1. A 4-year-old boy presents with redness, discharge, and crusting of both eyes. His symptoms started after a recent cold. What is the most appropriate management?

• Advise regular cleaning and observation
• Start topical antibiotics immediately
• Refer to ophthalmology urgently
• Prescribe oral antibiotics

Answer: Advise regular cleaning and observation

Most infective conjunctivitis in children is viral. Symptomatic relief with regular eyelid cleaning is typically sufficient; antibiotics are not routinely required.

2. A 10-year-old girl presents with bilateral itchy, watery eyes during spring. She denies vision changes or pain. What is the most appropriate treatment?

• Topical antihistamines
• Oral antibiotics
• Topical corticosteroids
• Warm compresses and lubrication

Answer: Topical antihistamines

Allergic conjunctivitis often improves significantly with topical antihistamines, reducing itching and tearing.

3. A 3-year-old boy presents with an inward-turning left eye. The corneal light reflex is asymmetrical. What is the most appropriate next step?

• Refer to ophthalmology for further evaluation
• Reassure parents and review in 6 months
• Prescribe corrective glasses immediately
• Perform cover-uncover test in the clinic

Answer: Refer to ophthalmology for further evaluation

Strabismus requires prompt referral to evaluate visual acuity, rule out amblyopia, and initiate treatment such as patching or glasses.

4. A 2-year-old girl presents with a white reflex in her right eye noticed in photos. Examination reveals leukocoria. What is the most likely diagnosis?

• Retinoblastoma
• Congenital cataract
• Retinal detachment
• Coats disease

Answer: Retinoblastoma

Retinoblastoma typically presents with a white pupillary reflex (leukocoria) in photos or on exam; prompt referral to oncology is necessary.

5. A 12-year-old boy presents with difficulty sleeping and constant worry about school performance. He is otherwise healthy. What is the most appropriate first-line treatment?

• Cognitive behavioural therapy (CBT)
• Start sertraline
• Refer for inpatient psychiatric care
• Prescribe short-term benzodiazepines

Answer: Cognitive behavioural therapy (CBT)

In paediatric anxiety, psychotherapy (especially CBT) is preferred initially to teach coping strategies and modify anxiety-provoking thoughts.

6. A 9-year-old boy is struggling at school due to difficulty focusing and frequent impulsive behaviour. Symptoms are also present at home. What is the most appropriate next step?

• Comprehensive behavioural and educational assessment
• Start methylphenidate immediately
• Reassure parents and review in 6 months
• Refer for psychological counselling

Answer: Comprehensive behavioural and educational assessment

ADHD diagnosis requires a thorough multi-disciplinary assessment, gathering info from parents, teachers, and clinical evaluation.

7. A 3-year-old boy is not speaking in sentences, avoids eye contact, and does not engage in pretend play. What is the most appropriate next step?

• Refer for developmental assessment
• Reassure parents that speech will develop with time
• Start speech therapy immediately
• Conduct genetic testing for chromosomal abnormalities

Answer: Refer for developmental assessment

Early identification of ASD ensures access to supportive therapies and interventions, improving outcomes.

8. A 5-year-old girl presents with multiple bruises at different stages of healing and no clear explanation. What is the most appropriate next step?

• Report concerns to child protection services
• Reassure the parents and document findings
• Observe the child over several follow-up visits
• Refer the child for psychological counselling

Answer: Report concerns to child protection services

Healthcare professionals are legally mandated to report suspected child abuse to ensure safety and immediate intervention.

9. A 10-year-old boy frequently gets into fights, disobeys rules, and shows no remorse for his actions. What is the most likely long-term complication if untreated?

• Antisocial personality disorder
• Generalised anxiety disorder
• Major depressive disorder
• Schizophrenia

Answer: Antisocial personality disorder

Without intervention, severe conduct disorder can escalate to antisocial personality disorder in later adolescence or adulthood.

10. A 15-year-old girl with anorexia nervosa is hospitalised for severe malnutrition. She develops confusion, weakness, and arrhythmias. Blood tests show hypophosphataemia. What is the most likely diagnosis?

• Refeeding syndrome
• Acute kidney injury
• Electrolyte imbalance from diuretics
• Hypocalcaemia-induced tetany

Answer: Refeeding syndrome

During refeeding, insulin surge drives phosphate into cells, leading to hypophosphataemia and possible cardiac, neurological, and muscular complications.