Pediatrics Prometric exam questions with answers

1. Question 1Growth, Development, Adolescent Medicine & Behavioral Pediatricseasy

   At an 18-month health review, which finding most requires prompt developmental evaluation?

   1. AUses about 10 single words but no two-word phrases
   2. BLoss of words he used regularly at 14 months
   3. CCannot yet jump with both feet together
   4. DWalks with a wide-based gait and falls occasionally
   Show answer and explanation▾

   Answer: B. Loss of words he used regularly at 14 months

   Loss of previously acquired language or social skills at any age is a red flag that needs prompt evaluation, including autism assessment and hearing testing. Using around 10 words without phrases is within the normal range at 18 months, as two-word combinations are expected by about 24 months. A wide-based gait with occasional falls is typical of a new walker, and jumping with both feet usually develops around 2 years.

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

   A term breastfed infant is noted to be visibly jaundiced at 16 hours of age. The mother is blood group O RhD positive. What is the most appropriate next step?

   1. AEncourage more frequent breastfeeds and review on day 5
   2. BStop breastfeeding and give formula for 48 hours
   3. CMeasure serum bilirubin urgently, with blood group and direct antiglobulin test
   4. DReassure the parents that this is physiological jaundice
   Show answer and explanation▾

   Answer: C. Measure serum bilirubin urgently, with blood group and direct antiglobulin test

   Jaundice in the first 24 hours of life is pathological until proven otherwise and requires an urgent serum bilirubin measurement plotted on a treatment threshold chart, plus investigation for haemolysis such as ABO incompatibility, which is likely with a group O mother. Physiological jaundice does not appear before 24 hours. Interrupting breastfeeding does not address the cause and is not recommended.

3. Question 3Neonatology & Perinatal Medicine (NICU)hard

   A 3-day-old term infant who fed well initially develops sudden bilious vomiting. The abdomen is soft and not distended, and he is haemodynamically stable. An abdominal radiograph shows a few gas-filled loops without obstruction. What is the most appropriate investigation?

   1. AUrgent upper gastrointestinal contrast study
   2. BContrast enema to exclude Hirschsprung disease
   3. CAbdominal ultrasound to look for pyloric stenosis
   4. DRepeat abdominal radiograph in 12 hours
   Show answer and explanation▾

   Answer: A. Urgent upper gastrointestinal contrast study

   Bilious vomiting in a neonate is malrotation with midgut volvulus until proven otherwise, and a non-distended abdomen with an unremarkable radiograph does not exclude it. An urgent upper GI contrast study showing the position of the duodenojejunal flexure is the investigation of choice in a stable infant, while an unstable infant goes directly to laparotomy. Pyloric stenosis causes non-bilious vomiting, and waiting risks bowel infarction.

4. Question 4Acute Care, Pediatric Emergency & Critical Care (PICU)medium

   A 2-year-old (12 kg) with fever has cold peripheries, a capillary refill time of 5 seconds and a heart rate of 180/min, and is diagnosed with septic shock in a hospital with intensive care. After intravenous access and antibiotics, which initial fluid resuscitation is most appropriate?

   1. AMaintenance fluids only, to avoid fluid overload
   2. BBoluses of 20 mL/kg 5% dextrose solution
   3. CBoluses of 10 to 20 mL/kg balanced crystalloid, reassessing after each
   4. D4.5% human albumin as the first-line bolus fluid
   Show answer and explanation▾

   Answer: C. Boluses of 10 to 20 mL/kg balanced crystalloid, reassessing after each

   International paediatric sepsis guidance recommends boluses of 10 to 20 mL/kg, preferably of balanced crystalloid, with reassessment for response and signs of fluid overload after each, up to about 40 to 60 mL/kg in the first hour where intensive care is available. Withholding boluses in a child with shock is harmful. Albumin is not recommended as the initial fluid, and dextrose solutions are not resuscitation fluids.

5. Question 5Acute Care, Pediatric Emergency & Critical Care (PICU)medium

   A 15 kg 3-year-old develops stridor, generalised urticaria and hypotension after eating cashew nuts. What is the correct dose of intramuscular adrenaline (1 mg/mL)?

   1. A0.5 mg (0.5 mL)
   2. B1.5 mg (1.5 mL)
   3. C0.015 mg (0.015 mL)
   4. D0.15 mg (0.15 mL)
   Show answer and explanation▾

   Answer: D. 0.15 mg (0.15 mL)

   The intramuscular adrenaline dose in anaphylaxis is 0.01 mg/kg of the 1 mg/mL solution, up to a maximum single dose of 0.5 mg, which gives 0.15 mg for this child; this also matches the 150 microgram dose used for young children. The 0.5 mg dose is the adult or older child maximum. A tenfold error in either direction is a recognised medication safety risk, so doses should be double-checked.

6. Question 6Infectious Diseases, Immunology & Allergyhard

   A well-appearing 15-day-old term infant has a rectal temperature of 38.4 C with no focus of infection. What is the most appropriate management?

   1. AInflammatory markers first to decide whether lumbar puncture is needed
   2. BUrinalysis, blood culture and lumbar puncture, then admission for parenteral antibiotics
   3. COral amoxicillin and outpatient review
   4. DUrinalysis only, with discharge and review in 24 hours if negative
   Show answer and explanation▾

   Answer: B. Urinalysis, blood culture and lumbar puncture, then admission for parenteral antibiotics

   Febrile infants aged 8 to 21 days have a high rate of serious bacterial infection and inflammatory markers are not reliable enough to exclude meningitis, so current AAP guidance recommends urinalysis, blood culture and CSF analysis followed by admission and parenteral antibiotics. Using inflammatory markers to decide on lumbar puncture applies to well-appearing infants aged 22 to 28 days. Outpatient management is not appropriate at this age.

7. Question 7Infectious Diseases, Immunology & Allergyhard

   A 4-year-old boy has had a Staphylococcus aureus liver abscess, Serratia marcescens osteomyelitis and pulmonary aspergillosis. Which test is most appropriate to confirm the likely diagnosis?

   1. AFlow cytometry for CD18 expression
   2. BLymphocyte subset count
   3. CDihydrorhodamine flow cytometry
   4. DSerum immunoglobulin levels
   Show answer and explanation▾

   Answer: C. Dihydrorhodamine flow cytometry

   Recurrent deep infections with catalase-positive organisms such as S. aureus, Serratia and Aspergillus suggest chronic granulomatous disease, a defect of the phagocyte NADPH oxidase. The dihydrorhodamine flow cytometry test shows absent or reduced oxidative burst and is the preferred screening test, followed by genetic testing. CD18 deficiency causes leukocyte adhesion deficiency with delayed cord separation and absent pus, and immunoglobulins and lymphocyte subsets assess humoral and T cell defects.

8. Question 8Respiratory Medicineeasy

   A 4-month-old has 3 days of coryza, cough, fine crackles and wheeze. Respiratory rate is 54/min, SpO2 is 95% in air and she is feeding adequately. What is the most appropriate management?

   1. ASupportive care with advice on feeding and when to seek help
   2. BOral prednisolone for 3 days
   3. CA trial of nebulised salbutamol
   4. DOral amoxicillin for 5 days
   Show answer and explanation▾

   Answer: A. Supportive care with advice on feeding and when to seek help

   This is mild bronchiolitis, which is managed supportively at home with safety-net advice about worsening breathing, poor feeding or apnoea. Bronchodilators, corticosteroids and antibiotics do not improve outcomes in bronchiolitis and are not recommended by AAP or NICE guidance. Admission is indicated for hypoxaemia, apnoea, severe distress or inadequate feeding.

9. Question 9Cardiovascular Medicinemedium

   A 5-month-old with unrepaired tetralogy of Fallot becomes irritable, deeply cyanosed and hyperpnoeic after crying, and his systolic murmur becomes softer. After calming him and placing him in the knee-to-chest position with oxygen, he remains cyanosed. Which is the most appropriate next drug?

   1. AFurosemide
   2. BDigoxin
   3. CMorphine
   4. DAdenosine
   Show answer and explanation▾

   Answer: C. Morphine

   During a hypercyanotic spell, infundibular spasm increases right-to-left shunting, which softens the murmur. Management is knee-chest positioning, oxygen, then morphine to reduce agitation and hyperpnoea, followed by fluid bolus, phenylephrine to raise systemic resistance and intravenous beta-blockade if needed. Digoxin and furosemide do not relieve outflow obstruction, and adenosine is for supraventricular tachycardia.

10. Question 10Gastroenterology, Hepatology & Nutritionmedium

    A 5-week-old boy has projectile non-bilious vomiting. A venous gas shows pH 7.52, chloride 86 mmol/L, potassium 2.9 mmol/L and bicarbonate 34 mmol/L. Ultrasound confirms pyloric stenosis. What is the most appropriate next step?

    1. AIntravenous fluid resuscitation and electrolyte correction before pyloromyotomy
    2. BEmergency pyloromyotomy within the hour
    3. CIntravenous erythromycin to relax the pylorus
    4. DOral rehydration solution followed by early surgery
    Show answer and explanation▾

    Answer: A. Intravenous fluid resuscitation and electrolyte correction before pyloromyotomy

    Pyloric stenosis causes a hypochloraemic, hypokalaemic metabolic alkalosis, and pyloromyotomy is not an emergency; the infant needs intravenous fluids with sodium chloride and potassium until chloride and bicarbonate normalise, because uncorrected alkalosis increases the risk of postoperative apnoea. Oral feeds should be withheld. Erythromycin is not standard first-line treatment.

11. Question 11Endocrinology, Metabolic Disease & Geneticshard

    A 10-day-old boy with normal genitalia presents with vomiting, lethargy and poor weight gain. Sodium is 122 mmol/L, potassium 7.1 mmol/L and glucose 2.4 mmol/L. What is the most appropriate immediate treatment?

    1. AIntravenous 0.9% sodium chloride and oral fludrocortisone only
    2. BIntravenous 0.9% sodium chloride, intravenous dextrose and intravenous hydrocortisone
    3. CIntravenous calcium gluconate and insulin-dextrose only
    4. DIntravenous hydrocortisone only after a synacthen test result is available
    Show answer and explanation▾

    Answer: B. Intravenous 0.9% sodium chloride, intravenous dextrose and intravenous hydrocortisone

    Hyponatraemia, hyperkalaemia and hypoglycaemia in the second week of life in a boy with normal genitalia suggest a salt-wasting adrenal crisis from 21-hydroxylase deficiency. After taking samples (including 17-hydroxyprogesterone, cortisol and renin), treatment is immediate saline, dextrose and stress-dose hydrocortisone, which also has mineralocorticoid activity at high doses. Treatment must not be delayed for test results, and calcium or insulin alone do not treat the underlying crisis.

12. Question 12Hematology & Oncologymedium

    A 4-year-old girl has had petechiae and bruising for 2 days, 3 weeks after a viral illness. She is well, with no mucosal bleeding, lymphadenopathy or hepatosplenomegaly. Platelets are 14 x10^9/L, and the haemoglobin, white cell count and blood film are otherwise normal. What is the most appropriate management?

    1. ABone marrow aspirate before any decision
    2. BPlatelet transfusion
    3. COral prednisolone for 4 weeks
    4. DObservation with parental education, without drug treatment
    Show answer and explanation▾

    Answer: D. Observation with parental education, without drug treatment

    In typical childhood immune thrombocytopenia with no or only skin bleeding, international guidance recommends observation regardless of platelet count, as most children recover within months and serious bleeding is rare. Bone marrow examination is not needed when the features are typical. Corticosteroids are reserved for significant bleeding and, if used, should be short courses rather than prolonged therapy, and platelet transfusion is only for life-threatening bleeding.

13. Question 13Nephrology, Urology, Fluids & Electrolyteseasy

    An 8-year-old has cola-coloured urine, periorbital oedema and hypertension 2 weeks after a sore throat. Which serum complement pattern is most consistent with the likely diagnosis?

    1. ALow C3 with normal C4
    2. BNormal C3 and C4 with positive anti-GBM antibodies
    3. CNormal C3 and C4 with raised IgA
    4. DLow C3 and low C4
    Show answer and explanation▾

    Answer: A. Low C3 with normal C4

    Post-streptococcal glomerulonephritis activates the alternative complement pathway, giving a low C3 with a normal C4, and C3 usually normalises within 6 to 8 weeks; persistence suggests another diagnosis such as C3 glomerulopathy. Low C3 and C4 together suggests classical pathway activation, as in lupus nephritis. IgA nephropathy causes haematuria within a day or two of a respiratory infection with normal complement.

14. Question 14Neurology & Neurodevelopmental Disorderseasy

    A 20-month-old has a 2-minute generalised seizure on the first day of a febrile viral illness and has fully recovered within an hour. Neurological examination is normal and there are no meningeal signs. What is the most appropriate management?

    1. AStart daily levetiracetam prophylaxis
    2. BTreat the fever source and reassure; no routine EEG or neuroimaging
    3. CArrange an EEG and MRI of the brain
    4. DPerform a lumbar puncture as routine
    Show answer and explanation▾

    Answer: B. Treat the fever source and reassure; no routine EEG or neuroimaging

    A brief generalised seizure without recurrence in 24 hours in a febrile child aged 6 months to 5 years who recovers fully is a simple febrile seizure. AAP guidance advises against routine EEG, neuroimaging or blood tests, and lumbar puncture is only indicated if there are meningeal signs or other features suggesting CNS infection. Continuous antiseizure prophylaxis is not recommended because risks outweigh benefits.

15. Question 15Musculoskeletal, Rheumatology, Dermatology & ENT/Eyemedium

    A 6-year-old boy has palpable purpura on the buttocks and legs, knee arthralgia and colicky abdominal pain. Platelet count, urinalysis and blood pressure are normal. Which follow-up is most important?

    1. AEchocardiography at 2 and 6 weeks
    2. BWeekly platelet counts for 2 months
    3. CSkin biopsy before discharge
    4. DSerial urinalysis and blood pressure checks for at least 6 months
    Show answer and explanation▾

    Answer: D. Serial urinalysis and blood pressure checks for at least 6 months

    In IgA vasculitis (Henoch-Schonlein purpura), nephritis may develop weeks to months after the rash, so urine and blood pressure should be monitored for at least 6 months, with referral for persistent proteinuria, hypertension or impaired renal function. The platelet count is normal by definition. Echocardiography is required in Kawasaki disease, not IgA vasculitis, and a skin biopsy is not needed in a typical presentation.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.