Paediatrics is about 7% of NRE Step I, roughly 14 of 200 items, and a large part of it is Pakistan-specific: the EPI immunisation schedule, diarrhoea management with ORS and zinc, IMCI classification of pneumonia, severe acute malnutrition, neonatal jaundice and sepsis, and childhood TB, typhoid, malaria and dengue. The syllabus text for paediatrics was not readable in the copy we reviewed, so the topic list follows the standard Pakistani MBBS final-year scope. Two Step II OSCE stations are also paediatric.
Weight and expected item count
PM&DC's blueprint gives paediatrics 14 of the 140 clinical items. At about 63 seconds per item that is under 15 minutes of paper time, but the domain is dense with rules that must be recalled exactly: age cut-offs, doses per kilogram, schedules. Rules are easy to learn and easy to lose marks on.
What is tested
| Block | Topics |
|---|---|
| Growth and prevention | Growth, development and milestones; immunisation against the Pakistan EPI schedule and contraindications |
| Neonatology | Neonatal resuscitation, jaundice and sepsis; prematurity and respiratory distress syndrome |
| Nutrition | Protein-energy malnutrition, severe acute malnutrition and micronutrient deficiency |
| Infections and fluids | Acute diarrhoea, dehydration, ORS and zinc; pneumonia and bronchiolitis (IMCI classification); childhood tuberculosis; febrile illness: typhoid, malaria and dengue in children |
| Cardiorespiratory | Congenital heart disease and rheumatic fever; childhood asthma and croup |
| Renal and haematology | Nephrotic syndrome and UTI; thalassaemia major and sickle cell disease |
| Neurology and genetics | Seizures, meningitis and cerebral palsy; Down, Turner and cystic fibrosis |
| Endocrine and emergencies | Type 1 diabetes, hypothyroidism, short stature; paediatric emergencies and poisoning; child abuse and neglect |
Local guideline points
- EPI schedule: BCG and OPV at birth; pentavalent, OPV and PCV at 6, 10 and 14 weeks, with IPV at 14 weeks; MR dose 1 and typhoid conjugate vaccine at 9 months; MR dose 2 at 15 months. These come from secondary sources, so confirm on epi.gov.pk. Hepatitis B entered the programme in 2002, Hib in 2009, PCV in 2012, IPV in 2015 and rotavirus in 2017. TCV went nationwide in 2022 and MR replaced measles vaccine in 2021.
- Diarrhoea: low-osmolarity ORS plus zinc, 20 mg a day for 10 to 14 days (10 mg a day under six months), per WHO.
- IMCI pneumonia: fast breathing is 60 or more breaths a minute under 2 months, 50 or more at 2 to 11 months, and 40 or more at 1 to 5 years.
- Thalassaemia major: a recognised burden in Pakistan; know the transfusion and iron chelation principles and the importance of carrier screening.
- Childhood typhoid: most typhoid cases in Pakistan occur in under-15s (86% in a 2023 burden estimate), which is why TCV is in the infant schedule.
- Childhood TB: WHO endorses a four-month regimen (2HRZ(E)/2HR) for non-severe TB in children aged 3 months to 16 years.
Three typical traps
- Applying adult rules to children. Doses are per kilogram, vital-sign cut-offs vary by age, and fluids follow dehydration grade. A normal adult respiratory rate is a danger sign in an infant, so read the age before the number.
- Confusing the vaccination schedule with the contraindication list. Stems can ask what to give a child who is mildly unwell (most minor illnesses are not contraindications) or who has had a severe reaction to a previous dose. Learn the true contraindications, which are few.
- Missing red flags in a "fever" stem. A febrile infant, a child with neck stiffness, or a child with fever and bleeding in a dengue area each demands a different first action. The trap is to treat all fevers as the same.
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How to revise it
| Day | Focus |
|---|---|
| 1 | Growth charts, milestones, red flags in development; 20 questions |
| 2 | EPI card from the official site: write it from memory, then check. Contraindications. |
| 3 | Neonatal: resuscitation steps, jaundice causes and thresholds for phototherapy by guideline, sepsis, RDS |
| 4 | Diarrhoea and dehydration; severe acute malnutrition; vitamin A and iron |
| 5 | IMCI pneumonia, bronchiolitis, asthma, croup; childhood TB |
| 6 | Congenital heart disease, rheumatic fever, nephrotic syndrome, UTI, thalassaemia |
| 7 | Seizures, meningitis, genetic syndromes, diabetes, emergencies, child abuse; mixed block of 40 |
Write every per-kilogram dose you learn with its units. See the study plan for how this fits into a full schedule.
Core facts to state without notes
- Milestones: social smile at about 6 to 8 weeks, sitting without support at about 6 months, walking at about 12 months, two-word phrases at about 2 years. Know the red flags for delay.
- Neonatal jaundice: jaundice in the first 24 hours is pathological until proved otherwise (haemolysis, sepsis); prolonged jaundice beyond 2 weeks needs a conjugated bilirubin check.
- Dehydration: classify as none, some or severe. Some dehydration is treated with ORS; severe dehydration needs intravenous fluids and close review.
- Severe acute malnutrition: uncomplicated cases are treated at home with ready-to-use therapeutic food; complicated cases (infection, poor appetite, oedema) are admitted for stabilisation with therapeutic milk, using WHO protocols.
- Nephrotic syndrome: minimal change disease is the commonest cause in children, and steroids are first-line.
- Rheumatic fever: diagnosed with the Jones criteria after a recent streptococcal infection; prevention of recurrence is by long-term penicillin.
- Thalassaemia major: presents in the first years with anaemia, growth failure and hepatosplenomegaly; management is regular transfusion with iron chelation.
Self-check list
| Can you say, in one sentence each... | Mark |
|---|---|
| The EPI card at each age, and the true contraindications | red, amber or green |
| The IMCI classification of a child with cough | red, amber or green |
| The first steps in neonatal resuscitation | red, amber or green |
| The danger signs that mean urgent referral in any child | red, amber or green |
| The usual causes of a child with fever and rash in Pakistan | red, amber or green |
Links to other domains
Paediatrics pairs with community medicine (EPI, nutrition, IMCI), obstetrics and gynaecology (the newborn) and medicine (the same infections in adults). For vaccine history and programme facts with sources, read local guidelines you must know.
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Frequently asked questions
How many paediatrics questions are in NRE Step I?
PM&DC's blueprint gives 14 of 140 clinical items, about 7% of the paper.
Do I need to know the Pakistan EPI schedule?
Yes. Immunisation against the Pakistan EPI schedule and its contraindications is a core paediatrics topic. Secondary sources place MR dose 1 and TCV at 9 months and MR dose 2 at 15 months. Confirm the card on epi.gov.pk.
What is the zinc dose for diarrhoea in children?
WHO advises zinc 20 mg a day for 10 to 14 days, and 10 mg a day for infants under six months, together with low-osmolarity ORS.
What are the IMCI fast-breathing cut-offs?
60 or more breaths per minute under 2 months, 50 or more at 2 to 11 months, and 40 or more at 1 to 5 years.
Is thalassaemia in the paediatrics syllabus?
Thalassaemia major and sickle cell disease are listed under paediatric haematology in the standard Pakistani scope that we follow.
Is the paediatrics syllabus published in full?
Not in the copy of the 2024 PM&DC document that we read, so our topic list follows the standard Pakistani MBBS final-year scope. Check the PDF on pmdc.pk.