Key points
- Practice questions written for revision, not copies of any exam. They follow the single-best-answer vignette style of final and licensing exams.
- Topics: neonatal jaundice, growth, immunisation, diarrhoea and dehydration, pneumonia, malnutrition, febrile seizures, congenital heart disease, nephrotic syndrome, anaemia and childhood infections.
- Each explanation says why the answer is right and why the common distractors are wrong.
- Doses and protocols follow WHO and widely used international guidance. Check your local guideline before treating a child.
Questions
1. A term baby is jaundiced at 18 hours of age. What is the most important next step?
A. Reassure, as physiological jaundice is common
B. Measure serum bilirubin urgently and look for haemolysis
C. Stop breastfeeding
D. Wait until day 3
E. Give oral antibiotics
Answer: B. Jaundice in the first 24 hours is always pathological until proved otherwise, and haemolytic disease (Rhesus or ABO incompatibility, G6PD deficiency) must be excluded. Physiological jaundice appears after 24 hours and peaks around day 3 to 5. Breastfeeding should continue.
2. An 8-month-old has had three days of watery diarrhoea. She is lethargic, has sunken eyes, drinks poorly and a skin pinch goes back very slowly. How is her dehydration classified, and what is the treatment according to WHO?
A. No dehydration; oral fluids at home
B. Some dehydration; oral rehydration solution
C. Severe dehydration; intravenous fluids
D. Severe dehydration; antibiotics only
E. Some dehydration; zinc only
Answer: C. Lethargy, sunken eyes, poor drinking and a very slow skin pinch are signs of severe dehydration, which needs rapid intravenous fluids (Ringer's lactate), then oral rehydration solution once she can drink. Zinc is given to all children with diarrhoea for 10 days. Antibiotics are for dysentery or cholera, not for watery diarrhoea in general.
3. A 2-year-old has a cough, fast breathing (RR 52/min) and lower chest wall indrawing but is alert and drinking. What is the WHO classification and treatment?
A. Cough or cold; home care
B. Pneumonia; oral amoxicillin
C. Severe pneumonia; always refer for injectable antibiotics
D. Bronchiolitis; no treatment
E. Asthma; salbutamol
Answer: B. In the current WHO approach, fast breathing or chest indrawing without general danger signs is pneumonia treated with oral amoxicillin. Severe pneumonia is reserved for danger signs such as inability to drink, convulsions, lethargy or stridor, and needs referral and injectable treatment. Older teaching classified chest indrawing as severe, so follow the guideline your country uses.
4. A 1-year-old has weight-for-length below -3 standard deviations, bilateral pitting oedema of the feet and a skin rash. What is the diagnosis?
A. Marasmus
B. Kwashiorkor
C. Normal variant
D. Nephrotic syndrome only
E. Cretinism
Answer: B. Bilateral pitting oedema defines oedematous malnutrition (kwashiorkor), which sits at the severe end of acute malnutrition. Marasmus is severe wasting without oedema. Treatment starts with feeding as per WHO: stabilisation with F-75, treating hypoglycaemia, hypothermia, infection and electrolyte problems, then rehabilitation with F-100 or ready-to-use therapeutic food.
5. A 3-year-old has a generalised tonic-clonic seizure lasting 2 minutes with a temperature of 39.5 °C and a runny nose. He is alert after the seizure. What is the diagnosis?
A. Epilepsy
B. Simple febrile seizure
C. Bacterial meningitis
D. Cerebral malaria in all cases
E. Infantile spasms
Answer: B. A short generalised seizure with fever in a child aged 6 months to 5 years, with a quick recovery and an obvious source, is a simple febrile seizure. Look for meningitis if the child is drowsy, has neck stiffness, a bulging fontanelle or is under 12 months and unimmunised. In malaria-endemic areas, test for malaria. Antipyretics do not prevent recurrence.
6. A newborn has a harsh pansystolic murmur at the left lower sternal edge at 3 days of age and is otherwise well and feeding. What is the most likely lesion?
A. Ventricular septal defect
B. Tetralogy of Fallot
C. Patent ductus arteriosus in all cases
D. Coarctation of the aorta
E. Transposition of the great arteries
Answer: A. A pansystolic murmur at the left lower sternal edge is typical of a ventricular septal defect. It often appears after a few days, once the pulmonary vascular resistance falls. Cyanosis in the first days suggests transposition or other duct-dependent lesions. A machinery murmur suggests a persistent ductus.
7. A 5-year-old has periorbital swelling, frothy urine, heavy proteinuria and low albumin. Blood pressure is normal and there is no haematuria. What is the first-line treatment?
A. Intravenous antibiotics
B. Oral prednisolone
C. Renal biopsy before any treatment
D. Furosemide alone
E. Plasma exchange
Answer: B. This is minimal change nephrotic syndrome, the commonest cause at this age, and it responds to corticosteroids. Biopsy is reserved for atypical features, such as haematuria, hypertension, low complement or steroid resistance. Give penicillin prophylaxis in some protocols and watch for infection and thrombosis.
8. Which vaccine is given at birth in the standard WHO schedule?
A. Measles
B. BCG and oral polio (and hepatitis B in many countries)
C. Rotavirus
D. Human papillomavirus
E. Meningococcal conjugate vaccine
Answer: B. BCG, a birth dose of oral polio vaccine and, in many countries, a birth dose of hepatitis B are given at birth. Rotavirus, pentavalent and pneumococcal vaccines start at 6 weeks, measles-containing vaccines from 9 months, and human papillomavirus vaccine in adolescence. Always check the national schedule.
9. A 10-month-old is pale with a haemoglobin of 6 g/dL, microcytic hypochromic cells and a diet of mostly cow's milk. What is the most likely cause?
A. Beta-thalassaemia major
B. Iron deficiency anaemia
C. Folate deficiency
D. Aplastic anaemia
E. Sickle cell disease
Answer: B. A milk-heavy diet that is low in iron, with microcytic hypochromic cells, points to iron deficiency. Treat with oral iron, correct the diet and look for hookworm or malaria where relevant. Thalassaemia major presents earlier with hepatosplenomegaly. Sickle cell disease has sickled cells and dactylitis.
10. A 4-year-old has fever, a spreading rash that began behind the ears, conjunctivitis, cough and white spots on the buccal mucosa. What is the diagnosis?
A. Rubella
B. Measles
C. Scarlet fever
D. Roseola
E. Chickenpox
Answer: B. Koplik spots, with the three Cs (cough, coryza, conjunctivitis) and a descending maculopapular rash, are diagnostic of measles. Give vitamin A to all children with measles, and watch for pneumonia, otitis media, diarrhoea and encephalitis. Rubella is milder, and scarlet fever causes a sandpaper rash with a strawberry tongue.
11. A 6-year-old with sickle cell disease has fever of 39 °C. What is the correct approach?
A. Paracetamol and review next week
B. Urgent assessment, blood cultures and immediate antibiotics
C. Wait for malaria test only
D. Give iron
E. Advise fluids and rest
Answer: B. Children with sickle cell disease are functionally asplenic and at high risk of overwhelming sepsis from encapsulated organisms, so fever is an emergency. Take cultures, give broad-spectrum antibiotics at once and test for malaria. Prevention includes penicillin prophylaxis, pneumococcal vaccination and malaria chemoprophylaxis in endemic areas.
12. At what age should a typically developing child first walk independently?
A. 6 months
B. 9 to 18 months
C. 24 months
D. 30 months
E. 36 months
Answer: B. Most children walk between 9 and 18 months, with a median of about 12. Referral for assessment is indicated when a child is not walking by 18 months. Corrected age is used for preterm infants.
References
- World Health Organization. Pocket Book of Hospital Care for Children.
- World Health Organization. Integrated Management of Childhood Illness.
- Nelson Textbook of Pediatrics. Elsevier.
- Illustrated Textbook of Paediatrics (Lissauer). Elsevier.