PLAB 1 Paediatrics

Question 1

A 3-year-old child presents to A&E with a barking cough, stridor at rest, and mild chest wall recession. According to NICE guidelines, what is the most appropriate initial management?

Accepted Answer

Single dose of oral dexamethasone (0.15 mg/kg)

Answer

This presentation is consistent with moderate croup (viral laryngotracheobronchitis). NICE recommends a single dose of oral dexamethasone (0.15 mg/kg) for all children presenting with croup. Nebulised adrenaline is reserved for severe croup with significant respiratory distress.

Question 2

A 6-week-old infant is brought to the GP with projectile vomiting after every feed for the past week. On examination, a small olive-shaped mass is palpable in the right upper quadrant. What is the most likely diagnosis?

Accepted Answer

Pyloric stenosis

Answer

Pyloric stenosis typically presents at 2-8 weeks of age with progressive projectile non-bilious vomiting. A palpable 'olive' in the right upper quadrant is the classic examination finding. It is more common in firstborn males. Diagnosis is confirmed by ultrasound and treated with Ramstedt's pyloromyotomy.

Question 3

A 2-year-old child presents with a 5-day history of high fever (>39°C), bilateral non-purulent conjunctival injection, strawberry tongue, cervical lymphadenopathy, and a polymorphous rash. What is the most likely diagnosis?

Accepted Answer

Kawasaki disease

Answer

Kawasaki disease requires fever for ≥5 days plus at least 4 of 5 criteria: bilateral conjunctival injection, oral mucosal changes (strawberry tongue, cracked lips), polymorphous rash, cervical lymphadenopathy, and extremity changes. Treatment with IV immunoglobulin and aspirin reduces the risk of coronary artery aneurysms.

Question 4

A 4-year-old child is brought to A&E with sudden onset of drooling, high fever, and sitting in a tripod position. The child appears toxic and has a muffled voice. What is the most likely diagnosis and immediate priority?

Accepted Answer

Acute epiglottitis — do not examine the throat; call senior anaesthetist for airway management

Answer

Acute epiglottitis presents with the 4 D's: Drooling, Dysphagia, Dysphonia, and Distress. The child often adopts a tripod position. It is a life-threatening airway emergency. Do NOT examine the throat (risk of complete airway obstruction). Call a senior anaesthetist immediately for controlled airway management.

Question 5

According to the UK immunisation schedule, at what age should a child receive their first dose of the MMR vaccine?

Accepted Answer

12 months (on or after their first birthday)

Answer

The UK childhood immunisation schedule recommends the first dose of MMR vaccine at 12 months of age (on or after the first birthday). The second dose is given at 3 years 4 months (pre-school booster). MMR protects against measles, mumps, and rubella.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 Paediatrics