Paediatrics, Obstetrics & Gynaecology

A 2-year-old has a barking cough, hoarse voice and inspiratory stridor after two days of coryza. He is alert and drinking. What is the most appropriate treatment?

• AA single dose of oral dexamethasone✓
• BNebulised salbutamol
• CInhaled corticosteroid for four weeks
• DOral amoxicillin

Answer: This is croup, a viral illness; a single dose of oral dexamethasone (0.15 mg/kg) reduces severity and admissions. Antibiotics have no role, and salbutamol treats bronchospasm rather than upper airway swelling.

A 4-month-old has three days of coryza, then a wheezy cough, fast breathing and feeding difficulty in December. What is the most likely diagnosis?

• AAsthma
• BPneumonia
• CCroup
• DBronchiolitis✓

Answer: Bronchiolitis, usually caused by respiratory syncytial virus, affects infants under one year in the winter months, presenting with coryza followed by cough, wheeze, tachypnoea and poor feeding. Management is supportive. Asthma is not diagnosed at this age.

An 18-month-old has a generalised seizure lasting three minutes during a fever of 39.5°C and recovers fully. There is no previous history. What should the parents be told?

• AThe child will need long-term anticonvulsant treatment with sodium valproate to prevent any further seizures
• BThe child has epilepsy and must have an EEG and a brain scan this week so that treatment can be started without delay
• CThis is a simple febrile seizure; about a third of children have another, but it does not mean epilepsy✓
• DFever must be prevented with regular paracetamol and ibuprofen during any illness to stop the seizures recurring

Answer: A simple febrile seizure is generalised, lasts under 15 minutes and does not recur within 24 hours, in a child aged six months to five years. Roughly one in three children has a recurrence; the risk of epilepsy is only slightly raised, and antipyretics do not prevent recurrence.

A 9-month-old has episodes of screaming and drawing up his legs, vomiting, and passes stool resembling redcurrant jelly. A sausage-shaped mass is felt in the abdomen. What is the most likely diagnosis?

• AHirschsprung's disease
• BIntussusception✓
• CGastroenteritis
• DPyloric stenosis

Answer: Intussusception, most common between 6 and 18 months, presents with intermittent colicky pain, vomiting, redcurrant-jelly stool and a palpable mass, and is confirmed on ultrasound and treated by air enema. Pyloric stenosis presents at around six weeks with projectile vomiting.

A woman at 34 weeks' gestation has a blood pressure of 152/98 mmHg with 2+ protein on a urine dipstick and no previous hypertension. What is the diagnosis and the first-line antihypertensive?

• AChronic hypertension; amlodipine
• BGestational hypertension; ramipril
• CPre-eclampsia; lisinopril
• DPre-eclampsia; labetalol✓

Answer: New hypertension after 20 weeks with significant proteinuria is pre-eclampsia. NICE recommends labetalol as first-line treatment (nifedipine or methyldopa if unsuitable). ACE inhibitors are contraindicated in pregnancy.

A 26-year-old woman with seven weeks of amenorrhoea has left iliac fossa pain and light vaginal bleeding. Her urinary pregnancy test is positive and transvaginal ultrasound shows an empty uterus with a left adnexal mass. What is the most likely diagnosis?

• AEctopic pregnancy✓
• BOvarian torsion
• CThreatened miscarriage
• DPelvic inflammatory disease

Answer: A positive pregnancy test with an empty uterus and an adnexal mass is an ectopic pregnancy until proven otherwise, and needs urgent gynaecology assessment for methotrexate or surgical management depending on size, hCG and symptoms. A threatened miscarriage would show an intrauterine pregnancy.

A pregnant woman asks about screening for Down's syndrome. Which test is offered in the first trimester in the NHS?

• AThe quadruple blood test — AFP, hCG, oestriol and inhibin A — at 12 weeks
• BThe combined test — nuchal translucency with PAPP-A and β-hCG between 11 and 14 weeks✓
• CAmniocentesis at 12 weeks, offered routinely to every pregnant woman
• DThe 20-week anomaly ultrasound scan on its own, with no blood tests

Answer: The combined test between 11 and 14 weeks uses the nuchal translucency measurement and maternal blood markers to estimate risk. The quadruple test is a second-trimester alternative for women who book late, and amniocentesis is a diagnostic test offered only after a high-chance screening result.

A 3-month-old who is not yet mobile is brought to the GP with a bruise on the cheek. The parents say he rolled against the cot bars. What is the most appropriate action?

• ATreat this as a possible safeguarding concern and refer for same-day paediatric assessment✓
• BPrescribe arnica cream for the bruise and advise the parents to fit padded cot bumpers to prevent a recurrence
• CReassure the parents that bruises are common in babies and arrange a routine review in two weeks
• DRecord the bruise and the parents' explanation in the notes and take no further action unless it happens again

Answer: Bruising in a baby who is not independently mobile is a recognised safeguarding red flag, whatever explanation is offered, and requires same-day referral for paediatric assessment and safeguarding procedures. Reassurance without assessment is unsafe.

A 6-week-old baby has projectile vomiting after every feed and is hungry afterwards. What is the most likely diagnosis?

• AIntussusception
• BGastro-oesophageal reflux
• CPyloric stenosis✓
• DCoeliac disease

Answer: Non-bilious projectile vomiting with a hungry baby at around six weeks is pyloric stenosis, confirmed on ultrasound and treated by pyloromyotomy after correcting the metabolic alkalosis.

A woman at 36 weeks' gestation has painless bright red vaginal bleeding. What is the most likely diagnosis and what must not be done?

• ACervical ectropion — no action needed
• BPlacenta praevia — a digital vaginal examination must not be performed✓
• CLabour — send her home to await regular contractions, since a show is normal at this stage
• DPlacental abruption — an urgent digital vaginal examination is needed to assess the cervix

Answer: Painless bleeding in late pregnancy suggests placenta praevia; a digital examination can provoke torrential haemorrhage, so the placental site is checked by ultrasound first. Abruption is typically painful with a tense uterus.

A 3-year-old has a fever, a runny nose, red eyes and a blotchy red rash that started behind the ears and spread down. She has not been vaccinated. What is the most likely diagnosis?

• AMeasles✓
• BHand, foot and mouth disease
• CChickenpox
• DScarlet fever

Answer: Fever, coryza, conjunctivitis and a maculopapular rash spreading from the head downwards in an unvaccinated child is measles, a notifiable disease. Chickenpox is vesicular and scarlet fever has a sandpaper rash with a strawberry tongue.

A 28-year-old woman who is 8 weeks pregnant asks which supplement she should take. What is recommended?

• AIron tablets for all pregnant women regardless of blood count, since anaemia is universal in pregnancy and the baby's stores depend on it
• BNo supplements are needed with a balanced diet, since folate and vitamin D are plentiful in fresh vegetables, dairy foods and sunlight
• CHigh-dose vitamin A daily throughout pregnancy, since it is needed for the development of the baby's eyes and skin
• DFolic acid 400 micrograms daily until 12 weeks and vitamin D 10 micrograms daily throughout pregnancy✓

Answer: Folic acid reduces neural tube defects and vitamin D supports bone health; vitamin A in high doses is teratogenic, and iron is given only for anaemia.