SMLE Pediatrics Syllabus

Pediatrics syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Pediatrics in SMLE, not a summary of it.

1. 1

   Neonatology

   3 topics

   • Neonatal Resuscitation
   • Neonatal Jaundice
   • Neonatal Sepsis
2. 2

   Growth and Development

   3 topics

   • Milestones
   • Growth Disorders
   • Developmental Disorders

Pediatrics flashcards for SMLE

21 of 50 cards from the Pediatrics deck — real questions with worked answers.

1. During neonatal resuscitation, what is the correct compression-to-ventilation ratio and combined rate for a newborn requiring chest compressions?

   A ratio of $3:1$ (3 compressions to 1 breath), giving 90 compressions and 30 breaths per minute, for a total of $120$ events per minute.

2. In the initial steps of neonatal resuscitation, what three questions determine whether a newborn stays with the mother or requires intervention?

   Is the baby term? Is there good muscle tone? Is the baby breathing or crying? If all three are 'yes,' routine care with the mother; if any is 'no,' begin the initial steps (warm, dry, stimulate, position airway).

3. What heart rate threshold during neonatal resuscitation indicates the need to begin positive pressure ventilation (PPV)?

   A heart rate below $100$ beats/min (or apnea/gasping) after the initial steps mandates starting PPV.

4. At what heart rate during neonatal resuscitation should chest compressions be initiated?

   When the heart rate remains below $60$ beats/min despite $30$ seconds of effective PPV (ideally with an endotracheal tube and $100\%$ oxygen).

5. What is the recommended dose and preferred route of epinephrine in neonatal resuscitation?

   Intravenous/intraosseous epinephrine $0.01$–$0.03$ mg/kg (of $1{:}10{,}000$ concentration); the preferred route is the umbilical vein. Endotracheal dosing is higher at $0.05$–$0.1$ mg/kg if no IV access.

6. What are the five components of the APGAR score, and when is it assessed?

   Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration; each scored $0$–$2$ for a max of $10$, assessed at $1$ and $5$ minutes (and every 5 min up to 20 if low).

7. What preductal oxygen saturation target is expected at 5 minutes and at 10 minutes of life during neonatal resuscitation?

   About $80$–$85\%$ at 5 minutes and $85$–$95\%$ at 10 minutes, measured by a right-hand (preductal) pulse oximeter.

8. For term newborns, what initial oxygen concentration is recommended when starting PPV, versus preterm infants?

   Term and late-preterm ($\geq 35$ weeks) start with $21\%$ oxygen (room air); preterm infants ($<35$ weeks) start with $21$–$30\%$, then titrate to target saturations.

9. What defines pathologic (versus physiologic) neonatal jaundice by timing of onset?

   Jaundice appearing in the first $24$ hours of life is always pathologic; physiologic jaundice appears after $24$ hours, peaks around days $3$–$5$, and resolves within $1$–$2$ weeks.

10. What is the most common cause of severe early (first 24 hours) neonatal hyperbilirubinemia due to hemolysis?

    Isoimmune hemolytic disease from blood group incompatibility—Rh incompatibility (most severe) and ABO incompatibility (most common), producing unconjugated hyperbilirubinemia with a positive direct Coombs test.

11. Distinguish unconjugated from conjugated neonatal hyperbilirubinemia by the conjugated (direct) bilirubin threshold.

    Conjugated hyperbilirubinemia is defined by a direct bilirubin $>1$ mg/dL (or $>20\%$ of total). Conjugated jaundice is always pathologic and suggests cholestasis (e.g., biliary atresia).

12. What is kernicterus, and which bilirubin fraction causes it?

    Kernicterus is bilirubin-induced neurologic dysfunction from deposition of free unconjugated (fat-soluble) bilirubin in the basal ganglia and brainstem, causing lethargy, hypertonia, opisthotonus, and later choreoathetoid cerebral palsy and hearing loss.

13. Compare breastfeeding jaundice and breast milk jaundice by timing and mechanism.

    Breastfeeding (breastfeeding-failure) jaundice appears in the first week from inadequate intake and dehydration (increased enterohepatic circulation). Breast milk jaundice appears later (days $5$–$14$, persisting weeks) due to substances in milk that increase enterohepatic reabsorption.

14. What is the first-line treatment for significant unconjugated neonatal hyperbilirubinemia, and how does it work?

    Phototherapy with blue light ($\sim 460$–$490$ nm), which converts unconjugated bilirubin into water-soluble photoisomers (lumirubin) that are excreted without conjugation.

15. When is exchange transfusion indicated in neonatal jaundice?

    When total serum bilirubin exceeds the exchange threshold on the nomogram despite intensive phototherapy, or when there are signs of acute bilirubin encephalopathy; it rapidly removes bilirubin and antibody-coated red cells.

16. What enzyme deficiency causes Crigler-Najjar and Gilbert syndromes, and how do they differ in severity?

    Deficiency of UDP-glucuronosyltransferase (UGT1A1). Crigler-Najjar type I has complete absence (severe, kernicterus risk); type II is partial; Gilbert syndrome is a mild reduction causing benign intermittent unconjugated hyperbilirubinemia with stress.

17. How is early-onset neonatal sepsis defined by timing, and what is the classic causative organism?

    Early-onset sepsis occurs within the first $72$ hours (often $\leq 24$ h) of life, acquired vertically from the maternal genital tract; the classic pathogen is Group B Streptococcus (Streptococcus agalactiae), followed by E. coli.

18. How does late-onset neonatal sepsis differ from early-onset in timing and typical organisms?

    Late-onset sepsis presents after $72$ hours (up to $\sim 90$ days), often nosocomial or community-acquired; common organisms include coagulase-negative Staphylococci, Staphylococcus aureus, E. coli, Klebsiella, and Listeria.

19. What are the major maternal risk factors for early-onset neonatal sepsis?

    Maternal GBS colonization, prolonged rupture of membranes ($\geq 18$ hours), chorioamnionitis/maternal fever, preterm labor, and a previous infant with invasive GBS disease.

20. What is the standard empiric antibiotic regimen for early-onset neonatal sepsis?

    Ampicillin plus an aminoglycoside (gentamicin). Cefotaxime is added if Gram-negative meningitis is suspected; ampicillin specifically covers Listeria and Enterococcus.

21. What intrapartum prophylaxis prevents early-onset GBS neonatal sepsis, and who receives it?

    Intravenous penicillin G (or ampicillin) given intrapartum to mothers who are GBS-positive on $35$–$37$ week screening, have GBS bacteriuria, a prior GBS-affected infant, or unknown status with risk factors.

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