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RACP DWE Paediatrics study materials
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RACP DWE Paediatrics practice questions

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Question 1Paediatrics & Child Health

A 3-year-old child presents with fever, bilateral conjunctivitis, cracked lips, and a polymorphous rash. Which finding is most consistent with Kawasaki disease?

  1. Hepatosplenomegaly
  2. Exudative pharyngitis
  3. Cervical lymphadenopathy greater than 1.5 cm Correct answer.
  4. Vesicular rash on the trunk

Explanation

Kawasaki disease is diagnosed by fever plus at least four of five principal features: conjunctivitis, oral mucosal changes, rash, extremity changes, and cervical lymphadenopathy greater than 1.5 cm in diameter. Nonsuppurative cervical adenopathy is a recognised criterion.

Question 2Paediatrics & Child Health

A 6-week-old infant has a hoarse cry, inspiratory stridor, and a barking cough. Which diagnosis is most likely?

  1. Tracheomalacia
  2. Laryngomalacia Correct answer.
  3. Laryngeal web
  4. Croup

Explanation

Laryngomalacia is the most common cause of stridor in infancy, typically presenting with inspiratory stridor that worsens when supine and improves in prone position. It usually resolves by 12 to 18 months without intervention.

Question 3Paediatrics & Child Health

A newborn is noted to have a sacral dimple with a tuft of hair and a small skin tag. What is the most appropriate next step in management?

  1. MRI of the brain
  2. Reassurance and routine follow-up
  3. Ultrasound of the spine Correct answer.
  4. Topical antibiotic application

Explanation

A sacral dimple with a hair tuft or skin tag is a high-risk marker for occult spinal dysraphism. Spinal ultrasound is the initial screening test in infants under 6 months when the posterior elements are not yet ossified; MRI is used if ultrasound is abnormal or the child is older.

Question 4Paediatrics & Child Health

A 4-year-old child is brought in with a 3-day history of fever and a rash that began on the face and spread downwards. The rash consists of small red macules and papules that have become confluent. Which diagnosis is most likely?

  1. Roseola infantum
  2. Rubella
  3. Measles Correct answer.
  4. Scarlet fever

Explanation

Measles classically presents with a cephalocaudal spread of a maculopapular rash, fever, cough, coryza, and conjunctivitis. The rash begins on the face and behind the ears and spreads downwards over 3 to 4 days.

Question 5Paediatrics & Child Health

A 2-year-old child has a 2-day history of profuse watery diarrhoea and vomiting. On examination, the child is lethargic with sunken eyes, delayed capillary refill, and reduced skin turgor. What is the most appropriate initial fluid management?

  1. Oral rehydration solution
  2. Subcutaneous fluid infusion
  3. Intravenous isotonic crystalloid bolus Correct answer.
  4. Nasogastric rehydration

Explanation

Severe dehydration with shock, lethargy, and delayed capillary refill requires rapid intravenous isotonic crystalloid resuscitation. Oral or nasogastric routes are inadequate when the child is shocked or has altered consciousness.

Question 6Paediatrics & Child Health

A 10-year-old child presents with a 2-week history of polyuria, polydipsia, and weight loss. A capillary blood glucose is 22 mmol/L (396 mg/dL). Which finding is most consistent with a diagnosis of type 1 diabetes mellitus?

  1. Ketonuria Correct answer.
  2. Haematuria
  3. Proteinuria
  4. Glycosuria alone

Explanation

Type 1 diabetes commonly presents with ketoacidosis, and ketonuria reflects insulin deficiency and lipolysis. Ketonuria in a child with hyperglycaemia and osmotic symptoms supports the diagnosis and identifies risk of diabetic ketoacidosis.

Question 7Paediatrics & Child Health

A 9-month-old infant is brought in after a generalised tonic-clonic seizure lasting 2 minutes associated with fever of 39 degrees Celsius. The child is now alert with no focal neurology. What is the most appropriate management?

  1. Reassurance and antipyretics Correct answer.
  2. Long-term anticonvulsants
  3. Lumbar puncture
  4. Electroencephalogram

Explanation

Simple febrile convulsions in children aged 6 months to 5 years with a brief generalised seizure and full recovery do not require investigation or long-term anticonvulsants. Management focuses on treating the fever and reassuring the family.

Question 8Paediatrics & Child Health

A newborn is exclusively breastfed and has not received vitamin K prophylaxis. At 4 weeks of age, the infant presents with bruising and bleeding from the umbilicus. What is the most likely diagnosis?

  1. Haemophilia A
  2. Immune thrombocytopenia
  3. Von Willebrand disease
  4. Vitamin K deficiency bleeding Correct answer.

Explanation

Late vitamin K deficiency bleeding occurs between 2 and 12 weeks in exclusively breastfed infants who did not receive vitamin K at birth. It can present with gastrointestinal or intracranial bleeding and is prevented by intramuscular vitamin K at birth.

Question 9Paediatrics & Child Health

A 7-year-old child with a history of recurrent wheeze is being assessed for asthma. Which investigation is most useful in confirming the diagnosis?

  1. Skin prick testing
  2. Chest radiograph
  3. Spirometry with bronchodilator reversibility Correct answer.
  4. Serum IgE level

Explanation

Spirometry demonstrating airflow obstruction with significant reversibility after a bronchodilator supports a diagnosis of asthma in a child old enough to perform the test reliably. Peak flow variability can also be used but is less definitive.

Question 10Paediatrics & Child Health

A 3-year-old child is brought in with a 4-day history of high fever, irritability, and refusal to walk. On examination, there is tenderness over the right tibia with overlying warmth. What is the most appropriate initial investigation?

  1. Serum alkaline phosphatase
  2. Blood culture and plain radiograph Correct answer.
  3. Bone scan
  4. MRI of the lower limb

Explanation

Acute osteomyelitis in children is investigated with blood cultures and plain radiographs, although radiographs may be normal early in the illness. Empiric intravenous antibiotics should be started after cultures are taken.

Question 11Paediatrics & Child Health

A 5-year-old child presents with periorbital oedema, frothy urine, and hypertension. Urinalysis shows 3+ protein and red cell casts. Which diagnosis is most likely?

  1. IgA nephropathy
  2. Acute post-streptococcal glomerulonephritis Correct answer.
  3. Urinary tract infection
  4. Nephrotic syndrome

Explanation

Acute post-streptococcal glomerulonephritis presents with nephritic syndrome: haematuria, hypertension, oedema, and red cell casts after a streptococcal infection. Proteinuria is usually mild to moderate rather than in the nephrotic range.

Question 12Paediatrics & Child Health

A 12-year-old boy presents with a 3-month history of fatigue, weight loss, and a non-tender neck lump. Examination reveals a firm, fixed cervical lymph node. What is the most appropriate next step in management?

  1. Antibiotic therapy
  2. Excisional lymph node biopsy Correct answer.
  3. Fine needle aspiration
  4. Observation for 6 weeks

Explanation

A persistent, firm, non-tender lymph node in an older child raises concern for malignancy such as lymphoma. Excisional biopsy provides adequate tissue for histology and immunohistochemistry, which are essential for diagnosis.

Question 13Paediatrics & Child Health

A 10-month-old infant presents with a 2-day history of fever, irritability, and pulling at the left ear. Otoscopy shows a bulging, erythematous tympanic membrane. What is the most appropriate first-line antibiotic?

  1. Azithromycin
  2. Trimethoprim-sulfamethoxazole
  3. Amoxicillin Correct answer.
  4. Ciprofloxacin

Explanation

High-dose amoxicillin is first-line therapy for acute otitis media in children without penicillin allergy, covering the common pathogens Streptococcus pneumoniae and Haemophilus influenzae.

Question 14Paediatrics & Child Health

A 2-year-old child presents with a 1-week history of fever, abdominal pain, and bloody diarrhoea. Stool culture grows Shiga toxin-producing Escherichia coli. Which complication should be monitored for?

  1. Intussusception
  2. Haemolytic uraemic syndrome Correct answer.
  3. Toxic megacolon
  4. Aplastic crisis

Explanation

Shiga toxin-producing E. coli infection can be complicated by haemolytic uraemic syndrome, characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. Antibiotics may increase the risk and are generally avoided.

Question 15Paediatrics & Child Health

A 15-year-old girl presents with a 6-month history of amenorrhoea, weight loss, and cold intolerance. Examination reveals bradycardia and dry skin. Which investigation is most useful in confirming the diagnosis?

  1. Pelvic ultrasound
  2. Thyroid function tests Correct answer.
  3. Bone age radiograph
  4. Serum oestradiol

Explanation

Symptoms of amenorrhoea, cold intolerance, bradycardia, and dry skin suggest hypothyroidism, which is confirmed with thyroid function tests showing elevated TSH and low free T4. Hypothyroidism is a treatable cause of secondary amenorrhoea.

Question 16Paediatrics & Child Health

A 4-year-old child has a 3-day history of fever, sore throat, and a generalised erythematous rash with sandpaper texture. Examination reveals a strawberry tongue and circumoral pallor. What is the most appropriate treatment?

  1. Amoxicillin-clavulanate
  2. Phenoxymethylpenicillin Correct answer.
  3. Ceftriaxone
  4. Erythromycin

Explanation

Scarlet fever is caused by group A streptococcus and is treated with penicillin, with phenoxymethylpenicillin being first-line. This shortens illness and reduces the risk of rheumatic fever.

Question 17Paediatrics & Child Health

A newborn is noted to have a heart murmur and cyanosis. Echocardiography shows a single large vessel arising from the heart with a ventricular septal defect. Which diagnosis is most likely?

  1. Tricuspid atresia
  2. Tetralogy of Fallot
  3. Transposition of the great arteries
  4. Truncus arteriosus Correct answer.

Explanation

Truncus arteriosus is characterised by a single arterial trunk that supplies the systemic, pulmonary, and coronary circulations, and is almost always associated with a ventricular septal defect.

Question 18Paediatrics & Child Health

A 6-year-old child presents with a 2-week history of pallor, fatigue, and bruising. Full blood count shows pancytopenia. What is the most appropriate next investigation?

  1. Reticulocyte count
  2. Serum ferritin
  3. Abdominal ultrasound
  4. Bone marrow aspirate and trephine Correct answer.

Explanation

Pancytopenia in a child raises concern for bone marrow failure such as acute leukaemia or aplastic anaemia. Bone marrow aspiration and trephine biopsy provide the definitive diagnosis.

Question 19Paediatrics & Child Health

A 3-year-old child presents with a 2-day history of fever and a swollen, red, tender knee. Joint aspiration reveals turbid fluid with a white cell count of 80,000 per microlitre and Gram-positive cocci. What is the most appropriate initial management?

  1. Intra-articular corticosteroid injection
  2. Intravenous antibiotics and surgical drainage Correct answer.
  3. Oral antibiotics alone
  4. Immobilisation and observation

Explanation

Septic arthritis requires prompt intravenous antibiotics and drainage of the joint to prevent cartilage destruction. Gram-positive cocci in a child most commonly reflect Staphylococcus aureus.

Question 20Paediatrics & Child Health

A 2-year-old child presents with a 1-day history of drooling, fever, and a muffled voice. The child is sitting forward and appears toxic. What is the most appropriate initial step?

  1. Urgent airway assessment and intubation Correct answer.
  2. Lateral neck radiograph
  3. Examination of the throat with a tongue depressor
  4. Oral antibiotics and discharge

Explanation

The presentation suggests epiglottitis, a medical emergency requiring urgent airway management. Throat examination with a tongue depressor may precipitate airway obstruction and should be avoided.

Question 21Paediatrics & Child Health

A 14-year-old girl presents with a 3-month history of fatigue, weight gain, and cold intolerance. Examination reveals bradycardia and dry skin. Which finding is most consistent with primary hypothyroidism?

  1. Low TSH with elevated free T4
  2. Elevated TSH with low free T4 Correct answer.
  3. Low TSH with low free T4
  4. Elevated TSH with elevated free T4

Explanation

Primary hypothyroidism is characterised by an elevated TSH due to loss of negative feedback and a low free T4. This pattern distinguishes thyroid failure from central hypothyroidism.

Question 22Paediatrics & Child Health

A 7-year-old child with a history of recurrent abdominal pain is diagnosed with Helicobacter pylori infection. Which regimen is most appropriate for eradication?

  1. Bismuth subsalicylate alone
  2. Triple therapy with a proton pump inhibitor and two antibiotics Correct answer.
  3. Amoxicillin alone
  4. Proton pump inhibitor alone

Explanation

H. pylori eradication requires combination therapy, typically a proton pump inhibitor plus two antibiotics, to overcome resistance and achieve high eradication rates.

Question 23Paediatrics & Child Health

A 3-day-old neonate born to a mother with prolonged rupture of membranes presents with lethargy, poor feeding, and apnoea. Which organism is most likely responsible?

  1. Group B Streptococcus Correct answer.
  2. Escherichia coli
  3. Staphylococcus aureus
  4. Listeria monocytogenes

Explanation

Group B Streptococcus is the most common cause of early-onset neonatal sepsis, particularly with prolonged rupture of membranes. It presents with respiratory distress, lethargy, and poor feeding in the first week of life.

Question 24Paediatrics & Child Health

A 5-year-old child with nephrotic syndrome is on high-dose corticosteroids and develops fever, abdominal pain, and hypotension. Which diagnosis should be considered first?

  1. Spontaneous bacterial peritonitis Correct answer.
  2. Acute appendicitis
  3. Gastroenteritis
  4. Urinary tract infection

Explanation

Children with nephrotic syndrome on corticosteroids are immunosuppressed and at risk of spontaneous bacterial peritonitis, most commonly due to Streptococcus pneumoniae. Fever and abdominal pain should prompt urgent paracentesis and antibiotics.

Question 25Paediatrics & Child Health

A 10-year-old child presents with a 2-week history of fever, weight loss, and a new murmur. Blood cultures grow Streptococcus viridans. Which underlying condition is most likely?

  1. Kawasaki disease
  2. Rheumatic fever
  3. Congenital heart disease Correct answer.
  4. Myocarditis

Explanation

Infective endocarditis in children most often occurs in those with congenital heart disease or prosthetic material. Streptococcus viridans is a typical organism from the oral cavity.

Question 26Paediatrics & Child Health

A 6-month-old infant is brought to the emergency department with a 1-day history of poor feeding and lethargy. On examination the anterior fontanelle is sunken, the mucous membranes are dry, and capillary refill is 4 seconds. What is the most appropriate initial fluid management?

  1. An immediate 20 mL/kg bolus of 0.9% sodium chloride Correct answer.
  2. Oral rehydration solution given by nasogastric tube
  3. A 10 mL/kg bolus of 5% glucose
  4. Restriction of total fluids to two-thirds of maintenance

Explanation

In a child with clinical signs of shock, such as delayed capillary refill and lethargy, the priority is rapid intravascular volume expansion. An isotonic crystalloid bolus of 20 mL/kg given rapidly is the standard first step, followed by reassessment. Hypotonic or glucose-containing fluids do not restore circulating volume effectively.

Question 27Paediatrics & Child Health

Which of the following is the most common congenital heart defect detected in newborns?

  1. Ventricular septal defect Correct answer.
  2. Coarctation of the aorta
  3. Transposition of the great arteries
  4. Tricuspid atresia

Explanation

Ventricular septal defect is the most frequently occurring congenital cardiac malformation, accounting for roughly a quarter to a third of cases. Small defects are often asymptomatic and may close spontaneously. Cyanotic lesions such as transposition are individually much less common.

Question 28Paediatrics & Child Health

A 4-year-old child is brought in with a 3-day history of fever, coryza, cough, and red eyes, followed by a rash beginning behind the ears and spreading downwards. Which finding on examination best supports the diagnosis?

  1. Koplik spots on the buccal mucosa Correct answer.
  2. A strawberry tongue with desquamation of the fingers
  3. Tender cervical lymphadenopathy with conjunctival injection
  4. A sandpaper rash in the flexures

Explanation

The prodrome of fever, coryza, cough, and conjunctivitis followed by a descending rash is characteristic of measles. Koplik spots, small white lesions on an erythematous buccal mucosa, appear before or with the rash and are pathognomonic. They are transient, so their absence does not exclude the diagnosis.

Question 29Paediatrics & Child Health

A term newborn is noted at 12 hours of age to be jaundiced. Which single investigation is most important to perform first?

  1. Full blood count and reticulocyte count
  2. Blood group and antibody screen of mother and infant
  3. Total and conjugated serum bilirubin Correct answer.
  4. Direct Coombs test

Explanation

Jaundice within the first 24 hours of life is always pathological and requires urgent measurement of bilirubin, including the conjugated fraction, to determine severity and guide treatment. The result also helps distinguish haemolytic from other causes. Other tests are then chosen according to the bilirubin pattern and clinical findings.

Question 30Paediatrics & Child Health

A 3-year-old child has a 2-day history of profuse watery diarrhoea and vomiting and is mildly dehydrated. Which organism is the most likely cause?

  1. Rotavirus Correct answer.
  2. Entamoeba histolytica
  3. Salmonella typhi
  4. Giardia lamblia

Explanation

Rotavirus is a leading cause of acute watery diarrhoea and vomiting in young children, particularly in the pre-vaccination or under-vaccinated population. It typically causes profuse watery stools without blood. The other listed organisms more often produce persistent, bloody, or systemic illness.

Question 31Paediatrics & Child Health

A 10-year-old boy with sickle cell disease presents with fever of 39 degrees Celsius, cough, and tachypnoea. What is the most appropriate immediate management step?

  1. Give intravenous broad-spectrum antibiotics promptly after cultures are taken Correct answer.
  2. Start oral penicillin and arrange outpatient review
  3. Await chest radiograph results before starting antibiotics
  4. Transfuse packed red cells before any other treatment

Explanation

Children with sickle cell disease are functionally asplenic and at high risk of rapidly overwhelming bacterial infection. Fever therefore mandates prompt intravenous broad-spectrum antibiotics after blood cultures, without delaying for imaging. This approach also covers pneumonia, which is the likely source here.

Question 32Paediatrics & Child Health

A 7-year-old child is brought in with a 2-week history of generalised oedema, and urinalysis shows heavy proteinuria with no haematuria. Which feature on examination most strongly supports a diagnosis of nephrotic syndrome?

  1. Periorbital oedema that is worse on waking Correct answer.
  2. Blood pressure above the 95th centile
  3. A palpable flank mass
  4. Gross haematuria with clots

Explanation

Nephrotic syndrome is characterised by heavy proteinuria, hypoalbuminaemia, and oedema, which is often periorbital and most pronounced after overnight recumbency. Hypertension and haematuria suggest an alternative diagnosis such as nephritic syndrome. A flank mass would raise concern for a renal tumour.

Question 33Paediatrics & Child Health

A 5-year-old child presents with a 1-day history of fever, sore throat, and drooling, and is sitting upright and leaning forward. What is the most appropriate next step in management?

  1. Send a throat swab for culture and start oral antibiotics
  2. Examine the throat with a tongue depressor to visualise the tonsils
  3. Arrange urgent airway assessment with anaesthetic support and avoid distressing the child Correct answer.
  4. Reassure the parents and discharge with analgesia

Explanation

Drooling, fever, and a tripod posture suggest epiglottitis or another cause of acute upper airway obstruction. The priority is to keep the child calm and involve senior anaesthetic and ENT staff for controlled airway assessment. Throat examination or other distressing manoeuvres can precipitate complete airway obstruction.

Question 34Paediatrics & Child Health

Which of the following is the most appropriate first-line treatment for a 6-year-old child with newly diagnosed absence seizures?

  1. Sodium valproate
  2. Phenytoin
  3. Ethosuximide Correct answer.
  4. Carbamazepine

Explanation

Ethosuximide is first-line therapy for childhood absence epilepsy because it effectively suppresses absence seizures with a favourable adverse-effect profile. Sodium valproate is an alternative, particularly if other seizure types coexist. Carbamazepine and phenytoin can worsen absence seizures.

Question 35Paediatrics & Child Health

A 2-month-old infant is noted to have a heart murmur. Which finding would most strongly suggest a ventricular septal defect rather than a harmless murmur?

  1. A mid-diastolic murmur at the apex
  2. A harsh pansystolic murmur at the lower left sternal edge with a palpable thrill Correct answer.
  3. A soft systolic murmur with no other abnormality
  4. A continuous machinery murmur below the clavicle

Explanation

A ventricular septal defect produces a harsh pansystolic murmur best heard at the lower left sternal edge, often with a thrill when the defect is significant. A soft murmur without other findings is more consistent with a benign flow murmur. Continuous murmurs suggest a patent ductus arteriosus.

Question 36Paediatrics & Child Health

Which of the following is the most appropriate first-line treatment for a child with newly diagnosed type 1 diabetes mellitus presenting without ketoacidosis?

  1. Dietary modification alone
  2. A basal-bolus subcutaneous insulin regimen Correct answer.
  3. A fixed-dose premixed insulin twice daily
  4. Metformin monotherapy

Explanation

Type 1 diabetes results from absolute insulin deficiency, so insulin replacement is essential. A basal-bolus regimen using a long-acting basal insulin plus rapid-acting mealtime insulin most closely mimics physiological secretion and allows flexible dosing. It is the preferred regimen in children and adolescents.

Question 37Paediatrics & Child Health

A 12-year-old girl is brought in with a 3-day history of fever, flank pain, and dysuria. Urinalysis shows nitrites and leukocytes. Which organism is the most likely causative agent?

  1. Enterococcus faecalis
  2. Staphylococcus saprophyticus
  3. Proteus mirabilis
  4. Escherichia coli Correct answer.

Explanation

Escherichia coli is responsible for the large majority of urinary tract infections in children. It is a common faecal organism that ascends the urethra. Other organisms are less common and often associated with structural abnormalities or prior instrumentation.

Question 38Paediatrics & Child Health

A 15-year-old boy presents with a 2-week history of fever, sore throat, fatigue, and cervical lymphadenopathy. Examination reveals tonsillar exudate and palpable splenomegaly. Which investigation is most appropriate to confirm the diagnosis?

  1. Bone marrow aspiration
  2. Epstein-Barr virus serology or heterophile antibody test Correct answer.
  3. Throat culture for Corynebacterium diphtheriae
  4. Rapid antigen detection for group A streptococcus

Explanation

Fever, pharyngitis, lymphadenopathy, fatigue, and splenomegaly suggest infectious mononucleosis, usually caused by Epstein-Barr virus. Serology, including heterophile antibody testing in older children, confirms the diagnosis. Splenomegaly is an important clue that distinguishes this from simple streptococcal pharyngitis.

Question 39Paediatrics & Child Health

A 3-year-old child is brought in with a 1-day history of fever, irritability, and refusal to bear weight on the right leg. On examination there is tenderness over the proximal tibia without joint effusion. Which investigation is most useful initially?

  1. Bone scan
  2. Magnetic resonance imaging of the leg Correct answer.
  3. Measurement of serum alkaline phosphatase
  4. Plain radiograph of the leg

Explanation

The presentation suggests acute osteomyelitis, which is most accurately diagnosed with magnetic resonance imaging, particularly early in the illness. MRI detects marrow oedema and soft tissue involvement before bony changes appear. Plain radiographs are typically normal in the first week or two.

Question 40Paediatrics & Child Health

A 4-year-old child is brought in with a 2-day history of fever, cough, and rapid breathing. On examination there is tachypnoea, subcostal recession, and crackles in the right lower zone. Which finding best indicates severe pneumonia requiring hospital admission?

  1. Temperature of 38.5 degrees Celsius
  2. Oxygen saturation of 88% on room air Correct answer.
  3. A cough that is worse at night
  4. A history of asthma in a sibling

Explanation

Hypoxaemia, reflected by an oxygen saturation below 90 to 92% on room air, is a marker of severe pneumonia and an indication for admission and oxygen therapy. Other red flags include grunting, inability to feed, and altered consciousness. Fever alone does not define severity.

Question 41Paediatrics & Child Health

A 6-year-old child presents with a 2-week history of colicky abdominal pain, and a purpuric rash is noted over the buttocks and extensor surfaces of the legs. Which complication should be specifically monitored for?

  1. Cataract formation
  2. Optic neuritis
  3. Intussusception and renal involvement Correct answer.
  4. Hepatic veno-occlusive disease

Explanation

The combination of colicky abdominal pain and a palpable purpuric rash on the buttocks and extensor surfaces suggests Henoch-Schonlein purpura, now called IgA vasculitis. Gastrointestinal involvement can cause intussusception or bleeding, and renal involvement can cause nephritis. Monitoring for these complications is essential.

Question 42Paediatrics & Child Health

Which of the following is the most appropriate screening test for developmental dysplasia of the hip in a 6-week-old infant?

  1. Ultrasound of the hips Correct answer.
  2. Plain radiograph of the pelvis
  3. Magnetic resonance imaging of the hips
  4. Computed tomography of the pelvis

Explanation

Ultrasound is the preferred imaging method for screening for developmental dysplasia of the hip in infants under about 6 months of age, because the femoral head is largely cartilaginous. It allows dynamic assessment of hip stability and acetabular development. Radiographs become useful once the femoral head ossifies, usually after 4 to 6 months.

Question 43Paediatrics & Child Health

A 13-year-old girl presents with a 6-month history of low mood, poor sleep, and declining school performance after being bullied. Which is the most appropriate initial management step?

  1. Reassurance alone with no follow-up
  2. Immediate admission to a psychiatric unit
  3. A structured psychosocial assessment and referral to child mental health services Correct answer.
  4. Starting an antidepressant without further assessment

Explanation

When an adolescent presents with depressive symptoms, a thorough biopsychosocial assessment is needed to establish severity, risk, and contributing factors. Referral to child and adolescent mental health services provides appropriate evidence-based psychological therapy. Antidepressants are generally not started without specialist assessment.

Question 44Paediatrics & Child Health

A 2-year-old child is brought in with a 3-day history of fever and a generalised rash. On examination there is a crusted lesion near the mouth and several fluid-filled vesicles on the trunk. What is the most appropriate management?

  1. Acyclovir for all children with chickenpox
  2. Supportive care with analgesia and hygiene, reserving antivirals for high-risk children Correct answer.
  3. Oral amoxicillin to prevent secondary infection
  4. Immediate hospital admission for all children

Explanation

Chickenpox in an otherwise healthy child is usually self-limiting and managed with supportive care, including analgesia and measures to reduce skin infection. Antivirals are generally reserved for high-risk groups, such as immunocompromised children, neonates, and those with severe disease.

Question 45Paediatrics & Child Health

A 10-year-old child is brought in with a 3-day history of fever and a swollen, painful neck. Examination reveals tender anterior cervical lymphadenopathy and a fluctuant mass. Which is the most appropriate next step?

  1. Thyroid function testing as the first investigation
  2. Observation with analgesia alone
  3. Radiotherapy to the neck
  4. Ultrasound-guided aspiration or surgical drainage with antibiotics Correct answer.

Explanation

A fluctuant, tender cervical mass with fever suggests a suppurative lymphadenitis or abscess. Definitive management requires drainage or aspiration together with appropriate antibiotics. Ultrasound helps confirm the collection and guide drainage.

Question 46Paediatrics & Child Health

Which of the following is the most appropriate advice for the parents of a 9-month-old infant with a simple febrile seizure who has now recovered?

  1. Avoid all future vaccinations
  2. Arrange an electroencephalogram before discharge
  3. Start daily anticonvulsants to prevent recurrence
  4. Give antipyretics and provide safety advice, with reassurance that simple febrile seizures rarely cause harm Correct answer.

Explanation

Simple febrile seizures are common, self-limiting, and carry an excellent prognosis. Management focuses on treating the underlying illness, providing fever advice, and reassuring parents. Routine anticonvulsants, electroencephalography, and avoidance of vaccination are not indicated.

Question 47Paediatrics & Child Health

A 5-year-old child with a history of recurrent wheeze is diagnosed with asthma. Which of the following is the most appropriate controller therapy for persistent symptoms?

  1. Inhaled corticosteroid Correct answer.
  2. Inhaled short-acting beta-2 agonist alone
  3. Oral theophylline
  4. Long-acting beta-2 agonist as monotherapy

Explanation

Inhaled corticosteroids are the cornerstone of controller therapy for persistent asthma because they reduce airway inflammation and exacerbation frequency. Short-acting beta-2 agonists provide symptom relief but do not control underlying inflammation. Long-acting beta-2 agonists should not be used as monotherapy in asthma.

Question 48Paediatrics & Child Health

A 14-year-old boy presents with a 2-week history of fever, weight loss, night sweats, and a non-tender cervical lymph node. Which investigation is most likely to provide a definitive diagnosis?

  1. Serum lactate dehydrogenase measurement
  2. Chest radiograph alone
  3. Fine needle aspiration of the lymph node
  4. Excisional lymph node biopsy Correct answer.

Explanation

Persistent, non-tender lymphadenopathy with systemic symptoms such as fever, night sweats, and weight loss raises concern for lymphoma. Excisional biopsy is required for definitive histological diagnosis and classification. Fine needle aspiration may be inadequate for architecture-dependent diagnoses.

Question 49Paediatrics & Child Health

A 3-day-old neonate born at term is noted to have a heart murmur and weak femoral pulses. Which condition is most likely?

  1. Coarctation of the aorta Correct answer.
  2. Patent foramen ovale
  3. Atrial septal defect
  4. Mild pulmonary stenosis

Explanation

Weak femoral pulses in a neonate with a murmur suggest coarctation of the aorta, which causes upper limb hypertension and lower limb hypotension. The femoral pulse delay is a key clinical clue. Atrial septal defects and a patent foramen ovale typically do not cause weak femoral pulses.

Question 50Paediatrics & Child Health

A 10-year-old child with known epilepsy on sodium valproate presents with vomiting, lethargy, and confusion during an intercurrent illness. Which complication should be considered?

  1. Hyperammonaemia due to valproate toxicity Correct answer.
  2. Iron deficiency anaemia
  3. Hyperthyroidism
  4. Nephrotic syndrome

Explanation

Sodium valproate can cause hyperammonaemia, particularly during intercurrent illness or when combined with other drugs, leading to vomiting, lethargy, and encephalopathy. Measuring the ammonia level is important in this scenario. This is a recognised, potentially serious adverse effect.