FMGE Pediatric Review: Exam Strategies and Diagnosis

Anxiety is normal during FMGE preparation, but repeated revisions trigger recall. Focus on previous‑year questions that have appeared more than twice and aim for 100 % accuracy on them. Grand Tests reveal weak areas; spend half a day analyzing the results and targeting those gaps. When case scenarios feel confusing, read the question aloud or act as your own “Google translator” to bridge language gaps. Logical elimination helps you reach the correct answer even for atypical questions.

Fever with Rash (Differential Diagnosis)

Six primary causes dominate fever‑with‑rash presentations: measles, rubella, varicella‑zoster, roseola infantum, hand‑foot‑mouth disease, and erythema infectiosum. Distinguish them by rash distribution—trunk‑to‑face versus face‑to‑trunk—and by characteristic signs such as Koplik spots (measles), Nagayama spots (rubella), or Forchheimer spots (scarlet fever). Non‑febrile rashes like zinc‑deficiency acrodermatitis enteropathica or atopic dermatitis should also be considered.

Growth & Nutrition Assessment

Scammon’s growth curves describe neural, lymphoid, skeletal, and gonadal growth patterns. Mid‑Upper Arm Circumference (MUAC) between 15 cm and 17 cm is normal; a measurement below 11.5 cm signals severe undernutrition. Nutritional indices include weight‑for‑age (underweight), weight‑for‑height (wasting), and height‑for‑age (stunting).

Severe Acute Malnutrition (SAM)

SAM is diagnosed by any of the following: severe wasting (weight‑for‑height < ‑3 SD), MUAC < 11.5 cm, or symmetrical nutritional edema. Kwashiorkor reflects protein deficiency with edema, fatty liver, and the “fat‑sugar baby” appearance. Marasmus results from caloric deficiency, producing severe emaciation, “monkey facies,” and an insatiable appetite.

IMNCI Protocols (Dehydration & Pneumonia)

Dehydration is classified as none, some, or severe based on six clinical parameters: general condition, eyes, tears, mouth, thirst, and skin pinch. Pneumonia is identified by age‑specific fast‑breathing thresholds (≥ 60/min < 2 mo, ≥ 50/min 2–12 mo, ≥ 40/min 1–5 yr) plus chest indrawing or danger signs. Treatment follows a color‑coded plan: Green (Plan A, home care), Yellow (Plan B, oral antibiotics), Pink (Plan C, IV antibiotics and referral).

Neonatal Resuscitation (NRP)

The resuscitation sequence follows T‑A‑B‑C: Temperature, Airway, Breathing, Circulation. All initial steps and the start of positive‑pressure ventilation (PPV) must be completed within the “Golden Minute” (first 60 seconds after birth). Provide PPV for 30 seconds if heart rate < 100 bpm or respiratory effort is poor. If heart rate remains < 60 bpm despite PPV, intubate and begin chest compressions at a 3:1 compression‑to‑breath ratio. Attach the pulse‑oximeter probe to the right hand.

Glomerular Disease

Nephrotic syndrome presents with massive proteinuria (3+ or 4+); minimal‑change disease is the most common pediatric cause. Nephritic syndrome shows mild‑to‑moderate proteinuria, hematuria, and hypertension. Post‑streptococcal glomerulonephritis (PSGN) appears 1–3 weeks after infection, with low C3 and raised ASO titers. IgA nephropathy follows infection by 1–5 days, typically with normal C3 and ASO levels.

Pediatric Epilepsy

West syndrome features infantile spasms, hypsarrhythmia on EEG, and developmental delay. Absence seizures display a 3 Hz spike‑and‑slow‑wave pattern on EEG and are often triggered by hyperventilation.

Metabolic Disorders

Galactosemia stems from GALT deficiency, producing “oil‑drop” cataracts and a high risk of sepsis from E. coli. Alkaptonuria causes black urine on air exposure and ochronosis of sclera and ear cartilage. Phenylketonuria (PKU) yields a musty urine odor and brain damage from phenylalanine accumulation. Wilson’s disease presents with Kayser‑Fleischer rings, sunflower cataracts, and low serum ceruloplasmin; chelation with trientine plus oral zinc is the preferred treatment.

Neonatal Jaundice & Emergencies

Extrahepatic biliary atresia (EHBA) manifests as jaundice persisting beyond two weeks with clay‑colored stools and is the leading indication for liver transplantation; Kasai portoenterostomy must be performed before eight weeks of age. Kawasaki disease is identified by fever lasting more than five days, strawberry tongue, and conjunctivitis.