safeguarding evaluation.

What is the chromosomal abnormality in Down syndrome, and list its key clinical features.

Trisomy 21 (usually meiotic non-disjunction; less often translocation or mosaicism). Features: hypotonia, flat occiput/face, upslanting palpebral fissures, epicanthic folds, single palmar crease, Brushfield spots, protruding tongue, sandal gap; associated with congenital heart disease (esp. AVSD), duodenal atresia, hypothyroidism, leukaemia risk, and learning disability.

Contrast the karyotype and key features of Turner syndrome and Klinefelter syndrome.

Turner syndrome: 45,X (one X, female phenotype) — short stature, webbed neck, widely spaced nipples, cubitus valgus, coarctation of the aorta, primary amenorrhoea/ovarian failure. Klinefelter syndrome: 47,XXY (male phenotype) — tall stature, gynaecomastia, small firm testes, infertility, reduced secondary sexual characteristics.

What is the inheritance pattern and pathophysiology of cystic fibrosis, and what is the diagnostic test?

Autosomal recessive mutation in the CFTR gene (commonest ΔF508) on chromosome 7, causing defective chloride channel and thick secretions affecting lungs, pancreas, and gut. Diagnosed by the sweat test (sweat chloride >60 mmol/L) plus genetic testing; UK newborn heel-prick measures immunoreactive trypsinogen.

What is the inheritance pattern of Duchenne muscular dystrophy, and what is Gowers' sign?

X-linked recessive (dystrophin gene mutation), affecting boys. Gowers' sign is when a child uses their hands to 'walk up' their own legs to rise from the floor, indicating proximal lower-limb (pelvic girdle) muscle weakness. Creatine kinase is markedly elevated.

What is the most common childhood cancer overall, and what is the most common solid (and most common CNS) tumour of childhood?

Acute lymphoblastic leukaemia (ALL) is the most common childhood cancer overall. Brain tumours are the most common solid tumours; among them, astrocytoma is the most common, and medulloblastoma is the most common malignant posterior fossa tumour.

What are the typical presenting features of acute lymphoblastic leukaemia in a child?

Features from bone marrow failure and infiltration: anaemia (pallor, fatigue), thrombocytopenia (bruising, petechiae, bleeding), neutropenia (recurrent infections, fever), bone pain, lymphadenopathy, hepatosplenomegaly, and sometimes a mediastinal mass (T-cell ALL).

Compare Wilms tumour (nephroblastoma) and neuroblastoma in terms of origin, presentation, and key marker.

Wilms tumour arises from the kidney, presents as a unilateral, smooth abdominal mass that usually does NOT cross the midline, in children ~3 years, with haematuria/hypertension. Neuroblastoma arises from neural crest (sympathetic/adrenal), presents as an irregular abdominal mass that often CROSSES the midline, with elevated urinary catecholamines (VMA/HVA), and may cause 'panda eyes' and bone pain.

What does the TNM/staging principle and the term 'tumour lysis syndrome' refer to in paediatric oncology?

Tumour lysis syndrome is a metabolic emergency from rapid breakdown of tumour cells (often after starting chemotherapy in leukaemia/lymphoma), causing hyperkalaemia, hyperphosphataemia, hyperuricaemia, and secondary hypocalcaemia, risking acute kidney injury and arrhythmias. Prevented/treated with hydration, allopurinol or rasburicase.

At what Tanner stages and ages does puberty normally begin in girls and boys, and what defines precocious puberty?

Girls: puberty begins ~8-13 years, first sign is breast budding (thelarche, Tanner stage 2). Boys: begins ~9-14 years, first sign is testicular enlargement (>4 mL). Precocious puberty = secondary sexual characteristics before age 8 in girls and before age 9 in boys.

What is the Fraser/Gillick competence principle in adolescent health?

Gillick competence is the legal principle that a child under 16 with sufficient maturity and understanding can consent to their own medical treatment without parental consent. The Fraser guidelines specifically apply to contraceptive/sexual health advice, requiring that the young person understands the advice, cannot be persuaded to inform parents, is likely to continue having intercourse, and that their health/best interests require treatment.

Which features make up the HEEADSSS assessment framework used in adolescent consultations, and why is confidentiality important?

HEEADSSS: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/depression/self-harm, Safety. It is a psychosocial screening tool for adolescents. Confidentiality (with safeguarding limits) is essential to encourage honest disclosure of risk behaviours, with a clear explanation that confidentiality may be broken if there is risk of serious harm.