Chronic Paediatric Conditions Practice Questions

Question 1

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 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 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 5

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 6

A 16-year-old girl with type 1 diabetes for 10 years attends for transition planning to adult services. Her HbA1c has been consistently between 65-72 mmol/mol over the past 2 years. Annual screening shows persistent microalbuminuria (ACR 4.8 mg/mmol) and background diabetic retinopathy with scattered microaneurysms bilaterally. She is on appropriate therapy including an ACE inhibitor. She asks about her long-term prognosis. What is the most appropriate counselling regarding her microvascular complications?

Accepted Answer

Optimizing glycaemic control now can still slow progression even with established complications

Answer

Microalbuminuria at this stage is irreversible regardless of subsequent glycaemic control

Answer

With current control, progression to end-stage renal disease is inevitable within 10 years

Answer

Background retinopathy always progresses to proliferative retinopathy requiring laser therapy

Answer

Presence of two microvascular complications indicates imminent need for renal transplantation

Question 7

A 4-year-old boy with newly diagnosed generalized epilepsy is being commenced on sodium valproate. His mother asks about potential side effects. Which of the following monitoring investigations should be performed before starting sodium valproate and at regular intervals during treatment?

Accepted Answer

Liver function tests, full blood count, and serum ammonia

Answer

Full blood count, renal function, and thyroid function tests

Answer

Electrocardiogram, liver function tests, and lipid profile

Answer

Full blood count, vitamin D levels, and bone density scan

Answer

Renal function, serum drug levels, and electroencephalogram

Question 8

A 13-year-old boy with type 1 diabetes for 7 years presents with intermittent episodes of abdominal bloating, early satiety, nausea, and vomiting, particularly after meals. He reports that vomiting sometimes contains food eaten several hours earlier. His HbA1c is 82 mmol/mol. On examination, he has mild epigastric tenderness and a succussion splash. Screening for coeliac disease is negative. What is the most likely diagnosis?

Accepted Answer

Gastroparesis secondary to diabetic autonomic neuropathy

Answer

Diabetic ketoacidosis with gastric stasis

Answer

Superior mesenteric artery syndrome

Answer

Helicobacter pylori-associated gastritis

Answer

Coeliac disease with false-negative serology

Question 9

A 10-year-old girl with type 1 diabetes for 5 years uses insulin glargine 18 units once daily at bedtime and insulin aspart before meals. She participates in competitive gymnastics training 5 evenings per week from 5-7pm. Her mother reports that she frequently becomes hypoglycaemic during and after training sessions despite eating extra snacks. Pre-dinner glucose is usually 8-10 mmol/L. What is the most appropriate modification to her insulin regimen?

Accepted Answer

Reduce the pre-lunch insulin aspart dose by 30-50% on training days

Answer

Increase the pre-lunch insulin aspart dose to provide better afternoon glucose control

Answer

Switch insulin glargine from bedtime to morning administration

Answer

Add metformin to reduce insulin requirements

Answer

Split insulin glargine to twice daily administration with reduced total daily dose

Question 10

A 7-year-old boy with newly diagnosed focal epilepsy is being considered for anti-epileptic drug therapy. His seizures consist of focal motor seizures affecting his right arm with preserved awareness, occurring 2-3 times per week. MRI brain shows a small left frontal cortical dysplasia. His parents are concerned about side effects of medication. Which of the following statements regarding the decision to commence anti-epileptic drug treatment is most accurate?

Accepted Answer

The presence of a structural brain lesion increases the risk of seizure recurrence and supports starting treatment

Answer

Focal seizures with preserved awareness do not require anti-epileptic treatment

Answer

Anti-epileptic drugs should be started immediately after a single unprovoked seizure to prevent recurrence

Answer

Anti-epileptic drugs are contraindicated in children under 10 years due to neurodevelopmental concerns

Answer

Treatment should be delayed until seizures occur daily to confirm the diagnosis

Chronic Paediatric Conditions

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