Paeds Vivas · clinical-assessment-and-reasoning
Pallor in children: diagnostic approach — viva
Branching structured oral on paediatric pallor diagnostic approach.
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Target exams
RACP DCEMRCPCH Clinical
Prompt
A 2-year-old is brought to clinic because grandparents say the child looks pale. You are the paediatric registrar.
Opening
Examiner: How do you start? [1]
Candidate: I assess stability — appearance, work of breathing, perfusion and consciousness — before debating colour. I ask what changed from the child’s baseline and treat caregiver concern as data. I examine mucosae and palms in good light, knowing facial colour alone misleads across skin tones. [2] [5]
References7ShowHide
- [1]Wang M Iron Deficiency and Other Types of Anemia in Infants and Children. American family physician, 2016.PMID 26926814
- [2]Stoltzfus RJ Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. The Journal of nutrition, 1999.PMID 10460203
- [3]Baird DC Alpha- and Beta-thalassemia: Rapid Evidence Review. American family physician, 2022.PMID 35289581
- [4]Shimano KA Diagnostic work-up for severe aplastic anemia in children: Consensus of the North American Pediatric Aplastic Anemia Consortium. American journal of hematology, 2021.PMID 34342889
- [5]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
- [6]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428
- [7]Celkan TT What does a hemogram say to us? Turkish archives of pediatrics, 2020.PMID 32684755