# AMC MCQ Paediatrics Questions: 10 Free Practice MCQs

> 10 free AMC MCQ paediatrics questions with answers and explanations, from a bank of 191 paediatrics questions. Try them now, no sign up.

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Last updated: 2026-10-29

Ten AMC MCQ-style paediatrics questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 191 paediatrics questions and many more across every topic.

1. 1 / 10  
A 3-year-old girl is brought to a paediatric clinic with a 6-day history of high fever (39.5°C) that has not responded to paracetamol. On examination, she has bilateral non-purulent conjunctivitis, cracked red lips, a 'strawberry tongue', erythema of the palms and soles with mild swelling of her hands, and a single enlarged cervical lymph node measuring 1.8 cm.  
What is the most appropriate management?  
Show answer

**Answer: B.** Admit for urgent echocardiography, intravenous immunoglobulin (IVIG), and high-dose aspirin

**Why:** Kawasaki disease is an acute systemic medium-vessel vasculitis. The diagnosis is clinical, requiring fever for >= 5 days plus at least 4 of: conjunctival injection, oral mucous membrane changes (strawberry tongue), polymorphous rash, extremity changes (erythema/edema), and cervical lymphadenopathy. Prompt treatment with IVIG and high-dose aspirin reduces the risk of coronary artery aneurysms from 25% to <5%.

  * **A.** The presentation meets the diagnostic criteria for Kawasaki Disease; antibiotic therapy is inappropriate and delays critical therapy.
  * **C.** Delayed treatment of Kawasaki disease significantly increases the risk of coronary artery aneurysms; immediate admission is required.
  * **D.** High-dose aspirin and IVIG are the primary treatments; corticosteroids are reserved for refractory cases and are not first-line monotherapy.  
Sources: RCH Melbourne Clinical Practice Guideline: Kawasaki Disease
2. 2 / 10  
During resuscitation of a 2-year-old child in pulseless electrical activity the team notes distended neck veins, tracheal deviation and absent breath sounds on the right. The child collapsed shortly after a central line was inserted.  
Which reversible cause is most likely responsible?  
Show answer

**Answer: D.** Tension pneumothorax

**Why:** The RCH resuscitation guideline directs the team to address reversible causes, summarised as the 4 Hs and 4 Ts: hypoxaemia, hypovolaemia, hypo or hyperthermia, hypo or hyperkalaemia, tension pneumothorax, tamponade, toxins and thrombosis. The combination of a recent central line insertion, distended neck veins, tracheal deviation and unilateral absent breath sounds identifies tension pneumothorax, which must be relieved without delay. Hypovolaemia is treated with a 10 to 20 mL/kg crystalloid bolus but here there is no history of loss. Hypoglycaemia is corrected with 10 per cent glucose 2 mL/kg, and toxins are relevant only when an ingestion is suspected.

  * **A.** Low circulating volume is one of the four Hs, but this child's tracheal deviation and unilateral absent breath sounds indicate an obstructive cause rather than blood loss.
  * **B.** Glucose is corrected with 10 per cent glucose 2 mL/kg when hypoglycaemia is present, yet the examination findings do not fit a metabolic cause.
  * **C.** Ingested poisons are among the four Ts and the poisons information centre is contacted when ingestion is suspected, which is not described in this scenario.  
Sources: The Royal Children's Hospital Melbourne. Resuscitation: hospital management of cardiopulmonary arrest. Clinical Practice Guidelines.
3. 3 / 10  
A 4-year-old boy with croup is now pale and drowsy with episodes of agitation. He has biphasic stridor at rest, marked sternal recession and poor respiratory effort, and he is being managed in a resuscitation area with senior staff present.  
Which medication regimen is most appropriate?  
Show answer

**Answer: B.** Nebulised adrenaline 5 mL of 1:1000 plus dexamethasone 0.6 mg/kg (maximum 12 mg) IM or IV

**Why:** Life-threatening croup is managed with nebulised adrenaline 5 mL of 1:1000 together with dexamethasone 0.6 mg/kg (maximum 12 mg) given intramuscularly or intravenously while the airway is prepared for intubation, so option B is correct. Adrenaline alone gives only temporary relief and does not treat the subglottic swelling, making option A inadequate. Oral prednisolone at the moderate croup dose is too weak and too slow for a child with impending airway failure, so option C is wrong. Beta-2 agonists act on the lower airway and do not relieve laryngeal oedema, so option D does not treat the obstruction.

  * **A.** Adrenaline alone provides only temporary relief, and life-threatening croup also requires systemic corticosteroid to reduce the subglottic swelling.
  * **C.** Oral steroid at the moderate croup dose is inadequate for a child with exhaustion, and it delays the adrenaline needed for imminent obstruction.
  * **D.** Beta-2 agonists act on the lower airway and do not relieve laryngeal oedema, so this combination does not treat the obstruction.  
Sources: RCH Croup (Laryngotracheobronchitis) Guideline, September 2024
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5. 4 / 10  
A 2-year-old girl is brought to the emergency department with a temperature of 38.6°C for 2 days. She has no cough, diarrhoea, rash or joint symptoms, and her examination is normal apart from the fever.  
Which investigation is most likely to identify the source of her fever?  
Show answer

**Answer: B.** Urine microscopy and culture

**Why:** Urinary tract infection is the leading cause of serious bacterial infection in young children and often presents with fever alone, so a urine sample is required to diagnose or exclude it when clinically suspected, and it should be considered when fever without focus persists. A chest X-ray, stool culture and a malaria film all have low yield in this child, who has no respiratory, gastrointestinal or travel features.

  * **A.** Chest imaging is unlikely to help because there are no respiratory signs to suggest pneumonia in this child.
  * **C.** Gastrointestinal infection is unlikely without diarrhoea or abdominal symptoms, so stool culture has a very low yield here.
  * **D.** A blood film is not indicated without a travel history or other features suggesting malaria.  
Sources: The Royal Children's Hospital Melbourne, Clinical Practice Guidelines: Urinary tract infection (last updated October 2025)
6. 5 / 10  
A 4-year-old boy with a known egg allergy received intramuscular adrenaline for anaphylaxis in the emergency department 90 minutes ago. His wheeze and urticaria have fully resolved, he is playful and drinking, and no further adrenaline has been required.  
What is the minimum observation period before he may be considered for discharge?  
Show answer

**Answer: C.** Observe until at least 4 hours have passed since the last dose of adrenaline

**Why:** Adrenaline is the definitive treatment, and observation is aimed at detecting a biphasic reaction, which can occur after apparent improvement. The guideline requires observation for at least 4 hours after the last dose of adrenaline. Thirty minutes is unsafe, immediate discharge ignores the observation period, and overnight admission is reserved for features such as multiple adrenaline doses, circulatory involvement, a severe initial reaction or a long delay to emergency care.

  * **A.** Sending him home before the observation period is complete risks missing a biphasic reaction, because discharge is only considered once he has been free of adrenaline for at least 4 hours.
  * **B.** A further 30 minutes does not meet the required minimum, which is 4 hours after the last dose of adrenaline.
  * **D.** Overnight admission is reserved for specific features such as more than 2 adrenaline doses, circulatory involvement or a more severe initial reaction, none of which apply to this boy.  
Sources: RCH Clinical Practice Guideline: Anaphylaxis (The Royal Children's Hospital Melbourne, last updated October 2025)
7. 6 / 10  
A 9-year-old child has presented three times in a year with injuries, including burns and bruising, and the explanations have changed each time. The carers have not sought timely care and have not protected the child from further harm.  
Under the Children, Youth and Families Act 2005, which ground best describes this situation?  
Show answer

**Answer: A.** The child has suffered, or is likely to suffer, significant harm from physical injury and the parents have not protected the child

**Why:** Section 162 of the Children, Youth and Families Act 2005 provides that a child is in need of protection where the child has suffered, or is likely to suffer, significant harm as a result of physical injury and the parents have not protected, or are unlikely to protect, the child from harm of that type, and harm may accumulate over a series of acts or omissions. The abandonment, parental death or incapacity, and failure to provide basic care grounds describe different circumstances from the recurring injuries seen here.

  * **B.** There is no suggestion the carers are missing or that no suitable person can be found, so the abandonment ground does not apply.
  * **C.** Nothing indicates that the parents have died or become incapacitated, so this ground is not engaged.
  * **D.** That ground concerns the failure to provide basic care or effective medical care, which is not the primary issue when injuries have been inflicted and not protected against.  
Sources: Children, Youth and Families Act 2005 (Vic) section 162, reproduced in the RCH Children in Need of Protection page
8. 7 / 10  
A 6-year-old boy has a 10-day history of persistent cough that occurs in spasms at night. He is afebrile and his chest is clear. His general practitioner wants to confirm the suspected diagnosis of pertussis.  
Which investigation is the most appropriate to confirm the diagnosis?  
Show answer

**Answer: A.** Nasopharyngeal flocked swab for PCR

**Why:** A nasopharyngeal flocked swab for PCR is the investigation of choice because it is more sensitive than culture, although the test is usually negative after 21 days of illness or 5 to 7 days after effective antibiotics. Pertussis serology is not clinically useful, a chest X-ray is reserved for unwell infants under 6 months, and lymphocytosis, while correlating with severity in young infants, is not diagnostic.

  * **B.** Serology has no clinical role in confirming this infection, so it should not be used to make the diagnosis.
  * **C.** A chest X-ray is indicated only in unwell infants under 6 months and does not confirm pertussis in a well older child.
  * **D.** Lymphocytosis may reflect severity in young infants but is not diagnostic, and blood tests are not routinely performed.  
Sources: The Royal Children's Hospital Melbourne, Clinical Practice Guidelines: Whooping cough (pertussis) (last updated May 2025)
9. 8 / 10  
A 5-year-old boy is retrieved from a cold river and has a core temperature of 32.5 degrees Celsius. He is drowsy but breathing spontaneously, with no focal neurological signs and no evidence of hypoxic brain injury. He has been dried and wrapped in blankets.  
What is the most appropriate next step in temperature management?  
Show answer

**Answer: D.** Active warming to normothermia with warmed intravenous fluids, humidified oxygen and forced air warming blankets

**Why:** Hypothermia is a common complication of drowning and affects coagulation, cardiac function and drug handling. When the core temperature is below 34 degrees Celsius and there is no evidence of brain injury, the guideline recommends active warming to normothermia with warmed intravenous fluids, humidified oxygen and forced air warming blankets, alongside removing wet clothes and minimising exposure. Passive rewarming is too slow, immersion interferes with monitoring, and therapeutic hypothermia is a separate discussion for children with hypoxic brain injury.

  * **A.** Passive rewarming alone is too slow for a core temperature of 32.5 degrees Celsius without brain injury, where active warming is indicated.
  * **B.** Therapeutic hypothermia is a separate question in children with hypoxic brain injury and must be discussed with a paediatric intensivist.
  * **C.** Immersion warming is not used because it hampers monitoring and can cause peripheral vasodilatation with further cooling of the core.  
Sources: RCH Clinical Practice Guideline: Drowning (The Royal Children's Hospital Melbourne, last updated June 2020)
10. 9 / 10  
An 11-year-old boy has a 10-hour history of gradual left scrotal discomfort. On examination the left testis is normally positioned, the cremasteric reflex is present, and there is a small tender nodule at the upper pole with a faint blue discolouration visible through the scrotal skin.  
What is the most likely diagnosis?  
Show answer

**Answer: D.** Torsion of the testicular appendage

**Why:** Torsion of the appendix testis is a common cause of acute scrotal pain in prepubertal boys and produces a tender nodule at the upper pole with a blue dot sign seen through the skin. The cremasteric reflex is preserved and the testis remains normally positioned, which helps distinguish it from testicular torsion. Epididymo-orchitis is very rarely seen between the ages of 7 and 16 years and is usually febrile, while an irreducible hernia is an infantile problem that produces a firm inguinoscrotal swelling extending from the groin.

  * **A.** A high-riding, transversely lying testis with an absent cremasteric reflex is expected in torsion, whereas this boy has a normally positioned testis and an intact reflex.
  * **B.** This infection is very rarely seen between 7 and 16 years of age and typically produces fever with tenderness of the postero-lateral testis.
  * **C.** An irreducible hernia produces a firm, tender inguinoscrotal swelling that extends to the scrotum and is seen in infants rather than this age group.  
Sources: RCH Melbourne Clinical Practice Guideline: Acute scrotal pain or swelling (2026)
11. 10 / 10  
A 4-year-old girl in childcare has had 6 days of paroxysmal cough. She was diagnosed with pertussis and started on appropriate antibiotics today. Her parents ask when she can return to childcare.  
What is the earliest she may return to childcare?  
Show answer

**Answer: D.** After she has completed 5 days of appropriate antibiotics

**Why:** Exclusion from childcare continues until the earliest of 21 days after symptom onset, 14 days after the onset of paroxysmal cough, or completion of 5 days of appropriate antibiotics. Because she started treatment today, completing 5 days of antibiotics gives the earliest safe return. Returning immediately while still infectious, waiting the full 21 days, or waiting 14 days from the paroxysmal cough would all keep her away longer than necessary.

  * **A.** She remains infectious until she has completed 5 days of treatment, so an immediate return would expose other children.
  * **B.** Twenty one days from symptom onset is only the latest of the three criteria, and earlier return is allowed once antibiotics have been taken for 5 days.
  * **C.** Fourteen days after the paroxysmal cough begins is one of the possible endpoints, but completing 5 days of antibiotics allows an earlier return.  
Sources: The Royal Children's Hospital Melbourne, Clinical Practice Guidelines: Whooping cough (pertussis) (last updated May 2025)

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