Acute Paediatrics Practice Questions

Question 1

According to the NICE traffic light system for assessing febrile illness in children under 5 years, which of the following features would place a child in the high-risk 'red' category requiring urgent specialist assessment?

Accepted Answer

Non-blanching rash appearing during the consultation

Answer

Temperature greater than 39°C in a child aged 6-12 months

Answer

Capillary refill time of 2 seconds centrally

Answer

Respiratory rate of 55 breaths per minute in a 6-month-old infant

Answer

Reduced activity and not responding normally to social cues

Question 2

A 6-month-old baby presents with failure to thrive, chronic diarrhea, and recurrent respiratory infections. Sweat chloride test is 70 mmol/L (normal <40). What is the most likely diagnosis?

Accepted Answer

Cystic fibrosis

Answer

Celiac disease

Answer

Immunodeficiency

Answer

Inflammatory bowel disease

Answer

Lactose intolerance

Question 3

A 8-year-old child presents with fever, sore throat, and a sandpaper-like rash over the trunk and limbs. The tongue appears red with prominent papillae ("strawberry tongue"). What is the most likely diagnosis?

Accepted Answer

Scarlet fever

Answer

Viral exanthem

Answer

Kawasaki disease

Answer

Measles

Answer

Erythema infectiosum

Question 4

A 8-year-old child presents with fever, irritability, and a widespread petechial rash that doesn't blanch with pressure. The child appears unwell and has neck stiffness. What is the most appropriate immediate management?

Accepted Answer

IV benzylpenicillin

Answer

Oral antibiotics

Answer

Lumbar puncture

Answer

Blood cultures

Answer

CT head

Question 5

A 4-year-old child presents with fever, irritability, and neck stiffness. Lumbar puncture shows: opening pressure 25 cmH₂O, WCC 800/μL (90% neutrophils), protein 2.8 g/L, glucose 1.2 mmol/L (serum glucose 6.0 mmol/L). What is the most likely diagnosis?

Accepted Answer

Bacterial meningitis

Answer

Viral meningitis

Answer

Tuberculous meningitis

Answer

Fungal meningitis

Answer

Normal CSF

Question 6

A 3-year-old child presents with a barking cough, inspiratory stridor, and hoarse voice. The symptoms are worse at night. The child is alert and playful. What is the most likely diagnosis?

Accepted Answer

Croup

Answer

Epiglottitis

Answer

Bronchiolitis

Answer

Pneumonia

Answer

Foreign body aspiration

Question 7

A 2-year-old child presents with a 3-day history of cough, wheeze, and difficulty breathing. The symptoms started gradually and the child has been feeding poorly. On examination, there are widespread fine crackles and wheeze. What is the most likely diagnosis?

Accepted Answer

Bronchiolitis

Answer

Asthma

Answer

Pneumonia

Answer

Croup

Answer

Foreign body aspiration

Question 8

A 9-year-old boy with known asthma presents to the emergency department with an acute exacerbation. Following administration of oxygen, nebulized salbutamol, ipratropium bromide, and oral prednisolone, he remains in respiratory distress with oxygen saturation 92% on high-flow oxygen, peak flow 30% of predicted, and poor respiratory effort. What is the appropriate dose and route of magnesium sulphate administration in this clinical scenario?

Accepted Answer

40 mg/kg (maximum 2 g) intravenous infusion over 20 minutes

Answer

25 mg/kg (maximum 1 g) intravenous bolus over 5 minutes

Answer

40 mg/kg nebulized with salbutamol

Answer

50 mg/kg (maximum 2.5 g) intravenous infusion over 30 minutes

Answer

150 mg nebulized with ipratropium bromide

Question 9

A 4-year-old boy presents with sudden onset high fever of 40.2°C, drooling, and severe difficulty swallowing. He is sitting upright, leaning forward with his neck extended, and appears anxious. There is inspiratory stridor and he is reluctant to speak. Oxygen saturation is 96% on air. What is the single most appropriate immediate action?

Accepted Answer

Contact senior anaesthetist and ENT surgeon urgently without disturbing the child

Answer

Examine the throat with tongue depressor to visualize the epiglottis

Answer

Obtain blood cultures and commence intravenous antibiotics immediately

Answer

Administer nebulized adrenaline and oral dexamethasone

Answer

Perform lateral neck X-ray to confirm the diagnosis

Acute Paediatrics

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