Growth, Development & Safeguarding Practice Questions

Question 1

An 8-year-old girl with asthma is brought to the emergency department with severe breathlessness. She is sitting upright, unable to complete sentences, with respiratory rate 38/min, heart rate 140/min, and oxygen saturation 91% on air. She has widespread wheeze with reduced air entry bilaterally. Peak expiratory flow is 35% of predicted. She has received three doses of back-to-back salbutamol nebulisers with oxygen and ipratropium bromide. What defines this as life-threatening asthma requiring escalation of care?

Accepted Answer

Oxygen saturation less than 92% on air

Answer

Peak expiratory flow less than 50% of predicted value

Answer

Inability to complete sentences in one breath

Answer

Respiratory rate greater than 30 breaths per minute

Answer

Heart rate greater than 130 beats per minute

Question 2

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 3

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 4

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 5

A 17-month-old boy presents to the emergency department with burns to both feet. The mother reports he climbed into the bath while she was answering the door and sustained the burns. The burns are symmetric, circumferential, with a clear demarcation line at the ankles, sparing the soles. There are no splash marks. The child appears frightened and clings to the mother. What is the most appropriate interpretation of these burn characteristics?

Accepted Answer

The symmetry and demarcation suggest forced immersion; inconsistent with the stated mechanism

Answer

The absence of splash marks indicates the water temperature was not excessively hot

Answer

The pattern is consistent with the child stepping into hot water accidentally

Answer

The sparing of the soles suggests protective flexor withdrawal reflex during accidental immersion

Answer

The circumferential distribution is typical of curious toddlers exploring bath water

Question 6

A multi-agency safeguarding conference discusses a 9-year-old girl living with her mother and mother's partner. The girl disclosed sexual abuse by the partner to her teacher. Medical examination findings are non-specific. The mother initially did not believe the disclosure but now states she will protect her child. The partner denies allegations and remains in the home. Social care recommends the child's name be placed on a child protection plan. What is the strongest evidence-based factor that should most heavily influence the decision about immediate safety?

Accepted Answer

The alleged perpetrator's continued presence in the household

Answer

The absence of definitive physical findings on medical examination

Answer

The mother's statement that she will now protect the child

Answer

The alleged perpetrator's denial of the allegations

Answer

The child's age and ability to provide a credible disclosure

Question 7

A paediatric team reviews three infants with head circumference concerns. Infant A (4 months): head circumference crossing from 50th to 91st centile with bulging fontanelle and vomiting. Infant B (6 months): head circumference consistently on 98th centile since birth, father has large head. Infant C (5 months): head circumference crossing from 75th to 25th centile with developmental regression. Which infant requires the most urgent neuroimaging?

Accepted Answer

Infants A and C

Answer

Infant A only

Answer

Infant B only

Answer

Infant C only

Answer

All three infants

Question 8

A 7-year-old boy is brought to the GP by his grandmother who recently gained custody. She reports he was living in poor conditions with his mother, who has substance misuse problems. The boy frequently wets the bed, hoards food in his room, is reluctant to be left alone, and has angry outbursts. Growth is on the 2nd centile for height and weight; he was on the 50th centile at age 2. Which aspect of this presentation is most concerning for long-term neurodevelopmental impact?

Accepted Answer

Growth faltering from 50th centile to 2nd centile between ages 2-7 years

Answer

Current height and weight on 2nd centile

Answer

Nocturnal enuresis at age 7 years

Answer

Food hoarding behaviour

Answer

Separation anxiety and angry outbursts

Question 9

A 36-month-old girl is assessed in the developmental clinic. She speaks in 3-4 word sentences, can pedal a tricycle, builds a tower of 9 cubes, and can copy a circle. She cannot yet hop on one foot or copy a cross. She feeds herself with a spoon and fork but cannot yet use a knife. Which statement best describes her development?

Accepted Answer

Age-appropriate development across all domains

Answer

Global developmental delay requiring urgent investigation

Answer

Isolated gross motor delay with other domains appropriate

Answer

Fine motor delay with speech and gross motor appropriate

Answer

Speech and language delay with motor skills appropriate

Question 10

A 11-month-old infant is brought to the emergency department by her father with a swollen right thigh. He reports she was crawling and suddenly started crying. X-ray reveals a spiral fracture of the right femur. The infant is pre-mobile and not yet pulling to stand. There is no history of trauma. On examination, there are no other injuries. What is the single most important next step?

Accepted Answer

Contact the named nurse for safeguarding and initiate child protection procedures

Answer

Discuss with orthopaedics for fracture management and discharge home with follow-up

Answer

Arrange bone profile and vitamin D level to investigate for metabolic bone disease

Answer

Obtain detailed history from the mother separately to corroborate the mechanism

Answer

Request a full blood count and clotting screen to exclude bleeding disorder

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