Children and Young People Flashcards
1
Q
A two-year-old boy has had a fever for seven days with a rash. Suspected Kawasaki disease.
Which ONE of the following symptoms or signs supports the diagnosis?
A. Changes in limb proximities
B. Inguinal lymphadenopathy
C. Changes in the lips and oral cavity
D. Unilateral conjunctivitis
E. Absence of a rash
A
Answer: C. Changes in the lips and oral cavity
Justification: Clinical features of Kawasaki disease include fever >5 days and ≥4 of: bilateral conjunctivitis, mucosal changes, extremity changes, rash, and cervical lymphadenopathy.
Resource: NICE NG143. Fever in under 5s. 2019 (updated 2021).
2
Q
Early onset neonatal sepsis is most associated with:
A. Intrapartum maternal intake of oral antibiotic
B. Intrapartum temperature of 37.5ºC
C. Prolonged second stage of labour
D. Maternal bacterial vaginosis at 39 weeks
E. Maternal group B streptococcal colonisation
A
Answer: E. Maternal group B streptococcal colonisation
Justification: Maternal GBS colonisation in current pregnancy significantly raises risk of early-onset sepsis.
Resource: NICE NG195 (2021).
3
Q
A one-year-old boy is constipated. What is the MOST appropriate first-line medication?
A. Movicol
B. Ispaghula husk
C. Senna
D. Lactulose
E. Docusate
A
Answer: A. Movicol
Justification: Movicol is effective, well-tolerated, and first-line in children >1 year.
Resource: Rahim S. Childhood constipation. InnovAiT 2019; 12(11): 626–634.
4
Q
Four-year-old with dysuria, loin pain, and nitrites on dip. Best antibiotic?
A. Nitrofurantoin
B. Cefalexin
C. Ciprofloxacin
D. Trimethoprim
E. Amoxicillin
A
Answer: B. Cefalexin
Justification: Cefalexin is first-line for pyelonephritis in children.
Resource: NICE NG224. UTI in under 16s. 2022.
5
Q
Four-year-old with dysuria and positive urine dipstick. Best next step?
A. Await culture
B. Ciprofloxacin 7 days
C. Trimethoprim 3 days + prophylaxis
D. Trimethoprim for 3 days
E. Trimethoprim for 7 days
A
Answer: D. Trimethoprim for 3 days
Justification: 3-day course for uncomplicated UTI in children over 3 months.
Resource: NICE NG224. UTI in under 16s. 2022.
6
Q
What is required to confirm diagnosis of head lice?
A. Evidence of pruritus
B. Live lice
C. Nits
D. Scalp redness
E. Dead lice
A
Answer: B. Live lice
Justification: Diagnosis requires detection of live lice. Nits are not diagnostic.
Resources: RCGP Curriculum; BAD Head Lice Guide.
7
Q
Newborn blood spot screening tests for:
A. Galactosaemia
B. Congenital adrenal hyperplasia
C. Fragile X syndrome
D. Down’s syndrome
E. Medium-chain acyl-CoA dehydrogenase deficiency
A
Answer: E. Medium-chain acyl-CoA dehydrogenase deficiency
Justification: MCADD is one of the inherited metabolic diseases screened by NHS blood spot.
Resource: PHE. NHS NBS Programme.
8
Q
Which is the ONLY licensed drug to treat Tourette’s syndrome?
A. Risperidone
B. Diazepam
C. Olanzapine
D. Haloperidol
E. Sulpiride
A
Answer: D. Haloperidol
Justification: Haloperidol is the only licensed treatment for tics despite side effects.
Resource: Poulter & Mills. InnovAiT 2018; 11(7): 362–365.
9
Q
How long after desmopressin should fluids be restricted?
A. 4 hours
B. 6 hours
C. 8 hours
D. 10 hours
E. 12 hours
A
Answer: C. 8 hours
Justification: Restrict fluids from 1 hour before to 8 hours after desmopressin.
Resource: NICE CG111. Bedwetting. 2010.
10
Q
5-year-old boy with speech delay and limited play. Most likely diagnosis?
A. OCD
B. Reactive attachment disorder
C. PTSD
D. Rett disorder
E. ASD
A
Answer: E. ASD
Justification: Social interaction deficits and repetitive behaviours suggest ASD.
Resource: RCGP Curriculum.
11
Q
Four-year-old with faecal overflow and impaction. First-line treatment?
A. Glycerine microenema
B. Lactulose
C. Macrogol (polyethylene glycol)
D. Senna
E. Sodium picosulphate
A
Answer: C. Macrogol (polyethylene glycol)
Justification: Macrogol is first-line for disimpaction and ongoing constipation treatment.
Resource: NICE QS62. Constipation in Children. 2014.
12
Q
4-month-old girl with cough, wheeze, crackles, feeding well. Most likely diagnosis?
A. Asthma
B. Bronchiolitis
C. Pneumonia
D. Viral-induced wheeze
E. Acute laryngotracheobronchitis
A
Answer: B. Bronchiolitis
Justification: Common LRTI in infants; crackles + wheeze + feeding symptoms support diagnosis.
Resource: NICE NG9. Bronchiolitis. 2015.
13
Q
4-year-old boy had one UTI, now asymptomatic. Next step?
A. DMSA
B. Micturating cystogram
C. IVU
D. No investigation required
E. Renal ultrasound
A
Answer: D. No investigation required
Justification: No further investigation if age ≥6 months, first infection, full recovery.
Resource: NICE NG224. UTI in under 16s. 2022.
14
Q
3-week-old with jaundice from birth. Well otherwise. Best action?
A. Reassess in 48h
B. Admit to paediatric unit
C. Stop breastfeeding
D. MSU for UTI
E. Reassure – breast milk jaundice
A
Answer: B. Admit to paediatric unit
Justification: Jaundice within first 24 hours requires urgent referral.
Resource: NICE CG98. Jaundice under 28 days. 2010 (updated 2016).
15
Q
Desmopressin side effect parents should be warned about?
A. Cardiac dysrhythmia
B. Insomnia
C. Hyponatraemia
D. Dry mouth
E. Diarrhoea
A
Answer: C. Hyponatraemia
Justification: Fluid retention can lead to hyponatraemia; suspend during illness.
Resource: BNF; NICE CG111.
16
Q
Cochrane review: What complication does antibiotics reduce in AOM?
A. Mastoiditis
B. Hearing loss
C. Pain at 24h
D. TM perforation
E. Recurrent AOM
A
Answer: D. Tympanic membrane perforation
Justification: Antibiotics reduce TM perforation (NNT 33) and contralateral AOM (NNT 11).
Resource: Venekamp et al. Cochrane 2015; CD000219.
17
Q
Strongest risk factor for developmental dysplasia of the hip?
A. Oligohydramnios
B. Single pregnancy
C. IUGR
D. Being male
E. Polyhydramnios
A
Answer: A. Oligohydramnios
Justification: External factors like oligohydramnios and breech increase risk.
Resource: NICE CKS; RCGP MSK guide.
18
Q
Best way to measure temp in 3-week-old?
A. Forehead chemical dot
B. Axillary electronic
C. Infra-red tympanic
D. Oral
E. Rectal
A
Answer: B. Axillary electronic
Justification: For <4 weeks, axillary electronic thermometer is recommended.
Resource: NICE NG143. Fever under 5s. 2019 (updated 2021).
19
Q
6-week-old bottle-fed baby with unresolved constipation despite treatment. Passed meconium on day 3. Next step?
A. Reassess after weaning
B. Start laxatives
C. Refer to health visitor
D. Refer to paediatrician
E. Change milk and reassess
A
Answer: D. Refer to paediatrician
Justification: Consider Hirschsprung’s; refer if no response to treatment within 4 weeks.
Resource: NICE CG99. Constipation. 2010 (updated 2017).
20
Q
6-week check: white pupil + absent red reflex. Most appropriate next step?
A. Routine ophthalmology referral
B. Review in 6 months
C. Urgent paediatric referral
D. Social services referral
E. Urgent ophthalmology referral
A
Answer: E. Urgent ophthalmology referral
Justification: White pupil/leukocoria could indicate cataract or retinoblastoma.
Resource: Machin A. Cataracts. InnovAiT 2018; 11(11): 634–638.
21
Q
Which ONE of the following conditions are currently screened for as part of the NHS newborn blood spot (NBS) screening programme?
A. Cystic fibrosis
B. Gilbert’s syndrome
C. Coeliac disease
D. Hepatitis B
E. Human immunodeficiency virus (HIV)
A
Answer: A. Cystic fibrosis
Justification: NBS screens for:
- Sickle cell disease
- Cystic fibrosis
- Congenital hypothyroidism
- Inherited metabolic diseases: PKU, MCADD, MSUD, IVA, GA1, HCU
Resource: PHE. NHS newborn blood spot (NBS) screening programme.
22
Q
A ten-year-old girl is on medication for idiopathic generalised epilepsy. Her parents ask how long she must be seizure-free before stopping medication.
A. One year
B. Two years
C. Three years
D. Four years
E. Five years
A
Answer: B. Two years
Justification: NICE recommends considering AED withdrawal if seizure-free for at least 2 years, with specialist input and gradual tapering.
Resource: NICE NG217. Epilepsies in children. 2022.
23
Q
15-year-old boy with 2-month history of fever, fatigue and painful red swelling above the knee. Worse at night.
A. Juvenile idiopathic arthritis
B. Osgood–Schlatter’s disease
C. Gout
D. Reactive arthritis
E. Ewing’s sarcoma
A
Answer: E. Ewing’s sarcoma
Justification: Presents with fever, night/rest pain, persistent swelling. Urgent referral required.
Resource: NICE NG12. Suspected cancer: recognition and referral. 2015 (updated 2023).
24
Q
Three-week-old baby jaundiced since birth. Breastfed. Jaundice developed in first 24 hrs.
A. Admit to paediatric/neonatal unit
B. Reassure – breastmilk jaundice
C. Stop breastfeeding
D. Send urine MSU
E. Reassess in 48 hours
A
Answer: A. Admit to paediatric/neonatal unit
Justification: Jaundice in first 24 hours is a red flag — requires urgent specialist assessment.
Resource: NICE CG98. Jaundice in newborns <28 days. Updated 2023.
25
11-year-old boy, short stature, pre-pubertal. Dropped from 50th to 10th centile. Both parents tall.
A. Abdominal ultrasound
B. Chromosomal analysis
C. Bone age x-ray
D. Echocardiogram
E. Growth hormone measurement
Answer: C. Bone age x-ray
Justification: Radiological bone age assessment helps distinguish constitutional delay vs pathology.
Resource: RCGP Curriculum; NICE short stature guidance.
26
4-year-old with 6-day fever, conjunctivitis, dry lips, swollen hands/feet, lymphadenopathy.
A. Fifth disease
B. Sixth disease
C. Kawasaki disease
D. Hand, foot and mouth
E. Lyell’s disease
Answer: C. Kawasaki disease
Justification: Classic features. Fever + ≥4 signs diagnostic. Prompt treatment reduces coronary risk.
Resource: NICE NG143. Fever in under 5s. Updated 2021.
27
2.5-year-old girl with fever, limp, hot tender knee, not weight bearing.
A. FBC/ESR
B. Analgesia & antibiotics + safety net
C. Admit to paeds A&E
D. Review in one week
E. Refer to paeds orthopaedics outpatients
Answer: C. Admit to paeds A&E
Justification: Non-weight bearing, fever and red joint = septic arthritis until proven otherwise.
Resource: NICE NG143. Limping child pathway.
28
2-month-old infant. Mother asks at what temperature infant is high risk for serious illness.
A. 38.0°C
B. 38.5°C
C. 39.0°C
D. 39.5°C
E. 40°C
Answer: A. 38.0°C
Justification: Temp ≥38°C in under 3 months = red (high risk) according to NICE traffic light system.
Resource: NICE NG143. Fever in under 5s. Updated 2021.
29
14-year-old girl with intermittent headaches. Diagnosed with migraine. Which drug NOT recommended?
A. Aspirin
B. Ibuprofen
C. Paracetamol
D. Zolmitriptan
E. Sumatriptan
Answer: A. Aspirin
Justification: Contraindicated under age 16 due to Reye’s syndrome risk.
Resources: BNF for Children; RCPCH National Reye’s Syndrome Foundation UK.
30
Safest way to check temperature in 3-year-old boy?
A. Infra-red tympanic
B. Electronic axillary
C. Rectal thermometer
D. Oral electronic
E. Forehead chemical dot
Answer: A & B — Infra-red tympanic, Electronic axillary
Justification: NICE recommends tympanic or axillary in 4 weeks to 5 years. Forehead strips are unreliable.
Resource: NICE NG143. Fever in under 5s. Updated 2021.
31
Four-month-old girl on trimethoprim for UTI, feeding well, first UTI. E. coli cultured.
A. Repeat urine culture
B. Refer to emergency department
C. Start prophylactic nitrofurantoin
D. Renal ultrasound within 6 weeks
E. No further action required
Answer: D. Renal ultrasound within 6 weeks
Justification: NICE recommends renal US within 6 weeks for <6 months with first UTI.
Resource: NICE QS36. UTI in children. Updated 2022.
32
18-month-old with recurrent wheeze preceded by coryzal symptoms. Well between episodes.
A. Multi-trigger wheeze
B. Bronchiolitis
C. Asthma
D. Croup
E. Episodic viral wheeze
Answer: E. Episodic viral wheeze
Justification: Wheeze limited to viral illnesses with full recovery between = episodic viral wheeze.
Resource: InnovAiT 2021; 14(9): 557–564.
33
14-year-old girl with IBD hasn’t started periods, has breast development and pubic hair.
A. Paediatric referral
B. Pelvic US
C. Gonadotrophins
D. Reassure and review in 6 months
E. TFTs
Answer: D. Reassure and review in 6 months
Justification: Breast development but no menses before age 15 = monitor. Not yet abnormal.
Resource: RCGP Curriculum; IBD puberty delay guidance.
34
4-year-old girl, third UTI in 6 months. Responding well to abx.
A. US within 6 weeks post-infection
B. US during infection
C. MCUG in 4–6 months
D. DMSA during infection
E. MCUG during infection
Answer: A. Ultrasound within 6 weeks post-infection
Justification: Recurrent UTIs → US within 6 weeks. DMSA if further indicated.
Resource: NICE NG224. UTI in under 16s. 2022.
35
4-year-old boy with dysuria, positive nitrites & leucocytes.
A. Await culture
B. Ciprofloxacin 7 days
C. 3 days trimethoprim + prophylaxis
D. Trimethoprim 3 days
E. Trimethoprim 7 days
Answer: D. Trimethoprim 3 days
Justification: NICE recommends 3 days oral antibiotics for children >3 months with uncomplicated UTI.
Resource: NICE NG224. 2022.
36
15-year-old with acute headache, fever, vomiting, intermittent confusion, no photophobia or rash.
A. Aspirin overdose
B. Pseudomonas
C. Ecstasy
D. Herpes simplex
E. Hib
Answer: D. Herpes simplex
Justification: Presentation consistent with encephalitis (no meningism, no rash). HSV is most common cause.
Resource: NICE NG224; RCGP Acute Paeds module.
37
Which is TRUE about managing episodic viral wheeze?
A. ICS and montelukast cannot be used together
B. Environmental factors don’t need consideration
C. Spacer = nebuliser in efficacy
D. LABA is first-line
E. Oral steroids reduce hospital stay
Answer: C. Spacer = nebuliser in efficacy
Justification: Nebulisers offer no advantage over correct spacer use in preschool wheeze.
Resources: RCGP EKU18; BMJ 2014; 348: g15.
38
4-year-old with overflow diarrhoea. Suspect faecal impaction. Best first-line treatment?
A. Glycerine enema
B. Lactulose
C. Macrogol
D. Senna
E. Sodium picosulphate
Answer: C. Macrogol
Justification: Macrogols are first-line for disimpaction and maintenance.
Resource: NICE QS62. Constipation. 2014.
39
15-year-old discloses past FGM done abroad. Most appropriate action?
A. Discuss with parents
B. Inform school
C. Examine genitalia
D. Report to police
E. No action needed
Answer: D. Report to police
Justification: Mandatory police reporting applies to FGM disclosures in under-18s in England/Wales.
Resource: RCGP Safeguarding Guidance.
40
3-year-old asthmatic girl breathless with URTI. Most concerning sign?
A. Can’t speak in sentences
B. Accessory muscle use
C. RR 40
D. Pulse 140
E. Silent chest
Answer: E. Silent chest
Justification: Silent chest is a sign of life-threatening asthma.
Resource: NICE NG244. Managing acute asthma. 2024.
41
Early onset neonatal sepsis is most likely to be associated with which one of the following?
A. Maternal bacterial vaginosis at 39 weeks' gestation
B. Intrapartum temperature of 37.5ºC
C. Maternal group B streptococcal colonisation
D. Prolonged second stage of labour
E. Intrapartum maternal intake of oral antibiotic
Answer: C. Maternal group B streptococcal colonisation
Justification: GBS colonisation in current pregnancy significantly increases risk of early-onset sepsis. Other risk factors include prelabour ROM, prematurity, prolonged ROM, maternal fever >38°C, and prior neonatal GBS infection.
Resource: NICE NG195. Neonatal infection (early onset).
42
Which ONE of the following clinical signs is NOT identified as intermediate or high risk of serious illness in a child under the age of five?
A. Poor feeding
B. Reduced urine output
C. Rigors
D. Moist mucous membranes
E. Nasal flaring
Answer: D. Moist mucous membranes
Justification: Moist mucous membranes are not concerning. Signs such as dry mucosa, poor feeding, nasal flaring, and rigors are markers of at least intermediate risk.
Resource: NICE NG143. Fever in under 5s (2021).
43
When assessing for fever in a child <4 weeks, what is the recommended method?
A. Electronic thermometer in the groin
B. Chemical dot thermometer in the axilla
C. Electronic thermometer in the oral cavity
D. Chemical dot thermometer in the groin
E. Electronic thermometer in the axilla
Answer: E. Electronic thermometer in the axilla
Justification: In infants under 4 weeks, axillary electronic thermometers are accurate and safe.
Resources: NICE NG143; RCGP EKU13 (2022).
44
A 7-week-old boy has persistent evening crying. No vomiting, thriving well. Most appropriate INITIAL management?
A. Prescribe Gaviscon
B. Refer to paediatrician
C. Advice and reassurance
D. Prescribe simeticone
E. Prescribe lactase
Answer: C. Advice and reassurance
Justification: Typical infantile colic. Reassurance and support are first-line unless symptoms persist.
Resource: NICE CKS. Colic - infantile. Revised 2022.
45
A 9-year-old boy with primary nocturnal enuresis failed alarm therapy. Needs control for school trip. Best option?
A. Tolterodine
B. Desmopressin
C. Amitriptyline
D. Oxybutynin
E. Imipramine
Answer: B. Desmopressin
Justification: Desmopressin is appropriate for short-term control during travel or sleepovers.
Resource: NICE CKS. Bedwetting. Primary nocturnal enuresis.
46
Most common cause of bronchiolitis?
A. Epstein–Barr virus
B. Cytomegalovirus
C. Respiratory syncytial virus
D. Adenovirus
E. Rhinovirus
Answer: C. Respiratory syncytial virus
Justification: RSV causes 90% of bronchiolitis cases, especially during winter epidemics.
Resource: RCGP EKU17; NICE NG9 (2015).
47
Match the following child presentations with likely diagnoses:
- Barking cough, stridor, 18-month-old
- 5-month-old with wheeze, tachypnoea, nasal flaring
- 10-year-old with spasmodic night cough for 4 weeks, vomits after cough
A. RSV bronchiolitis
B. Pertussis
C. Croup
Answers:
- Barking cough: Croup
- Wheeze in 5-month-old: RSV bronchiolitis
- Spasmodic cough: Pertussis
Justification: Each diagnosis fits the clinical pattern and age group.
Resource: RCGP Curriculum. Children and young people. 2019.
48
7-year-old boy with nocturnal enuresis, star charts failed. Needs control for upcoming camping trip.
A. Oral oxybutynin
B. Intranasal desmopressin
C. Sublingual desmopressin
D. Oral imipramine
E. Enuresis alarm
Answer: C. Sublingual desmopressin
Justification: Sublingual desmopressin is preferred for short-term control. Intranasal route is no longer recommended.
Resource: NICE CKS. Bedwetting – short term control.
49
Kawasaki disease – which symptom supports the diagnosis?
A. Unilateral conjunctivitis
B. Inguinal lymphadenopathy
C. Absence of rash
D. Changes in lips/oral cavity
E. Changes in limb proximities
Answer: D. Changes in lips and oral cavity
Justification: Classic signs include fever >5 days + ≥4 features: mucosal changes, bilateral conjunctivitis, extremity changes, rash, and cervical lymphadenopathy.
Resource: NICE NG143 (2021).
50
7-month-old with crackles and RR 65. Which sign indicates SEVERE illness?
A. Temp 38.5°C
B. HR 112
C. Mild recession
D. O2 sat 96%
E. RR 65/min
Answer: E. RR 65/min
Justification: RR >60 in infants indicates severe illness and warrants further assessment.
Resource: RCGP EKU17; NICE NG143. Respiratory assessment in infants.
51
11-month-old girl with mild bronchiolitis, feeding well, RR 36, O2 >92%. Best management?
A. Paediatric emergency admission
B. Oral dexamethasone
C. Oral clarithromycin
D. Give self-care advice to parents
E. Nebulised salbutamol
Answer: D. Give self-care advice to the parents
Justification: Mild bronchiolitis with normal feeding and vitals should be managed at home with safety-netting.
Resource: NICE NG9. Bronchiolitis in children (2015).
52
6-week-old thriving baby with episodes of crying, knees to chest, no posseting. Likely colic. Initial treatment?
A. Gaviscon
B. Omeprazole
C. Simeticone
D. Advice and reassurance
E. Domperidone
Answer: D. Advice and reassurance
Justification: First-line for infantile colic is reassurance and soothing techniques.
Resource: NICE CKS. Colic - infantile (2022).
53
Contraindication to alcohol-based head lice treatment?
A. Psoriasis
B. Impetigo
C. Acne
D. Tinea capitis
E. Severe scalp eczema
Answer: E. Severe scalp eczema
Justification: Alcohol-based treatments can exacerbate severe eczema and cause irritation.
Resource: RCGP Head lice learning resource.
54
Most common reason for a child protection plan in UK?
A. Emotional abuse
B. Physical abuse
C. Trafficking
D. Neglect
E. Sexual abuse
Answer: D. Neglect
Justification: Neglect accounts for ~43% of child protection plans.
Resource: NICE NG76. Child abuse and neglect (2017).
55
8-year-old with ear pain, fever, mastoid swelling, pinna pushed forward. Most likely diagnosis?
A. Intracranial abscess
B. Luc abscess
C. Mastoiditis
D. Bezold abscess
E. Citelli abscess
Answer: C. Mastoiditis
Justification: Postauricular swelling and pinna displacement are typical of mastoiditis.
Resource: Parmanand & Atfeh. InnovAiT 2023; 16(8): 381–386.
56
Child accidentally ingests 10 ferrous sulfate 200 mg tablets. Asymptomatic. Next step?
A. Reassure and monitor at home
B. Give activated charcoal
C. Hospital referral
D. Gastric lavage
E. Observe for 6 hours in clinic
Answer: C. Hospital referral
Justification: Iron overdose is toxic and can be fatal. Hospital assessment essential even if asymptomatic.
Resource: NICE Paediatric poisoning protocols.
57
2-month-old baby with right occipital flattening, anterior ear and forehead on same side. Diagnosis?
A. Scaphocephaly
B. Congenital torticollis
C. Positional plagiocephaly
D. Neurofibromatosis
E. Congenital hydrocephalus
Answer: C. Positional plagiocephaly
Justification: Ipsilateral flattening, ear and forehead displacement suggest deformational plagiocephaly.
Resource: RCGP. Asymmetrical skulls in infants.
58
When should immunisations begin for premature neonates?
A. Start at 4 months
B. Follow corrected gestation schedule
C. Follow standard schedule
D. Use preterm-specific schedule
E. Avoid until 3 months
Answer: C. Follow standard schedule
Justification: All babies, including premature ones, should be vaccinated based on chronological age.
Resource: PHE. UK Immunisation Schedule.
59
8-year-old developed bedwetting 6 months after being dry. Which is LEAST likely cause?
A. Posterior urethral valves
B. Constipation
C. Emotional upset
D. Bullying
E. Diabetes mellitus
Answer: A. Posterior urethral valves
Justification: PUV is congenital and causes primary enuresis. Secondary enuresis usually has psychosocial or medical triggers.
Resource: NICE CG111. Bedwetting in under 19s (2010).
60
Mother with alcohol dependence fails to get child to school. This represents:
A. Physical abuse
B. Sexual abuse
C. Psychological abuse
D. Emotional abuse
E. Neglect
Answer: E. Neglect
Justification: Failing to provide education due to parental substance misuse constitutes neglect.
Resource: NICE NG76. Child abuse and neglect (2017).
61
A four-month-old infant is diagnosed with infantile colic.
Which of the following options is the SINGLE MOST effective treatment, if any?
A. No good evidence of effective treatment
B. Simethicone
C. Dicyclomine
D. Sugar
E. Cimetropium
Answer: A. No good evidence of effective treatment
Justification: There is no good evidence supporting any treatment (cimetropium, dicyclomine, simethicone or sugar). Dicyclomine is contraindicated <6 months. GPs should prioritise parental support.
Resource: RCGP Learning | Colic
62
A 14-year-old boy has recently started desmopressin for nocturnal enuresis.
For which SINGLE time period (in hours) should fluids be restricted AFTER taking desmopressin?
A. Four hours
B. Six hours
C. Eight hours
D. Ten hours
E. Twelve hours
Answer: C. Eight hours
Justification: Fluid should be restricted from 1 hour before to 8 hours after taking desmopressin to avoid hyponatraemia.
Resource: BNF | Desmopressin
63
A 5-year-old treated with amoxicillin for otitis media worsens after 3 days.
Which SINGLE medication is the MOST appropriate next step?
A. Switch to clarithromycin
B. Continue amoxicillin
C. Urgent ENT referral
D. Add metronidazole
E. Switch to co-amoxiclav
Answer: E. Switch to co-amoxiclav
Justification: If symptoms worsen despite 3 days of antibiotics, consider switching to co-amoxiclav.
Resource: Parmanand K, Atfeh M. InnovAiT 2023; 16(8): 381–386.
64
A 4-day-old baby has lost weight since birth.
What is the SINGLE MOST appropriate response?
A. Up to 20% weight loss acceptable
B. Up to 15% acceptable
C. Up to 10% acceptable
D. No weight loss is acceptable
E. Up to 5% acceptable
Answer: C. Up to 10% acceptable
Justification: Weight loss up to 10% is normal in the first week of life. Most regain by 2 weeks.
Resource: Harris DB. Faltering growth. InnovAiT 2024.
65
Which SINGLE factor is MOST associated with developmental dysplasia of the hip?
A. Intrauterine growth retardation
B. Single pregnancy
C. Polyhydramnios
D. Being male
E. Oligohydramnios
Answer: E. Oligohydramnios
Justification: External influences like oligohydramnios increase risk of hip dysplasia.
Resource: RCGP MSK guide
66
5-week-old breastfed baby with crying, vomiting, loose stools, PR bleeding, eczema.
What is the SINGLE MOST likely diagnosis?
A. Gastroenteritis
B. Cow’s milk protein allergy
C. Pyloric stenosis
D. Lactose intolerance
E. Chronic constipation
Answer: B. Cow’s milk protein allergy
Justification: GI and atopic symptoms suggest CMPA, even in breastfed infants.
Resource: Goodhead H, et al. InnovAiT 2021; 14(3): 185–192.
67
Which of the following is LEAST associated with physiological jaundice?
A. Breastfeeding
B. Cephalhaematoma
C. Hypothyroidism
D. Low birth weight
E. Prematurity
Answer: C. Hypothyroidism
Justification: Hypothyroidism is a pathological cause of jaundice. Other options are typical causes.
Resource: NICE CG98; RCGP Neonatal Jaundice Guide
68
Child with fever, rash on hands/feet, painful oral blisters.
Most likely cause?
A. CMV
B. Rotavirus
C. Coxsackievirus
D. HSP
E. Parvovirus B19
Answer: C. Coxsackievirus
Justification: Hand, foot and mouth disease is commonly caused by Coxsackie virus.
Resource: NICE NG143. Fever in under 5s
69
7-year-old girl with recurrent UTIs, pseudomonas in urine.
What is the SINGLE MOST appropriate radiological investigation?
A. DMSA scan
B. CT KUB
C. Ultrasound KUB
D. MCUG
E. X-ray KUB
Answer: C. Ultrasound KUB
Justification: Ultrasound is first-line for recurrent UTIs or atypical organisms like pseudomonas.
Resource: Aslam O, Aslam I. InnovAiT 2022.
70
Which SINGLE drug is commonly used off-label for insomnia in children with learning difficulties?
A. Temazepam
B. Melatonin
C. Chlorphenamine
D. Promethazine
E. Zopiclone
Answer: B. Melatonin
Justification: Melatonin is frequently used off-label for paediatric sleep disorders in neurodiverse children.
Resource: Johal H et al. InnovAiT 2022.
71
4-year-old with AOM, systemically well.
Which feature increases likelihood of benefiting from antibiotics?
A. Temp 38°C last night
B. Otorrhoea
C. Bulging tympanic membrane
D. History of glue ear
E. HR 102 bpm
Answer: B. Otorrhoea
Justification: NICE advises antibiotics for otorrhoea or bilateral AOM in children <2 years.
Resource: NICE CKS. Otitis media – acute.
72
10-month-old boy – which milestone is expected?
A. Walks unaided
B. Uses spoon
C. Pincer grip
D. Speaks 3 words (not mama/dada)
E. Stands on tiptoes
Answer: C. Pincer grip
Justification: Fine motor milestone at 10 months; others occur later.
Resource: Wellman S, Davis P. InnovAiT 2019; 12(2).
73
4-year-old with dry cough >3 months, worse outdoors & at night.
Most appropriate management?
A. Clarithromycin
B. Amoxicillin
C. Codeine linctus
D. Watchful waiting
E. Inhaled corticosteroid
Answer: E. Inhaled corticosteroid
Justification: NICE recommends 8–12 week ICS trial for suspected paediatric asthma.
Resource: NICE NG245. Asthma. 2024.
74
3.5-year-old boy, dry by day but nightly enuresis. Normal dipstick.
Most appropriate intervention?
A. Intranasal desmopressin
B. Enuresis alarm
C. Oral desmopressin
D. Imipramine
E. Reassurance
Answer: E. Reassurance
Justification: Age-appropriate enuresis; reassure parents and monitor.
Resource: NICE CG111. Bedwetting. 2010.
75
6-week-old baby with unilateral sticky eye, mucoid discharge.
Most likely diagnosis?
A. Ophthalmia neonatorum
B. Conjunctivitis
C. Nasolacrimal duct obstruction
D. Congenital cataract
E. Glaucoma
Answer: C. Nasolacrimal duct obstruction
Justification: Presents with mucoid discharge without redness. Common and self-limiting.
Resource: Ayoub DA, Beebeejaun DS. InnovAiT 2023.
76
6–8 week check: which finding needs IMMEDIATE referral?
A. Umbilical hernia
B. Preauricular skin tag
C. Stridor changing with position
D. Unilateral red reflex
E. Unilateral tearing
Answer: D. Unilateral red reflex
Justification: Asymmetry suggests cataract or retinoblastoma – urgent referral required.
Resource: PHE. NIPE Handbook.
77
Which sign is MOST concerning for meningococcal septicaemia?
A. Cold hands and feet
B. Halitosis
C. Peeling fingertip skin
D. Sore throat
E. Blurred vision
Answer: A. Cold hands and feet
Justification: Sign of shock. Requires urgent assessment in suspected meningococcal disease.
Resource: NICE NG240. 2024.
78
First-line pharmacological treatment for childhood constipation?
A. Glycerol
B. Docusate
C. Macrogol
D. Senna
E. Ispaghula husk
Answer: C. Macrogol
Justification: NICE recommends macrogols first-line, often combined with non-pharmacological measures.
Resource: NICE CKS. Constipation – children.
79
Best method for checking temperature in children aged 4 weeks to 5 years?
A. Forehead thermometer
B. Infrared tympanic
C. Mercury in axilla
D. Oral electronic
E. Rectal thermometer
Answer: B. Infrared tympanic
Justification: Tympanic and axillary electronic/chemical dot are appropriate in this age group.
Resource: NICE NG143. Fever in under 5s.
80
4-year-old with 12-hour earache. Eating/drinking fine. Red right drum, normal temp.
Most appropriate action?
A. Prescribe amoxicillin
B. Prescribe beclomethasone spray
C. Review in 3 days if not improving
D. Review next week if deafness persists
E. Arrange audiogram
Answer: C. Review in 3 days if not improving
Justification: Delayed prescribing approach recommended for most cases of uncomplicated AOM.
Resource: NICE CKS. Otitis media – acute.
81
According to national guidance, how many completed stools are needed per week to consider childhood constipation diagnosis?
A. Less than five per week
B. Less than three per week
C. Less than four per week
D. Less than two per week
Answer: B. Less than three per week
Justification: Constipation is defined as passing fewer than three complete stools per week. Chronic if >8 weeks.
Resource: RCGP Learning. Children and Young People; NICE guidance.
82
An 18-month-old had mild dysuria 3 days ago, resolved now. Urine dipstick showed microscopic haematuria.
What is the SINGLE MOST appropriate management option?
A. Reassure and monitor
B. Send MSU for culture
C. Repeat urine dipstick in 3 weeks
D. Refer to paediatric nephrologist
E. Treat with antibiotics
Answer: C. Repeat urine dipstick in 3 weeks
Justification: A one-off haematuria during illness is common. Repeat after 3 weeks unless persistent.
Resource: Babakhablou R, Beattie T. InnovAiT 2020.
83
Match each case to the correct diagnosis:
1. 1-year-old, fever, irritability, purpuric rash →
2. 5-day-old, jaundice, poor feeding, neck tone ↑ →
3. 13-year-old, headache, worse in AM, whooshing ears →
A. Idiopathic intracranial hypertension
B. Kernicterus
C. Meningococcal septicaemia
Answers:
1 → C. Meningococcal septicaemia
2 → B. Kernicterus
3 → A. Idiopathic intracranial hypertension
Justification: Each scenario matches classic signs of the listed condition.
Resource: RCGP Learning. Children and Young People.
84
Which statement about cow’s milk protein allergy (CMPA) is INCORRECT?
A. CMPA can cause respiratory tract symptoms
B. Exclusion from mother’s diet if breastfeeding
C. Use hydrolysed formula if bottle-fed
D. Affects 2–3% of children
E. Soya milk is recommended as substitute
Answer: E. Soya milk is recommended as substitute
Justification: Soya milk is not recommended due to risk of co-allergy.
Resource: RCGP Learning. Children and Young People.
85
10-week-old baby, vomiting for 12 hours, now bile-stained. Normal stools yesterday.
What is the SINGLE MOST likely diagnosis?
A. Biliary atresia
B. Tracheo-oesophageal fistula
C. Gastroenteritis
D. GORD
E. Volvulus
Answer: E. Volvulus
Justification: Bile-stained vomit is a red flag suggesting bowel obstruction. Volvulus requires urgent surgery.
Resource: NICE guidance.
86
5-year-old boy with ADHD. No dietary triggers found. What is the SINGLE MOST appropriate advice?
A. No diets help ADHD
B. Fat soluble vitamins
C. Eliminate colourings
D. Eliminate additives
E. Fatty acid supplements
Answer: A. No diets help ADHD
Justification: No evidence supports special diets for ADHD. Emphasise nutrition, routine and exercise.
Resource: NICE NG87 (2019).
87
4-month-old baby dies from SIDS after minor illness. What is a known additional risk factor?
A. Supine sleeping
B. Breastfeeding
C. Older mother
D. Preterm birth
E. Pacifier use
Answer: D. Preterm birth
Justification: Prematurity increases SIDS risk. Breastfeeding and pacifiers are protective.
Resource: BMJ 2015; RCGP Curriculum.
88
4-year-old girl with fever 6 days, dry lips, conjunctivitis, rash, lymphadenopathy.
What is the SINGLE MOST likely diagnosis?
A. Erythema toxicum
B. Kawasaki’s disease
C. Measles
D. Meningococcal septicaemia
E. Scarlet fever
Answer: B. Kawasaki’s disease
Justification: Classic symptoms: fever >5 days + 4 of 5 criteria including conjunctivitis, oral changes, rash, etc.
Resource: RCGP Curriculum.
89
Mother admits to shaking 6-month-old. Baby has chest bruises and mother flees.
What is the SINGLE MOST appropriate next step?
A. Contact social services
B. Contact paediatrician on-call
C. Contact health visitor
D. Contact police
E. Contact child protection doctor
Answer: D. Contact police
Justification: Immediate risk to child → call police to secure safety.
Resource: Working Together to Safeguard Children (2018).
90
What benefit do antibiotics provide in acute otitis media in children?
A. Reduce mastoiditis
B. Reduce recurrence
C. Reduce TM perforation
D. Reduce pain at 24h
E. Reduce hearing loss
Answer: C. Reduce TM perforation
Justification: Antibiotics reduce TM perforation (NNT = 33) and contralateral AOM (NNT = 11).
Resource: Cochrane Review (2015).
91
Which clinical finding is required to confirm a diagnosis of head lice?
A. Nits
B. Scalp redness
C. Pruritus
D. Live lice
E. Dead lice
Answer: D. Live lice
Justification: Only presence of live lice confirms diagnosis. Nits are empty eggs and not diagnostic.
Resource: RCGP Dermatology Curriculum; BAD Head Lice Guide.
92
6-month-old with RTI signs: chest recession, crackles, wheeze. Most likely pathogen?
A. H. influenzae
B. Parainfluenza virus
C. S. pneumoniae
D. B. pertussis
E. RSV
Answer: E. RSV
Justification: Crackles and wheeze suggest bronchiolitis, most commonly caused by RSV.
Resource: BJGP 2015; 65(631): 69–81.
93
BNF advice on use of codeine in under 12s?
A. OK for chronic cough
B. For diarrhoea
C. For migraine
D. For post-fracture pain
E. No indication
Answer: E. No indication
Justification: MHRA advises against any codeine use in <12s due to respiratory risks.
Resource: BNFC. Codeine phosphate; MHRA guidance (2015).
94
Breastfed baby with GORD symptoms not resolving after assessment. Next step?
A. Reduce feed volume
B. Add thickener to EBM
C. Oral alginate
D. Prone sleeping
E. H2 antagonist
Answer: C. Oral alginate
Justification: If breastfeeding advice fails, consider 1–2 week alginate trial.
Resource: NICE NG1 (2019).
95
Topical anaesthetic for 9-year-old girl needing venepuncture?
Select TWO options:
A. Lidocaine 1% with adrenaline
B. Lidocaine 1%
C. Lidocaine 2.5% + prilocaine 2.5%
D. Bupivacaine 0.5% + adrenaline
E. Bupivacaine 0.5%
Answer: C. Lidocaine 2.5% with prilocaine 2.5%
Justification: EMLA (lidocaine + prilocaine) and Ametop (tetracaine) are standard for topical use.
Resource: Williams C. InnovAiT 2015.
96
18-month-old, born at 34 weeks, poor weight gain. Which statement is true?
A. BMI centile > weight centile for underweight
B. Correct for gestation until 1 year
C. Use tape for height
D. Weight loss in first 2 weeks needs referral
E. Separate charts for breast vs bottle fed
Answer: B. Correct for gestation until 1 year
Justification: Use gestation correction until 1 year (or 2 years if <32 weeks).
Resource: RCPCH UK-WHO Growth Charts.
97
4-year-old boy with first UTI, responsive to antibiotics, now well. Next step?
A. DMSA
B. MCUG
C. IVU
D. No investigation
E. Renal US
Answer: D. No investigation
Justification: No imaging required after first uncomplicated UTI in children ≥6 months.
Resource: NICE NG224 (2022).
98
8-week-old with loud continuous diastolic murmur. Gold standard for CHD diagnosis?
A. MRI
B. CXR
C. ECG
D. Echo
E. CTCA
Answer: D. Echo
Justification: Echo is the gold standard for assessing congenital heart disease.
Resource: Jones B. InnovAiT 2020; 13(9): 534–541.
99
6-week-old vomiting after feeds. What feature supports diagnosis of uncomplicated GORD?
A. Episodic torticollis
B. Feeding distress
C. Epigastric pain
D. Drop from 90th to 25th centile
E. Variable stool colour
Answer: B. Feeding distress
Justification: Distress during feeding is typical in GORD. Other signs indicate complications or alternatives.
Resource: NICE NG1 (2019).
100
When is it MOST appropriate to try an enuresis alarm?
A. Failure after fluids, toileting, rewards
B. Child is <5 years
C. Bedwetting <2×/week
D. Parents blaming child
E. Parents overwhelmed by burden
Answer: A. Failure after fluids, toileting, rewards
Justification: Alarm therapy is first-line after behavioural measures fail. Not suitable for infrequent enuresis.
Resource: NICE CKS – Bedwetting management.
101
You see a 2-month-old bottle-fed baby who regurgitates milk after feeds, with distress and occasional gagging. No bilious vomiting, normal bowels, gaining weight.
Which is the MOST sensible initial management option?
A. Proton pump inhibitor
B. Antacid medication
C. Feed thickener
D. Hydrolysed formula
E. Reassurance only
Answer: C. Feed thickener
Justification: Reflux with distress can be managed stepwise, starting with feed thickeners. Hydrolysed formula is for CMPA.
Resource: Ayoub DA, Beebeejaun DS. InnovAiT 2023; 16(11): 547–552.
102
Three-year-old child with runny nose, cough, wheeze. Similar episode two months ago. O2 sat 97%, RR 40.
What is the SINGLE MOST likely diagnosis?
A. Bronchiolitis
B. Bronchopneumonia
C. Inhaled foreign body
D. Laryngotracheobronchitis
E. Viral induced wheeze
Answer: E. Viral induced wheeze
Justification: Recurrent wheeze without crackles in young children is most likely viral-induced.
Resource: RCGP Learning | Children and Young People.
103
What is the SINGLE MOST appropriate method to assess the body temperature of a two-week-old child?
A. Chemical dot thermometer in mouth
B. Chemical thermometer on forehead
C. Electronic thermometer in axilla
D. Electronic thermometer in mouth
E. Infrared thermometer on forehead
Answer: C. Electronic thermometer in axilla
Justification: For infants under 4 weeks, NICE recommends electronic axillary thermometers.
Resource: NICE NG143 (2021).
104
Two-year-old with 7-day fever and rash. Suspected Kawasaki disease.
Which ONE sign supports the diagnosis?
A. Changes in lips and oral cavity
B. Acute otitis media
C. Absence of rash
D. Unilateral conjunctivitis
E. Inguinal lymphadenopathy
Answer: A. Changes in lips and oral cavity
Justification: Typical Kawasaki signs include oral changes, bilateral conjunctivitis, rash, extremity changes, lymphadenopathy.
Resource: NICE NG143 (2021).
105
Five-year-old girl with UTI symptoms, culture shows +++ WBCs, no organisms (probable contamination).
Next step?
A. Oral trimethoprim
B. No further action
C. Inflammatory markers
D. Renal ultrasound
E. Topical clotrimazole
Answer: A. Oral trimethoprim
Justification: Treat if clinical signs of UTI present with pyuria even if culture negative.
Resource: NICE NG224 (2022).
106
12-year-old overweight boy with one-week limp, no trauma, can’t weight bear.
Most likely diagnosis?
A. Transient synovitis
B. Septic arthritis
C. SUFE
D. Perthes' disease
E. Osgood-Schlatter disease
Answer: C. Slipped upper femoral epiphysis
Justification: Overweight, gradual onset, antalgic gait → SUFE.
Resource: NICE CKS | Limping child.
107
Five-year-old girl with two-day history of diarrhoea and vomiting. No red flags.
What is the SINGLE MOST appropriate investigation pathway?
A. Full blood count
B. Stool microscopy
C. U&E
D. No investigation
E. Faecal calprotectin
Answer: D. No investigation
Justification: Well child, no blood/mucus/travel/immunosuppression = no tests needed.
Resource: NICE NG139. Diarrhoea and vomiting in children.
108
Which medication is appropriate for GORD in infants if feed-thickener and alginate therapy fail?
A. Omeprazole
B. Simeticone
C. Domperidone
D. Erythromycin
E. Metoclopramide
Answer: A. Omeprazole
Justification: PPI (or H2 blocker) for persistent GORD not responding to conservative measures.
Resource: NICE NG1 (2019).
109
Four-week-old with diarrhoea, vomiting, PR bleeding, eczema, wheeze.
Most likely diagnosis?
A. Colic
B. GORD
C. Cow’s milk protein allergy
D. Lactose intolerance
E. Intussusception
Answer: C. Cow’s milk protein allergy
Justification: Multisystem symptoms suggest CMPA. Trial elimination confirms diagnosis.
Resource: Pazhaniappan & Patel. InnovAiT 2021.
110
Six-week-old bottle-fed baby constipated despite laxatives. Passed meconium at 3 days.
What is the SINGLE MOST appropriate initial management step?
A. Refer to paediatrician
B. Refer to health visitor
C. Reassess after weaning
D. Prescribe laxatives
E. Change formula
Answer: A. Refer to paediatrician
Justification: Failure of treatment + delayed meconium = possible Hirschsprung’s.
Resource: NICE CG99 (updated 2017).
111
16-year-old girl post bone marrow transplant.
Most likely long-term MSK complication?
A. Osteochondritis
B. Osteomalacia
C. Osteomyelitis
D. Osteopetrosis
E. Osteoporosis
Answer: E. Osteoporosis
Justification: Children post-transplant are at high risk of reduced bone mineral density.
Resource: PubMed | Mechanisms of osteoporosis after haematopoietic cell transplantation.
112
Most appropriate management for majority of children with AOM?
A. Decongestants
B. Antihistamines
C. Antibiotics
D. Antipyretic measures only
E. Steroids
Answer: D. Antipyretic measures only
Justification: Most AOM cases are self-limiting. Offer analgesia and safety netting.
Resource: NICE CKS. Otitis media – acute.
113
Four-month-old girl, 2-day cough, crackles + occasional wheeze. Feeding well.
Most likely diagnosis?
A. Viral-induced wheeze
B. Pneumonia
C. Croup
D. Bronchiolitis
E. Asthma
Answer: D. Bronchiolitis
Justification: Crackles and wheeze in <1-year-old suggests bronchiolitis.
Resource: NICE NG9 (updated 2021).
114
Woman drank heavily throughout pregnancy.
Which is the MOST likely abnormality in infant?
A. Spina bifida
B. Mongolian blue spot
C. Prominent epicanthic folds
D. Microcephaly
E. Syndactyly
Answer: D. Microcephaly
Justification: FAS features include microcephaly, growth failure, neurodevelopmental delay.
Resource: RCGP Curriculum Topic Guide – Children & Young People.
115
At what age is it expected a child is consistently dry at night?
A. One year
B. Two years
C. Three years
D. Four years
E. Five years
Answer: E. Five years
Justification: Treatment may start from age 5, though often delayed until 7 years.
Resource: NICE CG111 (2010).
116
4-year-old with cough, coryza, fever, Koplik’s spots.
Most likely diagnosis?
A. Roseola
B. Parvovirus B19
C. Rubella
D. Measles
E. Mumps
Answer: D. Measles
Justification: Koplik’s spots + triad of fever, cough, coryza = measles.
Resource: Sachdev A. InnovAiT 2021; 14(6).
117
Best method to confirm active head lice infestation?
A. Microscopy
B. Combing for live lice
C. Scalp irritation
D. Wood’s lamp
E. Egg cases on shaft
Answer: B. Combing for live lice
Justification: Diagnosis requires identification of live lice.
Resource: BAD Head Lice Guidelines.
118
7-year-old boy with abdominal pain, purpuric rash over elbows/knees, recent coryza.
Most likely diagnosis?
A. Mesenteric adenitis
B. Meckel’s diverticulum
C. Appendicitis
D. Abdominal migraine
E. Henoch–Schönlein purpura
Answer: E. Henoch–Schönlein purpura
Justification: Purpura + joint/GI pain = HSP, a vasculitis common in 3–8-year-olds.
Resource: NICE CKS | HSP.
119
3-year-old girl with unexplained fever 38.1°C, normal exam.
Max time to test urine sample?
A. 1 hour
B. 4 hours
C. 12 hours
D. 24 hours
E. 48 hours
Answer: D. 24 hours
Justification: NICE advises urine should be tested within 24h for children with unexplained fever.
Resource: NICE NG224 (2022).
120
Newborn blood spot screening includes which condition?
A. Fragile X
B. Down syndrome
C. CAH
D. Galactosaemia
E. MCADD
Answer: E. MCADD
Justification: Included in newborn screening for inherited metabolic disorders.
Resource: PHE. NHS NBS Programme.
121
A 10-year-old girl with nocturnal enuresis is prescribed desmopressin.
Which ONE of the following is a recognised side-effect of desmopressin?
A. Insomnia
B. Dry skin
C. Cardiac dysrhythmia
D. Hyponatraemia
E. Diarrhoea
Answer: D. Hyponatraemia
Justification: Desmopressin causes fluid retention and may cause hyponatraemia. Parents should be advised to suspend it during illness until normal fluid balance resumes.
Resource: BNF; RCGP Learning.
122
3-year-old with itchy, dry, erythematous rash in flexures.
Most appropriate treatment per NICE?
A. Hydrocortisone 0.5% twice-daily
B. Clobetasol propionate 0.05% once-daily
C. Mometasone furoate 0.1% once-daily
D. Hydrocortisone 0.1% twice-daily
E. Clobetasone butyrate 0.05% once-daily
Answer: E. Clobetasone butyrate 0.05% once-daily
Justification: This child has moderate eczema. NICE recommends moderate potency topical steroids, plus emollients.
Resource: NICE CG57 (updated 2023).
123
Best method to measure temperature in a 3-week-old?
A. Chemical dot thermometer on forehead
B. Electronic thermometer in axilla
C. Infra-red tympanic thermometer
D. Oral thermometer
E. Rectal thermometer
Answer: B. Electronic thermometer in axilla
Justification: NICE recommends electronic axillary thermometry for infants under 4 weeks.
Resource: NICE NG143 (2021).
124
6-year-old with sudden limp post-viral URTI. Normal FBC/ESR/CRP/X-ray.
Most likely diagnosis?
A. SUFE
B. Perthes’ disease
C. Septic arthritis
D. Transient synovitis
E. Juvenile idiopathic arthritis
Answer: D. Transient synovitis
Justification: Common cause of hip pain in young children; preceded by viral infection; settles within 7 days.
Resource: RCGP Curriculum – Children & Young People.
125
1-year-old boy, constipated. Bowels open every 4–5 days, straining.
Best first-line medication?
A. Lactulose
B. Senna
C. Docusate
D. Movicol
E. Ispaghula husk (fybogel)
Answer: D. Movicol
Justification: First-line treatment of chronic constipation and disimpaction in children over 1 year.
Resource: NICE CKS – Constipation in children (2024).
126
2-year-old boy with FTT and frequent chest infections. Pale, <3rd centile height/weight.
Best initial investigation?
A. Bone age X-ray
B. Sweat test
C. Chromosomal analysis
D. Abdominal US
E. Home feeding observation
Answer: B. Sweat test
Justification: Recurrent chest infections + FTT → suspect cystic fibrosis. Sweat test is 98% sensitive.
Resource: RCGP Curriculum – Children and Young People.
127
7-month-old boy: cough 48h, RR 30, mottled skin, crepitations.
Which is a red flag necessitating hospital admission?
A. CRT 3s
B. Crepitations
C. RR 30
D. Temp 38.7°C
E. Mottled skin
Answer: E. Mottled skin
Justification: Mottling is a high-risk sign per NICE fever guidelines.
Resource: NICE NG143 (updated 2021).
128
6-month-old with 24h diarrhoea, 1 vomit. Breastfed, well, no dehydration signs.
Best advice?
A. Continue breastfeeding + ORS
B. Replace breast milk with water
C. Use full strength formula
D. Use half strength formula
E. Stop breastfeeding, use ORS
Answer: A. Continue breastfeeding + ORS
Justification: Maintain normal feeding + ORS for hydration.
Resource: NICE CG84 – Diarrhoea & vomiting under 5s (2009).
129
Which childhood respiratory illness has the shortest duration?
A. Common cold
B. Croup
C. Sore throat
D. Bronchiolitis
Answer: B. Croup
Justification: Symptoms typically resolve within 2 days.
Resource: BMJ 2013; 347: f7027.
130
Match to likely diagnoses:
15mo boy, pain q10–20min, bile vomit, RUQ mass →
12yo boy, LLQ + scrotal pain →
8yo boy, central pain radiating to RIF, vomited, T 38°C →
A. Intussusception
B. Testicular torsion
C. Appendicitis
Answers:
→ Intussusception
→ Testicular torsion
→ Appendicitis
Justification: Classical presentations of each condition.
Resource: RCGP Curriculum – Children and Young People (2019).
131
3-year-old girl: 5-day fever, conjunctivitis, oral erythema, cervical nodes.
Most likely diagnosis?
A. Kawasaki disease
B. Scarlet fever
C. Nephrotic syndrome
D. Mumps
E. HSP
Answer: A. Kawasaki disease
Justification: Presents with fever + ≥4 of: conjunctivitis, oral erythema, rash, lymphadenopathy, extremity changes.
Resource: Haywood M. Vasculitis. InnovAiT 2023; 16(3): 134–139.
132
6-week-old bottle-fed baby with crying after feeds, mild vomiting, worse when flat.
Best initial management?
A. Urgent allergy referral
B. Trial smaller feeds → thickened formula
C. Trial proton pump inhibitor
D. Coeliac screen
E. Lactose-free formula
Answer: B. Trial smaller feeds → thickened formula
Justification: Suspect GORD. NICE recommends stepwise management starting with non-drug approaches.
Resource: InnovAiT 2021; 14(6): 350–355.
133
5-week-old boy with reflux, failed thickener/alginate. Hungry, projectile vomiting, weight dropped 50th→25th centile.
Most likely diagnosis?
A. Biliary atresia
B. Lactose intolerance
C. Intussusception
D. Pyloric stenosis
E. Gastroenteritis
Answer: D. Pyloric stenosis
Justification: Projectile vomiting + keen to feed + weight loss = classic for pyloric stenosis.
Resource: RCGP Learning – Children and Young People.
134
3-week-old boy with soft reducible groin lump worse on crying.
Best management?
A. Emergency surgery
B. Abdominal ultrasound
C. Delay surgery to age 2
D. Refer for urgent surgical outpatient
E. Delay surgery to adulthood
Answer: D. Refer for urgent surgical outpatient
Justification: Inguinal hernias risk incarceration; refer urgently unless strangulated.
Resource: RCGP Curriculum – Children & Young People.
135
12-year-old boy with 3-month abdominal pain, missing school.
Which feature suggests organic cause?
A. Anxiety
B. Suprapubic pain
C. FHx of abdominal pain
D. Hb 13.6 g/dL
E. 75th centile height
Answer: B. Suprapubic pain
Justification: Organic causes include pain in RUQ, RIF, suprapubic or loin, plus systemic signs.
Resource: RCGP Curriculum – Children & Young People.
136
4-year-old with mild ADHD-like symptoms in limited settings.
Next best step?
A. Prescribe atomoxetine
B. Watchful waiting
C. Refer to child psychiatrist
D. Prescribe methylphenidate
E. Refer to health visitor
Answer: B. Watchful waiting
Justification: Mild, situational symptoms → monitor for 10 weeks, behavioural support.
Resource: NICE NG87 – ADHD (2019).
137
12–13 month immunisation includes protection against:
A. Tetanus
B. Polio
C. Pertussis
D. Rubella
E. Diphtheria
Answer: D. Rubella
Justification: MMR (measles, mumps, rubella) given at 12–13 months.
Resource: UKHSA Routine Immunisation Schedule.
138
7-year-old post meningitis discharge.
What is most appropriate routine follow-up?
A. Nasal swab
B. Immunoglobulins
C. Audiogram
D. Complement testing
E. FBC
Answer: C. Audiogram
Justification: Hearing loss is a known complication of meningitis.
Resource: NICE guidance; RCGP Learning.
139
3-year-old unable to kick a ball.
Which milestone suggests gross motor delay?
A. Jumped at 18 months
B. Unable to kick ball at 36 months
C. Pulled to stand at 9 months
D. Sat at 7 months
E. Walked alone at 12 months
Answer: B. Unable to kick ball at 36 months
Justification: Expected to kick ball by 2 years.
Resource: RCGP Curriculum – Milestones Guide.
140
Which is most likely to indicate child neglect?
A. 9yo eating chips in waiting room
B. 3yo missed flu jab
C. 7yo in dirty clothes after football
D. 14yo girl seeking contraception
E. 6yo obese with untreated dental decay
Answer: E. 6yo obese with untreated dental decay
Justification: Persistently missed care = medical neglect.
Resource: NICE NG76 – Child Abuse and Neglect (2017).
141
Which of the following is the SINGLE MOST appropriate definition of autism?
A. A group of motor and sensory symptoms with normal intellect
B. A group of motor symptoms that includes dyspraxia and ataxia
C. A group of symptoms clustered around persistent difficulties in social interaction and communication and the presence of stereotypic behaviours, resistance to change or restricted interests
D. A group of symptoms including forgetfulness, difficulty processing information and problems remembering number sequences
E. A group of symptoms suggestive of developmental delay, with a low intelligence quotient (IQ) and repetitive use of certain words
Answer: C. A group of symptoms clustered around persistent difficulties in social interaction and communication and the presence of stereotypic behaviours, resistance to change or restricted interests
Justification: Patients with autism have a triad of impairment affecting social imagination, interaction and communication.
Resource: RCGP. Autistic Spectrum Conditions. 2011 (updated 2021).
142
A mother brings her 12-year-old son who is disruptive in class, struggles socially, and has rigid routines.
What is the SINGLE MOST likely diagnosis?
A. Depression
B. Obsessive compulsive disorder
C. Attention deficit hyperactivity disorder
D. Adjustment disorder
E. Autistic Spectrum Disorder
Answer: E. Autistic Spectrum Disorder
Justification: ASD presents with impairments in social interaction and communication, with restricted interests and repetitive behaviours.
Resource: NICE Clinical Knowledge Summary. Autism in children. Revised 2023.
143
An eight-year-old boy with ulcerative colitis, well-controlled, last steroids 1 year ago. Height and weight stable at 25th centile.
What is the MOST appropriate interval for growth monitoring?
A. No routine review required
B. Six months
C. 12 months
D. Three months
E. One month
Answer: C. 12 months
Justification: In absence of active disease or ongoing steroids/puberty, routine review is annual.
Resource: NICE NG130. Ulcerative Colitis: management. 2019.
144
A 5-year-old boy with palliative neuroblastoma has uncontrolled abdominal pain despite maximum paracetamol and ibuprofen.
What is the SINGLE MOST appropriate next step?
A. Discuss with paediatrician
B. Keep him on paracetamol and ibuprofen
C. Start tramadol
D. Start amitriptyline
E. Start codeine phosphate
Answer: A. Discuss with paediatrician
Justification: Morphine is the next step per WHO guidance, but requires specialist prescribing and supervision.
Resource: WHO guidelines on persisting pain in children. 2020.
145
A mother is concerned about her 2-year-old's development.
Which milestone warrants urgent referral?
A. Just about holding object at 3 months
B. Reaching for objects by 4 months
C. Trying to walk at 20 months
D. Run by two-and-a-half years
E. Sitting unsupported by 8 months
Answer: C. Trying to walk at 20 months
Justification: Boys should walk by 18 months; girls by 24 months. Delay beyond this needs urgent referral.
Resource: Wellman S, Davis P. InnovAiT 2019; 12(2): 72–78.
146
A grandmother reports her 3-year-old grandson ignores her when told off and doesn’t seek comfort.
Which is the SINGLE MOST likely diagnosis?
A. Disinhibited attachment disorder
B. Resistant insecure attachment
C. Disorganised insecure attachment
D. Avoidant insecure attachment
E. Reactive attachment disorder
Answer: D. Avoidant insecure attachment
Justification: Avoidant attachment results from inconsistent caregiver responses and leads to emotional detachment.
Resource: Turner M, Beckwith H, Duschinsky R, et al. InnovAiT 2019; 12(4): 173–179.
147
A 13-year-old treated for leukaemia hasn't started menstruating.
What is the FIRST sign of normal female puberty?
A. Secondary dentition
B. Breast bud development
C. Epiphyseal fusion
D. Axillary sweating
E. Pubic hair development
Answer: B. Breast bud development
Justification: Breast bud (thelarche) is typically the first sign of female puberty.
Resource: RCGP Curriculum – Children and Young People.
148
Which ONE child requires immediate same day referral?
A. 8-month-old with head circumference from 90th to 95th centile
B. 6-month-old with plagiocephaly
C. 6-year-old with new unilateral upper motor neuron facial palsy
D. 7-year-old with 9-month history of headaches
E. 4-year-old with intermittent non-paralytic squint
Answer: C. 6-year-old with unilateral upper motor neuron facial palsy
Justification: Rapid-onset focal neuro signs in a child require same-day neuro referral.
Resource: NICE Guidance – Neurological Symptoms in Children.
149
24-year-old nursery worker, 14 weeks pregnant, worried about rubella risk.
Which is a feature of congenital rubella syndrome?
A. Trisomy 21
B. Meconium aspiration
C. Autism
D. Macrocephaly
E. Deafness
Answer: E. Deafness
Justification: Congenital rubella can cause deafness, cardiac defects, growth restriction, and ocular issues.
Resource: NICE Antenatal Care Guidelines; RCGP Curriculum.
150
3-year-old child has malaise and sore mouth for 3 days. Oral vesicles on tongue/palate, rash on hands/feet.
Most likely diagnosis?
A. Herpes simplex
B. Erythema multiforme
C. Aphthous stomatitis
D. Hand, foot and mouth disease
E. Chickenpox
Answer: D. Hand, foot and mouth disease
Justification: Typical features include oral ulcers and rash on hands/feet caused by Coxsackie virus.
Resource: RCGP Learning – Childhood Illnesses.
151
9-year-old boy with blinking, shoulder shrugging, clapping, swearing. Family history of OCD.
Most likely diagnosis?
A. Emotionally unstable personality disorder
B. Bipolar affective disorder
C. Tourette syndrome
D. Schizophrenia
E. Frontal lobe lesion
Answer: C. Tourette syndrome
Justification: Multiple motor + vocal tics for >1 year, onset <18 yrs. Associated with OCD.
Resource: RCGP Curriculum – Neurodevelopmental Disorders.
152
2-year-old with seal-like cough, 3-day coryza, stridor when upset. No drooling, T 37.6°C.
Best management?
A. Oral dexamethasone
B. Nebulised adrenaline
C. Oral amoxicillin
D. Inhaled humidified air
E. Nebulised salbutamol
Answer: A. Oral dexamethasone
Justification: Mild croup is best treated with a single dose of oral steroid.
Resource: NICE CKS – Croup; RCGP Respiratory Guidance.
153
6-week-old baby with white pupil and absent red reflex in right eye.
Best management?
A. Urgent paediatric ophthalmology referral
B. Urgent paediatrics referral
C. Urgent social services referral
D. Routine ophthalmology referral
E. Reassure and review in 6 months
Answer: A. Urgent paediatric ophthalmology referral
Justification: Absent red reflex or leukocoria → urgent referral to rule out cataract or retinoblastoma.
Resource: Machin A. Cataracts. InnovAiT 2018; 11(11): 634–638.
154
14-month-old with cough, coryza, coarse crackles right lung, T 39.2°C, RR 50, O2 sat 94%.
Most likely diagnosis?
A. Asthma
B. Croup
C. Pneumonia
D. Inhaled foreign body
E. Bronchiolitis
Answer: C. Pneumonia
Justification: Focal crackles and high fever suggest pneumonia.
Resource: BMJ 2017; 356: j686 – Community-acquired pneumonia in children.
155
4-year-old boy with dysuria, loin pain, bedwetting. T 38.8°C. Dip positive for nitrites/leukocytes.
Best antibiotic per NICE?
A. Trimethoprim
B. Nitrofurantoin
C. Ciprofloxacin
D. Cefalexin
E. Amoxicillin
Answer: D. Cefalexin
Justification: First-line oral antibiotic for upper UTI/pyelonephritis in children.
Resource: NICE NG224. UTI in under 16s. 2022.
156
Which ONE of the following predisposes to GORD in children?
A. Asthma
B. Parental history of IBS
C. Growth velocity <50th centile
D. Cerebral palsy
E. Post-term delivery
Answer: D. Cerebral palsy
Justification: CP increases GORD risk due to neuromuscular incoordination.
Resource: NICE NG1. GORD in children. Updated 2019.
157
Which is NOT recommended for treating head lice in children?
A. Wet combing
B. Dimeticone 4% lotion
C. Permethrin 5% cream
D. Dimeticone 4% spray
E. Malathion 0.5% lotion
Answer: C. Permethrin 5% cream
Justification: Permethrin is effective for scabies, but not licensed for lice in children <18 years.
Resource: BNF – Skin Infections.
158
12-year-old boy with primary nocturnal enuresis. No meds wanted.
What is the MOST appropriate behavioural advice?
A. Regular daytime and pre-sleep toileting
B. Avoid tartrazine
C. Double micturition at bedtime
D. Fluid restriction to 1000ml
E. Wake every 2 hours overnight
Answer: A. Regular daytime and pre-sleep toileting
Justification: NICE advises regular toileting and avoiding caffeine; limit waking only short term.
Resource: NICE CKS – Bedwetting (Enuresis).
159
10-year-old boy with ADHD, persistent cough like a grunt, blinking, worse when tired. Normal exams/tests.
Most likely diagnosis?
A. Tic disorder
B. Asthma
C. LRTI
D. Generalised anxiety disorder
E. Postnasal drip
Answer: A. Tic disorder
Justification: ADHD often coexists with tics. Normal chest findings support this.
Resource: RCGP Learning – ADHD and Comorbidities.
160
9-year-old boy with Down syndrome, lethargy, hepatosplenomegaly, T 35.8°C.
Best next step?
A. Urgent paediatrics (within 2 weeks)
B. Urgent FBC
C. Routine paediatric referral
D. Urgent abdominal US
E. Same-day paediatrics admission
Answer: E. Same-day paediatrics admission
Justification: Hepatosplenomegaly and lethargy in a child with Down syndrome = suspect leukaemia.
Resource: NICE NG12. Suspected Cancer: recognition and referral. Updated 2025.
