Paediatrics Medicine 10 Single Best Answer (SBA)
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1. A 3-year-old boy presents with fever, irritability, and tugging at his right ear. Otoscopic examination reveals a bulging, erythematous tympanic membrane. What is the most appropriate first-line management?
Answer: Monitor symptoms and provide analgesia
In mild acute otitis media, analgesia and observation are first-line as many cases resolve spontaneously. Antibiotics are for severe or prolonged infections.
2. A 10-year-old girl presents with sore throat, fever, and difficulty swallowing. Examination shows enlarged, erythematous tonsils with exudates. Her voice is muffled, and there is trismus. What is the most appropriate next step?
Answer: Refer for hospital admission and IV antibiotics
Peritonsillar abscess must be treated aggressively with hospitalisation, IV antibiotics, and possible surgical drainage to prevent airway compromise.
3. A 12-year-old boy presents with recurrent sneezing, nasal congestion, and itchy eyes, particularly during spring. What is the most appropriate first-line treatment?
Answer: Intranasal corticosteroids
Intranasal steroids reduce inflammation in allergic rhinitis effectively, addressing congestion, sneezing, and itching.
4. A 4-year-old child presents with high fever, drooling, and difficulty breathing. Examination reveals inspiratory stridor, and the child is sitting forward with their neck extended. What is the most appropriate next step?
Answer: Call an anaesthetist and prepare for emergency airway management
Suspected epiglottitis is a paediatric emergency. Keeping the child calm and arranging secure airway management in theatre are critical steps.
5. A 9-year-old boy presents with recurrent nosebleeds lasting 10-15 minutes. Examination reveals telangiectasias on the nasal mucosa. What is the most likely diagnosis?
Answer: Hereditary haemorrhagic telangiectasia (HHT)
HHT (Osler-Weber-Rendu syndrome) features telangiectasias in mucosal surfaces leading to recurrent epistaxis.
6. A 5-year-old boy with recurrent otitis media has delayed speech and difficulty following conversations. Audiometry reveals a conductive hearing loss. What is the most likely cause?
Answer: Otitis media with effusion (glue ear)
Chronic middle ear effusion in children commonly leads to conductive hearing loss and speech delays if untreated.
7. A 2-month-old infant presents with white plaques on the tongue and inner cheeks that cannot be scraped off. What is the most appropriate first-line treatment?
Answer: Nystatin suspension
Nystatin oral suspension is typically first-line for mild to moderate infant thrush (candidiasis).
8. A 10-year-old girl presents with fever, proptosis, and restricted eye movements. CT shows a collection in the orbit. What is the most appropriate next step?
Answer: Admit for IV antibiotics and consider surgical drainage
Orbital cellulitis is serious; urgent IV antibiotics and possibly surgical intervention are key to preserving vision.
9. A 6-year-old boy presents with ear pain and hearing loss after a middle ear infection. Otoscopy shows a perforated tympanic membrane with purulent discharge. What is the most appropriate management?
Answer: Prescribe oral amoxicillin and keep the ear dry
A small tympanic perforation from otitis media often heals with systemic antibiotics and water precautions. Tympanoplasty is reserved for persistent perforations.
10. A 12-year-old boy develops a widespread erythematous rash, blistering, and mucosal involvement after starting phenytoin. What is the most appropriate initial management?
Answer: Admit to a burns unit and stop phenytoin
SJS requires prompt discontinuation of the offending agent, supportive care, and often specialised inpatient management similar to burns care.
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