AMC MCQ - Australian Medical Council Multiple Choice Questions Paediatrics and Child Health Questions and Answers 1 — Questions and Answers
Question 1: A 2-year-old boy is brought to the emergency department with a 24-hour history of a harsh, barking cough and noisy breathing. His mother notes the symptoms are worse at night. On examination, he is alert, has a temperature of 38.1°C, and there is prominent inspiratory stridor at rest with moderate subcostal and intercostal retractions. His oxygen saturation is 96% on room air. According to Australian guidelines, what is the most appropriate initial pharmacological treatment?
- Nebulised salbutamol
- A single dose of oral dexamethasone (Correct answer)
- Intravenous ceftriaxone
- Humidified 'blow-by' oxygen
Correct answer: A single dose of oral dexamethasone
This child presents with moderate croup, characterized by a barking cough and stridor at rest with respiratory distress. The mainstay of treatment for moderate to severe croup is a single dose of corticosteroids to reduce airway inflammation. Oral dexamethasone or prednisolone are recommended first-line treatments. Nebulised adrenaline is reserved for severe croup. Antibiotics are not indicated as croup is viral. While oxygen may be needed if there is hypoxia, it is not the primary treatment, and corticosteroids should be administered first.
Question 2: A 14-month-old girl presents after a 2-minute generalised tonic-clonic seizure. Her parents report she had a fever of 39.2°C just prior to the event. She has now returned to her baseline neurological state, although she is drowsy. There is no history of previous seizures or neurological problems. On examination, she has a viral-appearing upper respiratory tract infection but no signs of meningism. What is the most important piece of advice to give her parents regarding this event?
- An urgent EEG is required to rule out epilepsy.
- Prophylactic antipyretics will prevent future febrile seizures.
- This was a simple febrile seizure, which is generally benign and does not cause brain damage. (Correct answer)
- She will need to start long-term anti-epileptic medication.
Correct answer: This was a simple febrile seizure, which is generally benign and does not cause brain damage.
This is a classic presentation of a simple febrile seizure: a generalised seizure lasting less than 15 minutes in a febrile child aged 6 months to 6 years with a rapid return to baseline. The most crucial part of management is parental reassurance and education. Simple febrile seizures are benign, do not cause long-term neurological damage, and do not significantly increase the risk of epilepsy. Routine investigations like an EEG are not indicated. While antipyretics can improve comfort, they have not been shown to prevent the recurrence of febrile seizures. Long-term anti-epileptic medication is not recommended.
Question 3: A 3-year-old presents with a 2-day history of vomiting and frequent watery diarrhoea. On examination, he is irritable and restless. His heart rate is 150/min, capillary refill time is 3 seconds, his eyes appear sunken, and he is crying with no tears. His mother reports he has not passed urine in over 10 hours. What is the most appropriate next step in management?
- Administer an immediate intravenous bolus of 20 mL/kg of 0.9% sodium chloride. (Correct answer)
- Prescribe oral ondansetron and encourage small, frequent sips of clear fluids at home.
- Advise the mother to give diluted fruit juice and lemonade for rehydration.
- Commence oral rehydration solution at a rate of 10 mL/kg/hr for 4 hours.
Correct answer: Administer an immediate intravenous bolus of 20 mL/kg of 0.9% sodium chloride.
The child is showing clear signs of severe dehydration (or shock), including irritability/lethargy, marked tachycardia, prolonged capillary refill, sunken eyes, absent tears, and oliguria/anuria. This constitutes a medical emergency. The immediate priority is to restore circulatory volume with an intravenous fluid bolus of 20 mL/kg of an isotonic crystalloid like 0.9% sodium chloride. Oral rehydration is appropriate for mild to moderate dehydration but is insufficient for a child with signs of circulatory compromise. Sugary drinks like fruit juice and lemonade are hyperosmolar and can worsen diarrhoea.
Question 4: According to the Australian National Immunisation Program (NIP) Schedule, at what age is the first dose of the Measles, Mumps, and Rubella (MMR) vaccine routinely given?
- 6 months
- 18 months
- 4 years
- 12 months (Correct answer)
Correct answer: 12 months
The Australian National Immunisation Program (NIP) Schedule recommends the first dose of the MMR vaccine be administered at 12 months of age. A second dose, usually as part of the MMRV (Measles, Mumps, Rubella, Varicella) vaccine, is given at 18 months. The 4-year-old vaccination includes a booster for DTPa-IPV.
Question 5: A mother brings her 18-month-old son for a developmental check. She is concerned about his progress. Which of the following findings would be considered a 'red flag' for developmental delay at this age, warranting further investigation?
- He is not yet able to run.
- He cannot build a tower of more than 4 blocks.
- He is not yet walking independently.
- He does not use any single, meaningful words. (Correct answer)
Correct answer: He does not use any single, meaningful words.
While there is a range for achieving milestones, the absence of any single, meaningful words by 18 months is a significant language delay and a developmental red flag. Most children are walking by 15-16 months, but not walking at 18 months, while requiring assessment, is less concerning than a complete lack of single words, especially if other motor skills are present. Running and building a tower of more than 4 blocks are milestones typically expected closer to 24 months.
Question 6: A 5-day-old, exclusively breastfed, term infant is brought for review due to increasing jaundice. The baby is feeding well, has adequate urine output, and is otherwise well. The mother is blood group O positive and the baby is A positive. A serum bilirubin level is performed. Which of the following features would most strongly suggest a pathological cause for the jaundice, rather than physiological or breast milk jaundice?
- The jaundice was first noticed on day 3 of life.
- The total serum bilirubin is 220 micromol/L.
- The conjugated bilirubin component is 35 micromol/L. (Correct answer)
- A positive Direct Antiglobulin Test (Coombs' test).
Correct answer: The conjugated bilirubin component is 35 micromol/L.
A conjugated bilirubin level greater than 20% of the total, or an absolute value >20 micromol/L, is always considered pathological and requires urgent investigation to rule out causes like biliary atresia or neonatal hepatitis. Physiological jaundice typically appears after 24 hours and peaks around day 3-5. Breast milk jaundice can cause a prolonged unconjugated hyperbilirubinaemia but the conjugated fraction remains normal. A positive Coombs' test indicates haemolysis (e.g., ABO incompatibility), which is pathological, but a raised conjugated fraction points towards a different and often more urgent set of cholestatic pathologies. Given the options, cholestasis (indicated by high conjugated bilirubin) is a major red flag.
AMC MCQ - Australian Medical Council Multiple Choice Questions Paediatrics and Child Health Questions and Answers 1
A 2-year-old boy is brought to the emergency department with a 24-hour history of a harsh, barking cough and noisy breathing.
His mother notes the symptoms are worse at night.
On examination, he is alert, has a temperature of 38.1°C, and there is prominent inspiratory stridor at rest with moderate subcostal and intercostal retractions.
His oxygen saturation is 96% on room air.
According to Australian guidelines, what is the most appropriate initial pharmacological treatment?