A 4-year-old has puffy eyes and swollen legs for one week. Urine: protein 4+, no red cells. Serum albumin 1.8 g/dL (normal 3.5-5), cholesterol 380 mg/dL (normal below 200), blood pressure 96/60 mmHg. The most likely diagnosis is:

Acute post-streptococcal glomerulonephritis

Which daily measurement best monitors the progress of hydrocephalus in an infant?

Occipitofrontal head circumference

Chest circumference at the nipples

A 2-year-old with tetralogy of Fallot cries during a blood draw, becomes deeply blue and breathes fast and deep. What should the nurse do first?

Place the child in the knee-chest position

Lay the child flat with the legs lowered

Sit the child upright in high Fowler's position

Start chest compressions at 100 per minute

After cleft lip repair, the infant should be positioned:

On the back or side, never lying prone

Flat on the abdomen with the head turned

Prone with the face on a soft pillow

Prone, so that secretions drain freely

Common childhood illnesses and emergencies

26 AIIMS NORCET (Nursing Officer) practice questions on Common childhood illnesses and emergencies, part of Paediatric Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Hard
A 4-year-old has puffy eyes and swollen legs for one week. Urine: protein 4+, no red cells. Serum albumin 1.8 g/dL (normal 3.5-5), cholesterol 380 mg/dL (normal below 200), blood pressure 96/60 mmHg. The most likely diagnosis is:
1. ACongestive cardiac failure
2. BNephrotic syndrome
3. CAcute post-streptococcal glomerulonephritis
4. DAcute pyelonephritis
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Answer: B · Nephrotic syndrome
Heavy proteinuria, albumin below 2.5 g/dL, oedema and high cholesterol are the four features of nephrotic syndrome. Normal blood pressure and no haematuria make minimal change disease the likely type in a 4-year-old. Albumin is lost in the urine, plasma oncotic pressure falls and fluid moves into the tissues, starting around the eyes. The liver makes more lipoprotein, which raises the cholesterol.
- A: Heart failure does not cause 4+ proteinuria and very low albumin.
- C: Post-streptococcal GN gives haematuria, hypertension and oliguria, with only mild proteinuria.
- D: Pyelonephritis gives fever and pyuria, not massive proteinuria.
Question 2 · Easy
Which daily measurement best monitors the progress of hydrocephalus in an infant?
1. AChest circumference at the nipples
2. BLength from crown to heel
3. COccipitofrontal head circumference
4. DMid-upper arm circumference
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Answer: C · Occipitofrontal head circumference
In an infant whose sutures are still open, a build-up of CSF enlarges the skull, so head circumference rises faster than normal. The nurse measures the occipitofrontal circumference at the same point each day and plots it on a chart. The nurse also checks the anterior fontanelle for bulging and looks for sunset eyes. A rapid rise after shunt surgery suggests that the shunt is not working.
- A: Chest circumference is compared with head size in growth checks, not used to follow hydrocephalus.
- B: Length shows linear growth and does not reflect CSF build-up.
- D: MUAC is a nutrition screen, not a measure of head growth.
Question 3 · Medium
A 3-year-old on day 4 of treatment for staphylococcal pneumonia suddenly becomes breathless and restless, and breath sounds are absent over the right chest. The most likely complication is:
1. APyopneumothorax
2. BFebrile seizure
3. CBronchiolitis
4. DPulmonary oedema
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Answer: A · Pyopneumothorax
Staphylococcal pneumonia destroys lung tissue and forms abscesses and thin-walled pneumatoceles. These can rupture into the pleura, causing pyopneumothorax with sudden distress and absent breath sounds on one side. The nurse gives oxygen, places the child upright and informs the doctor, as an urgent chest X-ray and intercostal drain are needed. Empyema is also common with this organism.
- B: A seizure does not cause one-sided absent breath sounds.
- C: Bronchiolitis is a viral infection of infants with wheeze on both sides.
- D: Pulmonary oedema gives crackles on both sides, not a silent hemithorax.
Question 4 · Medium
A 2-year-old with tetralogy of Fallot cries during a blood draw, becomes deeply blue and breathes fast and deep. What should the nurse do first?
1. ALay the child flat with the legs lowered
2. BSit the child upright in high Fowler's position
3. CPlace the child in the knee-chest position
4. DStart chest compressions at 100 per minute
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Answer: C · Place the child in the knee-chest position
This is a hypercyanotic (tet) spell, in which crying increases right-to-left shunting across the VSD. Bringing the knees up to the chest, as in squatting, raises systemic vascular resistance and reduces venous return from the legs, so more blood flows to the lungs. The nurse calms the child and gives oxygen. Morphine and other drugs follow if the spell persists.
- A: Lowering the legs does not raise systemic resistance and does not reverse the shunt.
- B: Upright sitting does not increase systemic resistance as squatting does.
- D: The child is breathing and has a pulse, so compressions are not indicated.
Question 5 · Medium
After cleft lip repair, the infant should be positioned:
1. AFlat on the abdomen with the head turned
2. BOn the back or side, never lying prone
3. CProne with the face on a soft pillow
4. DProne, so that secretions drain freely
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Answer: B · On the back or side, never lying prone
The lip suture line must not be rubbed or pressed against the bedding. The infant is therefore kept on the back or side, or in an infant seat, and never placed prone. Elbow restraints stop the hands reaching the face, and the suture line is kept clean. Crying is limited because it strains the repair.
- A: Lying on the abdomen, even with the head turned, still presses the lip on the bed.
- C: A pillow under the face presses on the repair and is a suffocation risk.
- D: Lying prone rubs the lip suture line against the sheet.
Question 6 · Medium
A 7-month-old with a ventriculoperitoneal shunt is afebrile but has become irritable, vomits and has a bulging fontanelle and sunset eyes. The most likely cause is:
1. ANormal post-shunt recovery
2. BBlockage of the shunt
3. COver-drainage of CSF
4. DDehydration from gastroenteritis
Answer and explanation in LearnFree account
Question 7 · Easy
Which clinical feature distinguishes kwashiorkor from marasmus?
1. ASevere loss of subcutaneous fat
2. BAlert, irritable and hungry child
3. CBilateral pitting oedema of the feet
4. DWeight well below expected for age
Answer and explanation in LearnFree account
Question 8 · Easy
Beyond the newborn period, the most common cyanotic congenital heart disease is:
1. ATransposition of the great arteries
2. BPatent ductus arteriosus
3. CVentricular septal defect
4. DTetralogy of Fallot
Answer and explanation in LearnFree account
Question 9 · Medium
A 4-year-old on the ward starts a generalised tonic-clonic seizure. The nurse's first action is to:
1. AInsert a padded tongue depressor between the teeth
2. BGive oral paracetamol to bring the fever down
3. CHold the limbs firmly to stop the jerking movements
4. DTurn the child on the side and move hard objects away
Answer and explanation in LearnFree account
Question 10 · Medium
In a 2-year-old, a mid-upper arm circumference of 11.2 cm indicates:
1. AModerate acute malnutrition
2. BChronic stunting only
3. CSevere acute malnutrition
4. DNormal nutritional status
Answer and explanation in LearnFree account
Question 11 · Medium
A 2-year-old swallowed kerosene from a bottle 20 minutes ago and is coughing. Which order would the nurse question?
1. AGive syrup of ipecac to induce vomiting
2. BKeep the child nil by mouth for now
3. CWatch the respiratory rate and SpO2
4. DArrange a chest X-ray after 6 hours
Answer and explanation in LearnFree account
Question 12 · Medium
Parents of a child with steroid-sensitive nephrotic syndrome test the first morning urine with a dipstick at home. They should report a relapse when the dipstick shows:
1. A1+ protein after a day of active play
2. B3+ protein or more on 3 consecutive days
3. C2+ protein on one day during a cold
4. DTrace protein on any single morning
Answer and explanation in LearnFree account
Question 13 · Easy
The WHO low-osmolarity oral rehydration solution now used in India has a total osmolarity of:
1. A290 mOsm/L
2. B245 mOsm/L
3. C200 mOsm/L
4. D311 mOsm/L
Answer and explanation in LearnFree account
Question 14 · Hard
A 4-year-old has been convulsing for 7 minutes at home and arrives in the emergency room; repeated attempts at IV access have failed. The most appropriate first drug is:
1. ABuccal or intranasal midazolam
2. BOral phenobarbitone syrup
3. CIV phenytoin after access is found
4. DIntramuscular phenytoin injection
Answer and explanation in LearnFree account
Question 15 · Easy
Under treatment Plan B, a child with some dehydration should receive ORS in a volume of:
1. A75 mL/kg over 4 hours
2. B100 mL/kg over 6 hours
3. C50 mL/kg over 24 hours
4. D20 mL/kg over 1 hour
Answer and explanation in LearnFree account
Question 16 · Hard
A 2-year-old weighing 12 kg has severe dehydration from diarrhoea and an IV line is in place. Under WHO Plan C, what is the first phase of Ringer lactate?
1. A360 mL over 1 hour
2. B1200 mL over 3 hours
3. C900 mL over 4 hours
4. D360 mL over 30 minutes
Answer and explanation in LearnFree account
Question 17 · Easy
The early sign that should make a nurse suspect Hirschsprung disease in a term newborn is:
1. ARed currant-jelly stools with screaming
2. BNo meconium passed within 48 hours of birth
3. CProjectile non-bilious vomiting after feeds
4. DFrothy saliva with choking on first feed
Answer and explanation in LearnFree account
Question 18 · Medium
ReSoMal, not standard ORS, is used to rehydrate a child with severe acute malnutrition because it contains:
1. ALess sodium and more potassium
2. BNo potassium and more glucose
3. CMore sodium and more potassium
4. DMore sodium and less glucose
Answer and explanation in LearnFree account
Question 19 · Easy
A 3-year-old is admitted with a firm, smooth abdominal mass suspected to be a Wilms tumour. The most important nursing precaution before surgery is to:
1. APalpate the mass every 4 hours to track its size
2. BMassage the abdomen gently to ease discomfort
3. CGive a soap-water enema to clear the bowel
4. DAvoid palpating the abdomen
Answer and explanation in LearnFree account
Question 20 · Medium
Bowel washouts before surgery for Hirschsprung disease should be done with:
1. ASoap-suds solution
2. BPhosphate enemas
3. CWarm isotonic saline
4. DPlain tap water
Answer and explanation in LearnFree account
Question 21 · Hard
An infant with tetralogy of Fallot remains deeply cyanosed during a spell despite the knee-chest position and oxygen by face mask. Which drug should the nurse prepare next?
1. AAdrenaline
2. BDigoxin
3. CMorphine sulphate
4. DFurosemide
Answer and explanation in LearnFree account
Question 22 · Easy
ORS made up from a packet at home should be thrown away and a fresh batch made after:
1. A72 hours
2. B24 hours
3. C6 hours
4. D48 hours
Answer and explanation in LearnFree account
Question 23 · Hard
A 10-year-old with a large ventricular septal defect that was never repaired is now cyanosed with clubbing. What has most likely happened?
1. AThe septal defect has closed on its own
2. BPulmonary stenosis has developed with age
3. CPulmonary hypertension has reversed the shunt
4. DInfective endocarditis has damaged the valve
Answer and explanation in LearnFree account
Question 24 · Medium
A 6-year-old is brought from a field just sprayed with pesticide. He has pinpoint pupils, drooling, wheeze and a heart rate of 58/min. Which drug should the nurse prepare first?
1. ANaloxone
2. BFlumazenil
3. CAtropine
4. DPhysostigmine
Answer and explanation in LearnFree account
Question 25 · Hard
A 2-year-old weighs 7.8 kg; the expected weight for age is 12 kg. He has bilateral pitting oedema of both feet, flaky-paint skin and sparse, pale hair. By the Wellcome classification, he has:
1. AMarasmus
2. BUnderweight only
3. CMarasmic kwashiorkor
4. DKwashiorkor
Answer and explanation in LearnFree account

1 more Common childhood illnesses and emergencies questions

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Common childhood illnesses and emergencies

A 4-year-old has puffy eyes and swollen legs for one week. Urine: protein 4+, no red cells. Serum albumin 1.8 g/dL (normal 3.5-5), cholesterol 380 mg/dL (normal below 200), blood pressure 96/60 mmHg. The most likely diagnosis is:

Which daily measurement best monitors the progress of hydrocephalus in an infant?

A 3-year-old on day 4 of treatment for staphylococcal pneumonia suddenly becomes breathless and restless, and breath sounds are absent over the right chest. The most likely complication is:

A 2-year-old with tetralogy of Fallot cries during a blood draw, becomes deeply blue and breathes fast and deep. What should the nurse do first?

After cleft lip repair, the infant should be positioned:

A 7-month-old with a ventriculoperitoneal shunt is afebrile but has become irritable, vomits and has a bulging fontanelle and sunset eyes. The most likely cause is:

Which clinical feature distinguishes kwashiorkor from marasmus?

Beyond the newborn period, the most common cyanotic congenital heart disease is:

A 4-year-old on the ward starts a generalised tonic-clonic seizure. The nurse's first action is to:

In a 2-year-old, a mid-upper arm circumference of 11.2 cm indicates:

A 2-year-old swallowed kerosene from a bottle 20 minutes ago and is coughing. Which order would the nurse question?

Parents of a child with steroid-sensitive nephrotic syndrome test the first morning urine with a dipstick at home. They should report a relapse when the dipstick shows:

The WHO low-osmolarity oral rehydration solution now used in India has a total osmolarity of:

A 4-year-old has been convulsing for 7 minutes at home and arrives in the emergency room; repeated attempts at IV access have failed. The most appropriate first drug is:

Under treatment Plan B, a child with some dehydration should receive ORS in a volume of:

A 2-year-old weighing 12 kg has severe dehydration from diarrhoea and an IV line is in place. Under WHO Plan C, what is the first phase of Ringer lactate?

The early sign that should make a nurse suspect Hirschsprung disease in a term newborn is:

ReSoMal, not standard ORS, is used to rehydrate a child with severe acute malnutrition because it contains:

A 3-year-old is admitted with a firm, smooth abdominal mass suspected to be a Wilms tumour. The most important nursing precaution before surgery is to:

Bowel washouts before surgery for Hirschsprung disease should be done with:

An infant with tetralogy of Fallot remains deeply cyanosed during a spell despite the knee-chest position and oxygen by face mask. Which drug should the nurse prepare next?

ORS made up from a packet at home should be thrown away and a fresh batch made after:

A 10-year-old with a large ventricular septal defect that was never repaired is now cyanosed with clubbing. What has most likely happened?

A 6-year-old is brought from a field just sprayed with pesticide. He has pinpoint pupils, drooling, wheeze and a heart rate of 58/min. Which drug should the nurse prepare first?

A 2-year-old weighs 7.8 kg; the expected weight for age is 12 kg. He has bilateral pitting oedema of both feet, flaky-paint skin and sparse, pale hair. By the Wellcome classification, he has: