discussion.
Now, you might be thinking "the boys are getting a bit existentialist with this solve". We assure you, we're not. Paediatrics is a daunting field - it is a specialty after all. So, how do you learn it all for the exam in a couple of modules? The answer is by thinking about what's really high yield.
It's also worth remembering that each of you will have quite a lot of practical paediatric experience - after all it is a requirement of your training to keep a log book. So, a lot of the exam related paeds stuff, particularly the practical stuff, you should already know. As always, when you are thinking about a question in the exam, try to picture the patient in front of you. If you would not normally drip the child, don't feel compelled to put in a central line just because it's the exam.
With that in mind let's look at the topics of the most recent 19 paediatric questions up until the change of exams:
So, we think there are some definite themes to this list.
The first is that there are several “manage a specific medical condition” type questions:
Now, we are going to go out on a limb and say that these are paediatric “free hits”. That is, if you can say something sensible about managing these topics in adults, you must be able to say something sensible in kids – the management is effectively the same (you just need to put in the weight specific doses). So, you cover about a quarter of the list of paediatric topics just by knowing the stuff you have already studied well, with no additional effort. Awesome.
This brings us back to what is different about paediatrics.
There are two things.
The first is the assessment of a child – you can’t do it the same way you do in an adult, and important parts of the history are different. The differentials also change a bit for some conditions (most notably abdominal pain).
What are you going to be asked to assess?
Take a look at the list above, and it’s pretty obvious:
These are all high yield paediatric topics, and so being able to put together a sensible assessment type answer is important. What are the components of an assessment you need to be able to write about?
So, not that much really.
The second thing to thing about is specific paediatric issues that require management, and again, the list is not that big:
Now, our list is not exhaustive. We are happy to hear comments and suggestions via the VSG. The point we are trying to make this week is before you get lost in Cameron’s paediatric emergency medicine, think about what you really need to know. The links we have listed in the read section to the NSW Health Guidelines for Paediatrics in ED are really useful for reading about both the underlying basis for why we do what we do with common paediatric presentations, and for clinically focused reading that should translate to the exam.
It's also worth remembering that each of you will have quite a lot of practical paediatric experience - after all it is a requirement of your training to keep a log book. So, a lot of the exam related paeds stuff, particularly the practical stuff, you should already know. As always, when you are thinking about a question in the exam, try to picture the patient in front of you. If you would not normally drip the child, don't feel compelled to put in a central line just because it's the exam.
With that in mind let's look at the topics of the most recent 19 paediatric questions up until the change of exams:
- Fever and assessment
- Assessment of paediatric head injury
- Fever and assessment of the neonate
- Measles v Kawasaki
- Management of Ptx and LRTI
- Fever and investigation
- Assessment of a vomiting child
- Paediatric gastroenteritis
- Assessment of the jaundiced neonate
- Assessment and investigation of fever in a neonate
- Nasal foreign body
- Management of burns
- Assessment of abdominal pain
- Assessment of a vomiting neonate
- Nasal foreign body
- Assessment of the crying baby
- Management of anaphylaxis
- Management of status epilepticus/parent
- Management of asthma
So, we think there are some definite themes to this list.
The first is that there are several “manage a specific medical condition” type questions:
- Asthma
- DKA
- PTx and pneumonia
- Anaphylaxis
- Status epilepticus
- Burns
Now, we are going to go out on a limb and say that these are paediatric “free hits”. That is, if you can say something sensible about managing these topics in adults, you must be able to say something sensible in kids – the management is effectively the same (you just need to put in the weight specific doses). So, you cover about a quarter of the list of paediatric topics just by knowing the stuff you have already studied well, with no additional effort. Awesome.
This brings us back to what is different about paediatrics.
There are two things.
The first is the assessment of a child – you can’t do it the same way you do in an adult, and important parts of the history are different. The differentials also change a bit for some conditions (most notably abdominal pain).
What are you going to be asked to assess?
Take a look at the list above, and it’s pretty obvious:
- Febrile children (having an expert knowledge of this topic is a *must*)
- Abdominal pain
- (It hasn’t come up on the list but we’d add “sore hip”)
- Head injury
These are all high yield paediatric topics, and so being able to put together a sensible assessment type answer is important. What are the components of an assessment you need to be able to write about?
- Signs of toxicity
- Criteria for discharge
- Important paediatric history
- Birth stuff for very young children
- Vaccination stuff for older children
- And some minor issue specific stuff – ask about recent URTI for a patient with a sore hip or abdomen (transient synovitis, mesenteric adenitis etc), know your head injury stratification rules etc.
So, not that much really.
The second thing to thing about is specific paediatric issues that require management, and again, the list is not that big:
- Managing the parents
- NAI
- Specific paediatric medical problems:
- Measles/Kawasaki/other rashes
- Head injury
- Transient synovitis
- Neonatal jaundice
- Rehydrating a child with gastroenteritis
Now, our list is not exhaustive. We are happy to hear comments and suggestions via the VSG. The point we are trying to make this week is before you get lost in Cameron’s paediatric emergency medicine, think about what you really need to know. The links we have listed in the read section to the NSW Health Guidelines for Paediatrics in ED are really useful for reading about both the underlying basis for why we do what we do with common paediatric presentations, and for clinically focused reading that should translate to the exam.