UK Medical Licensing Assessment (UKMLA) Child Health (Paediatrics and Neonatology) Syllabus

Child Health (Paediatrics and Neonatology) syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Child Health (Paediatrics and Neonatology) in UK Medical Licensing Assessment (UKMLA), not a summary of it.

1. 1

   The Newborn and Neonatology

   4 topics

   • Neonatal assessment and resuscitation
     • Newborn examination (NIPE)
     • Apgar score and neonatal resuscitation
     • Newborn screening including bloodspot
   • Prematurity and its complications
     • Respiratory distress syndrome
     • Necrotising enterocolitis
     • Retinopathy of prematurity and IVH
   • Neonatal jaundice
     • Physiological and pathological causes
     • Phototherapy and kernicterus
   • Congenital and neonatal infection
     • Early and late onset sepsis
     • Congenital infections (TORCH)
2. 2

   Growth, Development and Nutrition

   5 topics

   • Normal growth and faltering growth
     • Growth charts and centiles
     • Causes and assessment of faltering growth
   • Developmental milestones and delay
     • Domains of development
     • Global and specific developmental delay
   • Neurodevelopmental conditions
     • Autism spectrum disorder
     • ADHD and learning disability
   • Infant feeding and nutrition
     • Breastfeeding and formula feeding
     • Weaning and nutritional deficiencies
   • Puberty and its disorders
3. 3

   Acute Paediatric Illness

   4 topics

   • The febrile child
     • Traffic light assessment of risk
     • Serious bacterial infection and meningococcal disease
     • Kawasaki disease
   • Paediatric respiratory illness
     • Bronchiolitis
     • Croup and epiglottitis
     • Acute asthma and viral wheeze
   • Dehydration and gastrointestinal illness
     • Gastroenteritis and fluid management
     • Pyloric stenosis and intussusception
   • The seriously unwell child
     • Paediatric sepsis
     • Diabetic ketoacidosis in children
     • Anaphylaxis and the convulsing child
4. 4

   Chronic and Genetic Conditions in Childhood

   5 topics

   • Congenital heart disease
     • Cyanotic and acyanotic lesions
     • Innocent versus pathological murmurs
   • Chronic respiratory and inherited disease
     • Cystic fibrosis
     • Childhood asthma management
   • Genetic and chromosomal disorders
     • Down syndrome and other trisomies
     • Inborn errors of metabolism
   • Childhood epilepsy and febrile seizures
   • Childhood malignancy and renal disease
5. 5

   Child Protection and Community Child Health

   4 topics

   • Recognition of non-accidental injury
     • Suspicious injuries and patterns
     • Fabricated or induced illness
   • Sudden unexpected death in infancy
   • Immunisation in childhood
   • Common behavioural and emotional problems

Child Health (Paediatrics and Neonatology) flashcards for UK Medical Licensing Assessment (UKMLA)

24 of 50 cards from the Child Health (Paediatrics and Neonatology) deck — real questions with worked answers.

1. What are the five components of the APGAR score used in neonatal assessment?

   Appearance (colour), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration (respiratory effort). Each scored 0-2, assessed at 1 and 5 minutes; max total = 10.

2. In the newborn life support algorithm, what is the recommended ratio of chest compressions to ventilations, and at what heart rate do you start compressions?

   Compression:ventilation ratio is $3:1$. Start chest compressions if heart rate remains below $60$ bpm despite 30 seconds of effective ventilation (after the initial 5 inflation breaths).

3. What is the WHO definition of prematurity, and what are the subcategories by gestational age?

   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).

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

   Respiratory distress syndrome (surfactant deficiency), intraventricular haemorrhage, necrotising enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia (chronic lung disease), and patent ductus arteriosus.

5. What is the pathophysiology of neonatal respiratory distress syndrome (RDS), and which antenatal treatment reduces its incidence?

   Deficiency of surfactant (produced by type II pneumocytes) causing alveolar collapse and increased work of breathing. Antenatal maternal corticosteroids (e.g. betamethasone) accelerate fetal lung maturation and reduce incidence.

6. Why is neonatal jaundice in the first 24 hours of life always pathological, and what is the most important cause?

   Physiological and breast milk jaundice never appear before 24 hours, so any jaundice $<24$ h indicates pathology. The key cause is haemolysis - especially rhesus or ABO incompatibility (also G6PD deficiency, hereditary spherocytosis).

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

   Bilirubin encephalopathy - deposition of unconjugated (lipid-soluble) bilirubin in the basal ganglia, causing irreversible neurological damage (athetoid cerebral palsy, sensorineural deafness, learning disability). Only unconjugated bilirubin crosses the blood-brain barrier.

8. Distinguish unconjugated from conjugated neonatal jaundice in terms of causes and clinical significance.

   Unconjugated (prehepatic/haemolytic, physiological, breast milk, sepsis): risk of kernicterus, treated with phototherapy. Conjugated (>25 mcmol/L or >20% of total) is always pathological - causes include biliary atresia and neonatal hepatitis; pale stools/dark urine; needs urgent investigation.

9. List the TORCH organisms responsible for congenital infection.

   Toxoplasmosis, Other (syphilis, varicella, parvovirus B19, listeria), Rubella, Cytomegalovirus (CMV), Herpes simplex virus. CMV is the commonest congenital infection.

10. What is the classic triad of congenital rubella syndrome?

    Sensorineural deafness, congenital cataracts, and congenital heart disease (classically patent ductus arteriosus). Also 'blueberry muffin' rash and microcephaly.

11. Which organism most commonly causes early-onset neonatal sepsis, and what is the standard empirical antibiotic regimen in the UK?

    Group B Streptococcus ($\textit{Streptococcus agalactiae}$). UK empirical treatment for early-onset sepsis is benzylpenicillin plus gentamicin.

12. What is the formula relating weight to age for estimating the average weight of a child aged 1-5 years?

    $\text{Weight (kg)} = (\text{age in years} + 4) \times 2$. A useful APLS estimate for resuscitation drug/fluid dosing.

13. Define faltering growth (failure to thrive) using centile criteria.

    A sustained drop across centile lines on the growth chart: a fall of $\geq 1$ centile space if birthweight was below the 9th centile, $\geq 2$ spaces if birthweight was 9th-91st, or $\geq 3$ spaces if birthweight was above the 91st centile.

14. At what age does a child typically double and triple their birth weight?

    Birth weight doubles by approximately $5$ months and triples by approximately $12$ months (1 year).

15. List the four domains of developmental assessment in children.

    Gross motor; fine motor and vision; speech, language and hearing; and social, emotional and behavioural development.

16. State the median ages for these gross motor milestones: head control, sitting unsupported, walking unsupported.

    Good head control by $\sim 4$ months; sitting unsupported by $\sim 6$ months (limit 9 months); walking unsupported by $\sim 12$ months (limit 18 months).

17. What is the limit age for walking, and what should an isolated failure to walk by this age prompt?

    The limit age for walking unsupported is $18$ months. Failure prompts assessment for causes such as cerebral palsy and, in boys, checking creatine kinase for Duchenne muscular dystrophy.

18. List the core diagnostic features of autism spectrum disorder (ASD).

    Persistent deficits in social communication and social interaction, plus restricted, repetitive patterns of behaviour, interests or activities (including sensory abnormalities). Onset in early developmental period.

19. What are the three core symptom domains of ADHD?

    Inattention, hyperactivity, and impulsivity. Symptoms must be present in $\geq 2$ settings (e.g. home and school), persist $\geq 6$ months, and cause functional impairment.

20. What is the recommended duration of exclusive breastfeeding, and when should solid foods (weaning) be introduced?

    Exclusive breastfeeding is recommended for the first $6$ months. Solids (complementary feeding/weaning) should be introduced at around $6$ months, not before $4$ months.

21. Which vitamin supplements are recommended for breastfed infants in the UK and why?

    Vitamin D (all breastfed infants, $8.5$-$10$ mcg/day) because breast milk is low in vitamin D, and vitamin K at birth to prevent haemorrhagic disease of the newborn. Breast milk is also low in vitamin K.

22. Define delayed and precocious puberty in girls and boys.

    Precocious: secondary sexual characteristics before $8$ years (girls) or $9$ years (boys). Delayed: absence by $13$ years (girls) or $14$ years (boys). Delayed puberty is more common and usually benign in boys.

23. What is the first sign of puberty in girls versus boys, and how is pubertal staging described?

    First sign in girls is breast development (thelarche); in boys it is testicular enlargement ($\geq 4$ mL volume). Staged using Tanner stages 1-5.

24. Define fever in a child and state the highest-risk age group for serious bacterial infection.

    Fever is a temperature $\geq 38\,^{\circ}\mathrm{C}$. Infants $<3$ months (especially $<1$ month) are at highest risk; any infant $<3$ months with fever $\geq 38\,^{\circ}\mathrm{C}$ needs full septic screen and admission.

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