Revision Questions (Medical students - 4th Year) (with answers)
Paediatrics Revision Questions
© 2012-2025 Dr. Joseph Mizzi
Case 1: Acute Ear Pain
A 6-year-old girl presents to the Emergency Department with severe right ear pain and a fever of 39°C. Otoscopic examination reveals an inflamed right tympanic membrane.
a) What is the most likely diagnosis?
b) Which pathogens are commonly implicated in this condition?
c) Outline the appropriate management for this patient.
d) What are potential complications if left untreated?
e) When should a referral to an otolaryngologist be considered?
Case 2: Headaches
A child presents to the outpatient clinic with a 4-week history of morning headaches and coughing. Fundoscopic examination reveals bilateral papilloedema.
a) What is the differential diagnosis?
b) Which investigations are necessary to determine the underlying cause?
c) What are the immediate management steps?
d) Discuss the potential long-term sequelae of untreated raised intracranial pressure.
Case 3: Pallor and Bruising
An 8-year-old girl presents with pallor and bruising. Laboratory results: Hb 6.3 g/dL; WBC 28 x10⁹/L; Platelets 12 x10⁹/L; peripheral blood smear shows blasts.
a) What is the most probable diagnosis?
b) How would you confirm this diagnosis?
c) What are the prognostic factors in this condition?
d) Outline the initial management plan.
e) What are the common complications associated with treatment?
Case 4: Pallor
A toddler is referred for evaluation of pallor. Laboratory results: Hb 7.0 g/dL; WBC 5.3 x10⁹/L; Platelets 240 x10⁹/L; MCV 68 fL.
a) What are the two most likely diagnoses?
b) Which additional tests would you perform to differentiate between these diagnoses?
c) Discuss the management strategies for each condition.
d) What dietary advice would you provide to the parents?
Case 5: Rash
A boy presents with a 2 day history of purpuric rash on his legs and buttocks, abdominal pain, and painful swelling of the right ankle. The child is clinically well and afebrile.
a) What is the most likely diagnosis?
b) Which two investigations would you perform and why?
c) How would you manage this condition?
d) Name one gastrointestinal and one renal complication associated with this condition.
e) What is the typical prognosis?
Case 6: Difficulty Walking
A 7-year-old boy develops progressive difficulty walking over two days, accompanied by headaches and limb pain. He had a febrile illness two weeks prior. Neurological examination reveals lower limb weakness, absent tendon reflexes, and sensory loss.
a) What is the likely diagnosis?
b) What findings would you expect in the cerebrospinal fluid analysis?
c) Should this child be admitted to the hospital? Justify your answer.
d) Is this condition notifiable to the health authorities?
e) Discuss the long-term management and rehabilitation strategies.
Case 7: Acute Pallor and Jaundice
A 2-year-old boy is brought to the Emergency Department on Good Friday. He was well the previous day but is now weak, tachypnoeic, pale, and jaundiced. He is afebrile, and his urine is very dark.
a) What is the most likely diagnosis?
b) Explain the cause of the dark urine.
c) How would you manage this child acutely?
d) Which tests would confirm your diagnosis?
e) What preventive advice would you offer to the parents?
Case 8: Proteinuria
A preschool child presents with scrotal and lower limb swelling. Urinalysis shows +++ proteinuria without haematuria. Blood pressure is normal.
a) What is the most likely diagnosis?
b) Is a renal biopsy indicated in this case?
c) Which investigations would you perform?
d) Outline the management plan.
e) Discuss the prognosis and potential for relapse.
Case 9: Neonatal Cyanosis
A neonate is noted to be centrally cyanosed on the second day of life.
a) What is the differential diagnosis?
b) How would you confirm that the infant is cyanosed?
c) Which two investigations would help distinguish between pulmonary and cardiac causes, and how?
d) What immediate management steps are necessary?
e) Discuss the long-term outlook for common causes of neonatal cyanosis.
Case 10: Dehydration
A child presents with fever and vomiting.
a) What is the differential diagnosis?
b) How would you assess the degree of dehydration in this child?
c) If intravenous fluids are required, how would you calculate the hourly rate?
d) What are the indications for hospital admission in such cases?
e) Discuss the role of oral rehydration therapy.
Case 11: Acute Asthma Exacerbation
A 7-year-old boy is brought urgently to the Emergency Department with an acute asthma attack.
a) How would you assess the severity of his attack?
b) Outline the immediate management steps.
c) What is the long-term management plan for this patient?
d) Discuss the importance of patient and parent education in asthma management.
e) What are the criteria for intensive care unit admission?
Case 12: Acute Fever and Petechial Rash
A 5-year-old girl is brought to the paediatric Emergency Department with fever and a petechial rash.
a) What is the presumptive diagnosis?
b) What is the initial management?
c) Which investigations are essential?
d) Discuss the public health implications and necessary notifications.
e) What prophylactic measures should be taken for close contacts?
Case 13: Hypovolaemic Shock
An unconscious child is rushed to the Emergency Department in cardiovascular shock. The child has been experiencing vomiting and diarrhoea for the past 24 hours.
a) How would you assess the child's cardiovascular status?
b) What is your acute management plan?
c) Which laboratory tests would you order?
d) Discuss the potential complications if treatment is delayed.
e) What are the key components of discharge planning and parental education?
Case 14: Febrile Seizure
A previously healthy 18-month-old boy is brought to the emergency department after a 3-minute generalized tonic-clonic seizure at home. He had a temperature of 38.9°C on arrival. There is no post-ictal focal deficit, and he is alert and interactive after the event.
a) What is the most likely diagnosis?
b) What features would suggest this is not a simple febrile seizure?
c) What investigations are indicated in this case?
d) How would you counsel the parents about recurrence and prognosis?
e) When is long-term anticonvulsant therapy indicated?
Case 15: Failure to Thrive
A 9-month-old girl is brought to clinic with concerns about poor weight gain. Her weight has dropped from the 25th to below the 0.4th centile over the past 3 months. She is otherwise alert and meeting developmental milestones.
a) What is the definition of failure to thrive (FTT)?
b) List three broad categories of causes of FTT.
c) What aspects of the history would help differentiate between organic and non-organic causes?
d) Outline your initial approach to investigation.
e) How would you manage this child?
Case 16: Constipation
A 5-year-old boy presents with abdominal pain and infrequent bowel movements. He passes hard stools every 4–5 days and has occasional soiling of his underwear.
a) What is the most likely diagnosis?
b) What red flags would prompt further investigation?
c) What initial investigations would you consider?
d) Outline your management plan.
e) How would you counsel the parents to prevent recurrence?
Case 17: Polyuria and Polydipsia
A 10-year-old girl is brought to hospital with a 3-week history of polyuria, polydipsia, and weight loss. On examination she is mildly dehydrated and tachypnoeic, with a fruity smell on her breath.
a) What is the likely diagnosis and complication?
b) What urgent investigations are required?
c) How would you manage this patient acutely?
d) What are the key principles of long-term diabetes management in children?
e) What are potential long-term complications?
Case 18: Sudden Collapse in a Toddler
A 2-year-old previously healthy boy suddenly starts coughing while eating a piece of apple. He becomes distressed, unable to cough effectively, and begins to turn blue. His mother calls for help.
a) What is the immediate management of this child?
b) Outline the steps of paediatric basic life support in a child over 1 year of age.
c) What differences would there be in the BLS approach if the child were <1 year old?
d) What are the signs of complete vs partial airway obstruction in children?
Case 19: Neonatal Jaundice
A 3-day-old term baby is noted to be jaundiced. She is feeding well and has normal stools and urine. On exam she is alert, pink, and well hydrated.
a) What is the most likely cause of jaundice in this case?
b) What features suggest pathological jaundice?
c) What investigations are indicated?
d) Outline the management of significant neonatal jaundice.
e) What are the risks of untreated severe hyperbilirubinaemia?
Case 20: Limp in a Child
A 6-year-old boy presents with a limp for the past 2 days. He had a mild upper respiratory tract infection a week ago. He is afebrile, able to bear weight with a slight limp, and has no joint swelling.
a) What is the most likely diagnosis?
b) What other differential diagnoses must be considered?
c) What investigations are appropriate at this stage?
d) How would you manage the child if this is transient synovitis?
e) When should you consider referral to orthopaedics or further imaging?
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