Pediatrics MCQs for NEET PG
861 worked Pediatrics questions across 72 areas. Each one has its own page with the reasoning for every option.
What this set is
Paediatrics covers growth, development, neonatology, nutrition, immunisation and childhood diseases. Milestones, vaccine schedules and neonatal conditions are reliable scoring areas.
This page lists the 861 Pediatrics questions that have a full worked page: 669 application questions that put a fact to use on a patient or a finding, and 192 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Pediatrics practice bank in the app is larger, with 3,566 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Pediatrics test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Pediatrics covers in the exam
- Growth and development
- Neonatology
- Nutrition and malnutrition
- Immunisation
- Paediatric infections
- Genetic and metabolic disorders
- Systemic paediatrics
- Paediatric emergencies
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Pediatrics study guide.
Worked questions by area
72 areas, largest first. Open an area to see its questions.
Neonatology112
- Neonatology · ApplicationA newborn becomes visibly jaundiced in the first 24 hours of life. What is the most likely cause?
- Neonatology · ApplicationA preterm infant on enteral feeds develops abdominal distension, bilious aspirates and bloody stools. Which radiological sign is characteristic of the likely diagnosis?
- Neonatology · ApplicationA 30-week preterm infant on enteral feeds on day 8 develops abdominal distension, bilious aspirates and bloody stools. Abdominal radiograph shows linear intramural gas.…
- Neonatology: resuscitation · ApplicationA newborn is not breathing and has a heart rate of 50 per minute despite 30 seconds of effective ventilation with a bag and mask. What is the next step?
- Neonatology: kangaroo mother care · ApplicationA stable 1.6 kg preterm baby is being fed by cup. Which statement about kangaroo mother care (KMC) is correct?
- Neonatology: antenatal steroids · ApplicationA woman at 30 weeks of gestation is in preterm labour. Which antenatal intervention most reduces neonatal respiratory distress syndrome?
- Neonatology: necrotising enterocolitis · ApplicationA preterm infant of 30 weeks on day 8 develops feed intolerance, abdominal distension and bloody stools. An abdominal X-ray shows linear lucencies in the bowel wall. Wh…
- Neonatology: hypoglycaemia · ApplicationA 12-hour-old symptomatic term baby has a blood glucose of 20 mg/dl and is jittery. What is the best immediate treatment?
- Neonatology: seizures · ApplicationA term baby has seizures on day 2 after a difficult delivery with Apgar 3 at 1 minute. Glucose and calcium are normal. What is the first-line anticonvulsant?
- Neonatology: cooling for HIE · Multi-stepA 38-week neonate with moderate hypoxic-ischaemic encephalopathy is being considered for therapeutic hypothermia. Which regimen is standard?
- Neonatology: bronchopulmonary dysplasia · ApplicationA preterm infant born at 28 weeks still requires supplemental oxygen at 36 weeks postmenstrual age. This defines which condition?
- Neonatology: retinopathy of prematurity · ApplicationA baby is born at 29 weeks and 1.1 kg. When should the first screening for retinopathy of prematurity be done under Indian recommendations?
- Neonatology: persistent pulmonary hypertension · Multi-stepA term baby with meconium aspiration has severe hypoxaemia with a pre-ductal to post-ductal saturation difference of more than 10 percent despite 100 percent oxygen. Wh…
- Neonatology: thermal care · ApplicationA newborn is found to have an axillary temperature of 36.2 degrees C. According to WHO classification, how is this described?
- Neonatology: HBNC schedule · ApplicationUnder the Home Based Newborn Care programme, an ASHA visits the home of a baby born in a health facility on which days?
- Neonatology: asymmetric IUGR · ApplicationA term baby is born with weight below the 10th centile but head circumference and length near the 50th centile. Which statement is correct?
- Neonatology: infant of diabetic mother · ApplicationA macrosomic newborn of a mother with poorly controlled diabetes is jittery at 3 hours. Which complication is most likely?
- Neonatology: biliary atresia · ApplicationA 5-week-old breastfed infant has persistent jaundice, pale stools and dark urine. Conjugated bilirubin is raised. What is the most appropriate surgical timing goal for…
- Neonatology: polycythaemia · ApplicationA plethoric newborn has a venous haematocrit of 72 percent and is symptomatic with irritability and poor feeding. What is the treatment?
- Neonatology: NRP epinephrine · Multi-stepIn a newborn, the heart rate remains below 60 per minute after 60 seconds of effective chest compressions with ventilation. What is the next step?
- Neonatology: neonatal tetanus · ApplicationA 7-day-old baby born at home, who fed well initially, now cannot suck, has jaw stiffness and spasms on touch. Which statement is correct?
- Neonatology: neonatal resuscitation initial steps · ApplicationA term baby is born limp, not breathing, after a clear liquor. Following the NRP sequence, what is the first set of actions?
- Neonatology: oxygen in preterm resuscitation · ApplicationHow should oxygen be used when resuscitating a 30-week preterm infant?
- Neonatology: temperature classification · ApplicationA newborn has an axillary temperature of 34.0 C. How is this classified?
- Neonatology: respiratory distress syndrome radiology · ApplicationA 29-week preterm develops grunting and retractions at 2 hours of life. The chest radiograph is most likely to show which pattern?
- Neonatology: less invasive surfactant · Multi-stepA 30-week preterm on CPAP has increasing oxygen need and a chest radiograph showing ground-glass opacities. What is the preferred way of giving surfactant?
- Neonatology: meconium aspiration syndrome · ApplicationA post-term baby born through thick meconium-stained liquor has severe respiratory distress. The X-ray is most likely to show which findings?
- Neonatology: intraventricular haemorrhage · ApplicationA 28-week preterm becomes pale and hypotonic on day 2 with a bulging fontanelle and a falling haematocrit. Which investigation confirms the likely diagnosis, and where…
- Neonatology: ABO incompatibility · ApplicationA mother with O positive blood delivers a term baby with A positive blood who is jaundiced at 20 hours. The direct Coombs test is weakly positive and the smear shows sp…
- Neonatology: Rh haemolytic disease · Multi-stepA baby of an Rh-negative mother with a previous unprotected pregnancy is born pale, oedematous and hepatosplenomegaly with a strongly positive Coombs test and cord bili…
- Neonatology: bronze baby syndrome · Multi-stepA neonate on phototherapy for cholestatic jaundice develops a grey-brown discolouration of the skin and urine. What is the likely explanation?
- Neonatology: Crigler-Najjar syndrome · Multi-stepA neonate has severe unconjugated hyperbilirubinaemia that is unresponsive to phenobarbitone, with normal liver enzymes and no haemolysis. Which enzyme defect is respon…
- Neonatology: early onset sepsis · ApplicationA term baby has lethargy, poor feeding, and temperature instability at 30 hours after prolonged rupture of membranes. Which empirical antibiotics are appropriate for ea…
- Neonatology: sepsis diagnostic workup · ApplicationWhich investigation is the gold standard for confirming neonatal sepsis?
- Neonatology: neonatal meningitis duration · ApplicationA neonate with sepsis has cerebrospinal fluid showing pleocytosis with a positive Gram stain. What is the usual duration of antibiotic treatment for gram-negative menin…
- Neonatology: infant of diabetic mother · Multi-stepA macrosomic newborn of a poorly controlled diabetic mother is jittery and has a systolic murmur with septal hypertrophy on echo. Which pair of complications is also ty…
- Neonatology: pyridoxine-dependent seizures · Multi-stepA neonate has recurrent seizures that fail to respond to phenobarbitone, midazolam and phenytoin, with normal glucose, calcium, and cranial imaging. What is the next be…
- Neonatology: subgaleal haemorrhage · Multi-stepAfter a vacuum-assisted delivery, a baby has a boggy swelling over the scalp that crosses sutures and extends to the neck, with pallor, tachycardia and falling haemoglo…
- Neonatology: symmetric vs asymmetric IUGR · ApplicationA newborn has weight, length and head circumference all below the 10th centile. Which insult most likely explains this pattern?
- Neonatology: newborn screening tests · ApplicationWhich pair of newborn screening tests is correctly matched?
- Neonatology: pulse oximetry for critical congenital heart disease · ApplicationA healthy-looking term newborn is screened at 24 hours with pulse oximetry. Which result is a positive screen needing echocardiography?
- Neonatology: IMNCI danger signs in a young infant · ApplicationA 3-week-old is brought with breathing rate of 64 per minute, no chest indrawing and normal temperature. What is the IMNCI classification and action?
- Neonatology: neonatal conjunctivitis timing · Multi-stepA newborn has profuse purulent eye discharge with swollen lids on day 3 of life. Which organism is most likely?
- Neonatology: neonatal abstinence syndrome · ApplicationA newborn of an opioid-dependent mother is irritable, with high-pitched cry, tremors, diarrhoea and sneezing. Which drug is used for severe withdrawal?
- Neonatology: fetal alcohol syndrome · ApplicationA newborn has microcephaly, a smooth philtrum, thin upper lip, and short palpebral fissures. The mother consumed alcohol heavily during pregnancy. What is the diagnosis?
- Neonatology: acute bilirubin encephalopathy · Multi-stepA 5-day-old term breastfed baby is lethargic, hypotonic and sucks poorly, with deep jaundice and a total bilirubin well above the exchange line. What should be done?
- Neonatology: necrotising enterocolitis · Multi-stepA 28-week infant on enteral feeds develops abdominal distension and bloody stools on day 10. Which radiological finding is an absolute indication for surgery?
- Neonatology: vitamin K deficiency bleeding · ApplicationA 3-week-old exclusively breastfed baby who did not receive vitamin K at birth presents with an intracranial bleed. The platelet count is normal. Which coagulation patt…
- Neonatology: infant of diabetic mother · ApplicationA woman with poorly controlled pregestational diabetes is counselled about fetal risks. Which malformation is the most specific for diabetic embryopathy?
- Neonatology: birth trauma · ApplicationA newborn delivered by vacuum extraction shows a soft scalp swelling over the right parietal bone that was absent at birth and is enlarging on day 2. The swelling does…
- Neonatology: anorectal malformation · Multi-stepA male newborn has no anal opening and passes meconium in the urine. A perineal inspection shows a flat bottom with no fistula. What is the most appropriate management?
- Neonatology: Hirschsprung disease · ApplicationA 3-week-old boy, who passed no meconium for 48 hours after birth, now has abdominal distension, fever and explosive foul-smelling diarrhoea after a rectal examination.…
- Neonatology: pulmonary hypoplasia · ApplicationA newborn with flattened facies, low-set ears and limb deformities is born after pregnancy complicated by severe oligohydramnios. He has severe respiratory distress wit…
- Neonatology: chronic bilirubin encephalopathy · Multi-stepA 4-year-old who had very high unconjugated bilirubin as a newborn now has athetoid movements, high-frequency sensorineural deafness and limited upward gaze. Which brai…
- Neonatology: bilateral choanal atresia · ApplicationA term newborn is cyanosed and in distress when quiet, with retractions, but becomes pink when crying. A feeding catheter cannot be passed through either nostril. What…
- Neonatology: Pierre Robin sequence · ApplicationA newborn has a small, receding chin, a U-shaped cleft palate, and noisy breathing with retractions when lying supine that improve on turning to the side. What is the f…
- Neonatology: hypoxic ischaemic encephalopathy staging · ApplicationA term newborn with perinatal asphyxia is examined at 12 hours. He is lethargic with decreased tone and a weak suck, has bradycardia, constricted pupils and has had two…
- Neonatology: late neonatal hypocalcaemia · ApplicationA 6-day-old term baby fed undiluted cow's milk is jittery and has a generalised seizure. Serum calcium is low, phosphate is high and glucose is normal. What is the most…
- Neonatology: neonatal lupus and heart block · ApplicationRoutine antenatal scanning at 24 weeks shows a fetal heart rate of 55 per minute with no structural heart defect. The mother has Sjogren syndrome. Which maternal antibo…
- Neonatology: twin-twin transfusion syndrome · Multi-stepMonochorionic twins are born. Twin A is small, pale with haemoglobin 11 g/dL and was in an oligohydramnios sac. Twin B is large and plethoric with haemoglobin 23 g/dL a…
- Neonatology: neonatal herpes simplex infection · ApplicationA 10-day-old term baby has a cluster of vesicles on the scalp, then develops lethargy, poor feeding and a seizure. The mother had a genital lesion at delivery. Which tr…
- Neonatology: neonatal Graves disease · Multi-stepOn day 3 a newborn is irritable and tachycardic with a small goitre and a poor weight gain despite good feeding. His mother had thyroidectomy for Graves disease 5 years…
- Neonatology: congenital lobar emphysema · Multi-stepA 2-month-old has progressive tachypnoea and a hyperinflated left chest. The radiograph shows a hyperlucent left upper zone with attenuated vascular markings, compresse…
- Neonatology: neonatal alloimmune thrombocytopenia · Multi-stepA term baby has petechiae on day 1 with a platelet count of 15,000 per microlitre and is otherwise well. The mother has a normal platelet count and no history of ITP. W…
- Neonatology: Klumpke palsy · ApplicationAfter a difficult breech delivery, a newborn has a weak hand grip, paralysed wrist and finger flexors, and a claw hand. The same side shows ptosis and a small pupil. Wh…
- Neonatology: birth-related facial nerve palsy · ApplicationA newborn delivered with forceps cries with the mouth drawn to the right. The left eye stays open, and forehead wrinkling is absent on the left. What is the most approp…
- Neonatology: clavicle fracture at birth · ApplicationA large newborn after shoulder dystocia holds the right arm still, with an asymmetric Moro reflex. There is crepitus and a lump over the middle of the right clavicle, a…
- Neonatology: collodion baby · ApplicationA term newborn is encased in a tight, shiny, parchment-like membrane with eversion of the eyelids and lips. Cracks are appearing at the joints. What is the most importa…
- Neonatology: meconium ileus · ApplicationA term newborn has not passed meconium by 36 hours and has a distended abdomen with bilious vomiting. The abdominal film shows a ground-glass appearance with few air-fl…
- Neonatology: subcutaneous fat necrosis · Multi-stepA term infant who needed prolonged resuscitation at birth develops firm, violaceous nodules over the cheeks and back at 2 weeks. At 4 weeks the infant is irritable, vom…
- Neonatology: parvovirus B19 and fetal hydrops · ApplicationA pregnant woman has a slapped-cheek illness at 20 weeks. Ultrasound later shows fetal ascites and skin oedema with a raised middle cerebral artery velocity. Which mech…
- Neonatology: anaemia of prematurity · ApplicationA 6-week-old born at 26 weeks is pale, feeds poorly and has tachycardia. Haemoglobin is 7.5 g/dL, with a low reticulocyte count and a negative Coombs test. What is the…
- Neonatology: umbilical granuloma · ApplicationA 2-week-old has a moist pink 5 mm nodule at the base of the umbilicus with a little serous discharge. The surrounding skin is normal and the baby is well. What is the…
- Neonatology: mechanism of phototherapy · ApplicationWhich mechanism mainly lowers serum bilirubin during phototherapy for neonatal jaundice?
- Neonatology: non-shivering thermogenesis · ApplicationA cold-stressed term newborn maintains temperature mainly by which mechanism?
- Neonatology: neonatal myasthenia gravis · ApplicationA mother with myasthenia gravis delivers a term baby who has a feeble cry, weak suck and facial weakness within hours. Which mechanism explains the baby's illness?
- Neonatology: hyperoxia test · Multi-stepA cyanosed newborn is given 100 percent oxygen for 10 minutes, but the arterial PaO2 stays low, below about 100 mmHg. What does this indicate?
- Neonatology: feeding a preterm with immature suck-swallow · ApplicationA stable 31-week preterm baby cannot coordinate sucking, swallowing and breathing. What is the best method of feeding?
- Neonatology: tension pneumothorax · Multi-stepA preterm baby on CPAP suddenly deteriorates. The right chest is hyperresonant with reduced breath sounds, the apex beat is shifted to the left, and a fibreoptic light…
- Neonatology: hypernatraemic dehydration in a breastfed baby · Multi-stepA 5-day-old exclusively breastfed baby has fallen from 3.2 kg to 2.7 kg. The baby is jaundiced with dry mucosa, has few wet nappies, and serum sodium is 158 mmol/L. Wha…
- Neonatology: sacral dimples · Multi-stepA routine examination finds sacral skin markings in four newborns. Which baby most needs an ultrasound of the spine?
- Neonatology · ApplicationWhat is meconium aspiration associated with?
- Neonatology · ApplicationWhat can delayed passage of meconium suggest?
- Neonatology · ApplicationWhat is a danger sign in neonate?
- Neonatology · ApplicationWhat can cause neonatal hypoglycemia?
- Neonatology · ApplicationWhat is the standard quick assessment immediately after birth?
- Neonatology · ApplicationWhat is a common cause of physiologic jaundice in newborns?
- Neonatology · ApplicationWhat is the best initial nutrition for most healthy newborns?
- Neonatology · ApplicationWhat finding in a newborn requires urgent assessment for sepsis?
- Neonatology · ApplicationWhat supports safe newborn sleep?
- Neonatology · ApplicationWhat is an important warning sign in neonatal jaundice?
- Neonatology · ApplicationWhat is a common cause of respiratory distress immediately after preterm birth?
- Neonatology · ApplicationWhat is the main concern with low blood glucose in a newborn?
- Neonatology · ApplicationWhat is the purpose of newborn screening programs?
- Neonatology · ApplicationWhat score is routinely used to assess newborn transition at birth?
- Neonatology · ApplicationWhat commonly causes physiologic jaundice in newborns?
- Neonatology · ApplicationWhat is preferred nutrition for most healthy newborns when possible?
- Neonatology · ApplicationWhich newborn feature requires urgent assessment for possible sepsis?
- Neonatology · ApplicationWhat is the immediate priority for a newborn who is apneic after initial warming and stimulation?
- Neonatology · ApplicationWhat is the first action for a newborn who is not breathing effectively after initial drying and stimulation?
- Neonatology · ApplicationWhich sign suggests pathological neonatal jaundice requiring assessment?
- Neonatology · ApplicationWhy is vitamin K given to newborns?
- Neonatology: neonatal resuscitation · Multi-stepA newborn is apneic with a heart rate of 80/min after drying, warming, and stimulation. What is the next most important intervention?
- Neonatology: jaundice · Multi-stepA newborn becomes visibly jaundiced at 12 hours of life. How should this be interpreted?
- Neonatology: sepsis · Multi-stepA 4-day-old has poor feeding, temperature instability, lethargy, and apnea. What is the appropriate approach?
- Neonatology: necrotizing enterocolitis · Multi-stepA premature infant develops abdominal distension, bilious aspirates, bloody stools, lethargy, and pneumatosis intestinalis on abdominal radiograph. What is the diagnosis?
- Neonatology: respiratory distress syndrome · ApplicationA very premature newborn has grunting, nasal flaring, retractions, and diffuse ground-glass lung appearance shortly after birth. What is the likely diagnosis?
- Neonatology: meconium aspiration · ApplicationA term newborn delivered through meconium-stained fluid has respiratory distress and patchy coarse pulmonary infiltrates. What is most likely?
- Neonatology: patent ductus arteriosus · ApplicationA preterm infant has a continuous machinery murmur, bounding pulses, and widened pulse pressure. Which lesion is most likely?
- Neonatology: hypoglycemia · ApplicationA jittery newborn of a mother with diabetes has poor feeding and low blood glucose. What is the likely mechanism?
- Neonatology: congenital diaphragmatic hernia · ApplicationA newborn has severe respiratory distress, scaphoid abdomen, and bowel sounds in the left chest. What is the diagnosis?
- Neonatology: congenital hypothyroidism · ApplicationWhich clinical feature can occur in untreated congenital hypothyroidism?
Systemic paediatrics66
- Systemic paediatrics: ventricular septal defect · ApplicationA 2-month-old has a loud pansystolic murmur at the left lower sternal border with a small muscular defect on echocardiography, with good weight gain and no heart failur…
- Systemic paediatrics: prostaglandin E1 use · ApplicationA 3-day-old becomes deeply cyanosed and shocked as the ductus closes, with a single loud S2 and no murmur, in a suspected duct-dependent lesion. What is the immediate d…
- Systemic paediatrics: tetralogy of Fallot · ApplicationA cyanosed 8-month-old has a single S2 and an ejection systolic murmur at the left upper sternal border. The chest X-ray shows a boot-shaped heart with oligaemic lung f…
- Systemic paediatrics: tricuspid atresia and Ebstein anomaly · Multi-stepA cyanosed infant has an ECG showing left axis deviation with left ventricular hypertrophy and diminished right-sided forces. Which lesion is most consistent, and which…
- Systemic paediatrics: endocarditis prophylaxis · ApplicationBefore a dental extraction, which child most needs infective endocarditis prophylaxis?
- Systemic paediatrics: steroid resistant nephrotic syndrome · Multi-stepA 6-year-old with nephrotic syndrome has persistent proteinuria after 6 weeks of daily prednisolone. What is the best next step?
- Systemic paediatrics: frequently relapsing nephrotic syndrome · ApplicationA child with steroid-sensitive nephrotic syndrome has had three relapses in six months with steroid toxicity. Which drug choice is appropriate to spare steroids?
- Systemic paediatrics: vesicoureteric reflux · ApplicationA 2-year-old girl after a febrile urinary tract infection has grade III vesicoureteric reflux on micturating cystourethrogram. Which investigation shows renal scarring,…
- Systemic paediatrics: antenatal hydronephrosis · Multi-stepA male newborn has antenatal hydronephrosis with a thick-walled bladder and poor urinary stream. Which test is done first after 48 hours of life, and which diagnosis is…
- Systemic paediatrics: cerebral palsy management · ApplicationA 4-year-old with spastic quadriplegic cerebral palsy has painful leg adductor spasticity and difficulty with perineal care. Which treatments reduce focal and generalis…
- Systemic paediatrics: neural tube defects · ApplicationA newborn has a lumbosacral myelomeningocele and later develops hydrocephalus. Which hindbrain abnormality is associated, and what is the timing of repair?
- Systemic paediatrics: Reye syndrome · ApplicationA 7-year-old recovering from influenza and given aspirin develops persistent vomiting, then confusion and seizures, with raised ammonia and transaminases but a normal b…
- Systemic paediatrics: childhood brain tumours · Multi-stepA 7-year-old has morning vomiting, ataxia and papilloedema, with a midline cerebellar mass on MRI. Another child presents with bitemporal visual field defects and a sup…
- Systemic paediatrics: cystic fibrosis lung disease · Multi-stepA 12-year-old with cystic fibrosis has repeated exacerbations and sputum culture growing mucoid Pseudomonas aeruginosa. Which therapy is recommended for chronic suppres…
- Systemic paediatrics: primary ciliary dyskinesia · Multi-stepA child with chronic wet cough since infancy, recurrent otitis media and bronchiectasis has dextrocardia on the chest X-ray. What is the diagnosis?
- Systemic paediatrics: thalassaemia major transfusion · Multi-stepA 2-year-old with transfusion-dependent beta thalassaemia major is started on regular transfusions. What pre-transfusion haemoglobin target and curative option apply?
- Systemic paediatrics: sickle cell disease in infancy · Multi-stepA 9-month-old with HbSS presents with painful swelling of both hands and feet. What is the diagnosis, and what measure reduces the risk of fatal infection in these chil…
- Systemic paediatrics: infant gastro-oesophageal reflux · ApplicationA 4-month-old thriving infant regurgitates small amounts after feeds, is happy, and gains weight well. What is the best approach?
- Systemic paediatrics: systemic lupus in children · Multi-stepA 13-year-old girl has a malar rash, arthritis, proteinuria with haematuria and fever. Which immunological test is the most specific for this diagnosis?
- Systemic paediatrics: persistent rickets work-up · Multi-stepA 3-year-old with rickets and short stature has not improved after 3 months of adequate vitamin D and calcium. What is the most appropriate next step?
- Systemic paediatrics: acute lymphoblastic leukaemia prognosis · ApplicationA 4-year-old with B-cell acute lymphoblastic leukaemia has a presenting WBC of 20,000 and a t(12;21) translocation. What does this indicate?
- Systemic paediatrics: pyloric stenosis management · ApplicationA 5-week-old boy with projectile non-bilious vomiting has a palpable olive and is dehydrated. What must be done before pyloromyotomy?
- Systemic paediatrics: coeliac disease with IgA deficiency · Multi-stepA child with chronic diarrhoea and poor growth has a negative IgA anti-tissue transglutaminase and an undetectable total serum IgA. What is the best next test?
- Systemic paediatrics: post-streptococcal glomerulonephritis · Multi-stepA boy with post-streptococcal glomerulonephritis still has a low C3 level and haematuria 4 months later. What should be suspected?
- Systemic paediatrics: Guillain-Barre syndrome · Multi-stepA 7-year-old has ascending symmetric weakness and absent knee jerks two weeks after a diarrhoeal illness. CSF shows high protein with 2 cells per microlitre. Which orga…
- Systemic paediatrics: transposition of great arteries · ApplicationA term baby, born to a diabetic mother, is deeply cyanosed from the first day. An echocardiogram shows the aorta arising from the right ventricle with an intact ventric…
- Systemic paediatrics: prostaglandin infusion · ApplicationA cyanosed newborn with pulmonary atresia is started on a prostaglandin E1 infusion and becomes apnoeic an hour later. What is the appropriate response?
- Systemic paediatrics: intussusception reduction · Multi-stepA haemodynamically stable 7-month-old has ultrasound-proven ileocolic intussusception. Which clinical finding would make non-operative reduction by air enema contraindi…
- Systemic paediatrics: undescended testis · ApplicationA 12-month-old boy has a left testis that is impalpable in the scrotum and cannot be milked down from the inguinal canal. It was not in the scrotum at birth and has not…
- Systemic paediatrics: nursemaid elbow · ApplicationA 2-year-old stops using her right arm after her father pulled her up by the hand. She holds the arm extended and pronated, cries on moving the elbow and has no swellin…
- Systemic paediatrics: congenital long QT syndrome · ApplicationA 6-year-old deaf child has had syncope during a swimming race and after a sudden loud noise. ECG shows a corrected QT interval of 520 ms. Which drug is the mainstay of…
- Systemic paediatrics: Wolff-Parkinson-White syndrome · ApplicationA 12-year-old has sudden-onset palpitations at a rate of about 200 per minute that last for minutes. Resting ECG between episodes shows a short PR interval and a slurre…
- Systemic paediatrics: acute myocarditis · ApplicationA 5-year-old develops tachypnoea, tachycardia, a gallop rhythm and hepatomegaly a week after a viral URI. Chest radiograph shows cardiomegaly, ECG shows low voltages wi…
- Systemic paediatrics: atrioventricular septal defect in Down syndrome · ApplicationAn infant with Down syndrome has a systolic murmur and early heart failure. ECG shows a superior (left) axis deviation with a prolonged PR interval. Which lesion is mos…
- Systemic paediatrics: Bartter syndrome · Multi-stepA 2-year-old has polyuria, failure to thrive and normal blood pressure. Potassium is 2.6 mmol/L with metabolic alkalosis, renin and aldosterone are high, and urine calc…
- Systemic paediatrics: autosomal recessive polycystic kidney disease · Multi-stepA neonate has bilateral massive flank masses with oligohydramnios, Potter facies and respiratory distress from pulmonary hypoplasia. Years later the child develops port…
- Systemic paediatrics: IgA nephropathy · ApplicationA 10-year-old boy has painless gross haematuria that began on the first day of a sore throat, and has settled in 3 days. A similar episode occurred last year. He has no…
- Systemic paediatrics: Alagille syndrome · Multi-stepAn infant has cholestatic jaundice, a triangular face, a posterior embryotoxon on eye examination, butterfly vertebrae and a peripheral pulmonary stenosis murmur. Which…
- Systemic paediatrics: Glanzmann thrombasthenia · Multi-stepA 3-year-old has had recurrent epistaxis and gum bleeding since infancy. Platelet count, PT and aPTT are normal. Platelet aggregation is absent with ADP, collagen and e…
- Systemic paediatrics: Bernard-Soulier syndrome · Multi-stepA boy has mucosal bleeding with a platelet count of 60,000 per microlitre and giant platelets on the smear. Ristocetin does not induce aggregation, and the defect is no…
- Systemic paediatrics: microcytic anaemia in thalassaemia trait · ApplicationA 6-year-old has haemoglobin 9.4 g/dL, MCV 62 fL, RBC count 5.8 million per microlitre and a normal RDW. Ferritin is normal. Which diagnosis is most likely?
- Systemic paediatrics: thrombocytopenia with absent radii · Multi-stepA newborn has platelets of 20,000 per microlitre, bilateral absent radii and well-formed thumbs. Which diagnosis is most likely?
- Systemic paediatrics: infantile haemangioma · ApplicationA 2-month-old has a rapidly enlarging, raised, bright red lesion on the upper eyelid that is starting to cover the pupil. Which is the first-line systemic treatment?
- Systemic paediatrics: juvenile myoclonic epilepsy · ApplicationA 15-year-old girl has jerks of the arms on waking that make her drop things. She had a generalised tonic-clonic seizure after a night of little sleep. EEG shows genera…
- Systemic paediatrics: acute disseminated encephalomyelitis · Multi-stepA 6-year-old develops fever, encephalopathy, ataxia and visual loss two weeks after a viral illness. MRI shows multiple large, poorly marginated T2 hyperintense lesions…
- Systemic paediatrics: idiopathic intracranial hypertension · ApplicationAn obese 13-year-old girl has headaches worse lying down, transient visual obscurations and pulsatile tinnitus. She has bilateral papilloedema, MRI shows no mass, and l…
- Systemic paediatrics: obstructive sleep apnoea in children · ApplicationA 5-year-old snores loudly with witnessed pauses in breathing, restless sleep and daytime hyperactivity. Examination shows grade 3 tonsils, and polysomnography confirms…
- Systemic paediatrics: Takayasu arteritis in children · Multi-stepAn 11-year-old girl has headaches and fatigue. Blood pressure is 170/110 mmHg in the right arm, left radial and femoral pulses are weak, an abdominal bruit is heard and…
- Systemic paediatrics: Hodgkin lymphoma immunophenotype · Multi-stepA 14-year-old has painless, firm supraclavicular nodes, fever, drenching night sweats and a widened mediastinum. Excision biopsy shows large binucleate cells with promi…
- Systemic paediatrics: embryonal rhabdomyosarcoma · ApplicationA 2-year-old girl has bloody vaginal discharge and a grape-like mass protruding from the introitus. Biopsy shows small round to spindle cells, some with cross-striation…
- Systemic paediatrics: acute promyelocytic leukaemia · ApplicationA 6-year-old has bleeding gums and purpura. The blood count shows pancytopenia with abnormal promyelocytes containing multiple bundles of Auer rods. PT and aPTT are pro…
- Systemic paediatrics: juvenile myasthenia gravis · ApplicationA 10-year-old has drooping of both eyelids and double vision that worsen towards evening and improve after rest. Repetitive nerve stimulation shows a decremental respon…
- Systemic paediatrics: choledochal cyst · Multi-stepA 4-year-old girl has recurrent right upper abdominal pain, intermittent jaundice and a palpable right upper quadrant mass. Ultrasound shows a fusiform cystic dilatatio…
- Systemic paediatrics: Crohn disease histology · Multi-stepA 13-year-old has 6 months of abdominal pain, diarrhoea, weight loss, growth delay and a perianal fissure. Colonoscopy shows patchy ulcers with normal mucosa between th…
- Systemic paediatrics: ulcerative colitis extraintestinal disease · ApplicationA 12-year-old has bloody diarrhoea, urgency and tenesmus. Colonoscopy shows continuous friable inflammation from the rectum up to the splenic flexure, and serum p-ANCA…
- Systemic paediatrics: infant inguinal hernia · ApplicationA 2-month-old boy has an intermittent right groin bulge that appears on crying and reduces on its own. Examination between episodes is otherwise normal. What is the bes…
- Systemic paediatrics: Gitelman syndrome · Multi-stepA 14-year-old has muscle cramps, carpopedal spasm and fatigue. Investigations show hypokalaemia, metabolic alkalosis, hypomagnesaemia and low urinary calcium excretion,…
- Systemic paediatrics: complicated parapneumonic effusion · ApplicationA 4-year-old with pneumonia remains febrile after 72 hours of intravenous antibiotics. The radiograph shows a large right pleural effusion. Aspirated fluid is turbid wi…
- Systemic paediatrics: Stevens-Johnson syndrome · ApplicationA 9-year-old with epilepsy started carbamazepine 12 days ago and now has fever, painful oral and conjunctival erosions and targetoid skin lesions with blistering over 8…
- Systemic paediatrics: Hashimoto thyroiditis · ApplicationA 12-year-old girl has fatigue, constipation, weight gain and slowing of growth. She has a firm, diffuse, non-tender goitre. TSH is high and free T4 is low. Which antib…
- Systemic paediatrics: infantile Blount disease · ApplicationAn obese 3-year-old who walked at 10 months has progressive bowing of both legs that is worsening rather than correcting. The radiograph shows sharp varus angulation wi…
- Systemic paediatrics: acute transverse myelitis versus Guillain-Barre syndrome · Multi-stepA 7-year-old has back pain followed within 24 hours by flaccid weakness of both legs, urinary retention and loss of sensation below the nipples. Knee jerks are absent i…
- Systemic paediatrics: acute appendicitis imaging · ApplicationA 9-year-old has 24 hours of periumbilical pain that has shifted to the right iliac fossa, with anorexia, vomiting, fever of 38 degrees C and rebound tenderness. Which…
- Systemic paediatrics: Somogyi effect in type 1 diabetes · Multi-stepA 10-year-old with type 1 diabetes on twice-daily regular and NPH insulin has fasting blood glucose of 280 mg/dL with morning ketonuria. A 3 a.m. glucose check is 48 mg…
- Systemic paediatrics: haemophagocytic lymphohistiocytosis · Multi-stepAn 18-month-old has fever for 12 days, hepatosplenomegaly and bicytopenia. Ferritin is 8500 ng/mL, triglycerides are 410 mg/dL and fibrinogen is 90 mg/dL. Bone marrow s…
- Systemic paediatrics: congenital nephrotic syndrome · Multi-stepA 6-week-old has generalised oedema, heavy proteinuria, hypoalbuminaemia and hyperlipidaemia. The placenta was large, alpha-fetoprotein was raised in pregnancy, and the…
Paediatric infections50
- Paediatric infections: plan C dehydration · Multi-stepA 3-year-old with watery diarrhoea is lethargic, has sunken eyes and cannot drink. What is the correct fluid regimen under WHO Plan C?
- Paediatric infections: severe pneumonia management · Multi-stepA 10-month-old has cough, fast breathing and lower chest indrawing but is alert, feeding well and has normal oxygen saturation. What is the current recommended manageme…
- Paediatric infections: SAANS pneumonia campaign · ApplicationDuring a SAANS campaign visit, a 1-year-old has cough and fast breathing with an SpO2 of 88 percent on pulse oximetry. What is the appropriate action?
- Paediatric infections: hand foot and mouth disease · ApplicationA 3-year-old has vesicles on palms, soles and oral mucosa. In an outbreak, a child develops myoclonic jerks, ataxia and neurogenic pulmonary oedema. Which agent is asso…
- Paediatric infections: tubercular meningitis staging · ApplicationA child with TB meningitis is drowsy with neck stiffness and cranial nerve palsy but no coma. How is this staged by the BMRC system, and what is the adjunctive therapy?
- Paediatric infections: dengue critical phase · Multi-stepA 6-year-old with 4 days of fever now has defervescence, abdominal pain, persistent vomiting, rising haematocrit and falling platelets. Which management principle is co…
- Paediatric infections: bacterial meningitis therapy · Multi-stepA 2-year-old has fever, neck stiffness and turbid CSF with neutrophils and low glucose. Which management is correct?
- Paediatric infections: acute otitis media · ApplicationA 4-year-old has ear pain and fever, with a bulging, red tympanic membrane. Which treatment is recommended in the usual case?
- Paediatric infections: MIS-C · Multi-stepA 7-year-old with persistent fever for 5 days, rash, conjunctivitis, hypotension, raised CRP, ferritin and troponin, and a positive SARS-CoV-2 antibody test 4 weeks aft…
- Paediatric infections: giardiasis and amoebiasis · ApplicationA 5-year-old has foul-smelling greasy stools, bloating and weight loss for 3 weeks, and stool microscopy shows trophozoites with a pear shape. Which drug is appropriate?
- Paediatric infections: HIV-exposed infant testing · Multi-stepA 6-week-old infant born to an HIV-positive mother has a positive DNA PCR test. What is the recommended action?
- Paediatric infections: osteomyelitis · ApplicationA 7-year-old has fever and acute pain with refusal to bear weight on the right leg, localised tenderness over the distal femur and raised CRP. Which organism and imagin…
- Paediatric infections: leprosy in children · ApplicationA 10-year-old has multiple hypopigmented anaesthetic patches over 6 body areas and a positive slit skin smear. Which regimen is used?
- Paediatric infections: subacute sclerosing panencephalitis · ApplicationAn 8-year-old who had measles at the age of one now has intellectual decline and repetitive myoclonic jerks. EEG shows periodic high-amplitude complexes. What is the di…
- Paediatric infections: mumps complications · ApplicationIn an outbreak of mumps among school children, which is the commonest extra-salivary complication in prepubertal children?
- Paediatric infections: urinary tract infection imaging · ApplicationA 5-month-old girl has a first febrile urinary tract infection that responds to treatment. Which investigation should be done?
- Paediatric infections: haemolytic uraemic syndrome · Multi-stepA 3-year-old develops bloody diarrhoea after eating undercooked meat. Five days later he is pale, oliguric and has haemoglobin 7 g/dL with schistocytes, platelets 40,00…
- Paediatric infections: scrub typhus · ApplicationA 7-year-old from a rural area has had fever for 8 days. An eschar is seen in the axilla with tender regional lymphadenopathy, thrombocytopenia and raised transaminases…
- Paediatric infections: staphylococcal scalded skin syndrome · Multi-stepA 3-year-old with fever and irritability has perioral erythema, then large sheets of skin that peel off when gently rubbed. The oral mucosa is spared. What is the mecha…
- Paediatric infections: retropharyngeal abscess · ApplicationAn 18-month-old has fever, drooling, refusal to feed, a stiff neck that resists extension and a muffled voice. Which finding is expected on a lateral neck radiograph?
- Paediatric infections: infantile botulism · ApplicationA 5-month-old has constipation, a weak cry, poor sucking, ptosis, dilated sluggish pupils and descending symmetric weakness over several days. What is the mechanism of…
- Paediatric infections: Mycoplasma pneumonia · ApplicationA 10-year-old has had 2 weeks of dry hacking cough, low-grade fever and headache but looks fairly well. The chest radiograph shows patchy bilateral interstitial infiltr…
- Paediatric infections: staphylococcal pneumonia · ApplicationA 10-month-old with skin pustules a week ago now has high fever, fast breathing and grunting. The chest radiograph shows thin-walled air-filled cysts and a right pyopne…
- Paediatric infections: Pneumocystis pneumonia in infants · Multi-stepA 4-month-old with untreated HIV infection has tachypnoea, hypoxia and a dry cough with minimal chest signs. Chest radiograph shows bilateral diffuse ground-glass shado…
- Paediatric infections: typhoid intestinal perforation · ApplicationA 9-year-old in the third week of enteric fever suddenly develops severe abdominal pain, a rigid abdomen and a fall in temperature and blood pressure. An erect abdomina…
- Paediatric infections: bone marrow culture in typhoid · ApplicationA 6-year-old with 10 days of fever suspected to be enteric fever has already received 3 days of oral antibiotics, and the blood culture is sterile. Which test is most l…
- Paediatric infections: relapse in vivax malaria · ApplicationA 9-year-old is treated with chloroquine for P. vivax malaria and clears the parasitaemia. Six weeks later fever and parasitaemia recur, with no new travel or exposure.…
- Paediatric infections: dengue early diagnosis · ApplicationDuring the monsoon, a 7-year-old on the second day of fever has myalgia, retro-orbital pain and a positive tourniquet test. Which laboratory test best confirms dengue a…
- Paediatric infections: neonatal varicella prevention · Multi-stepA term baby is born to a mother whose chickenpox rash appeared 3 days before delivery. The baby is well and has no lesions. What is the best step?
- Paediatric infections: post-varicella cerebellar ataxia · ApplicationA 5-year-old develops unsteady gait, truncal ataxia and intention tremor 8 days after the rash of chickenpox. He is alert, afebrile and has no signs of raised intracran…
- Paediatric infections: orbital cellulitis · ApplicationA 6-year-old with sinusitis has fever, a swollen red eyelid and is unwilling to look sideways. Which finding most reliably indicates orbital (postseptal) rather than pr…
- Paediatric infections: peritonsillar abscess · ApplicationA 14-year-old has fever, severe one-sided throat pain, a muffled voice, difficulty opening the mouth and a bulging soft palate with the uvula pushed to the opposite sid…
- Paediatric infections: bacterial tracheitis · Multi-stepA 4-year-old with a barking cough and stridor looks toxic with high fever. Nebulised adrenaline and dexamethasone give no relief, and laryngoscopy under care shows thic…
- Paediatric infections: parapneumonic effusion · ApplicationA 3-year-old with lobar pneumonia remains febrile after 72 hours of intravenous antibiotics. Percussion is stony dull at the right base with reduced breath sounds. What…
- Paediatric infections: tuberculin anergy · Multi-stepA 3-year-old with severe acute malnutrition and fever has miliary mottling on chest radiograph, but the Mantoux test reads 0 mm at 72 hours. Which explanation is most l…
- Paediatric infections: hydrocephalus in tubercular meningitis · ApplicationA child with tubercular meningitis develops a bulging fontanelle and ventricular dilatation on CT. Which mechanism most commonly produces the hydrocephalus?
- Paediatric infections: lymphoid interstitial pneumonitis in HIV · ApplicationAn 8-year-old with perinatally acquired HIV has chronic cough, bilateral painless parotid enlargement, generalised lymphadenopathy and finger clubbing. Chest radiograph…
- Paediatric infections: visceral leishmaniasis diagnosis · ApplicationA 6-year-old from eastern India has 3 months of irregular fever, weight loss and a huge spleen reaching the umbilicus, with pancytopenia and hypergammaglobulinaemia. Wh…
- Paediatric infections: post-kala-azar dermal leishmaniasis · Multi-stepA 7-year-old treated for kala-azar in Bihar 2 years ago now has hypopigmented macules and erythematous nodules over the face, with no sensory loss and a normal general…
- Paediatric infections: hookworm anaemia · ApplicationA barefoot 7-year-old from a rural area has marked pallor, pedal oedema, a microcytic hypochromic smear and eosinophilia. Stool contains ova with a thin shell and a seg…
- Paediatric infections: sequelae of bacterial meningitis · ApplicationA 3-year-old is about to be discharged after recovering from pneumococcal meningitis. Which assessment is essential before or soon after discharge?
- Paediatric infections: lumbar puncture contraindications · Multi-stepA 4-year-old with fever and neck stiffness has a Glasgow Coma Score of 8, papilloedema, and an irregular breathing pattern. Bacterial meningitis is suspected. What is t…
- Paediatric infections: poliomyelitis versus Guillain-Barre syndrome · Multi-stepA 3-year-old has fever followed by sudden, asymmetric flaccid weakness of one leg with absent knee jerk and intact sensation. Which additional feature favours poliomyel…
- Paediatric infections: late complication of diphtheria · ApplicationA child recovering from pharyngeal diphtheria develops pallor, a rapid irregular pulse, a gallop rhythm and ECG evidence of heart block 2 weeks after onset. What is the…
- Paediatric infections: herpetic gingivostomatitis · ApplicationA 2-year-old has high fever, drooling, refusal to feed, and swollen bleeding gums with vesicles and shallow ulcers on the lips, tongue and gingiva. The palms and soles…
- Paediatric infections: streptococcal pharyngitis treatment · ApplicationA 7-year-old has fever, tonsillar exudate, tender anterior cervical nodes and no cough. A rapid antigen test for group A streptococcus is positive. Which treatment best…
- Paediatric infections: early congenital syphilis · ApplicationA 3-week-old has persistent blood-stained nasal discharge, a copper-coloured maculopapular rash on the palms and soles, and hepatosplenomegaly. The mother's syphilis se…
- Paediatric infections: pertussis household contacts · ApplicationA 5-week-old is admitted with confirmed pertussis. Which measure should be taken for his household contacts, including a 4-year-old sibling and the parents?
- Paediatric infections: chlamydial pneumonia of infancy · ApplicationA 6-week-old afebrile baby has a staccato cough, tachypnoea and hyperinflated lungs with bilateral infiltrates. The mother reports a purulent eye discharge in the baby…
- Paediatric infections: infectious mononucleosis advice · ApplicationA 15-year-old with Epstein-Barr virus infectious mononucleosis has palpable splenomegaly and wants to resume football. What advice is appropriate?
Genetic and metabolic disorders48
- Genetic and metabolic disorders: Down syndrome features · ApplicationA hypotonic newborn has upslanting palpebral fissures, a single palmar crease and bilious vomiting, with a double bubble sign on abdominal X-ray. Which cardiac lesion a…
- Genetic and metabolic disorders: Down syndrome associations · Multi-stepWhich complication in a child with Down syndrome requires screening before sports participation and anaesthesia?
- Genetic and metabolic disorders: organic acidaemia · Multi-stepA previously well neonate on day 4 has poor feeding, lethargy and tachypnoea, with high anion gap metabolic acidosis, ketonuria and hyperammonaemia. Which group of diso…
- Genetic and metabolic disorders: McArdle disease · ApplicationAn adolescent has painful muscle cramps and myoglobinuria on strenuous exercise, but after a brief rest can continue exercising comfortably (second wind). Which enzyme…
- Genetic and metabolic disorders: leukodystrophies · Multi-stepAn 8-year-old boy has declining school performance, visual loss, spastic gait and skin hyperpigmentation with adrenal insufficiency. Which test is raised?
- Genetic and metabolic disorders: Lesch-Nyhan syndrome · ApplicationA 2-year-old boy has choreoathetosis, spasticity, self-mutilating biting of lips and fingers, and orange crystals in the diapers. Which enzyme is deficient?
- Genetic and metabolic disorders: inheritance patterns · ApplicationWhich statement about inheritance patterns is correct?
- Genetic and metabolic disorders: mitochondrial disease · Multi-stepA 3-year-old has developmental regression, ataxia, and bilateral basal ganglia lesions on MRI, with raised blood and CSF lactate. Which diagnosis is most likely?
- Genetic and metabolic disorders: osteogenesis imperfecta · ApplicationAn infant has multiple fractures after minimal trauma, blue sclerae and hearing loss in the family. Which defect and which treatment apply?
- Genetic and metabolic disorders: achondroplasia · ApplicationA child has macrocephaly, frontal bossing, rhizomelic limb shortening, trident hands and normal intelligence, born to average-sized parents. Which gene is mutated?
- Genetic and metabolic disorders: Hunter syndrome · Multi-stepA 4-year-old boy has coarse facies, hepatosplenomegaly, aggressive behaviour and no corneal clouding. His maternal uncle had a similar illness. Which enzyme is deficient?
- Genetic and metabolic disorders: immune thrombocytopenia · ApplicationA well 4-year-old develops petechiae and bruises two weeks after a viral illness. The platelet count is 15,000 per microlitre, haemoglobin and white cell count are norm…
- Genetic and metabolic disorders: Wiskott-Aldrich syndrome · ApplicationA 1-year-old boy has eczema, recurrent otitis media and prolonged bleeding after a minor injury. The platelet count is low and the platelets are small. What is the diag…
- Genetic and metabolic disorders: X-linked agammaglobulinaemia · ApplicationA 10-month-old boy has had repeated pneumococcal pneumonia and sinusitis since 6 months of age. Tonsils are absent and lymph nodes are not palpable. Which finding is ex…
- Genetic and metabolic disorders: chronic granulomatous disease · Multi-stepA 3-year-old boy has recurrent liver abscesses and lymphadenitis due to Staphylococcus aureus and Aspergillus. A nitroblue tetrazolium test does not turn blue. What is…
- Genetic and metabolic disorders: leukocyte adhesion deficiency · Multi-stepAn infant has delayed umbilical cord separation at 5 weeks, omphalitis and recurrent skin infections without pus formation. The blood count shows marked neutrophilia. W…
- Genetic and metabolic disorders: Noonan syndrome · Multi-stepA boy with short stature, webbed neck, low-set ears, ptosis and pectus excavatum has a normal 46,XY karyotype and a systolic ejection murmur at the upper left sternal b…
- Genetic and metabolic disorders: Alport syndrome · ApplicationA 9-year-old boy has recurrent episodes of haematuria, bilateral high-frequency sensorineural hearing loss, and his maternal uncle died of renal failure. Biopsy would s…
- Genetic and metabolic disorders: Menkes disease · ApplicationA 3-month-old boy has seizures, hypotonia and sparse, twisted, brittle hair. Serum copper and ceruloplasmin are low. Which defect is present?
- Genetic and metabolic disorders: Zellweger syndrome · Multi-stepA neonate has profound hypotonia, a high forehead with flat facies, a large fontanelle, hepatomegaly, seizures and punctate calcification of the patellae. Which laborat…
- Genetic and metabolic disorders: Niemann-Pick disease · Multi-stepA 6-month-old has hepatosplenomegaly, failure to thrive and progressive loss of milestones, with a macular cherry-red spot. Which enzyme is deficient?
- Genetic and metabolic disorders: Fabry disease · ApplicationA 10-year-old boy has episodes of burning pain in the hands and feet with fever, reddish-purple punctate skin lesions around the umbilicus and reduced sweating. His mat…
- Genetic and metabolic disorders: biotinidase deficiency · Multi-stepA 3-month-old has seizures, hypotonia, a scaly skin rash and hair loss. Blood shows metabolic acidosis with raised lactate, and urine has an abnormal organic acid profi…
- Genetic and metabolic disorders: hereditary tyrosinaemia type 1 · Multi-stepA 5-month-old has hepatomegaly, failure to thrive, a coagulopathy not corrected by vitamin K, renal tubular dysfunction with rickets and a boiled-cabbage odour. Which t…
- Genetic and metabolic disorders: hereditary fructose intolerance · Multi-stepA 9-month-old starts sweetened fruit juice and sucrose-containing weaning foods. Within hours she vomits, sweats, becomes lethargic and has hypoglycaemia. Liver is enla…
- Genetic and metabolic disorders: ataxia telangiectasia · ApplicationA 4-year-old has progressive gait ataxia, conjunctival telangiectasia and recurrent sinopulmonary infections. Which laboratory finding is expected?
- Genetic and metabolic disorders: Friedreich ataxia · Multi-stepA 13-year-old has progressive gait ataxia, absent knee and ankle jerks, pes cavus, scoliosis and impaired vibration and position sense. Which accompanying problem is th…
- Genetic and metabolic disorders: Krabbe disease · ApplicationA 5-month-old, previously normal, becomes inconsolably irritable with episodic stiffening, loses head control and develops optic atrophy. CSF protein is raised, nerve c…
- Genetic and metabolic disorders: nephropathic cystinosis · Multi-stepA 14-month-old has poor growth, polyuria, polydipsia and florid rickets. Urine shows glycosuria with a normal blood glucose, generalised aminoaciduria and phosphaturia.…
- Genetic and metabolic disorders: hyper IgE syndrome · ApplicationA 6-year-old boy has recurrent staphylococcal skin abscesses that are notably non-inflamed, pneumonias that leave pneumatoceles, chronic eczema, coarse facies, retained…
- Genetic and metabolic disorders: Smith-Lemli-Opitz syndrome · Multi-stepA newborn boy has microcephaly, ptosis, an upturned nose, syndactyly of the second and third toes, hypospadias and poor feeding. Plasma cholesterol is low and 7-dehydro…
- Genetic and metabolic disorders: Hartnup disease · Multi-stepA 7-year-old has episodic photosensitive pellagra-like rash, intermittent cerebellar ataxia and emotional lability during fasting and illness, despite adequate dietary…
- Genetic and metabolic disorders: glutaric aciduria type 1 · Multi-stepA 10-month-old with a head circumference above the 97th centile and mild hypotonia develops sudden dystonia and loss of motor skills after a febrile illness. MRI shows…
- Genetic and metabolic disorders: Canavan disease · ApplicationA 6-month-old has macrocephaly, marked head lag, poor visual following and progressive hypotonia that later turns into spasticity. MRI shows diffuse symmetrical subcort…
- Genetic and metabolic disorders: Morquio syndrome · ApplicationA 6-year-old has short-trunk dwarfism, pectus carinatum, genu valgum, corneal clouding and normal intelligence. Neck films show odontoid hypoplasia. Which glycosaminogl…
- Genetic and metabolic disorders: hereditary angioedema · ApplicationA 9-year-old has recurrent painless, non-itchy swelling of the face and limbs, and episodes of severe abdominal colic after minor trauma. There is no urticaria and no r…
- Genetic and metabolic disorders: Apert versus Crouzon syndrome · Multi-stepTwo infants have coronal craniosynostosis with a tall skull, shallow orbits with proptosis and midface hypoplasia, both due to FGFR2 mutations. Which additional finding…
- Genetic and metabolic disorders: Cornelia de Lange syndrome · Multi-stepA 3-year-old has severe growth failure, microcephaly, bushy eyebrows meeting in the midline, a long smooth philtrum, thin upper lip, small hands with a proximally place…
- Genetic and metabolic disorders: alpha-1 antitrypsin deficiency · Multi-stepA 2-month-old has prolonged cholestatic jaundice, pale stools and hepatomegaly. Sweat chloride is normal, urine reducing substances are absent, and liver biopsy shows p…
- Genetic and metabolic disorders: congenital myotonic dystrophy · Multi-stepA newborn has marked hypotonia, a tented upper lip, bilateral talipes and respiratory distress after a pregnancy complicated by polyhydramnios. His mother has a long th…
- Genetic and metabolic disorders: Charcot-Marie-Tooth disease · ApplicationA 14-year-old has high-arched feet, hammer toes, distal leg wasting, foot drop and absent ankle jerks. There is no ataxia or cardiomyopathy, and nerve conduction veloci…
- Genetic and metabolic disorders: malignant infantile osteopetrosis · ApplicationA 4-month-old has failure to thrive, pallor, hepatosplenomegaly, nystagmus and poor visual response. Radiographs show uniformly dense bones with a bone-within-bone appe…
- Genetic and metabolic disorders: tetrahydrobiopterin deficiency · Multi-stepA 5-month-old with high phenylalanine on newborn screening has been on a strict phenylalanine-restricted formula, and the phenylalanine is now acceptable. He neverthele…
- Genetic and metabolic disorders: xeroderma pigmentosum · ApplicationA 3-year-old has severe sunburn and blistering after minimal sun exposure, freckle-like pigmentation of exposed skin, photophobia and a squamous cell carcinoma on the l…
- Genetic and metabolic disorders: Chediak-Higashi syndrome · ApplicationA 3-year-old has silvery-grey hair, pale skin with photophobia, recurrent pyogenic infections and a mild bleeding tendency. Which abnormality is most likely on the peri…
- Genetic and metabolic disorders: Peutz-Jeghers syndrome · ApplicationA 9-year-old has dark brown macules on the lips and buccal mucosa and recurrent colicky abdominal pain. At laparotomy for obstruction, an intussusception is found with…
- Genetic and metabolic disorders: homozygous familial hypercholesterolaemia · ApplicationA 6-year-old has yellow planar xanthomas over the hands and buttocks and tendon xanthomas. Total cholesterol is 700 mg/dL, and both parents have moderately raised chole…
- Genetic and metabolic disorders: Shwachman-Diamond syndrome · Multi-stepA 10-month-old has failure to thrive with bulky, foul-smelling stools, recurrent infections and an absolute neutrophil count of 400 per microlitre. Sweat chloride is no…
Immunisation48
- Immunisation · ApplicationA 10-week-old infant brought for the second dose of pentavalent vaccine has a runny nose and a temperature of 37.8 degrees Celsius but is feeding well and active. What…
- Immunisation: rotavirus · ApplicationWhich statement about the rotavirus vaccine in UIP is correct?
- Immunisation: fractional IPV · ApplicationHow is fractional IPV (fIPV) administered in the Indian schedule?
- Immunisation: PCV schedule · ApplicationWhich is the UIP schedule for pneumococcal conjugate vaccine?
- Immunisation: Japanese encephalitis · ApplicationIn JE-endemic districts of India, when is the JE vaccine given under UIP?
- Immunisation: boosters · ApplicationWhich pair correctly describes UIP tetanus-diphtheria vaccination in older children?
- Immunisation: cold chain · ApplicationWhich vaccine pair is freeze-sensitive and must never be frozen?
- Immunisation: vaccine vial monitor · ApplicationOn a vaccine vial monitor, the inner square has become the same colour as the outer circle. What should be done?
- Immunisation: open vial policy · ApplicationAfter reconstitution, within how many hours must BCG and measles-rubella vaccine be used?
- Immunisation: anaphylaxis · ApplicationA child develops stridor, wheeze and hypotension 10 minutes after vaccination. What is the immediate drug of choice and dose?
- Immunisation: typhoid conjugate vaccine · ApplicationWhich statement about the typhoid conjugate vaccine under IAP recommendations is correct?
- Immunisation: HPV · ApplicationWhat is the IAP recommended schedule of HPV vaccine for a healthy 10-year-old girl?
- Immunisation: varicella · ApplicationWhat is the IAP recommendation for varicella vaccination in a healthy 15-month-old child?
- Immunisation: hepatitis A · ApplicationWhat is the correct schedule of the inactivated hepatitis A vaccine under IAP guidance?
- Immunisation: hepatitis B prophylaxis · ApplicationA term newborn is born to an HBsAg-positive mother. What is the best post-exposure prophylaxis?
- Immunisation: interval for live vaccines · ApplicationA child received a measles-containing vaccine yesterday and now needs another live parenteral vaccine. What is the rule?
- Immunisation: immunocompromised child · ApplicationA child with HIV and severe immunosuppression needs polio vaccination. Which is preferred?
- Immunisation: AEFI classification · Multi-stepAfter a vaccine session, six children develop fever and local abscess. Investigation shows the nurse used a single syringe contaminated by a non-sterile technique. How…
- Immunisation: BCG scar and lymphadenitis · ApplicationA 6-week-old infant has a 1 cm non-suppurative left axillary lymph node on the side of BCG vaccination, with no fever or systemic illness. What is the recommended manag…
- Immunisation: polio vaccines in UIP · ApplicationWhich statement about polio vaccination under the Universal Immunisation Programme is correct?
- Immunisation: measles-rubella schedule · ApplicationWhich statement about the measles-rubella vaccine in the UIP is correct?
- Immunisation: IAP additional vaccines · ApplicationWhich set of vaccines is included in the IAP schedule but not routinely in the UIP?
- Immunisation: pertussis encephalopathy · Multi-stepAn infant developed encephalopathy with convulsions and coma 4 days after the first dose of whole cell DPT, with no other cause found. What should be done at the next s…
- Immunisation: shake test · Multi-stepA health worker suspects that a vial of DPT vaccine has been frozen. Which test is used to check for freeze damage, and what indicates damage?
- Immunisation: open vial policy · ApplicationUnder the open vial policy in India, which vaccines can be reused up to 28 days if storage conditions are met?
- Immunisation: catch-up immunisation principle · ApplicationA 10-month-old received two doses of pentavalent vaccine at 6 and 10 weeks and then defaulted. What is the correct approach for the remaining doses?
- Immunisation: polio eradication and AFP surveillance · ApplicationIn which year was India certified polio-free by the WHO, and which surveillance supports this?
- Immunisation: herd immunity and measles · Multi-stepMeasles has a basic reproduction number of 12 to 18. What level of population immunity is needed to interrupt transmission?
- Immunisation: RSV prevention · ApplicationWhich approach protects young infants against severe RSV bronchiolitis in the first months of life?
- Immunisation: rotavirus vaccine contraindication · ApplicationWhich infant should NOT receive the oral rotavirus vaccine?
- Immunisation: tetanus wound prophylaxis · Multi-stepA completely unimmunised 4-year-old has a deep soil-contaminated wound after a fall in a field. What is the right prophylaxis?
- Immunisation: tetanus-prone wound · ApplicationA 6-year-old who received only one DPT dose in infancy presents with a deep, soil-contaminated wound from a fall in a field. Which is the most appropriate prophylaxis?
- Immunisation: vaccine-associated paralytic polio · ApplicationWhich statement about vaccine-associated paralytic poliomyelitis from oral polio vaccine is correct?
- Immunisation: conjugate vaccines · ApplicationWhy is the Haemophilus influenzae type b capsular polysaccharide conjugated to a protein carrier in the vaccine given to infants?
- Immunisation: egg allergy and measles-containing vaccine · ApplicationA 12-month-old developed hives after eating egg. She is now due for the measles-containing vaccine. What is the appropriate advice?
- Immunisation: aluminium adjuvant and injection route · ApplicationA trainee wants to give pentavalent vaccine as a shallow subcutaneous injection in the infant's thigh fat because it looks easier. Why is deep intramuscular injection p…
- Immunisation: measles vaccine given before 9 months · ApplicationDuring a measles outbreak in a district, a 7-month-old infant is given a measles-containing vaccine dose. What is the correct approach to this infant's routine schedule?
- Immunisation: circulating vaccine-derived poliovirus · Multi-stepThree unimmunised children in a low-coverage area develop flaccid paralysis. Stool isolates are Sabin-derived strains with genetic changes that have regained neurovirul…
- Immunisation: rationale for IPV after OPV type 2 withdrawal · ApplicationGlobally, the trivalent oral polio vaccine was replaced by a bivalent vaccine containing types 1 and 3. Why was inactivated polio vaccine added to routine schedules at…
- Immunisation: measles post-exposure prophylaxis · ApplicationA healthy, unimmunised 14-month-old child was in close contact with a measles case 2 days ago. No contraindication to vaccines exists. What is the best step?
- Immunisation: varicella exposure in leukaemia · ApplicationA 6-year-old on chemotherapy for acute lymphoblastic leukaemia has never had chickenpox or varicella vaccine. His classmate was diagnosed with chickenpox yesterday. Wha…
- Immunisation: hypotonic hyporesponsive episode · ApplicationEight hours after her first whole-cell pertussis-containing injection, an infant becomes pale, limp and unresponsive but keeps breathing normally with no rash or strido…
- Immunisation: tetanus protection in pregnancy · ApplicationA primigravida at 14 weeks with no prior tetanus immunisation attends an antenatal clinic in India. Which schedule best prevents neonatal tetanus?
- Immunisation: influenza vaccine in young children · ApplicationA healthy 3-year-old is to receive inactivated influenza vaccine for the first time. Which schedule is recommended?
- Immunisation: catch-up for children aged 7 years or more · ApplicationAn 8-year-old who never received any DPT-containing vaccine needs a primary series for tetanus and diphtheria. Which vaccine is used?
- Immunisation: pertussis protection through pregnancy · ApplicationA mother at 30 weeks of pregnancy asks how her newborn can be protected from whooping cough in the first weeks, before infant vaccination begins. Which vaccine is recom…
- Immunisation: Hib vaccine and herd effect · ApplicationAfter Haemophilus influenzae type b conjugate vaccine was introduced, invasive disease also fell among unimmunised young children in the community. What mechanism expla…
- Immunisation: AEFI coincidental event · ApplicationA 7-month-old develops fever and a positive malaria smear the day after a DPT vaccine session. Investigation shows no fault in the vaccine or in administration, and the…
Growth and development41
- Growth and development · ApplicationA child can copy a circle and a cross but cannot yet copy a triangle. What is the approximate age of the child?
- Growth and development: delayed fontanelle closure · ApplicationA 14-month-old has a large open anterior fontanelle, frontal bossing, and a rachitic rosary. Which cause of delayed fontanelle closure is most consistent?
- Growth and development: head and chest circumference crossover · ApplicationAt what age does chest circumference normally become equal to head circumference?
- Growth and development: upper to lower segment ratio · ApplicationA 10-year-old child has short stature with an upper to lower segment ratio of 1.3. What is the approximate normal ratio at this age, and what does this finding suggest?
- Growth and development: mid-parental height · ApplicationA boy's father is 170 cm and his mother is 156 cm. What is his mid-parental (target) height using the standard formula?
- Growth and development: familial short stature · ApplicationA 6-year-old girl has height below the 3rd centile, normal growth velocity, bone age equal to chronological age, and both parents are short. What is the diagnosis?
- Growth and development: growth hormone deficiency · Multi-stepA 3-year-old with proportionate short stature, a micropenis, and episodes of hypoglycaemia has a single central incisor. Which test confirms the suspected diagnosis?
- Growth and development: walking and running · ApplicationA child stands with support, cruises, and walks a few steps alone but cannot run. Which age is most consistent?
- Growth and development: building with cubes · ApplicationA child scribbles spontaneously, builds a tower of 3 cubes, and uses a spoon with spillage. What is the approximate developmental age?
- Growth and development: language milestones · ApplicationA child coos, babbles with consonant sounds, says one or two meaningful words, and follows simple commands but does not join words. Which age is most likely?
- Growth and development: ATNR and parachute reflex · ApplicationWhich statement about primitive and postural reflexes is correct?
- Growth and development: developmental red flags · ApplicationA 10-month-old cannot sit without support. Which statement describes the red flag cut-offs correctly?
- Growth and development: global developmental delay · ApplicationA 2-year-old has delayed sitting and walking, speaks no words, and shows poor social interaction. How is this best labelled?
- Growth and development: intellectual disability grading · ApplicationAccording to IQ classification, which range corresponds to mild intellectual disability?
- Growth and development: delayed puberty definition · ApplicationA 14-year-old boy has no testicular enlargement. How is this classified?
- Growth and development: premature thelarche · Multi-stepA 2-year-old girl has bilateral breast enlargement with no pubic hair, normal growth velocity, and a prepubertal bone age. What is the best management?
- Growth and development: pubertal growth spurt · ApplicationA 12-year-old girl who attained menarche six months ago and a 12-year-old boy with testicular volume of 6 mL attend a growth clinic together. A parent asks who has the…
- Growth and development · ApplicationAt a 4-month visit an infant's head circumference is on the 90th percentile, and the baby is feeding, developing and examining normally. Which approach is best?
- Growth and development: craniosynostosis · ApplicationA 3-month-old has a long, narrow head with a palpable bony ridge along the midline, a small anterior fontanelle and a head that is increased in anteroposterior length b…
- Growth and development: delayed puberty with anosmia · ApplicationA 16-year-old boy has no pubertal development and is unable to smell. Testes are prepubertal, and serum LH, FSH and testosterone are all low, with otherwise normal pitu…
- Growth and development: squint and vision screening · ApplicationA 2-year-old's mother notes that one eye looks turned in. A torch held at arm's length shows the corneal light reflex at the centre of the right pupil but displaced tow…
- Growth and development: night terrors · ApplicationA 4-year-old screams, sits up with wide eyes, sweats and has a fast pulse about an hour after falling asleep. He cannot be consoled, does not recognise his parents and…
- Growth and development: evaluation of speech delay · ApplicationA 30-month-old has about ten single words and no two-word phrases. He points, imitates, plays pretend games and makes good eye contact. Motor milestones are normal. Wha…
- Growth and development: premature adrenarche · ApplicationA 7.5-year-old girl has had pubic hair, axillary hair and body odour for six months. She has no breast buds, her growth velocity is normal, and bone age is only slightl…
- Growth and development: treatment of central precocious puberty · Multi-stepA 7-year-old girl has had breast development since age 6, a rapid growth rate and an advanced bone age. A GnRH stimulation test gives a pubertal LH peak, and the MRI of…
- Growth and development: non-organic failure to thrive · ApplicationAn 18-month-old with weight below the 3rd centile is withdrawn and poorly cared for. On a hospital ward eating ordinary meals, she gains 800 g in two weeks. What is the…
- Growth and development: Piaget preoperational stage · ApplicationA 4-year-old tells his mother that the moon is following their car and that his teddy is sad because it was left behind. Which cognitive stage does this thinking repres…
- Growth and development: early hand preference · ApplicationA 7-month-old uses only the right hand to reach and grasp, while the left hand stays fisted and is rarely used. What does this early pattern suggest?
- Growth and development: gross motor skills at four years · ApplicationA child hops on one foot and walks down stairs alternating feet but cannot yet skip. What is the approximate age?
- Growth and development: infantile growth phase · Multi-stepA newborn with congenital growth hormone deficiency has a normal birth length, yet hypoglycaemia and a micropenis suggest the diagnosis. Why is the length at birth usua…
- Growth and development · ApplicationWhat is an expected gross-motor milestone around one year of age?
- Growth and development · ApplicationWhat parameter is especially useful for monitoring brain growth in infancy?
- Growth and development · ApplicationWhat is a typical language milestone near two years?
- Growth and development · ApplicationWhat is a common social milestone in infancy?
- Growth and development · ApplicationWhat is a typical fine-motor milestone late in infancy?
- Growth and development · ApplicationWhat developmental concern warrants prompt assessment?
- Growth and development · ApplicationWhat gross-motor skill is expected near one year of age?
- Growth and development · ApplicationWhat measurement is useful for monitoring infant brain growth?
- Growth and development · ApplicationWhich developmental skill is expected around the end of the first year in many children?
- Growth and development · ApplicationWhat is a key principle when assessing developmental delay?
- Growth and development · ApplicationWhat is the most useful measure for detecting faltering growth over time?
Paediatric emergencies38
- Paediatric emergencies · Multi-stepA 2-year-old suddenly chokes while eating peanuts, then develops persistent cough and unilateral wheeze with reduced air entry on the right. An expiratory chest film sh…
- Paediatric emergencies · Multi-stepA 4-year-old has been having a generalised tonic-clonic seizure for more than five minutes and is still convulsing on arrival. Which drug class is first-line?
- Paediatric emergencies: infant CPR technique · ApplicationTwo health workers begin CPR on an 8-month-old infant. Which technique is recommended for chest compressions?
- Paediatric emergencies: epinephrine dose in arrest · ApplicationIn paediatric cardiac arrest, what is the correct dose and interval of epinephrine?
- Paediatric emergencies: defibrillation dose · ApplicationA child in cardiac arrest has ventricular fibrillation on the monitor. What energy is used for the first and second shocks?
- Paediatric emergencies: bradycardia management · Multi-stepA 6-month-old with bronchiolitis is limp with a heart rate of 50 per minute, poor perfusion and SpO2 of 70 percent. What is the first step?
- Paediatric emergencies: supraventricular tachycardia in infants · ApplicationA 2-month-old is irritable and pale with a regular narrow-complex tachycardia of 250 per minute but good perfusion. After vagal manoeuvres fail, what is the next drug?
- Paediatric emergencies: fluid bolus caution · Multi-stepA 3-year-old with severe febrile illness and no signs of shock or dehydration, with a capillary refill of 2 seconds, is being considered for a fluid bolus in a resource…
- Paediatric emergencies: dhatura poisoning · Multi-stepA child who ate seeds from a roadside plant is flushed, with dry skin, dilated pupils, hot body, delirium and urinary retention. Which toxidrome and antidote apply?
- Paediatric emergencies: button battery ingestion · Multi-stepA 2-year-old swallowed a coin-like button battery and an X-ray shows a double-contour disc at the level of the upper oesophagus. What is the required action?
- Paediatric emergencies: lead poisoning · Multi-stepA 3-year-old with pica, abdominal colic, constipation and anaemia has basophilic stippling on the smear and lead lines at the metaphyses. Blood lead level is 55 mcg/dL.…
- Paediatric emergencies: scorpion sting · Multi-stepA 5-year-old stung by a red scorpion has cold extremities, sweating, hypertension, tachycardia and pulmonary oedema with salivation. Which drug directly reverses the au…
- Paediatric emergencies: hypernatraemia correction · Multi-stepA 10-month-old with gastroenteritis has a serum sodium of 170 mEq/L and is rehydrated. What is the safe rate of lowering the sodium?
- Paediatric emergencies: hyperkalaemia management · Multi-stepA child with acute kidney injury has a serum potassium of 7.5 mEq/L with peaked T waves and wide QRS complexes. Which is the first drug to protect the heart?
- Paediatric emergencies: raised intracranial pressure · Multi-stepA child with severe head injury shows decerebrate posturing and a dilating pupil. Which therapy is appropriate to lower the intracranial pressure, and which fluid shoul…
- Paediatric emergencies: burns in children · ApplicationWhich chart is used to estimate the burn surface area in a child, and what is the first consideration when a toddler has immersion burns over the buttocks with clear de…
- Paediatric emergencies: brief resolved unexplained event · ApplicationA 3-week-old had an episode of colour change, hypotonia and apnoea lasting 30 seconds that resolved spontaneously, and is now normal on examination. What is the best ap…
- Paediatric emergencies: ETAT triage · ApplicationIn the emergency triage assessment and treatment approach, which child must receive immediate emergency treatment?
- Paediatric emergencies: shock in severe acute malnutrition · Multi-stepA severely malnourished 2-year-old is lethargic with cold hands, weak pulse and delayed capillary refill, but has no diarrhoea. What is the recommended fluid for shock?
- Paediatric emergencies: meningococcal septicaemia · Multi-stepA 5-year-old has fever, rapidly spreading purpuric rash, hypotension and cold peripheries. What are the immediate management and the prophylaxis for close contacts?
- Paediatric emergencies: acute liver failure in children · Multi-stepA 4-year-old with jaundice develops encephalopathy and INR of 3.0 not corrected by vitamin K. Which statement about the cause and management is correct?
- Paediatric emergencies: testicular torsion · Multi-stepA 14-year-old boy awakens with sudden severe left scrotal pain, nausea, a high-riding horizontal testis and absent cremasteric reflex. What is the correct management?
- Paediatric emergencies: methaemoglobinaemia · Multi-stepA 2-year-old develops cyanosis after drinking water from a well with high nitrate content. SpO2 is 85 percent and does not improve with oxygen, PaO2 is normal and blood…
- Paediatric emergencies: neurotoxic snake bite · ApplicationA 9-year-old who was sleeping on the floor wakes with severe abdominal pain, then develops ptosis and difficulty swallowing. There is no local swelling at a tiny bite m…
- Paediatric emergencies: salicylate poisoning · Multi-stepA 3-year-old ingested several tablets of her grandmother's aspirin. She has vomiting, tinnitus, fever and rapid deep breathing. Which blood gas pattern is typical?
- Paediatric emergencies: carbon monoxide poisoning · ApplicationA 6-year-old is rescued from a closed room where a charcoal stove burned overnight. She is drowsy with headache and vomiting, and a pulse oximeter reads 99 percent on r…
- Paediatric emergencies: haemotoxic snake bite · ApplicationA 7-year-old bitten on the foot 3 hours ago has marked local swelling, bleeding from the gums and oozing at the bite site. What is the most useful bedside test to guide…
- Paediatric emergencies: tension pneumothorax · ApplicationA 9-year-old after a road accident has severe respiratory distress, absent breath sounds on the right, hyperresonance, tracheal deviation to the left, distended neck ve…
- Paediatric emergencies: acute chest syndrome · Multi-stepA 7-year-old with sickle cell anaemia admitted with a painful crisis develops fever, cough, chest pain and SpO2 of 88 percent on day 2. The chest radiograph shows a new…
- Paediatric emergencies: exertional heat stroke · ApplicationA 16-year-old collapses during a cricket match in hot humid weather. Rectal temperature is 41.8 degrees C, the skin is hot and dry, and he is confused. Which is the mos…
- Paediatric emergencies: tricyclic antidepressant poisoning · Multi-stepA 2-year-old is brought drowsy after ingesting her grandmother's tablets. She has dilated pupils, dry mucosa, tachycardia, a sudden generalised seizure and an ECG with…
- Paediatric emergencies: hypertensive emergency · ApplicationA 9-year-old with acute glomerulonephritis has BP 165/115 mmHg, severe headache, vomiting and a generalised seizure. Which approach is recommended?
- Paediatric emergencies: paediatric cervical spine injury · ApplicationA 3-year-old is brought after a fall from a height. Why are cervical spine injuries at this age more often at upper levels than in adults?
- Paediatric emergencies: abusive head trauma · Multi-stepA 4-month-old is brought with irritability, vomiting and a seizure. The parents report no injury. The fontanelle bulges, CT shows an interhemispheric subdural haemorrha…
- Paediatric emergencies: cardiac tamponade · ApplicationA 6-year-old with a tuberculous pericardial effusion becomes restless with BP 70/50 mmHg, heart rate 160 per minute, muffled heart sounds, distended neck veins and puls…
- Paediatric emergencies: febrile neutropenia · ApplicationA 5-year-old on induction chemotherapy for acute lymphoblastic leukaemia has a temperature of 38.7 degrees C and an absolute neutrophil count of 200 per microlitre. She…
- Paediatric emergencies: acute severe asthma add-on therapy · ApplicationA 7-year-old with acute severe asthma has received three doses of nebulised salbutamol with ipratropium and oral prednisolone. He remains breathless with SpO2 91 percen…
- Paediatric emergencies: corrosive ingestion · ApplicationA 3-year-old swallowed a toilet cleaner 1 hour ago. She is drooling, refuses fluids and has hoarse cry with mild stridor. What is the correct initial management?
Cardiology33
- Cardiology: tet spell · ApplicationA 2-year-old with tetralogy of Fallot becomes deeply cyanosed, irritable and tachypnoeic during crying. What is the first step in management?
- Cardiology: ASD · ApplicationA 5-year-old has a systolic ejection murmur at the left upper sternal edge and a wide, fixed split of the second heart sound. What is the likely lesion?
- Cardiology: transposition of the great arteries · ApplicationA cyanosed term newborn has a single loud S2 and chest X-ray showing a narrow mediastinum with an egg-on-side silhouette and increased pulmonary vascularity. What drug…
- Cardiology: TAPVC · Multi-stepA cyanosed infant has chest X-ray showing a figure-of-eight or snowman heart. Which condition is suggested?
- Cardiology: coarctation of aorta · ApplicationA 10-year-old has hypertension in the arms, weak femoral pulses and rib notching on chest X-ray. Which sign on X-ray indicates the stenosis site?
- Cardiology: Eisenmenger syndrome · Multi-stepA young adult with a large unrepaired VSD develops cyanosis, clubbing and a loud P2, with the murmur disappearing. What has happened?
- Cardiology: acute rheumatic fever · ApplicationA 9-year-old with sore throat 3 weeks ago presents with migratory polyarthritis, fever, a new apical pansystolic murmur and raised ASO titre. Which category of Jones cr…
- Cardiology: rheumatic fever prophylaxis · ApplicationA child with rheumatic fever and carditis without residual valve disease needs secondary prophylaxis. Which regimen is preferred and for how long?
- Cardiology: Sydenham chorea · ApplicationA 10-year-old girl has involuntary purposeless movements, emotional lability and milk-maid grip. Which statement is correct?
- Cardiology: infective endocarditis · Multi-stepA child with a VSD has fever for 2 weeks, new murmur, splinter haemorrhages and Roth spots. What is the most common causative organism in this setting?
- Cardiology: hypoplastic left heart · Multi-stepA previously well newborn on day 3 develops cold peripheries, acidosis and shock with weak pulses as the ductus closes. Which condition is likely?
- Cardiology: Ebstein anomaly · Multi-stepA newborn has cyanosis and a massively enlarged right atrium on chest X-ray (box-shaped heart). Maternal use of which drug during pregnancy is associated?
- Cardiology: heart failure in infancy · ApplicationA 6-week-old with a large VSD has tachypnoea, poor feeding, sweating on feeds and hepatomegaly. What is the usual initial medical therapy?
- Cardiology · ApplicationWhat feature suggests coarctation of aorta?
- Cardiology · ApplicationWhat is a continuous machinery murmur typical of?
- Cardiology · ApplicationWhat causes cyanotic spells in TOF?
- Cardiology · ApplicationWhat is a sign of heart failure in infant?
- Cardiology · ApplicationWhat is a common sign of congenital heart disease in infancy?
- Cardiology · ApplicationWhat type of congenital heart lesion is a ventricular septal defect?
- Cardiology · ApplicationWhat can a central cyanotic congenital heart lesion cause?
- Cardiology · ApplicationWhat is a common feature of heart failure in an infant?
- Cardiology · ApplicationWhat sign can suggest congenital heart disease in an infant?
- Cardiology · ApplicationWhat type of lesion is a ventricular septal defect?
- Cardiology · ApplicationWhich finding is most concerning in an infant with possible congenital heart disease?
- Cardiology · ApplicationWhich illness pattern is characteristic of Kawasaki disease?
- Cardiology · ApplicationWhich sign is most suggestive of heart failure in a young infant?
- Cardiology · ApplicationWhat is the typical murmur timing of a ventricular septal defect?
- Cardiology: duct-dependent lesions · Multi-stepA newborn with critical coarctation becomes shocked and acidotic after the ductus arteriosus closes. Which infusion can maintain ductal patency while definitive care is…
- Cardiology: tetralogy of Fallot · ApplicationA cyanotic infant with tetralogy of Fallot becomes acutely more cyanosed and irritable during crying. Which position may help relieve a hypercyanotic spell?
- Cardiology: coarctation · ApplicationAn infant has poor feeding, shock after the first week of life, weak femoral pulses, and higher arm than leg blood pressure. What lesion is most likely?
- Cardiology: Kawasaki disease · Multi-stepA child has fever for six days, bilateral nonpurulent conjunctivitis, red cracked lips, polymorphous rash, cervical lymphadenopathy, and swollen hands. What diagnosis i…
- Cardiology: transposition of great arteries · Multi-stepA newborn has profound cyanosis shortly after birth with little response to oxygen. Which intervention may be lifesaving while definitive repair is arranged?
- Cardiology: ventricular septal defect · ApplicationA child has a harsh pansystolic murmur at the left lower sternal border and poor weight gain. What congenital lesion is most likely?
Neurology32
- Neurology · ApplicationA 2.5-year-old child has a generalised tonic-clonic seizure lasting about 3 minutes during a febrile illness. He recovers fully within minutes, and examination is norma…
- Neurology · ApplicationA 5-month-old boy with hypopigmented ash-leaf macules has clusters of brief flexor spasms on waking, with developmental regression. EEG shows chaotic high-voltage activ…
- Neurology: cerebral palsy · ApplicationA 2-year-old born at 28 weeks has stiff legs that cross in a scissoring pattern when held upright, with relatively normal arm function and normal intelligence. What is…
- Neurology: infantile spasms · ApplicationA 6-month-old has clusters of flexor spasms with developmental regression, and EEG shows chaotic high-voltage activity with multifocal spikes. What is the EEG pattern a…
- Neurology: absence epilepsy · ApplicationA 7-year-old has frequent staring spells of 10 seconds that are provoked by hyperventilation, with a 3 Hz spike-and-wave EEG. What is the drug of choice?
- Neurology: status epilepticus · ApplicationA 4-year-old has a generalised seizure continuing for 10 minutes. IV access is not yet available. Which is the best first-line drug?
- Neurology: Guillain-Barre syndrome · ApplicationA 6-year-old has ascending symmetrical weakness with areflexia 2 weeks after a diarrhoeal illness. CSF shows protein of 150 mg/dl with 2 cells per microlitre. What is t…
- Neurology: Duchenne muscular dystrophy · ApplicationA 5-year-old boy uses his hands to climb up his thighs to stand, has calf pseudohypertrophy and a CK of 20,000 IU/L. What is the finding called and the likely deficiency?
- Neurology: spinal muscular atrophy · ApplicationA floppy 4-month-old with tongue fasciculations, absent deep reflexes and a bell-shaped chest remains alert and smiling. Which gene is deleted?
- Neurology: Rett syndrome · ApplicationA girl develops normally until 12 months, then loses purposeful hand use with hand-wringing movements, deceleration of head growth and seizures. Which gene is involved?
- Neurology: ADHD · ApplicationA 9-year-old has inattention, hyperactivity and impulsivity in school and at home for more than 1 year. After behavioural measures, which drug is first-line?
- Neurology: benign rolandic epilepsy · ApplicationA 8-year-old has nocturnal seizures with facial twitching, drooling and speech arrest. EEG shows centrotemporal spikes. What is the prognosis?
- Neurology: neonatal hydrocephalus · ApplicationA 3-month-old has rapidly increasing head circumference, bulging fontanelle and sunset sign. What is the most common definitive treatment?
- Neurology: Lennox-Gastaut syndrome · Multi-stepA 4-year-old has multiple seizure types including tonic and atonic drops, intellectual disability and EEG showing slow spike-and-wave of 1.5 to 2.5 Hz. Which is the dia…
- Neurology: cerebral palsy types · ApplicationA preterm child has stiff legs, scissoring gait and toe walking with normal upper limb function and intellect. Which lesion and type are most likely?
- Neurology · ApplicationWhat is a common cause of cerebral palsy?
- Neurology · ApplicationWhat is a key sign of raised intracranial pressure in infant?
- Neurology · ApplicationWhat is initial priority in active seizure?
- Neurology · ApplicationWhat is a red flag headache feature?
- Neurology · ApplicationWhat is febrile seizure usually associated with?
- Neurology · ApplicationWhat is a priority during a prolonged seizure?
- Neurology · ApplicationWhat feature favors absence seizures?
- Neurology · ApplicationWhich febrile seizure feature is atypical and requires further evaluation?
- Neurology · ApplicationWhich finding may suggest raised intracranial pressure in an infant?
- Neurology: febrile seizure · ApplicationA previously healthy 18-month-old has a generalized convulsion lasting three minutes during a febrile viral illness and returns rapidly to baseline, with no focal defic…
- Neurology: bacterial meningitis · Multi-stepA child has fever, headache, neck stiffness, photophobia, and a rapidly spreading purpuric rash. What is the appropriate principle of management?
- Neurology: Duchenne muscular dystrophy · ApplicationA boy has delayed walking, frequent falls, calf pseudohypertrophy, and uses hands to rise from the floor. What diagnosis is most likely?
- Neurology: absence seizures · ApplicationA school-aged child has frequent brief staring spells with eyelid flutter, no postictal confusion, and 3-Hz generalized spike-wave activity. What is most likely?
- Neurology: muscular weakness · ApplicationAn infant has hypotonia, tongue fasciculations, absent reflexes, and paradoxical breathing. Which diagnosis is most likely?
- Neurology: cerebral palsy · ApplicationA child born prematurely has scissoring gait, increased leg tone, brisk reflexes, and delayed gross motor milestones. What subtype is most likely?
- Neurology: meningococcal sepsis · Multi-stepA febrile child has rapidly spreading nonblanching purpura, cold peripheries, prolonged capillary refill, and reduced consciousness. What is the immediate priority?
- Neurology: hydrocephalus · ApplicationAn infant has rapidly increasing head circumference, bulging fontanelle, sunset eyes, and vomiting. What condition should be suspected?
Infections30
- Infections: cholera · ApplicationA child of 5 years from an outbreak area has profuse rice-water stools and severe dehydration. After rehydration, which antibiotic is a recommended option?
- Infections: measles treatment · ApplicationA 2-year-old with measles is being treated. Which supplementation reduces complications and mortality?
- Infections: congenital rubella · ApplicationA newborn has cataract, patent ductus arteriosus and sensorineural deafness. The mother had a rash in the first trimester. What is the most likely diagnosis?
- Infections: varicella complications · ApplicationWhich drug should be avoided in a child with chickenpox because of the risk of Reye syndrome?
- Infections: diphtheria · ApplicationA 5-year-old unimmunised child has sore throat, low-grade fever, bull neck and a grey adherent membrane on the tonsils that bleeds on removal. What is the most importan…
- Infections: pertussis · ApplicationA 3-month-old has paroxysms of cough ending in a whoop and post-tussive vomiting. The white cell count shows marked lymphocytosis. Which drug is preferred?
- Infections: TB regimen · ApplicationWhat is the standard regimen for drug-sensitive pulmonary tuberculosis in a child under current Indian guidelines?
- Infections: TB diagnosis · ApplicationIn a young child with suspected pulmonary TB who cannot expectorate, which sample is appropriate for CBNAAT?
- Infections: TB preventive therapy · ApplicationA 3-year-old asymptomatic child is a household contact of a sputum smear-positive father. What is the recommended management?
- Infections: TB meningitis · Multi-stepA child with tuberculous meningitis has a CSF with raised lymphocytes, high protein, low glucose and hydrocephalus. Which adjunct improves outcome?
- Infections: dengue warning signs · ApplicationOn day 5 of fever, a child with dengue develops persistent vomiting, abdominal pain and rising haematocrit with falling platelets. How is this classified?
- Infections: dengue shock · Multi-stepA child with dengue is in shock with cold extremities, narrow pulse pressure and rising haematocrit. What is the initial fluid?
- Infections: severe malaria · ApplicationA child with falciparum malaria has cerebral involvement and cannot take oral drugs. What is the preferred drug?
- Infections: typhoid · ApplicationA 6-year-old has 8 days of step-ladder fever, relative bradycardia and coated tongue. Blood culture is positive for Salmonella Typhi. What is a recommended drug for unc…
- Infections: Kawasaki disease · ApplicationA 3-year-old has 6 days of fever, bilateral non-purulent conjunctivitis, cracked red lips, cervical lymphadenopathy and swelling of the hands. What is the treatment of…
- Infections: parvovirus B19 · ApplicationA child with sickle cell disease develops sudden pallor with Hb 3 g/dl and a very low reticulocyte count after a febrile illness with slapped cheek rash in a sibling. W…
- Infections: infectious mononucleosis · ApplicationA teenager with fever, exudative tonsillitis, posterior cervical lymphadenopathy and splenomegaly develops a rash after amoxicillin. Which test is the first-line bedsid…
- Infections: paediatric HIV diagnosis · ApplicationAn HIV-exposed infant is 6 weeks old. Which test confirms or excludes infection at this age?
- Infections: HIV prophylaxis · ApplicationWhich prophylaxis is recommended for an HIV-exposed infant from 6 weeks of age until infection is excluded?
- Infections: congenital CMV · ApplicationA newborn has microcephaly, jaundice, hepatosplenomegaly, petechiae and periventricular calcifications on cranial ultrasound. Which is the most likely infection?
- Infections: congenital toxoplasmosis · ApplicationA newborn has hydrocephalus, chorioretinitis and diffuse intracranial calcifications. The mother had contact with cats. What is the diagnosis?
- Infections: congenital syphilis · ApplicationAn 8-year-old with untreated congenital syphilis has peg-shaped notched upper incisors, interstitial keratitis and eighth nerve deafness. What is this triad called?
- Infections: meningitis steroids · ApplicationIn a child older than 6 weeks with suspected bacterial meningitis, dexamethasone is best given at which time?
- Infections: neonatal meningitis organisms · ApplicationWhich pair of organisms commonly cause early neonatal meningitis?
- Infections: epiglottitis · ApplicationA toxic-looking unimmunised 4-year-old sits leaning forward, drooling, with muffled voice and stridor. A lateral neck X-ray shows a thumb sign. What is the priority?
- Infections: AFP surveillance · ApplicationIn AFP surveillance for poliomyelitis, how many stool specimens should be collected, and within how many days of onset?
- Infections: rabies prophylaxis · ApplicationA 5-year-old has a deep bite on the face from a stray dog with bleeding. Which management is most appropriate?
- Infections: neonatal sepsis empirical · Multi-stepWhich statement about empirical therapy of late-onset neonatal sepsis in a hospital setting is most appropriate?
- Infections · ApplicationWhich infection causes parotid swelling?
- Infections · ApplicationWhich feature suggests measles?
Nutrition28
- Nutrition · ApplicationWhich feature most clearly distinguishes kwashiorkor from marasmus?
- Nutrition · ApplicationA 14-month-old exclusively breastfed child, rarely exposed to sunlight, has delayed walking, widened wrists, a rachitic rosary and Harrison sulcus. Alkaline phosphatase…
- Nutrition · ApplicationA 10-month-old fed only boiled cow's milk is irritable, refuses to move the legs, and has swollen bleeding gums and subperiosteal haemorrhages. Radiograph shows a groun…
- Nutrition: human versus cow milk · ApplicationWhich statement correctly compares human milk with undiluted cow's milk?
- Nutrition: vitamin D treatment · ApplicationAn 18-month-old with nutritional rickets has a normal calcium, low phosphate and high alkaline phosphatase. Which regimen is commonly used for treatment?
- Nutrition: vitamin A deficiency · ApplicationA child with night blindness shows foamy, triangular conjunctival patches. What is the treatment dose of vitamin A for a child older than 12 months?
- Nutrition: scurvy · ApplicationA 9-month-old on boiled cow's milk is irritable, lies with legs held in frog position, and has swollen bleeding gums. X-ray shows a ground-glass bone with a white line…
- Nutrition: iron deficiency · ApplicationA 14-month-old on exclusive milk feeds is pale with Hb 7 g/dl, microcytic hypochromic indices and a high red cell distribution width. Which parameter falls earliest in…
- Nutrition: acrodermatitis enteropathica · ApplicationAn infant weaned from breast milk develops perioral and perianal vesiculobullous dermatitis, alopecia and diarrhoea. Which supplement is the specific treatment?
- Nutrition: X-linked hypophosphataemic rickets · Multi-stepA 2-year-old boy has bowed legs, normal calcium, very low phosphate, high alkaline phosphatase and normal PTH. There is no response to usual vitamin D doses. What is th…
- Nutrition: SAM antibiotics · ApplicationWhich statement about routine antibiotics in SAM without complications is correct under the national guidelines?
- Nutrition: refeeding in recovery · Multi-stepA child with SAM during rehabilitation is on F-100 and gains 12 g/kg/day. Which criterion allows discharge from a nutrition rehabilitation centre?
- Nutrition · ApplicationWhich deficiency causes rickets?
- Nutrition · ApplicationExclusive breastfeeding is recommended initially for what reason?
- Nutrition · ApplicationWhat clinical sign is classically associated with kwashiorkor?
- Nutrition · ApplicationWhat feature is typical of marasmus?
- Nutrition · ApplicationWhat is the recommended main food source for infants during early months when possible?
- Nutrition · ApplicationWhat deficiency can cause rickets in children?
- Nutrition · ApplicationWhat physical sign may suggest vitamin A deficiency?
- Nutrition · ApplicationWhat is the preferred rehydration method for mild-to-moderate dehydration from diarrhea?
- Nutrition · ApplicationWhy is zinc often recommended in childhood diarrheal illness in many settings?
- Nutrition · ApplicationWhat symptom can indicate iron deficiency in a child?
- Nutrition · ApplicationWhat is a consequence of chronic childhood undernutrition?
- Nutrition · ApplicationWhat sign is classically associated with kwashiorkor?
- Nutrition · ApplicationWhich vitamin deficiency can cause angular cheilitis and glossitis in a child?
- Nutrition · ApplicationWhy is exclusive breastfeeding recommended for approximately the first six months when possible?
- Nutrition: rickets · ApplicationA toddler has delayed walking, bowed legs, widened wrists, and low vitamin D level. What diagnosis is most likely?
- Nutrition: iron deficiency · ApplicationWhich laboratory profile is most typical of iron-deficiency anemia in a child?
Nutrition and malnutrition27
- Nutrition and malnutrition: contraindications to breastfeeding · ApplicationIn which situation is breastfeeding contraindicated?
- Nutrition and malnutrition: therapeutic formulas for allergy · ApplicationA 2-month-old fed on cow's milk formula has bloody stools, vomiting and eczema. Which formula is appropriate?
- Nutrition and malnutrition: ten steps of SAM management · Multi-stepIn the WHO ten-step plan for a hospitalised child with severe acute malnutrition, which is the correct early order of priorities?
- Nutrition and malnutrition: refeeding syndrome · Multi-stepOn day 4 of aggressive nutritional rehabilitation, a severely malnourished child develops weakness, respiratory failure and arrhythmia. Which biochemical abnormality is…
- Nutrition and malnutrition: rickets biochemistry and imaging · Multi-stepIn active nutritional rickets, which biochemical pattern and radiographic finding are expected?
- Nutrition and malnutrition: vitamin K deficiency bleeding · ApplicationAn exclusively breastfed 6-week-old who did not receive vitamin K at birth presents with sudden intracranial haemorrhage. Which category of vitamin K deficiency bleedin…
- Nutrition and malnutrition: iodine deficiency disorders · ApplicationA child born in a goitre-endemic area has a short stature, coarse features, umbilical hernia, deaf-mutism and intellectual disability. Which condition does this represe…
- Nutrition and malnutrition: childhood obesity definition · ApplicationA 9-year-old girl has a BMI above the 95th percentile for her age and sex. How is this categorised?
- Nutrition and malnutrition: pellagra and beriberi · ApplicationA child on a maize-based diet has photosensitive dermatitis, diarrhoea and irritability. Which vitamin deficiency is responsible, and which is the deficiency in infanti…
- Nutrition and malnutrition: hypervitaminosis A · Multi-stepA toddler given a large vitamin A overdose over several weeks develops vomiting, bulging fontanelle, hair loss and painful bony swellings. What is the likely mechanism…
- Nutrition and malnutrition: cow's milk protein allergy proctocolitis · Multi-stepA well-appearing, thriving 6-week-old exclusively breastfed infant passes small streaks of blood and mucus in stools. Examination is normal. What is the best initial ma…
- Nutrition and malnutrition: lactose intolerance · ApplicationAn infant has persistent watery acidic stools with perianal excoriation after an episode of gastroenteritis. The stool pH is 5 and reducing substances are positive. Wha…
- Nutrition and malnutrition: stabilisation phase · ApplicationDuring the stabilisation phase of severe acute malnutrition, iron is withheld. What is the reason?
- Nutrition and malnutrition: hypophosphataemic rickets · Multi-stepA toddler with bowed legs and wrist widening has low phosphate, normal calcium, normal PTH and a raised ALP. He does not respond to routine vitamin D. What is the defect?
- Nutrition and malnutrition: moderate acute malnutrition · ApplicationA 14-month-old attends an anganwadi. She is alert and eats well, has no oedema, a mid-upper arm circumference of 12 cm and weight-for-height between -2 and -3 SD. What…
- Nutrition and malnutrition: vitamin B12 deficiency · Multi-stepA 9-month-old exclusively breastfed infant of a strictly vegan mother is pale, irritable and has lost previously gained skills, with tremors, a hypersegmented neutrophi…
- Nutrition and malnutrition: hypophosphatasia · Multi-stepAn infant has rachitic-looking metaphyses, poor feeding and hypercalcaemia. Serum alkaline phosphatase is markedly low, and urine phosphoethanolamine is raised. Which g…
- Nutrition and malnutrition: hereditary vitamin D-resistant rickets · Multi-stepA 14-month-old has severe rickets and total scalp alopecia. Calcium and phosphate are low, PTH and alkaline phosphatase are high, and 1,25-dihydroxyvitamin D is markedl…
- Nutrition and malnutrition: milk ejection reflex · ApplicationA breastfeeding mother notices milk dripping from the opposite breast when her baby cries or latches. Which hormone triggers this reflex?
- Nutrition and malnutrition: vitamin E deficiency in preterms · ApplicationA 6-week-old preterm baby on a formula rich in polyunsaturated fatty acids and iron has pallor and mild oedema. The blood count shows haemolytic anaemia with thrombocyt…
- Nutrition and malnutrition: riboflavin deficiency · ApplicationA malnourished child has cracks at the corners of the mouth, a red magenta-coloured tongue, photophobia and corneal vascularisation. Which deficiency is responsible?
- Nutrition and malnutrition: assessing vitamin D status · ApplicationAn infant given large repeated doses of vitamin D has vomiting, constipation, polyuria and a high serum calcium. Which test best reflects the vitamin D status?
- Nutrition and malnutrition: goat's milk and megaloblastic anaemia · ApplicationA 10-month-old fed only goat's milk is pale. The blood count shows macrocytic anaemia with hypersegmented neutrophils and megaloblastic marrow. Which nutrient is defici…
- Nutrition and malnutrition: essential fatty acid deficiency · ApplicationAn infant on long-term fat-free parenteral nutrition develops scaly dermatitis, sparse hair, thrombocytopenia and poor growth. Deficiency of which nutrient is likely?
- Nutrition and malnutrition: exogenous versus endocrine obesity · Multi-stepA 9-year-old with a BMI above the 97th centile is taller than most peers, with an advanced bone age, normal blood pressure and no striae. What is the most likely cause?
- Nutrition and malnutrition: hypocalcaemic seizure in rickets · ApplicationA 4-month-old with florid rickets has a generalised seizure. Serum calcium is 6.2 mg/dL. What is the immediate treatment?
- Nutrition and malnutrition: raw egg white and biotin · ApplicationA toddler who for months has eaten large amounts of raw egg white develops scaly periorificial dermatitis, alopecia and hypotonia. Which deficiency explains this?
Genetics22
- Genetics · ApplicationWhich congenital heart defect is most common in Down syndrome?
- Genetics · ApplicationA 7-year-old boy has intellectual disability, a long face, large ears, a prominent jaw and large testes. His maternal uncle has a similar problem. The underlying geneti…
- Genetics · ApplicationA tall adolescent boy with long limbs, small firm testes, sparse body hair and gynaecomastia is being evaluated. What is the most likely karyotype?
- Genetics · ApplicationA toddler has severe hypotonia and feeding difficulty in infancy, and now has hyperphagia, obesity, hypogonadism, short stature and almond-shaped eyes. What is the unde…
- Genetics: sex chromosome disorders · ApplicationA 14-year-old girl is short, has a webbed neck, a broad chest with widely spaced nipples, no breast development and primary amenorrhoea. Which cardiac lesion is associa…
- Genetics: Down syndrome translocation · Multi-stepA phenotypically normal mother carries a 14;21 Robertsonian translocation. What is the approximate risk of Down syndrome in her offspring?
- Genetics: Edwards syndrome · ApplicationA newborn has low birth weight, prominent occiput, clenched fists with overlapping index finger, rocker-bottom feet and VSD. What is the diagnosis?
- Genetics: Patau syndrome · ApplicationA newborn has cleft lip and palate, microphthalmia, scalp defects, postaxial polydactyly and holoprosencephaly. What is the likely karyotype?
- Genetics: fragile X · ApplicationA boy has intellectual disability, long face, large ears and macro-orchidism after puberty. Which genetic abnormality is responsible?
- Genetics: Prader-Willi syndrome · ApplicationA floppy infant with poor feeding grows into a child with hyperphagia, obesity, hypogonadism and mild intellectual disability. What is the mechanism?
- Genetics: Angelman syndrome · ApplicationA child has severe developmental delay, absent speech, ataxic gait, seizures and frequent inappropriate laughter. Which gene is involved?
- Genetics: Williams syndrome · ApplicationA child has elfin facies, outgoing personality, hypercalcaemia and supravalvular aortic stenosis. Which defect is responsible?
- Genetics: DiGeorge syndrome · ApplicationA neonate has hypocalcaemic seizures, an interrupted aortic arch, cleft palate and absent thymic shadow. What is the genetic cause?
- Genetics: neurofibromatosis 1 · ApplicationA 7-year-old has six cafe-au-lait spots larger than 5 mm, axillary freckling and Lisch nodules. What is the mode of inheritance and gene?
- Genetics: tuberous sclerosis · ApplicationA 6-month-old has infantile spasms, hypopigmented ash-leaf macules and cardiac rhabdomyomas. Which drug is the first-line treatment for the spasms in this condition?
- Genetics: Sturge-Weber syndrome · ApplicationA newborn has a unilateral port-wine stain on the forehead, seizures and glaucoma. What does neuroimaging typically show?
- Genetics: Beckwith-Wiedemann syndrome · Multi-stepA neonate has macroglossia, omphalocele, hemihypertrophy and hypoglycaemia. To which tumour is the child predisposed, requiring ultrasound surveillance?
- Genetics: Noonan syndrome · Multi-stepA boy has short stature, webbed neck, pectus excavatum, ptosis and pulmonary valve stenosis, with normal karyotype. Which gene is most often mutated?
- Genetics: Marfan syndrome · ApplicationA tall adolescent with arachnodactyly, upward lens dislocation and mitral valve prolapse has a family history of aortic dissection. What is the defective protein?
- Genetics: cystic fibrosis diagnosis · ApplicationA 1-year-old with recurrent chest infections, steatorrhoea and failure to thrive is suspected to have cystic fibrosis. Which test is the standard diagnostic?
- Genetics: Duchenne inheritance · ApplicationA woman has a brother and a son with Duchenne muscular dystrophy. What is the risk for her next male child?
- Genetics: mitochondrial inheritance · Multi-stepA family shows a disease transmitted from affected mothers to all of their children but never from affected fathers. Which pattern is this?
Endocrinology19
- Endocrinology: precocious puberty · ApplicationA 6-year-old girl develops breast enlargement and pubic hair with advanced bone age. Which statement defines this condition?
- Endocrinology: congenital adrenal hyperplasia · ApplicationA 10-day-old boy has vomiting, dehydration, hyponatraemia and hyperkalaemia. 17-hydroxyprogesterone is markedly elevated. What is the diagnosis?
- Endocrinology: CAH in a girl · ApplicationA newborn with 46,XX karyotype has clitoral enlargement and fused labioscrotal folds. Which is the likely cause?
- Endocrinology: DKA fluids · ApplicationA child in DKA with moderate dehydration and normal perfusion needs fluid resuscitation. What is the recommended approach?
- Endocrinology: DKA cerebral oedema · Multi-stepOn the fourth hour of DKA treatment a child develops headache, bradycardia, rising blood pressure and altered consciousness. What is the first treatment?
- Endocrinology: growth hormone deficiency · ApplicationA 6-year-old has short stature with a height velocity of 3 cm per year, delayed bone age and doll-like facies. A growth hormone stimulation test shows a peak GH of 4 ng…
- Endocrinology: neonatal hyperinsulinism · Multi-stepA macrosomic neonate has recurrent glucose levels below 30 mg/dl requiring glucose infusion above 12 mg/kg/min with low ketones and fatty acids. Which drug may be tried?
- Endocrinology: McCune-Albright syndrome · Multi-stepA 4-year-old girl has vaginal bleeding, large irregular cafe-au-lait macules and polyostotic fibrous dysplasia. What is the underlying defect?
- Endocrinology: pseudohypoparathyroidism · Multi-stepA child with short stature, round face, short fourth metacarpals, hypocalcaemia and raised PTH has end-organ resistance. What is the diagnosis?
- Endocrinology: Graves disease in a child · ApplicationA 12-year-old has weight loss, tremor, goitre and exophthalmos with suppressed TSH and high free T4. What is the first-line therapy?
- Endocrinology · ApplicationWhat is a concerning presentation of new-onset type 1 diabetes in a child?
- Endocrinology · ApplicationWhat presentation can suggest diabetic ketoacidosis in a child?
- Endocrinology · ApplicationWhich finding suggests diabetic ketoacidosis in a child with new diabetes?
- Endocrinology · ApplicationWhat is a key symptom of new-onset type 1 diabetes in a child?
- Endocrinology · ApplicationWhich feature should raise suspicion for diabetic ketoacidosis in a child with diabetes symptoms?
- Endocrinology: diabetic ketoacidosis · Multi-stepA child with new type 1 diabetes has polyuria, weight loss, vomiting, Kussmaul respirations, and ketonemia. Which complication must be monitored particularly closely du…
- Endocrinology: congenital hypothyroidism · ApplicationWhy is newborn screening for congenital hypothyroidism important?
- Endocrinology: type 1 diabetes · ApplicationA child has polyuria, polydipsia, weight loss, and high glucose with positive pancreatic autoantibodies. What is the diagnosis?
- Endocrinology: precocious puberty · ApplicationA girl develops breast development and pubic hair at age 6. What is the appropriate principle?
Gastroenterology19
- Gastroenterology: coeliac disease · ApplicationA 2-year-old has chronic diarrhoea, abdominal distension, failure to thrive and irritability after the introduction of wheat. Which is the best initial serological test?
- Gastroenterology: Meckel diverticulum · ApplicationA 2-year-old has painless, large-volume rectal bleeding. Which investigation is most useful?
- Gastroenterology: malrotation · ApplicationA 5-day-old develops sudden bilious vomiting. Upper GI contrast shows the duodenojejunal flexure on the right side with a corkscrew pattern. What is the urgent treatment?
- Gastroenterology: abdominal wall defects · ApplicationA newborn has a defect of the abdominal wall to the right of an intact umbilical cord with loops of bowel exposed without a covering sac. What is it?
- Gastroenterology · ApplicationWhat is a key danger of persistent vomiting in an infant?
- Gastroenterology · ApplicationWhat sign may indicate severe dehydration?
- Gastroenterology · ApplicationWhat condition is suggested by intermittent severe colicky pain and red currant jelly stool?
- Gastroenterology · ApplicationWhat is an important emergency concern in suspected intussusception?
- Gastroenterology · ApplicationWhat is the key treatment for most childhood acute gastroenteritis with mild dehydration?
- Gastroenterology · ApplicationWhich finding suggests severe dehydration in a child?
- Gastroenterology: intussusception · ApplicationAn infant has intermittent severe crying, vomiting, lethargy between episodes, and red currant-jelly stool. What is the most likely diagnosis?
- Gastroenterology: pyloric stenosis · ApplicationA 5-week-old has progressive nonbilious projectile vomiting after feeds, remains hungry, and has a palpable epigastric olive. Which electrolyte disturbance is expected?
- Gastroenterology: dehydration · ApplicationWhich finding most strongly suggests severe dehydration in a child with acute diarrhea?
- Gastroenterology: celiac disease · ApplicationA child has chronic diarrhea, abdominal distension, poor growth, iron-deficiency anemia, and dermatitis herpetiformis. What disease is likely?
- Gastroenterology: Hirschsprung disease · ApplicationA newborn fails to pass meconium in the first 48 hours and later has abdominal distension with explosive stool after rectal examination. What is most likely?
- Gastroenterology: biliary atresia · Multi-stepA 5-week-old has persistent jaundice, pale stools, dark urine, hepatomegaly, and elevated conjugated bilirubin. What diagnosis requires urgent referral?
- Gastroenterology: cow's-milk protein allergy · ApplicationA young infant has blood-streaked stools, eczema, vomiting, and otherwise normal growth after cow's-milk formula. What diagnosis should be considered?
- Gastroenterology: intussusception · ApplicationWhich imaging and treatment option can reduce uncomplicated ileocolic intussusception in a stable child?
- Gastroenterology: functional constipation · ApplicationA toddler with painful hard stools begins withholding stool, has large infrequent bowel movements, and is otherwise thriving with normal examination. What is most likely?
Nephrology19
- Nephrology · ApplicationA 4-year-old boy has puffy eyelids, heavy proteinuria, low serum albumin, normal blood pressure and no haematuria. What is the first-line treatment?
- Nephrology · ApplicationA 7-year-old has cola-coloured urine, periorbital oedema and hypertension two weeks after a sore throat. Which serological finding is expected?
- Nephrology · Multi-stepA male newborn has a poor urinary stream, a palpable bladder and bilateral hydronephrosis on antenatal scan, and has had oligohydramnios. After stabilisation, which inv…
- Nephrology: nephrotic complications · ApplicationA child with nephrotic syndrome develops fever, abdominal pain and tenderness. Which complication is most likely and which organism is the commonest cause?
- Nephrology: haemolytic uraemic syndrome · ApplicationA 3-year-old with bloody diarrhoea 5 days ago develops pallor, oliguria, anaemia with fragmented red cells and thrombocytopenia. Which organism is the usual cause?
- Nephrology: UTI imaging · ApplicationAfter a first febrile UTI in a 6-month-old infant, which investigation identifies vesicoureteric reflux?
- Nephrology: posterior urethral valves · ApplicationA newborn boy has a poor urinary stream, a palpable bladder and bilateral hydronephrosis. MCU shows a dilated posterior urethra. What is the diagnosis?
- Nephrology: distal RTA · Multi-stepA child with failure to thrive has normal anion gap metabolic acidosis, hypokalaemia, urine pH of 6.5 and nephrocalcinosis. Which condition is likely?
- Nephrology · ApplicationWhat is a classic feature of nephrotic syndrome in children?
- Nephrology · ApplicationWhat urine finding is typical in poststreptococcal glomerulonephritis?
- Nephrology · ApplicationWhat is a hallmark of nephritic syndrome?
- Nephrology · ApplicationWhat should be monitored in a child with significant diarrhea?
- Nephrology · ApplicationWhat is a classic feature of nephrotic syndrome?
- Nephrology · ApplicationWhat urine finding is typical of poststreptococcal glomerulonephritis?
- Nephrology · ApplicationWhich finding is typical of childhood nephrotic syndrome?
- Nephrology: nephrotic syndrome · ApplicationA child presents with periorbital edema, ascites, heavy proteinuria, hypoalbuminemia, and hyperlipidemia. What is the most likely syndrome?
- Nephrology: poststreptococcal glomerulonephritis · ApplicationTwo weeks after impetigo, a child develops cola-colored urine, edema, hypertension, and reduced complement C3. What is the most likely diagnosis?
- Nephrology: urinary tract infection · ApplicationA febrile infant without an obvious source has poor feeding and vomiting. Why should urine testing be considered?
- Nephrology: vesicoureteric reflux · ApplicationWhy does vesicoureteric reflux matter in children with recurrent febrile urinary tract infections?
Respiratory17
- Respiratory: foreign body aspiration · ApplicationA 2-year-old suddenly begins coughing and wheezing while eating peanuts. A chest X-ray in expiration shows hyperinflation of the right lung with mediastinal shift to th…
- Respiratory: asthma step-up · ApplicationA 7-year-old with persistent asthma has daytime symptoms 3 times a week while using low-dose inhaled budesonide. What is the best next step?
- Respiratory: acute severe asthma · ApplicationA child with acute severe asthma has SpO2 of 90 percent, speaks in single words and has poor response to the first nebulisation. Which combination is appropriate?
- Respiratory · ApplicationWhat causes wheeze in bronchiolitis?
- Respiratory · ApplicationWhat symptom suggests severe croup?
- Respiratory · ApplicationWhat is a key asthma trigger?
- Respiratory · ApplicationWhat sign indicates respiratory distress in infant?
- Respiratory · ApplicationWhat is a concern in bronchiolitis?
- Respiratory · ApplicationWhat is a common controller treatment for persistent asthma?
- Respiratory: bronchiolitis · ApplicationA 6-month-old has coryza followed by wheeze, crackles, increased work of breathing, and poor feeding in winter. What is the most likely diagnosis?
- Respiratory: croup · ApplicationA toddler has a barking cough, hoarse voice, and inspiratory stridor that worsens at night. What is the most likely diagnosis?
- Respiratory: epiglottitis · Multi-stepA febrile child is drooling, sitting forward, has muffled voice, and inspiratory distress. What is the safest immediate principle?
- Respiratory: asthma · ApplicationA child has recurrent episodes of wheeze, cough worse at night, reversible airflow limitation, and symptom-free intervals. What is most likely?
- Respiratory: foreign body aspiration · ApplicationA toddler suddenly coughs while eating peanuts and later has unilateral reduced breath sounds and localized wheeze. What is most likely?
- Respiratory: cystic fibrosis · ApplicationAn infant has recurrent chest infections, steatorrhea, poor weight gain, and elevated sweat chloride. What diagnosis is most likely?
- Respiratory: primary ciliary dyskinesia · ApplicationA child has chronic wet cough, recurrent sinusitis, otitis media, and situs inversus. What diagnosis is most likely?
- Respiratory: pertussis · ApplicationAn unimmunized infant has paroxysmal cough followed by inspiratory whoop and posttussive vomiting. What infection is likely?
Hematology14
- Hematology · ApplicationWhat causes painful vaso-occlusive crisis?
- Hematology · ApplicationWhat finding is typical in ITP?
- Hematology · ApplicationWhat can trigger sickle crisis?
- Hematology · ApplicationWhat is a common presentation of iron deficiency anemia in a child?
- Hematology · ApplicationWhat is a common sign of sickle cell vaso-occlusive crisis?
- Hematology · ApplicationWhat test helps evaluate anemia in a child?
- Hematology · ApplicationWhat presentation is common in iron deficiency anemia?
- Hematology · ApplicationWhich dietary history commonly contributes to iron deficiency in toddlers?
- Hematology: acute lymphoblastic leukemia · ApplicationA child has pallor, bruising, bone pain, lymphadenopathy, hepatosplenomegaly, and pancytopenia. What diagnosis should be urgently considered?
- Hematology: hemolytic uremic syndrome · Multi-stepA child develops pallor, oliguria, thrombocytopenia, and schistocytes several days after bloody diarrhea. What is the most likely diagnosis?
- Hematology: sickle cell disease · Multi-stepA child with sickle cell disease has fever, chest pain, cough, hypoxia, and a new pulmonary infiltrate. What is the diagnosis?
- Hematology: hemophilia · ApplicationA boy has recurrent painful swollen knees after minor trauma, prolonged aPTT, and normal platelet count. Which condition is most likely?
- Hematology: immune thrombocytopenia · ApplicationA child after a viral illness has petechiae and bruising, platelet count 12 x 10^9/L, but normal hemoglobin, white count, and examination. What is most likely?
- Hematology: transfusion reactions · Multi-stepDuring red-cell transfusion, a child develops fever, flank pain, hypotension, and dark urine. What is the immediate action?
Haematology13
- Haematology · Multi-stepA 9-month-old child of Mediterranean descent has progressive pallor since 5 months of age, hepatosplenomegaly and frontal bossing. Haemoglobin is low with microcytic hy…
- Haematology · ApplicationA 2-year-old with severe anaemia needing regular transfusions since infancy has frontal bossing and hepatosplenomegaly. A skull radiograph shows a hair-on-end appearanc…
- Haematology: ITP · ApplicationA 4-year-old well child has widespread petechiae and bruising for 3 days after a viral illness. Haemoglobin and white cell count are normal, the platelet count is 18 ×…
- Haematology: thalassaemia major · ApplicationA 1-year-old has severe pallor, hepatosplenomegaly and frontal bossing, with Hb 5 g/dl, microcytic hypochromic indices and HbF raised on electrophoresis. What is the ma…
- Haematology: sickle cell disease · ApplicationA 3-year-old with sickle cell disease has fever of 39.5 degrees C. Why is this an emergency?
- Haematology: haemophilia A · ApplicationA 2-year-old boy has haemarthrosis of the knee after minor trauma. aPTT is prolonged with normal PT and platelet count, and factor VIII is low. What is the treatment du…
- Haematology: sickle cell disease therapy · ApplicationA 6-year-old with sickle cell anaemia has had three painful vaso-occlusive crises this year. Which drug reduces the frequency of crises by raising fetal haemoglobin?
- Haematology: von Willebrand disease · ApplicationA teenage girl has menorrhagia and epistaxis. Investigations show prolonged bleeding time, normal platelet count, prolonged aPTT and reduced ristocetin-induced aggregat…
- Haematology: hereditary spherocytosis · ApplicationA child has chronic haemolysis, splenomegaly, spherocytes on smear and increased osmotic fragility. A defect in which protein is commonly involved?
- Haematology: G6PD deficiency · ApplicationA 3-year-old develops dark urine and jaundice 2 days after eating fava beans. Which smear finding is characteristic?
- Haematology: Diamond-Blackfan anaemia · Multi-stepA 3-month-old has severe macrocytic anaemia with reticulocytopenia and isolated absence of red cell precursors in the marrow with normal white cells and platelets. What…
- Haematology: Fanconi anaemia · Multi-stepA 6-year-old has pancytopenia, short stature, cafe-au-lait spots and absent thumbs. Which test confirms the diagnosis?
- Haematology · ApplicationWhich feature should prompt consideration of iron-deficiency anaemia in a toddler?
Metabolic13
- Metabolic: phenylketonuria · ApplicationA 4-month-old fair-skinned infant has a mousy odour, developmental delay and eczema. Which enzyme is deficient and what is the treatment?
- Metabolic: galactosaemia · ApplicationA neonate develops vomiting, jaundice, hepatomegaly and E. coli sepsis after starting breast milk. Urine reducing substances are positive and glucose oxidase test is ne…
- Metabolic: maple syrup urine disease · Multi-stepA neonate on day 5 develops poor feeding, lethargy, encephalopathy and urine with a maple syrup odour. Which amino acids are elevated?
- Metabolic: homocystinuria · Multi-stepA tall child with downward lens dislocation, intellectual disability and a history of thromboembolism has high urinary homocysteine. What is the first-line treatment tr…
- Metabolic: Gaucher disease · ApplicationA child has massive splenomegaly, anaemia, thrombocytopenia and bone pain. Bone marrow shows cells with crumpled tissue paper cytoplasm. Which enzyme is deficient?
- Metabolic: Tay-Sachs disease · ApplicationAn infant of Ashkenazi Jewish ancestry shows regression at 6 months, exaggerated startle, macular cherry-red spot and no organomegaly. What is the deficient enzyme?
- Metabolic: mucopolysaccharidosis · ApplicationA 2-year-old has coarse facies, corneal clouding, hepatosplenomegaly, joint stiffness and developmental regression. Which condition is likely?
- Metabolic: Hunter syndrome · Multi-stepA boy has coarse features, aggressive behaviour, hepatosplenomegaly and clear corneas. His maternal uncle had similar disease. What is the inheritance?
- Metabolic: Von Gierke disease · ApplicationA 6-month-old has hepatomegaly, doll-like facies, fasting hypoglycaemia, lactic acidosis, hyperuricaemia and hyperlipidaemia. Which enzyme is deficient?
- Metabolic: Pompe disease · Multi-stepA hypotonic 3-month-old has cardiomegaly with short PR interval, macroglossia and hepatomegaly. Which treatment is available?
- Metabolic: urea cycle defects · Multi-stepA term neonate becomes lethargic with respiratory alkalosis and ammonia of 900 micromol/L after protein feeds on day 3. Orotic acid in urine is raised and citrulline is…
- Metabolic: MCAD deficiency · Multi-stepA 14-month-old has lethargy and seizures after a prolonged fast during a viral illness. Glucose is 25 mg/dl with absent urine ketones. Which condition is likely?
- Metabolic: Wilson disease · ApplicationA 10-year-old has Kayser-Fleischer rings, haemolytic anaemia and raised transaminases. Which test pattern is expected?
Respiratory illness13
- Respiratory illness · ApplicationWhat is a common symptom of bronchiolitis in infants?
- Respiratory illness · ApplicationWhat is a common cause of croup?
- Respiratory illness · ApplicationWhat sound is characteristic of croup?
- Respiratory illness · ApplicationWhat is a concerning sign of pneumonia in a young child?
- Respiratory illness · ApplicationWhat is a key sign of severe respiratory distress?
- Respiratory illness · ApplicationWhat is a common viral cause of bronchiolitis?
- Respiratory illness · ApplicationWhat finding helps identify severe asthma exacerbation in a child?
- Respiratory illness · ApplicationWhat is an initial supportive measure for hypoxemia in a child?
- Respiratory illness · ApplicationWhat symptom is common in infant bronchiolitis?
- Respiratory illness · ApplicationWhat sound is characteristic of viral croup?
- Respiratory illness · ApplicationWhich feature in bronchiolitis requires urgent hospital assessment?
- Respiratory illness · ApplicationWhat is the usual cause of bronchiolitis in infants?
- Respiratory illness · ApplicationWhich sign suggests severe asthma in a child?
Development11
- Development: fine motor · ApplicationA child stacks six cubes into a tower, scribbles spontaneously and walks up stairs holding a rail with both feet on each step. What is the most likely age?
- Development: drawing · ApplicationA child copies a circle but cannot copy a square. Which age does this correspond to?
- Development: protective reflexes · ApplicationWhich protective reflex appears at about 8 to 9 months and persists throughout life?
- Development: developmental quotient · Multi-stepAn 18-month-old child has a developmental age of 9 months in all domains on formal testing. What is the developmental quotient and what does it indicate?
- Development: autism screening · ApplicationA 20-month-old has no pointing, poor eye contact and has lost the few words he had at 15 months. Which is the most appropriate screening tool?
- Development · ApplicationWhat milestone usually precedes walking?
- Development · ApplicationWhat is a concerning developmental feature?
- Development · ApplicationWhat is an important developmental screening principle?
- Development · ApplicationWhat is a gross-motor milestone?
- Development · ApplicationWhich developmental finding is a red flag at 18 months?
- Development: cerebral palsy · ApplicationAn infant has persistent early hand preference before 12 months, increased tone in one side, and delayed gross motor milestones. What condition should be considered?
Oncology11
- Oncology: ALL prognosis · ApplicationWhich feature in a child with ALL indicates a good prognosis?
- Oncology: neuroblastoma · ApplicationA 2-year-old has a hard abdominal mass crossing the midline, periorbital ecchymosis and opsoclonus-myoclonus. Which investigation supports the diagnosis?
- Oncology: Burkitt lymphoma · ApplicationA 7-year-old has a rapidly growing jaw mass with a starry-sky appearance on histology. Which translocation is characteristic?
- Oncology: Ewing sarcoma · ApplicationAn adolescent has pain and swelling of the femoral diaphysis with fever. X-ray shows an onion-peel periosteal reaction. Which translocation is typical?
- Oncology: osteosarcoma · ApplicationA 14-year-old has pain around the knee and an X-ray showing a metaphyseal lesion with sunburst periosteal reaction and Codman triangle. What is the commonest site of me…
- Oncology: Langerhans cell histiocytosis · Multi-stepA 2-year-old has seborrhoeic-like scalp rash, lytic skull lesions and diabetes insipidus. Which finding on electron microscopy or immunostaining confirms the diagnosis?
- Oncology: tumour lysis syndrome · Multi-stepWithin 24 hours of starting chemotherapy for a high-burden lymphoma, a child develops hyperkalaemia, hyperphosphataemia, hyperuricaemia and hypocalcaemia. Which drug is…
- Oncology · ApplicationWhich abdominal finding in a child should prompt urgent evaluation for Wilms tumor or neuroblastoma?
- Oncology: Wilms tumor · ApplicationA child has a smooth unilateral abdominal mass, hematuria, and hypertension. What renal malignancy is most likely?
- Oncology: neuroblastoma · ApplicationA child has an abdominal mass crossing the midline, periorbital ecchymoses, and elevated urinary catecholamine metabolites. What diagnosis is most likely?
- Oncology: acute leukemia · ApplicationWhich combination most strongly suggests leukemia rather than isolated ITP in a child with bruising?
Infectious disease10
- Infectious disease · ApplicationWhat is a typical presentation of measles?
- Infectious disease · ApplicationWhich finding may be seen in varicella?
- Infectious disease · ApplicationWhat is a classic feature of meningitis that requires urgent evaluation?
- Infectious disease · ApplicationWhat symptom is characteristic of pertussis?
- Infectious disease · ApplicationWhat is a common route of hepatitis A spread in children?
- Infectious disease · ApplicationWhat is a typical sign of hand-foot-and-mouth disease?
- Infectious disease · ApplicationWhat does a nonblanching rash with fever raise concern for?
- Infectious disease · ApplicationWhat is a common symptom of urinary tract infection in an infant?
- Infectious disease · ApplicationWhat is a typical presentation of measles?
- Infectious disease · ApplicationWhat lesion pattern is typical of varicella?
Emergencies7
- Emergencies: septic shock · ApplicationA child in septic shock has tachycardia, cold peripheries and prolonged capillary refill. Which is the initial fluid resuscitation?
- Emergencies: paracetamol poisoning · ApplicationA 3-year-old ingested a large quantity of paracetamol 5 hours ago. Which is the specific antidote?
- Emergencies: iron poisoning · ApplicationA toddler has swallowed his mother's iron tablets and now has vomiting, bloody diarrhoea and metabolic acidosis. Which chelator is used?
- Emergencies: kerosene ingestion · ApplicationA 2-year-old drank kerosene and is coughing with respiratory distress. Which statement guides management?
- Emergencies: organophosphate poisoning · ApplicationA child exposed to pesticide has miosis, salivation, bradycardia and fasciculations. What is the primary antidote?
- Emergencies: drowning · ApplicationAfter rescue from a pond, a child is apnoeic but has a pulse. Which is the priority in resuscitation of a drowning victim?
- Emergencies: child abuse · ApplicationA 3-month-old has subdural haemorrhage, retinal haemorrhages and rib fractures with no history of trauma. What is the most likely diagnosis?
GI7
- GI · ApplicationWhat is first-line fluid for mild-moderate diarrhea dehydration?
- GI · ApplicationBilious vomiting in infant should prompt exclusion of what?
- GI · ApplicationWhat is a red flag in constipation?
- GI · ApplicationWhat is a dehydration sign?
- GI · ApplicationWhat can bloody diarrhea indicate?
- GI · ApplicationWhat is classic in intussusception?
- GI · ApplicationWhat should bilious vomiting prompt?
Rheumatology7
- Rheumatology · ApplicationWhat is the most serious complication of Kawasaki disease?
- Rheumatology: IgA vasculitis · ApplicationA 6-year-old boy has a palpable purpuric rash on the buttocks and legs, joint pains, colicky abdominal pain and mild haematuria two weeks after a sore throat. Platelet…
- Rheumatology: juvenile idiopathic arthritis · ApplicationA 3-year-old girl has asymmetric arthritis of the knee and ankle for 8 weeks, with positive ANA. The most important complication to screen for is:
- Rheumatology: systemic JIA · Multi-stepA 5-year-old has daily spiking fever with evanescent salmon-pink rash, arthritis, hepatosplenomegaly and very high ferritin. What complication is feared?
- Rheumatology · ApplicationWhich symptom pattern is concerning for juvenile idiopathic arthritis?
- Rheumatology: juvenile idiopathic arthritis · ApplicationA child has persistent swelling and limitation of a knee for more than six weeks, with no infection or trauma. What diagnosis should be considered?
- Rheumatology: Henoch-Schonlein purpura · ApplicationA child has palpable purpura on the buttocks and legs, colicky abdominal pain, arthralgia, and hematuria. What diagnosis is most likely?
Immunization6
- Immunization · ApplicationWhat is the purpose of childhood vaccines?
- Immunization · ApplicationWhy is adherence to vaccine schedules important?
- Immunization · ApplicationWhat is the purpose of routine childhood vaccination?
- Immunization · ApplicationWhy are childhood vaccines scheduled at specific ages?
- Immunization · ApplicationWhy are routine childhood vaccines scheduled at specific ages?
- Immunization · ApplicationWhy are live attenuated vaccines generally avoided in children with severe cellular immunodeficiency?
Renal6
- Renal · ApplicationWhat is typical of poststreptococcal glomerulonephritis?
- Renal · ApplicationWhat can cause secondary enuresis?
- Renal · ApplicationWhat finding suggests nephritic syndrome?
- Renal · ApplicationWhat can recurrent UTI in child prompt?
- Renal: nephritic syndrome · ApplicationA child has hypertension, periorbital edema, dark urine, and red-cell casts after a sore throat. Which syndrome is present?
- Renal: posterior urethral valves · ApplicationA male newborn has poor urinary stream, palpable bladder, bilateral hydronephrosis, and renal impairment. What congenital obstruction is most likely?
Infectious diseases5
- Infectious diseases · ApplicationWhich symptom cluster should prompt concern for meningitis in a child?
- Infectious diseases · ApplicationWhich rash feature makes meningococcal disease an emergency consideration?
- Infectious diseases · ApplicationWhat is a typical feature of measles?
- Infectious diseases: measles · ApplicationAn unvaccinated child has fever, cough, coryza, conjunctivitis, Koplik spots, and then a descending maculopapular rash. What is the diagnosis?
- Infectious diseases: tuberculosis · ApplicationA child has chronic cough, weight loss, close household contact with pulmonary tuberculosis, and a positive tuberculin test. What is the next diagnostic priority?
Neonatal jaundice5
- Neonatal jaundice · ApplicationA 4-week-old breastfed infant has persistent jaundice, pale stools and dark urine. What is the most appropriate next step?
- Neonatal jaundice: breast milk jaundice · ApplicationA thriving, exclusively breastfed 10-day-old term infant has a bilirubin of 12 mg/dl, normal stools and no haemolysis. What is the most likely diagnosis and best manage…
- Neonatal jaundice: phototherapy · ApplicationWhich wavelength of light is most effective for phototherapy of neonatal jaundice?
- Neonatal jaundice: exchange transfusion · Multi-stepA newborn of an Rh-negative mother with a positive direct Coombs test needs exchange transfusion. Which blood is chosen?
- Neonatal jaundice · ApplicationWhy is jaundice in the first 24 hours of life concerning?
Pediatric emergencies5
- Pediatric emergencies · ApplicationWhat is a priority in a child with severe breathing difficulty?
- Pediatric emergencies · ApplicationWhat is the first response to an actively seizing child?
- Pediatric emergencies · ApplicationWhat is the priority for a child with severe breathing difficulty?
- Pediatric emergencies · ApplicationWhat position helps protect the airway in an unconscious child who is breathing normally?
- Pediatric emergencies: anaphylaxis · Multi-stepA child develops wheeze, facial swelling, widespread urticaria, and hypotension after eating peanuts. What is the first-line medication?
Adolescent health4
- Adolescent health · ApplicationWhat principle is important when caring for an adolescent?
- Adolescent health · ApplicationWhat is an important topic in a confidential adolescent assessment?
- Adolescent health · ApplicationWhat is a major goal of adolescent immunization counseling?
- Adolescent health · ApplicationWhat structured approach explores home, education, activities, drugs, sexuality, and safety with adolescents?
Adolescent medicine4
- Adolescent medicine · ApplicationWhich approach best supports confidential adolescent health care?
- Adolescent medicine: eating disorders · ApplicationAn adolescent has marked weight loss, intense fear of weight gain, body-image distortion, bradycardia, and amenorrhea. Which diagnosis is most likely?
- Adolescent medicine: confidentiality · Multi-stepAn adolescent requests confidential advice about contraception and appears able to understand the discussion. What is the best general approach?
- Adolescent medicine: suicide safety · Multi-stepAn adolescent reports current intent to die, a specific plan, access to medication, and cannot identify a safe adult. What is the immediate priority?
Child protection4
- Child protection · ApplicationWhat principle is essential when child abuse is suspected?
- Child protection · ApplicationWhy should growth charts be reviewed over time?
- Child protection · ApplicationWhat is the appropriate response to an injury pattern concerning for possible child abuse?
- Child protection · Multi-stepA nonmobile infant is brought with bruising on the torso and a history that changes between caregivers. What is the appropriate clinical response?
Diarrhea4
- Diarrhea · ApplicationWhat is the most important initial treatment for uncomplicated childhood diarrhea?
- Diarrhea · ApplicationWhich finding suggests some dehydration in a child?
- Diarrhea · ApplicationWhich solute in oral rehydration solution enables glucose-coupled water absorption?
- Diarrhea · ApplicationWhat sign suggests some dehydration in a child?
Endocrine4
Malnutrition4
- Malnutrition: SAM admission · ApplicationA 10-month-old with SAM has bilateral pitting oedema of the feet and legs, a good appetite, and no fever or danger signs. Where is the child best managed under current…
- Malnutrition: stabilisation feeds · ApplicationIn the stabilisation phase of inpatient SAM management, which feed is used and at what volume?
- Malnutrition: hypoglycaemia · ApplicationA 14-month-old child with SAM is lethargic with blood glucose of 40 mg/dl. What should be done?
- Malnutrition: dehydration in SAM · Multi-stepA child with SAM and watery diarrhoea has some dehydration but no shock. Which oral rehydration fluid is preferred?
Child safety3
Diarrhoea3
- Diarrhoea: plan B · ApplicationA 10 kg child has some dehydration with restlessness, sunken eyes and skin pinch going back slowly. What volume of ORS is to be given in the first 4 hours?
- Diarrhoea: severe dehydration fluids · ApplicationA 6-month-old with severe dehydration needs intravenous fluid. Which regimen is advised?
- Diarrhoea: dysentery · ApplicationA 3-year-old has bloody diarrhoea, fever and tenesmus for 2 days. Which is the most appropriate approach?
Growth3
- Growth: bone age · ApplicationWhich pair of ossification centres is present at birth in a mature term newborn and is used as a radiological sign of term maturity?
- Growth: constitutional delay · ApplicationA 14-year-old boy has short stature, delayed bone age, no pubertal signs and a father who reached puberty late. What is the most likely diagnosis?
- Growth · ApplicationWhich measurement reflects head growth in infancy?
Infection3
Neonatal surgery3
- Neonatal surgery · ApplicationWhich metabolic abnormality is typical of infantile hypertrophic pyloric stenosis?
- Neonatal surgery · ApplicationA term neonate has not passed meconium for 48 hours, with abdominal distension and bilious vomiting. Contrast enema shows a transition zone with a dilated proximal colo…
- Neonatal surgery: oesophageal atresia · ApplicationA newborn has excessive frothing at the mouth, and chokes and turns blue at the first feed. A feeding tube cannot be passed beyond about 10 cm and coils in the upper ch…
Orthopaedics3
- Orthopaedics: Perthes disease · ApplicationA 6-year-old boy has a limp and referred knee pain, with X-ray showing a sclerotic, flattened femoral head. What is the diagnosis?
- Orthopaedics: SCFE · ApplicationAn obese 13-year-old boy has knee pain and a limp with limited internal rotation of the hip. A frog-leg lateral X-ray shows posterior and inferior displacement of the f…
- Orthopaedics: septic arthritis · ApplicationA 3-year-old with fever refuses to bear weight and holds the hip flexed, abducted and externally rotated. Pain is severe with passive movement and ESR is raised. What i…
Respiratory diseases3
- Respiratory diseases · ApplicationA 2-year-old has a barking cough, hoarse voice and inspiratory stridor after a cold. He is playful and has low-grade fever. What is the most appropriate treatment?
- Respiratory diseases · ApplicationA 2-year-old has a barking cough, hoarse voice, inspiratory stridor and low-grade fever after a coryzal illness. Neck radiograph shows narrowing of the subglottic air c…
- Respiratory diseases: pneumonia · ApplicationAn 18-month-old child has a cough for 3 days and a respiratory rate of 46 per minute, with no chest indrawing, no danger signs and feeding well. Which is the best manag…
Behavioural2
- Behavioural: autism features · ApplicationA 3-year-old does not respond to name, avoids eye contact, has repetitive hand-flapping and has limited speech. Which statement is correct?
- Behavioural: specific learning disability · ApplicationA 9-year-old with normal intelligence and vision has persistent difficulty reading, spelling and decoding words. What is this called?
Congenital heart disease2
- Congenital heart disease · ApplicationWhich is the most common cyanotic congenital heart disease presenting beyond the neonatal period?
- Congenital heart disease: PDA · ApplicationA preterm infant of 30 weeks has a continuous machinery-like murmur at the left infraclavicular area, bounding pulses and a hyperdynamic precordium on day 4. Which drug…
Developmental pediatrics2
Health promotion2
Paediatric oncology2
- Paediatric oncology · Multi-stepA 2-year-old has an abdominal mass that crosses the midline, periorbital ecchymoses, bone pain and raised urinary vanillylmandelic and homovanillic acid. What is the mo…
- Paediatric oncology · ApplicationA 3-year-old child has an asymptomatic abdominal mass noticed by the mother. The mass is smooth, firm, does not cross the midline, and the child has hypertension. Urine…
Pediatric cardiology2
- Pediatric cardiology · ApplicationA 6-week-old has a harsh pansystolic murmur at the left lower sternal border, tachypnoea and poor weight gain. The murmur was soft in the first days of life. Which mech…
- Pediatric cardiology · ApplicationA cyanotic infant has tet spells relieved by squatting and a boot-shaped heart on chest X-ray. Which anatomical component is part of this lesion?
Safeguarding2
Child safeguarding1
Diarrhoeal diseases1
Emergency pediatrics1
Gastroenteritis1
Neuromuscular disorders1
Orthopedics1
Paediatric endocrinology1
Renal medicine1
Respiratory emergencies1
Respiratory infections1
Common questions
How many Pediatrics questions are there?
861 original questions across 669 topics, and the bank grows over time.
Which Pediatrics topics are covered?
Congenital heart disease, Nutrition, Neonatology, Diarrhoeal diseases, Rheumatology, Neonatal surgery, Genetics, Neonatal jaundice, Neurology, Nephrology, Paediatric surgery, Neuromuscular disorders, and more.
How difficult are these Pediatrics questions?
0 are recall, 669 are application and 192 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Pediatrics questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Pediatrics for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Pediatrics test?
Yes. The Pediatrics subject test is included with a paid term, with a countdown and a question palette.
How should I use these Pediatrics questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Pediatrics questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.