Pediatrics Prometric exam questions

The Pediatrics exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Pediatrics practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Acute Care, Pediatric Emergency & Critical Care (PICU)

   A 12-year-old in status asthmaticus is intubated for exhaustion and ventilated. Minutes later his blood pressure falls to 70/40 mmHg, saturations drop and peak inspiratory pressures rise sharply. Breath sounds are symmetrically reduced and the trachea is central. What is the most appropriate immediate action?

   1. AIncrease the ventilator respiratory rate to improve carbon dioxide clearance
   2. BGive a further 20 mL/kg fluid bolus and start adrenaline infusion
   3. CDisconnect the child from the ventilator and apply gentle manual chest compression to allow full exhalation
   4. DPerform immediate bilateral needle thoracocentesis
   Show answer and explanation

   Correct answer: C. Disconnect the child from the ventilator and apply gentle manual chest compression to allow full exhalation

   This picture is classic dynamic hyperinflation with breath stacking and auto-PEEP, which impedes venous return and causes hypotension; disconnecting the circuit and allowing prolonged exhalation, aided by chest compression, is both diagnostic and immediately therapeutic. Increasing the rate shortens expiratory time and worsens the problem. Tension pneumothorax is a differential but breath sounds are symmetrical and the trachea central, so blind bilateral needle decompression is not the first move; fluids and inotropes address the consequence rather than the cause.

   Reference: Nelson Textbook of Pediatrics, 21st Edition (2020), Mechanical Ventilation in Status Asthmaticus

2. Question 2 · Neonatology & Perinatal Medicine (NICU)

   An infant born at 26 weeks of gestation weighing 780 g is stable in the neonatal unit. When should the first retinopathy of prematurity screening examination be performed?

   1. AAt 4 weeks of chronological age, that is 30 weeks postmenstrual age
   2. BAt 31 weeks postmenstrual age
   3. CAt 36 weeks postmenstrual age or at discharge, whichever is sooner
   4. DOnly if the infant has required more than 28 days of supplemental oxygen
   Show answer and explanation

   Correct answer: B. At 31 weeks postmenstrual age

   For infants born at 22 to 27 weeks of gestation the first retinopathy of prematurity examination is scheduled at 31 weeks postmenstrual age, whereas infants born at 28 weeks or later are first examined at 4 weeks of chronological age. Screening is offered on the basis of gestational age of 30 weeks or less or birth weight of 1500 g or less, or on clinician judgement for larger unstable infants, and is not conditional on the duration of oxygen therapy. Examinations continue at intervals determined by the findings until the retina is fully vascularised or the criteria for regression are met.

   Reference: American Academy of Pediatrics, American Academy of Ophthalmology and AAPOS joint Screening Examination of Premature Infants for Retinopathy of Prematurity, Pediatrics 2018

3. Question 3 · Respiratory Medicine

   A 5-year-old with pneumococcal pneumonia remains febrile and hypoxic on day 4 of intravenous antibiotics. Ultrasound shows a large right pleural collection with dense septations and loculation occupying more than half the hemithorax. What is the most appropriate next step?

   1. AContinue intravenous antibiotics alone for a further 72 hours
   2. BPerform a single diagnostic and therapeutic needle thoracentesis
   3. CInsert a chest drain and give intrapleural fibrinolytic therapy
   4. DProceed directly to open thoracotomy and decortication
   Show answer and explanation

   Correct answer: C. Insert a chest drain and give intrapleural fibrinolytic therapy

   A large, septated (fibrinopurulent-stage) empyema causing ongoing fever and respiratory compromise requires drainage; small-bore chest tube insertion with intrapleural fibrinolytics such as urokinase or alteplase is the recommended first-line intervention and has outcomes equivalent to video-assisted thoracoscopic surgery at lower cost and morbidity. Antibiotics alone will not clear a loculated collection, simple thoracentesis cannot drain septated fluid durably, and open thoracotomy is reserved for failure of drainage plus fibrinolysis or VATS.

   Reference: British Thoracic Society Guidelines for the Management of Pleural Infection in Children (Thorax, 2005) and subsequent randomised trials of intrapleural urokinase; Nelson Textbook of Pediatrics, 22nd edition

4. Question 4 · Endocrinology, Metabolic Disease & Genetics

   A 9-year-old boy has short stature, a broad webbed neck, widely spaced nipples, pectus excavatum, bilateral ptosis with hypertelorism and low-set posteriorly rotated ears. Echocardiography shows moderate valvular pulmonary stenosis with a thickened dysplastic pulmonary valve, and his karyotype is 46,XY. Which is the most likely diagnosis?

   1. ATurner syndrome with 45,X/46,XY mosaicism
   2. BNoonan syndrome
   3. CWilliams syndrome
   4. DKlinefelter syndrome
   Show answer and explanation

   Correct answer: B. Noonan syndrome

   Noonan syndrome, most often caused by a gain-of-function PTPN11 variant in the RAS-MAPK pathway, produces short stature, a webbed neck, chest deformity, ptosis and characteristically a dysplastic pulmonary valve or hypertrophic cardiomyopathy, with a normal karyotype in a phenotypic male. Turner syndrome requires an abnormal karyotype and is typically associated with bicuspid aortic valve and coarctation rather than a dysplastic pulmonary valve. Williams syndrome causes supravalvular aortic stenosis with a distinctive sociable personality and infantile hypercalcaemia, and Klinefelter syndrome (47,XXY) causes tall stature with hypogonadism, not short stature with a webbed neck.

   Reference: Roberts et al., Noonan syndrome, The Lancet, 2013; Smith's Recognizable Patterns of Human Malformation, 8th edition (2022)

5. Question 5 · Hematology & Oncology

   A 13-year-old girl presents with fatigue, gum bleeding and extensive bruising. White cell count is 3.2 x10^9/L with abnormal promyelocytes containing multiple Auer rods, platelets 18 x10^9/L, fibrinogen 0.7 g/L, prolonged PT and raised D-dimer. Molecular testing confirms PML-RARA fusion. Which action is most urgent?

   1. AImmediate leukapheresis
   2. BStart all-trans retinoic acid (ATRA) without waiting for full cytogenetic confirmation, with aggressive blood product support
   3. CStart high-dose cytarabine induction chemotherapy
   4. DAdminister intrathecal methotrexate for central nervous system prophylaxis
   Show answer and explanation

   Correct answer: B. Start all-trans retinoic acid (ATRA) without waiting for full cytogenetic confirmation, with aggressive blood product support

   This is acute promyelocytic leukaemia with life-threatening coagulopathy, where early death from haemorrhage is the principal risk. ATRA should be started as soon as the diagnosis is suspected clinically or morphologically, alongside aggressive transfusion of platelets and cryoprecipitate/fibrinogen, because it rapidly reverses the coagulopathy. Leukapheresis is contraindicated in APL as it can worsen the coagulopathy, conventional intensive chemotherapy or intrathecal therapy before correcting coagulopathy increases bleeding risk, and neither addresses the immediate threat.

   Reference: Nelson Textbook of Pediatrics, 21st ed. (2020); European LeukemiaNet recommendations for the management of acute promyelocytic leukemia (2019)

6. Question 6 · Neurology & Neurodevelopmental Disorders

   A 10-year-old girl has a confirmed diagnosis of tuberous sclerosis complex with a pathogenic TSC2 variant, facial angiofibromas, cortical tubers and well-controlled epilepsy. She is asymptomatic at her annual review. Which surveillance investigation is specifically recommended as part of her routine long-term follow-up?

   1. AAbdominal MRI every one to three years to detect renal angiomyolipoma and cysts
   2. BAnnual bone marrow aspiration
   3. CAnnual colonoscopy from age 10 years
   4. DAnnual thyroid ultrasonography
   Show answer and explanation

   Correct answer: A. Abdominal MRI every one to three years to detect renal angiomyolipoma and cysts

   Renal angiomyolipoma is the leading cause of death in adults with tuberous sclerosis complex because of haemorrhage risk, so consensus surveillance includes abdominal MRI every one to three years throughout life, alongside serial brain MRI for subependymal giant cell astrocytoma until at least age 25, blood pressure and renal function checks, routine EEG, dermatological and ophthalmological review, and neuropsychiatric (TAND) screening. Bone marrow examination, colonoscopy and thyroid ultrasound are not part of tuberous sclerosis surveillance. mTOR inhibitors such as everolimus are used for growing angiomyolipomas and giant cell astrocytomas.

   Reference: Krueger DA & Northrup H, International Tuberous Sclerosis Complex Consensus Group surveillance and management recommendations (Pediatric Neurology, 2013; updated 2021)

7. Question 7 · Musculoskeletal, Rheumatology, Dermatology & ENT/Eye

   A 9-year-old boy has had constant thoracic back pain for 7 weeks that wakes him at night. He has lost 3 kg, walks with a stiff, guarded spine, and has an area of localised tenderness over T8. Which is the most appropriate next investigation?

   1. AReassurance and a postural exercise programme
   2. BUrgent MRI of the whole spine
   3. CBone densitometry (DXA)
   4. DStanding scoliosis radiograph only
   Show answer and explanation

   Correct answer: B. Urgent MRI of the whole spine

   Back pain in a prepubertal child that is persistent, nocturnal, focally tender and accompanied by weight loss and spinal rigidity carries a high probability of serious pathology such as infection (discitis, vertebral osteomyelitis, tuberculosis), malignancy or a spinal cord lesion, so urgent MRI of the whole spine is required. Reassurance and exercise are appropriate only for mechanical pain without red flags, DXA addresses bone density rather than a focal lesion, and a plain scoliosis film is insensitive for early infection and marrow infiltration.

   Reference: Nelson Textbook of Pediatrics, 22nd ed. (Elsevier, 2024); RCPCH/NICE guidance on red flags in childhood back pain

8. Question 8 · Infectious Diseases, Immunology & Allergy

   A 9-year-old boy who acquired hepatitis B perinatally is reviewed. He is asymptomatic with a normal examination. HBsAg is positive, HBeAg positive, anti-HBe negative, HBV DNA is very high, and ALT is persistently normal on repeated testing. Liver ultrasound is normal. What is the most appropriate management?

   1. AStart pegylated interferon alfa immediately
   2. BStart tenofovir monotherapy immediately
   3. CContinue regular monitoring of ALT, HBV DNA and HBeAg status without antiviral therapy at present
   4. DGive a booster course of hepatitis B vaccine to induce seroconversion
   Show answer and explanation

   Correct answer: C. Continue regular monitoring of ALT, HBV DNA and HBeAg status without antiviral therapy at present

   HBeAg positivity with very high HBV DNA and persistently normal ALT describes the immune-tolerant phase of chronic hepatitis B, in which antiviral therapy achieves poor rates of sustained response and is not recommended; regular surveillance for transition to the immune-active phase is the correct approach. Interferon and nucleos(t)ide analogues are indicated when ALT is persistently elevated with evidence of necroinflammation or fibrosis, and vaccination does not treat established infection.

   Reference: AASLD Hepatitis B Guidance (2018); ESPGHAN position paper on chronic hepatitis B in children (2013); EASL Clinical Practice Guidelines on HBV (2017)

9. Question 9 · Growth, Development, Adolescent Medicine & Behavioral Pediatrics

   A 13-year-old boy has a BMI on the 98th percentile and acanthosis nigricans over the posterior neck. He is otherwise asymptomatic. Which set of investigations is the most appropriate comorbidity screen?

   1. AFasting glucose or HbA1c, fasting lipid profile and ALT
   2. BSerum cortisol, growth hormone stimulation test and karyotype
   3. CThyroid ultrasound and antithyroid antibodies
   4. DAbdominal CT and fasting insulin only
   Show answer and explanation

   Correct answer: A. Fasting glucose or HbA1c, fasting lipid profile and ALT

   Guidelines recommend screening every child aged 10 years or older with obesity for dysglycaemia (fasting glucose, HbA1c or oral glucose tolerance test), dyslipidaemia (fasting lipid panel) and metabolic dysfunction-associated fatty liver disease (ALT), together with blood pressure measurement. Endocrine and genetic causes are pursued only when growth is decelerating or there is dysmorphism or developmental delay, since obese children with an endogenous cause are typically short. Thyroid imaging and abdominal CT are not screening tests, and isolated fasting insulin is not recommended.

   Reference: Hampl SE et al., AAP Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity (Pediatrics, 2023)

10. Question 10 · Gastroenterology, Hepatology & Nutrition

    A 9-month-old, exclusively breastfed by a mother following a strict vegan diet without supplementation, presents with pallor, hypotonia, developmental regression and irritability. Haemoglobin is 8 g/dL with an MCV of 105 fL and hypersegmented neutrophils. Which deficiency is most likely?

    1. AIron deficiency
    2. BVitamin B12 (cobalamin) deficiency
    3. CZinc deficiency
    4. DVitamin A deficiency
    Show answer and explanation

    Correct answer: B. Vitamin B12 (cobalamin) deficiency

    Infantile cobalamin deficiency from an unsupplemented vegan maternal diet classically causes megaloblastic (macrocytic) anaemia with hypersegmented neutrophils together with hypotonia, irritability and developmental regression, and it requires prompt B12 replacement to limit neurological sequelae. Iron deficiency produces a microcytic, not macrocytic, anaemia. Zinc deficiency causes acrodermatitis-like perioral and perianal rash with diarrhoea, and vitamin A deficiency causes xerophthalmia and night blindness rather than macrocytosis.

    Reference: Nelson Textbook of Pediatrics, 22nd ed.; WHO/UNICEF guidance on vitamin and mineral deficiencies in infancy

11. Question 11 · Cardiovascular Medicine

    A 7-month-old infant has had fever for 7 days with no identified source. The only clinical finding is bilateral bulbar conjunctival injection. CRP is 95 mg/L, ESR 68 mm/h, platelets 620 x 10^9/L, albumin 28 g/L, ALT 90 U/L, and urinalysis shows 15 white cells per high-power field with a sterile culture. What is the most appropriate next step?

    1. AContinue observation and repeat inflammatory markers in 72 hours
    2. BTreat empirically for urinary tract infection with intravenous antibiotics only
    3. CObtain an echocardiogram and treat as incomplete Kawasaki disease
    4. DPerform a bone marrow aspirate to exclude leukaemia
    Show answer and explanation

    Correct answer: C. Obtain an echocardiogram and treat as incomplete Kawasaki disease

    Infants under 12 months frequently present with incomplete Kawasaki disease and are at the highest risk of coronary aneurysms, so unexplained fever of 7 days or more with raised CRP or ESR plus three or more supplemental laboratory findings (anaemia, platelets 450 x 10^9/L or more after day 7, albumin 30 g/L or less, elevated ALT, sterile pyuria, white cells 15 x 10^9/L or more) warrants echocardiography and treatment. Sterile pyuria is part of the Kawasaki picture rather than evidence of urinary infection, and delaying treatment for observation forfeits the therapeutic window. There is nothing here to suggest leukaemia.

    Reference: AHA Scientific Statement: Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease, Circulation (2017)

12. Question 12 · Hematology & Oncology

    A 13-year-old girl presents with facial and neck swelling, distended neck veins, cough and orthopnoea that worsens when she lies flat. Chest radiograph shows a large anterior mediastinal mass with tracheal narrowing and a moderate right pleural effusion. Which approach to obtaining a tissue diagnosis is safest?

    1. AGeneral anaesthesia with supine thoracotomy and open biopsy of the mass
    2. BLeast invasive sampling first, such as pleural fluid cytology or peripheral blood/bone marrow, under local anaesthesia with the patient upright
    3. CImmediate empiric corticosteroids for 72 hours before any attempt at tissue sampling
    4. DRigid bronchoscopy under deep sedation to biopsy the airway
    Show answer and explanation

    Correct answer: B. Least invasive sampling first, such as pleural fluid cytology or peripheral blood/bone marrow, under local anaesthesia with the patient upright

    Superior vena cava syndrome with a large anterior mediastinal mass carries a serious risk of cardiorespiratory collapse under general anaesthesia or deep sedation, because loss of muscle tone and the supine position can cause complete airway or great-vessel compression that cannot be relieved. The safest strategy is to obtain diagnostic material by the least invasive route under local anaesthesia with the patient upright, such as pleural fluid cytology, peripheral blood, bone marrow or a peripheral node. Empiric steroids or radiotherapy are reserved for a critically compromised child in whom no tissue can be obtained, because they can obscure the histological diagnosis.

    Reference: Nelson Textbook of Pediatrics, 21st ed. (2020); Children's Oncology Group guidance on the anterior mediastinal mass

Pediatrics reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Pediatrics questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.