Paediatric MCQs

Question 1
A 14-year-old male with cystic fibrosis is admitted onto the paediatrics ward for a
suspected chest infection. After a few days on IV antibiotics the patient begins to
decline. They are extremely pyrexic, in respiratory distress and peripherally
shutdown. A CT chest is requested and the scan shows widespread liquefaction
and cavitation.
He is soon admitted to PICU for respiratory support.

What is the most likely causative organism?

A. Burkholderia cepacia
B. Haemophilus influenza
C. Moraxella catarrhalis
D. Staphylococcus aureus
E. Streptococcus pneumonia
Answer 1
A 14-year-old male with cystic fibrosis is admitted onto the paediatrics ward for
a suspected chest infection. After a few days on IV antibiotics the patient begins
to decline. They are extremely pyrexic, in respiratory distress and peripherally
shutdown. A CT chest is requested and the scan shows widespread liquefaction
and cavitation. Later that evening the boy passes away.

What is the most likely causative organism?

A. Burkholderia cepacia
B. Haemophilus influenza
C. Moraxella catarrhalis
D. Staphylococcus aureus
E. Streptococcus pneumonia
Bonus question
Which of the following is NOT a known complication of cystic fibrosis?

1. Meconium ileus
2. Bilateral absence of the vas deferens
3. Cognitive impairment
4. Pancreatic insufficiency
5. Allergic bronchopulmonary aspergillosis
Bonus question
Which of the following is NOT a known complication of cystic fibrosis?

1. Meconium ileus
2. Bilateral absence of the vas deferens
3. Cognitive impairment
4. Pancreatic insufficiency
5. Allergic bronchopulmonary aspergillosis
Question 2
A 4 day old infant in NICU (born at 28/40, with birthweight 1100g)
develops feeding intolerance, episodes of vomiting, and abdominal
distension. Examination reveals watery stools with specks of blood
present within the nappy. An abdominal X-ray is requested which
reveals gas in the bowel wall. What is the most likely diagnosis?

A. Intussusception
B. Necrotizing enterocolitis
C. Bowel perforation
D. Hirschsprung’s disease
E. Intestinal malrotation
Answer 2
A 4 day old infant in NICU (born at 28/40, with birthweight 1100g)
develops feeding intolerance, episodes of vomiting, and abdominal
distension. Examination reveals watery stools with specks of blood
present within the nappy. An abdominal X-ray is requested which
reveals gas in the bowel wall. What is the most likely diagnosis?

A. Intussusception
B. Necrotizing enterocolitis
C. Bowel perforation
D. Hirschsprung’s disease
E. Intestinal malrotation
Necrotising enterocolitis
• Risk factors:
• Low birth weight <1500g
• Prematurity
• Enteral feeding
• Formula feeding
• AXR – dilated, fixed bowel loops, pneumatosis intestinalis
• Management – Gut rest (7-10 days), IV antibiotics, TPN, +/- surgery
Question 3
A 5-week-old baby was admitted with RSV bronchiolitis. He was
saturating to 96 per cent in air this morning and was feeding two-thirds of
his usual amount of formula milk.
You are asked to review him as his work of breathing is worsening
overnight. He has nasal flaring, intercostal and subcostal recession,
tachypnoea and crepitations and wheeze heard bilaterally. What do you
expect his capillary blood gas to show?
 
A. pH 7.16 PCO2 23 PO2 75 BE –8 HCO3 18 mmol/L
B. pH 7.38 PCO2 41 PO2 90 BE +1 HCO3 25 mmol/L
C. pH 7.20 PCO2 61 PO2 62 BE +2 HCO3 26 mmol/L
D. pH 7.40 PCO2 9 PO2 56 BE +5 HCO3 28 mmol/L
E. pH 7.47 PCO2 47 PO2 83 BE +10 HCO3 35 mmol/L
Answer 3
A 5-week-old baby was admitted with RSV bronchiolitis. He was
saturating to 96 per cent in air this morning and was feeding two-thirds of
his usual amount of formula milk.
You are asked to review him as his work of breathing is worsening
overnight. He has nasal flaring, intercostal and subcostal recession,
tachypnoea and crepitations and wheeze heard bilaterally. What do you
expect his capillary blood gas to show?
 
A. pH 7.16 PCO2 23 PO2 75 BE –8 HCO3 18 mmol/L
B. pH 7.38 PCO2 41 PO2 90 BE +1 HCO3 25 mmol/L
C. pH 7.20 PCO2 61 PO2 62 BE +2 HCO3 26 mmol/L
D. pH 7.40 PCO2 9 PO2 56 BE +5 HCO3 28 mmol/L
E. pH 7.47 PCO2 47 PO2 83 kPa BE +10 HCO3 35 mmol/L
Question 4
A 5-year old boy is brought in to the GP with a 3-day history of a painful right
knee. The child has also had abdominal pain and vomiting over the past week,
which his mother attributes to ‘gastro.’
On examination you note a palpable non-blanching rash on his buttocks and
thighs. You perform a urine dipstick which shows erythrocytes + and protein +
+.
A) Haemolytic Uraemic Syndrome (HUS)
B) Reactive arthritis
C) Systemic Lupus Erythematosus (SLE)
D) Rheumatic fever
E) Henoch-Schonlein Purpura (HSP)
Answer 4
A 5-year old boy is brought in to the GP with a 3-day history of a painful right
knee. The child has also had abdominal pain and vomiting over the past week,
which his mother attributes to ‘gastro.’
On examination you note a palpable non-blanching rash on his buttocks and
thighs. You perform a urine dipstick which shows erythrocytes + and protein +
+.
A) Haemolytic Uraemic Syndrome (HUS)
B) Reactive arthritis
C) Systemic Lupus Erythematosus (SLE)
D) Rheumatic fever
E) Henoch-Schonlein Purpura (HSP)
Question 5
A 6-week old baby has been brought in to the hospital. Her Dad is
worried because she has had problems retaining feeds. He says
that soon after being fed she vomits up uncurdled milk quite
forcefully. She would then want to feed again. She does not appear
to be gaining weight. Given the likely diagnosis, which metabolic
abnormality would the patient most likely present with?

A. Hyperchloremic hyperkalemic metabolic acidosis

B. Hyperchloremic hypokalemic metabolic acidosis
C. Hyperchloremic hyperkalemic metabolic alkalosis
D. Hypochloremic hypokalaemic metabolic alkalosis
E. Hypochloremic hyperkalemic metabolic alkalosis
Question 5
A 6-week old baby has been brought in to the hospital. Her Dad is
worried because she has had problems retaining feeds. He says
that soon after being fed she vomits up uncurdled milk quite
forcefully. She would then want to feed again. She does not appear
to be gaining weight. Given the likely diagnosis, which metabolic
abnormality would the patient most likely present with?

A. Hyperchloremic hyperkalemic metabolic acidosis

B. Hyperchloremic hypokalemic metabolic acidosis
C. Hyperchloremic hyperkalemic metabolic alkalosis
D. Hypochloremic hypokalaemic metabolic alkalosis
E. Hypochloremic hyperkalemic metabolic alkalosis
Question 6
A 6-year old girl has short stature. She had a birth weight of 2kg at
term and had a coarctation of the aorta repair in infancy. She has
bilateral ptosis, a low posterior hairline, and multiple pigmented
naevi. She is on the 0.4th centile for height and the 2nd centile for
weight. Her mid-parental height is the 50th centile.
What single investigation is most likely to lead to a diagnosis?

A. Chest X-ray
B. Coeliac screen
C. Follicle-stimulating hormone (FSH) and luteinising hormone (LH)
levels
D. Karyotype
E. MRI scan of brain
Answer 6
A 6-year old girl has short stature. She had a birth weight of 2kg at
term and had a coarctation of the aorta repair in infancy. She has
bilateral ptosis, a low posterior hairline, and multiple pigmented
naevi. She is on the 0.4th centile for height and the 2nd centile for
weight. Her mid-parental height is the 50th centile.
What single investigation is most likely to lead to a diagnosis?

A. Chest X-ray
B. Coeliac screen
C. Follicle-stimulating hormone (FSH) and luteinising hormone (LH)
levels
D. Karyotype (45 XO)
E. MRI scan of brain
Question 7
A father brings his 15-month-old son in for review. He started walking two
months ago. The father has noticed that his son seems to be 'bow-legged' when
he walks.

Examination of the knees and hips is unremarkable with a full range of

movement. Leg length is equal. On standing the intercondylar distance is around
7cm.

What is the most appropriate action?

A. Refer to orthotics for shoe insets

B. Reassure that it is a normal variant and very likely to resolve by the age of 4
years
C. Refer to paediatric orthopaedics
D. Refer to physiotherapy for plantar flexion stretching exercises
E. Request an x—ray of the knees
Answer 7
A father brings his 15-month-old son in for review. He started walking two
months ago. The father has noticed that his son seems to be 'bow-legged' when
he walks.

Examination of the knees and hips is unremarkable with a full range of

movement. Leg length is equal. On standing the intercondylar distance is around
7cm.

What is the most appropriate action?

A. Refer to orthotics for shoe insets

B. Reassure that it is a normal variant and very likely to resolve by the age of 4
years
C. Refer to paediatric orthopaedics
D. Refer to physiotherapy for plantar flexion stretching exercises
E. Request an x—ray of the knees
Question 8
A 2-week old neonate presents with poor feeding and slow growth.
His mother also noted that he sweats when feeding. Physical
examination revealed a continuous machinery murmur in the aortic
and pulmonary areas.

Which of the following management is appropriate in this scenario?

A. Reassure, no extra management required

B. Indomethacin
C. Prostaglandins
D. Sildenafil
E. Refer for corrective surgery
Answer 8
A 2-week old neonate presents with poor feeding and slow growth.
His mother also noted that he sweats when feeding. Physical
examination revealed a continuous machinery murmur in the aortic
and pulmonary areas.

Which of the following management is appropriate in this scenario?

A. Reassure, no extra management required

B. Indomethacin
C. Prostaglandins
D. Sildenafil
E. Refer for corrective surgery
Answer 8
A 2-week old neonate presents with poor feeding and slow growth.
His mother also noted that he sweats when feeding. Physical
examination revealed a continuous machinery murmur in the aortic
and pulmonary areas.

Which of the following management is appropriate in this scenario?

A. Reassure, no extra management required

B. Fluid restriction, PEEP, Indomethacin
C. Prostaglandins
D. Sildenafil
E. Refer for corrective surgery
Question 9
A 6-month-old boy is brought into your practice by his adoptive parents,
complaining of an unusual pattern of movements recently in their son. They
were able to catch this on camera, and on watching the video you notice
subtle symmetrical contracting of his neck and drawing up of his legs,
followed by extending of his arms. He repeats this movement around 50
times before stopping.

What is the most likely diagnosis in this case?

A. Infantile colic
B. Tonic-clonic seizure
C. Focal aware seizure
D. Focal impaired awareness seizure
E. Infantile spasms
Answer 9.
A 6-month-old boy is brought into your practice by his adoptive parents,
complaining of an unusual pattern of movements recently in their son. They
were able to catch this on camera, and on watching the video you notice
subtle symmetrical contracting of his neck and drawing up of his legs,
followed by extending of his arms. He repeats this movement around 50
times before stopping.

What is the most likely diagnosis in this case?

A. Infantile colic
B. Tonic-clonic seizure
C. Focal aware seizure
D. Focal impaired awareness seizure
E. Infantile spasms
Question 10.
A 4-year-old boy is brought to the GP by his mother who states that
she has noted a 'barking' cough a few times every day for the last two
days. There has been no change to his appetite and his behaviour has
not changed. The GP does not find any abnormalities on examination.
Given the likely diagnosis of mild croup, what would be the first-line
treatment?

A. Nebulised adrenaline
B. Oral benzylpenicillin
C. Oral dexamethoasone
D. Oral predinisolone
E. Oral ibuprofen
Answer 10.
A 4-year-old boy is brought to the GP by his mother who states that
she has noted a 'barking' cough a few times every day for the last two
days. There has been no change to his appetite and his behaviour has
not changed. The GP does not find any abnormalities on examination.
Given the likely diagnosis of mild croup, what would be the first-line
treatment?

A. Nebulised adrenaline
B. Oral benzylpenicillin
C. Oral dexamethoasone
D. Oral predinisolone
E. Oral ibuprofen
Answer 10.
A 4-year-old boy is brought to the GP by his mother who states that
she has noted a 'barking' cough a few times every day for the last two
days. There has been no change to his appetite and his behaviour has
not changed. The GP does not find any abnormalities on examination.
Given the likely diagnosis of mild croup, what would be the first-line
treatment?

A. Nebulised adrenaline
B. Oral benzylpenicillin
C. +/- Oral dexamethoasone
D. OR +/- Oral predinisolone
E. Oral ibuprofen