1.

Question: What is the first principle of good care

regarding facility readiness?
Answer: Facilities must have basic equipment and
drugs in stock at all times, and adequate staff
skilled in paediatric care.
2. Question: According to the principles of good
care, what action should be taken immediately for
sick children arriving at the hospital?
Answer: They must be immediately triaged,
assessed and if necessary, provided with
emergency treatment as soon as possible.
3. Question: How thorough should the assessment
of diagnosis and illness severity be, and what is
crucial for documentation?
Answer: Assessment must be thorough, treatment
carefully planned, and all stages accurately and
comprehensively documented.
4. Question: What is the scope of these protocols,
and what care should be taken with less common
problems?
Answer: The protocols provide a minimum
standard for most, but not all, common problems.
Care needs to be taken to identify and treat
children with less common problems rather than
just applying the protocols.
5. Question: How should treatments be prescribed,
and what role do nurses play before
administration?
Answer: Treatments should be clearly and carefully
prescribed, usually based on weight, on patient
treatment sheets with doses checked by nurses
before administration.
6. Question: What is the role of parents/caretakers
in a child's care, and how should communication
be handled?
Answer: Parents/caretakers need to understand the
illness and treatment, provide invaluable
assistance, and should be communicated with
politely to improve interaction.
7. Question: How frequently should the response to
treatment be assessed for severely ill children, and
what should be documented?
Answer: Severely ill children must be reviewed
within the first 6 hours of admission, and progress
documented.
8. Question: Besides disease-specific care, what
other aspects of supportive care are considered
equally important?
Answer: Correct supportive care, particularly
adequate feeding, use of oxygen, and fluids, is as
important as disease-specific care.
9. Question: How should laboratory tests and
unnecessary drugs be managed according to the
principles of good care?
Answer: Laboratory tests should be used
appropriately, and the use of unnecessary drugs
should be avoided.
10. Question: What plan needs to be made as a
child leaves the hospital?
Answer: An appropriate discharge and follow-up
plan needs to be made.
11. Question: What hygiene practices are
emphasized to improve outcomes for all sick
children?
Answer: Good hand hygiene practices and good
hygiene in the patient's environment.
12. Question: What is the formula for calculating
total daily maintenance fluid for children weighing
0-10 kg?
Answer: 100 ml/kg/day
13. Question: What is the formula for calculating
total daily maintenance fluid for children weighing
11-20 kg?
Answer: 1000 ml + 50 ml/kg/day for each kg over
10 kg
14. Question: What is the formula for calculating
total daily maintenance fluid for children weighing
>20 kg?
Answer: 1500 ml + 20 ml/kg/day for each kg over
20 kg
15. Question: What fluid is recommended for
maintenance fluids?
Answer: Dextrose 5% or 10% in 0.45% Sodium
Chloride (or 0.9% Sodium Chloride if not possible to
obtain 0.45%)
16. Question: What is the general recommended
daily fluid amount for an infant aged 0-28 days?
Answer: 60-80 ml/kg/day (progressing up to 150
ml/kg/day by 5-7 days)
17. Question: What is the general recommended
daily fluid amount for an infant aged 29 days - 11
months?
Answer: 100-120 ml/kg/day
18. Question: What is the general recommended
daily fluid amount for a child aged 1-5 years?
Answer: 80-100 ml/kg/day
19. Question: What is the general recommended
daily fluid amount for a child aged >5 years?
Answer: 60-80 ml/kg/day
20. Question: What should be done if an infant is
feeding adequately orally?
Answer: Continue feeding and monitor for
hydration and clinical status.
21. Question: What should be done if oral feeds are
inadequate or contraindicated?
Answer: Start IV fluids for maintenance.
22. Question: What are the considerations for
children with oedema?
Answer: Reduce maintenance fluids, often to 2/3 or
1/2 of calculated requirements, or stop if severe
oedema is present.
23. Question: What are the considerations for
children with renal or cardiac failure?
Answer: Use 0.9% Sodium Chloride (normal saline)
and monitor serum sodium and glucose levels.
24. Question: What type of fluids should generally
be avoided for maintenance in children due to risk
of hyponatraemia?
Answer: Dextrose 5% in water (D5W) should
generally be avoided for maintenance in children
due to increased risk of hyponatraemia.
25. Question: What are the three core actions in
the emergency triage process?
Answer: 1. Assess ; 2. Classify ; 3. Act
26. Question: What are the four categories of
triage in sick children?
Answer: Emergency, Priority, Non-priority, Referral
(if applicable)
27. Question: List the signs that classify a child as
an "Emergency" case.
Answer: Obstructed airway, Central cyanosis,
Severe respiratory distress, Signs of shock, Coma,
Convulsing, Severe dehydration with danger signs.
28. Question: List the signs that classify a child as
a "Priority" case.
Answer: Respiratory distress (not severe), Pale,
Lethargic/sleepy, High fever, Severe pain, Signs of
malnutrition, Oedema of both feet, Referrals, etc.
29. Question: List the signs that classify a child as
a "Non-priority" case.
Answer: No Danger Signs, No Priority Signs, No
obvious severe illness.
30. Question: How quickly should an "Emergency"
case be assessed and treated?
Answer: Immediately (within 1-5 minutes).
31. Question: How quickly should a "Priority" case
be assessed?
Answer: Within 10 minutes.
32. Question: How quickly should a "Non-priority"
case be assessed?
Answer: Within 30 minutes (or as soon as possible).
33. Question: What should be the initial emergency
treatment for an "Emergency" child?
Answer: Open airway, give oxygen, provide
emergency treatment for shock, convulsions, or
severe dehydration.
34. Question: What does "Danger Sign" for triage
mean?
Answer: A clinical sign that indicates a high
likelihood of death or severe disability unless
immediate life-saving treatment is given.
35. Question: What does "Priority Sign" for triage
mean?
Answer: A clinical sign that does not immediately
threaten life but indicates a need for rapid
assessment and treatment to prevent progression
to an "Emergency."
36. Question: What is the general guidance for
reassessment in all triage categories?
Answer: Children in all categories should be
reassessed periodically to detect any changes in
their condition.
37. Question: What are the two initial steps in
Infant/Child Basic Life Support (BLS)?
Answer: 1. Ensure a safe environment. ; 2. Assess
responsiveness.
38. Question: What is the primary concern for a
child with altered consciousness or seizure?
Answer: Airway patency.
39. Question: What is the primary action if a child
is unconscious and unresponsive?
Answer: Shout for help, open the airway.
40. Question: What is the first step in assessing a
child's breathing after establishing an open airway?
Answer: Look, listen, and feel for breathing for no
more than 10 seconds.
41. Question: How long should you check for
breathing?
Answer: No more than 10 seconds.
42. Question: What are the signs of effective
breathing?
Answer: Normal chest rise and fall, audible
breathing sounds.
43. Question: What should you do if breathing is
absent or abnormal (e.g., gasping)?
Answer: Start rescue breaths immediately.
44. Question: What is the recommended number of
rescue breaths for a child?
Answer: 5 initial rescue breaths.
45. Question: What is the ratio of chest
compressions to breaths for a single rescuer in
child BLS?
Answer: 15 compressions : 2 breaths.
46. Question: What is the ratio of chest
compressions to breaths for two rescuers in child
BLS?
Answer: 15 compressions : 2 breaths.
47. Question: What is the compression depth for a
child?
Answer: At least 1/3 of the anterior-posterior
diameter of the chest (approx. 5 cm or 2 inches).
48. Question: What is the compression depth for an
infant?
Answer: At least 1/3 of the anterior-posterior
diameter of the chest (approx. 4 cm or 1.5 inches).
49. Question: What is the compression rate for
child BLS?
Answer: 100-120 compressions per minute.
50. Question: What is the hand placement for chest
compressions in a child?
Answer: Lower half of the sternum, just below the
nipple line (use heel of one hand for children, two
fingers for infants).
51. Question: What is the hand placement for chest
compressions in an infant?
Answer: Just below the nipple line, using two
fingers.
52. Question: When should you activate the
emergency response system (e.g., call for help)?
Answer: After 5 rescue breaths or after 1 minute of
CPR (if alone).
53. Question: What are the main danger signs in a
child with signs of life?
Answer: Any danger sign (convulsing, unconscious,
severe respiratory distress, shock, central
cyanosis, severe dehydration, severe pallor, severe
malnutrition).
54. Question: What immediate action should be
taken for a child with danger signs?
Answer: Provide emergency treatment
immediately, as for an "Emergency" child in triage.
55. Question: What immediate action should be
taken if a child presents with stridor?
Answer: Maintain airway, give oxygen, consider
nebulized adrenaline.
56. Question: What is the initial management for a
child with wheeze?
Answer: Give nebulized Salbutamol and oxygen if
indicated.
57. Question: What is the initial management for a
child with severe dehydration?
Answer: Give IV fluids quickly (e.g., Ringers Lactate
20ml/kg over 15-30 minutes).
58. Question: What is the initial management for a
child with a severe burn?
Answer: Cover with clean dressing, give pain relief,
prevent hypothermia, consider antibiotics.
59. Question: What is the initial management for a
child with severe pallor?
Answer: Give IV fluids for shock if present,
transfuse blood if severe anaemia.
60. Question: What is the initial management for a
child with high fever?
Answer: Give Paracetamol/Ibuprofen, look for
source of fever, manage according to cause.
61. Question: What is the primary indication for
oxygen therapy in children?
Answer: Hypoxaemia (low blood oxygen levels).
62. Question: What are the four clinical signs of
hypoxaemia that indicate the need for oxygen?
Answer: Central cyanosis, severe respiratory
distress (e.g., severe chest indrawing, grunting,
nasal flaring), SpO2 < 90% (or specific target),
deep rapid breathing.
63. Question: What is the target SpO2 (oxygen
saturation) range for children requiring oxygen?
Answer: 90-94% SpO2 (or a target appropriate for
the condition, e.g., higher for CO poisoning, lower
for COPD).
64. Question: At what SpO2 level should oxygen
therapy be initiated?
Answer: SpO2 less than 90%.
65. Question: How should oxygen therapy be
prescribed?
Answer: By medical order, specifying flow rate,
delivery device, and duration.
66. Question: What factors determine the oxygen
delivery device?
Answer: Child's age, comfort, and severity of
hypoxaemia.
67. Question: What flow rate is typically used for
nasal prongs in infants and young children?
Answer: 0.5-2 L/min.
68. Question: What flow rate is typically used for
face masks in children?
Answer: 5-10 L/min.
69. Question: What flow rate is typically used for
oxygen hoods or head boxes for infants?
Answer: 2-5 L/min.
70. Question: How often should a child receiving
oxygen be monitored?
Answer: Continuously for SpO2, respiratory rate,
and clinical signs.
71. Question: What potential complication should
be avoided with excessive oxygen administration,
especially in neonates?
Answer: Retinopathy of prematurity (ROP) and
chronic lung disease in neonates.
72. Question: When should an intra-osseous (IO)
line be considered for fluid and drug
administration?
Answer: When IV access cannot be obtained within
90 seconds (2 attempts) in a critically ill child
needing immediate fluid/drug administration.
73. Question: What are the preferred insertion sites
for an IO line in children?
Answer: Proximal tibia (most common), distal
femur, distal tibia, proximal humerus.
74. Question: What are the contraindications for IO
line insertion?
Answer: Fracture of the bone, previous attempt at
the same site, infection over the site, osteogenesis
imperfecta.
75. Question: What is the procedure for confirming
correct IO needle placement?
Answer: No swelling or extravasation, needle
stands upright, blood can be aspirated, fluid flows
freely without resistance.
76. Question: What steps should be taken after
confirming IO placement?
Answer: Secure the line, apply dressing, monitor
for extravasation or infection, and replace with IV
access as soon as possible.
77. Question: Can an IO line be used for blood
sampling?
Answer: Yes, blood can be aspirated for basic lab
tests.
78. Question: How long can an IO line remain in
place?
Answer: Maximum 24 hours.
79. Question: What should be done after an IO line
is no longer needed?
Answer: Remove the needle and apply firm
pressure to prevent leakage.
80. Question: What is the immediate priority in a
child presenting with convulsions?
Answer: Maintain airway, ensure breathing, protect
from injury.
81. Question: What is the first-line drug for
stopping ongoing seizures in children?
Answer: Diazepam.
82. Question: What is the recommended route and
dose for Diazepam for convulsions?
Answer: 0.3 mg/kg IV slow push (over 2-3 minutes).
Max 10mg.
83. Question: What is the alternative route and
dose for Diazepam for convulsions if IV access is
difficult?
Answer: 0.5 mg/kg rectally.
84. Question: What is the maximum number of
times Diazepam can be repeated?
Answer: Up to 2-3 times.
85. Question: What is the second-line drug for
convulsions if Diazepam is ineffective?
Answer: Phenobarbitone.
86. Question: What is the loading dose for
Phenobarbitone for convulsions?
Answer: 15-20 mg/kg IV slow push over 20-30
minutes.
87. Question: What is the maintenance dose for
Phenobarbitone for convulsions?
Answer: 5 mg/kg/day (usually divided twice daily).
88. Question: What is the management for status
epilepticus (seizure lasting >30 minutes or
recurrent without recovery)?
Answer: Secure airway, provide oxygen, consider
intubation, IV access, administer IV Diazepam, then
Phenobarbitone/Phenytoin. Investigate and treat
cause.
89. Question: What are the common causes of
convulsions in children?
Answer: Fever (febrile seizures),
meningitis/encephalitis, hypoglycemia, electrolyte
disturbances, cerebral malaria, head injury,
poisoning.
90. Question: What are the typical clinical
presentations of malaria in children?
Answer: Fever (often cyclical), chills, headache,
sweating, fatigue, muscle aches, nausea, vomiting,
diarrhoea, splenomegaly, pallor.
91. Question: What are the criteria for classifying
"Severe Malaria" in children?
Answer: Impaired consciousness/coma (Blantyre
Coma Scale < 3) ; severe prostration ; multiple
convulsions (>2 in 24 hrs) ; severe anaemia (Hb <
5g/dL) ; respiratory distress (acidotic breathing) ;
circulatory collapse/shock ; pulmonary oedema ;
acute kidney injury ; jaundice ; abnormal bleeding ;
hypoglycemia ; hyperparasitemia.
92. Question: What are the key diagnostic methods
for malaria?
Answer: Microscopy (blood smear), Rapid
Diagnostic Tests (RDTs).
93. Question: What is the first-line treatment for
uncomplicated malaria in children over 6 months?
Answer: Artemether-Lumefantrine (AL) or
Artemether-Amodiaquine (ASAQ).
94. Question: What is the treatment for severe
malaria in children?
Answer: Injectable Artesunate for at least 24 hours,
then transition to oral ACT (Artemether-
Lumefantrine or ASAQ) to complete 3 days.
95. Question: What is the loading dose for
injectable Artesunate in children ≤20Kg with
severe malaria?
Answer: 3.2 mg/kg IM stat (for first dose).
96. Question: What is the maintenance dose for
injectable Artesunate in children ≤20Kg with
severe malaria?
Answer: 1.6 mg/kg IM 24-hourly (after first dose).
97. Question: What is the loading dose for
injectable Artesunate in children >20Kg with
severe malaria?
Answer: 2.4 mg/kg IM/IV stat (for first dose).
98. Question: What is the maintenance dose for
injectable Artesunate in children >20Kg with
severe malaria?
Answer: 2.4 mg/kg IM/IV 24-hourly (after first
dose).
99. Question: What is the alternative injectable
antimalarial for severe malaria if Artesunate is not
available?
Answer: Quinine.
100. Question: What is the loading dose for Quinine
for severe malaria?
Answer: 20 mg salt/kg IV infusion over 4 hours,
then 10 mg salt/kg every 8 hours.
101. Question: What is the maintenance dose for
Quinine for severe malaria?
Answer: 10 mg salt/kg IV infusion over 4 hours
every 8 hours (or oral when able).
102. Question: What is the dose for
Artemether/Lumefantrine (Coartem) for different
weight bands?
Answer: Varies by weight (e.g., 5-14kg, 15-24kg,
25-34kg, >35kg), given twice daily for 3 days.
Specific number of tablets per dose.
103. Question: What is the dose for Amodiaquine +
Artesunate for different age/weight bands?
Answer: Varies by age/weight band (e.g., <1yr, 1-
3yr, 4-8yr, 9-14yr, >14yr), given once daily for 3
days. Specific number of tablets per dose.
104. Question: What is the dose for
Dihydroartemisinin + Piperaquine (Duocotec) for
different age/weight bands?
Answer: Varies by age/weight band, given once
daily for 3 days. Specific number of tablets per
dose.
105. Question: What is the dose for Primaquine (for
P. falciparum gametocytes) for children?
Answer: 0.75 mg/kg single dose, given on Day 3 of
ACT.
106. Question: What is the dose for Chloroquine
(for P. vivax and P. ovale) for different age/weight
bands?
Answer: 10 mg base/kg on day 1, then 5 mg
base/kg on days 2 and 3.
107. Question: What is the dose for
Sulfadoxine/Pyrimethamine (SP) for different
age/weight bands (IPTp/IPTi)?
Answer: Varies by age/weight, used for
Intermittent Preventive Treatment.
108. Question: What are the cardinal signs of
meningitis in children?
Answer: Fever, headache, neck stiffness,
photophobia, vomiting, irritability, lethargy,
bulging fontanelle (infants), convulsions, altered
consciousness, Kernig's sign, Brudzinski's sign.
109. Question: What investigations are essential
for suspected meningitis?
Answer: Lumbar puncture (CSF analysis), blood
culture, full blood count, electrolytes, blood
glucose.
110. Question: What are the typical CSF findings in
bacterial meningitis?
Answer: Turbid appearance, high white cell count
(>1000 cells/mm3, predominantly neutrophils),
high protein, low glucose.
111. Question: What are the typical CSF findings in
viral meningitis?
Answer: Clear appearance, low white cell count
(<100 cells/mm3, predominantly lymphocytes),
normal or slightly elevated protein, normal
glucose.
112. Question: What is the initial empirical
antibiotic treatment for suspected bacterial
meningitis in neonates (<1 month)?
Answer: Ampicillin + Gentamicin or Ampicillin +
Cefotaxime.
113. Question: What is the initial empirical
antibiotic treatment for suspected bacterial
meningitis in infants/children (1 month to 5 years)?
Answer: Ceftriaxone or Cefotaxime.
114. Question: What is the initial empirical
antibiotic treatment for suspected bacterial
meningitis in older children (>5 years)?
Answer: Ceftriaxone or Cefotaxime.
115. Question: What adjunctive therapy is
recommended for bacterial meningitis, and when
should it be given?
Answer: Dexamethasone, given just before or with
the first dose of antibiotics.
116. Question: What is the duration of antibiotic
treatment for bacterial meningitis?
Answer: 7-10 days for uncomplicated bacterial
meningitis, longer for severe cases or specific
pathogens.
117. Question: What are the potential
complications of meningitis?
Answer: Hydrocephalus, hearing loss, seizures,
developmental delay, cerebral palsy, visual
impairment.
118. Question: What is the primary cause of acute
watery diarrhoea in children?
Answer: Viral infections (e.g., Rotavirus).
119. Question: What are the main clinical types of
diarrhoea?
Answer: Acute watery diarrhoea, bloody diarrhoea
(dysentery), persistent diarrhoea.
120. Question: What are the key assessments to
determine the severity of dehydration?
Answer: General condition (alert, lethargic,
unconscious) ; sunken eyes ; tears
(absent/present) ; mouth/tongue moisture ; skin
turgor (skin pinch) ; thirst ; presence of shock.
121. Question: What are the signs of NO
dehydration?
Answer: Alert, no sunken eyes, tears present, moist
mouth/tongue, skin pinch goes back quickly, drinks
normally, no signs of shock.
122. Question: What is the management plan for
NO dehydration?
Answer: Continue feeding, give extra fluids (ORS or
safe home fluids), give Zinc, advise caretaker on
danger signs.
123. Question: What are the signs of SOME
dehydration?
Answer: Restless/irritable, sunken eyes, no tears,
dry mouth/tongue, skin pinch goes back slowly,
drinks eagerly/thirsty.
124. Question: What is the management plan for
SOME dehydration (Oral Rehydration Therapy)?
Answer: Plan B: Give ORS based on weight over 4
hours (e.g., 50-100 ml/kg). Continue feeding, give
Zinc.
125. Question: What are the signs of SEVERE
dehydration?
Answer: Lethargic/unconscious ; deeply sunken
eyes ; no tears ; very dry mouth/tongue ; skin
pinch goes back very slowly (>2 seconds) ; drinks
poorly or not at all ; signs of shock (cold
extremities, weak/fast pulse).
126. Question: What is the management plan for
SEVERE dehydration (IV fluids)?
Answer: Plan C: Rapid intravenous rehydration.
127. Question: What is the recommended fluid for
IV rehydration in severe dehydration?
Answer: Ringers Lactate.
128. Question: What is the fluid resuscitation
protocol for severe dehydration in children (initial
bolus and subsequent doses)?
Answer: Initial bolus: 20 ml/kg IV over 15-30
minutes. Reassess. Repeat if still signs of shock.
Then 50 ml/kg over 2.5 hours, then 25 ml/kg over
2.5 hours.
129. Question: What is the dose for Zinc Sulphate
for diarrhoea in children ≤ 6 months?
Answer: 10mg daily for 10-14 days.
130. Question: What is the dose for Zinc Sulphate
for diarrhoea in children > 6 months?
Answer: 20mg daily for 10-14 days.
131. Question: What are the general feeding
recommendations during and after diarrhoea?
Answer: Continue breastfeeding, offer frequent
small feeds of solid food, continue ORS.
132. Question: What should be avoided during
diarrhoea treatment?
Answer: Anti-diarrhoeal drugs (e.g., Loperamide)
and antibiotics (unless dysentery or specific
indication).
133. Question: What are the three cardinal signs of
DKA?
Answer: Hyperglycemia (>11 mmol/L) ; metabolic
acidosis (pH < 7.3 or bicarbonate < 15 mmol/L) ;
ketonemia/ketonuria.
134. Question: What are the immediate goals of
DKA management?
Answer: Correct dehydration ; correct acidosis ;
normalize glucose ; correct electrolyte
imbalances ; identify and treat precipitating
factors.
135. Question: What are the key investigations for
DKA?
Answer: Blood glucose ; electrolytes (Na, K, Cl) ;
blood gases (pH, bicarbonate) ; urine ketones ;
serum ketones ; FBC ; blood culture (if infection
suspected).
136. Question: What is the initial fluid resuscitation
for DKA?
Answer: Initial bolus of 10-20 ml/kg over 30-60
minutes.
137. Question: What type of fluid is used for initial
fluid resuscitation in DKA?
Answer: 0.9% Sodium Chloride (Normal Saline).
138. Question: What is the formula for calculating
maintenance fluid in DKA after initial resuscitation?
Answer: Calculated fluid deficit (over 48 hours)
plus maintenance fluid (24 hours).
139. Question: What is the rate of fluid
administration for DKA maintenance fluid?
Answer: Rate of fluid administration should be slow
and steady, aiming to rehydrate over 48 hours, not
rapidly. (Formula: ([Fluid Deficit] +
[Maintenance]) / 48 hours).
140. Question: When should insulin infusion be
started in DKA?
Answer: After initial fluid resuscitation (usually 1-2
hours after starting fluids) and once a urine output
is established.
141. Question: What is the initial rate of insulin
infusion for DKA?
Answer: 0.05-0.1 unit/kg/hour continuous IV
infusion.
142. Question: When should 5% Dextrose be added
to the IV fluids in DKA?
Answer: When blood glucose drops to 14-17
mmol/L (250-300 mg/dL).
143. Question: How should potassium be managed
in DKA?
Answer: Monitor serum potassium frequently. Give
potassium supplementation (IV or oral) after initial
bolus fluids and if potassium is normal or low,
ensuring urine output is established.
144. Question: What should be monitored
frequently during DKA management?
Answer: Blood glucose (hourly), electrolytes (2-4
hourly), ketones, neurological status.
145. Question: When is bicarbonate therapy
indicated in DKA?
Answer: Only in severe acidosis (pH < 6.9 or
severe hyperkalaemia) and with extreme caution,
as it can worsen cerebral oedema.
146. Question: What defines hypoglycemia in a
child with diabetes mellitus?
Answer: Blood glucose < 3.0 mmol/L (54 mg/dL).
147. Question: What are the common causes of
hypoglycemia in children with diabetes?
Answer: Too much insulin ; missed or delayed meal
; increased physical activity ; vomiting/diarrhoea ;
alcohol.
148. Question: What are the typical symptoms of
hypoglycemia?
Answer: Sweating ; tremor ; hunger ; palpitations ;
anxiety ; blurred vision ; headache ; dizziness ;
confusion ; irritability ; seizures ; loss of
consciousness.
149. Question: What is the immediate treatment
for mild to moderate hypoglycemia if the child is
conscious and can swallow?
Answer: Give fast-acting carbohydrate (e.g., 10-
15g glucose tablet, fruit juice, sugary drink).
Recheck glucose in 15 minutes.
150. Question: What is the immediate treatment
for severe hypoglycemia if the child is unconscious
or unable to swallow?
Answer: Give 10% Dextrose IV or Glucagon IM/SC.
151. Question: What is the dose of 10% Dextrose
for severe hypoglycemia?
Answer: 5ml/kg IV of 10% Dextrose slowly.
152. Question: What is the follow-up management
after correcting hypoglycemia?
Answer: After correction, give a complex
carbohydrate meal/snack to prevent recurrence.
Monitor blood glucose closely.
153. Question: What are the primary
anthropometric measurements used to assess
nutritional status in children?
Answer: Weight-for-age ; Height/Length-for-age ;
Weight-for-height/length ; Mid-Upper Arm
Circumference (MUAC) ; presence of bilateral
pitting oedema.
154. Question: How is wasting (acute malnutrition)
classified using weight-for-height/length Z-scores?
Answer: Severe Wasting: Z-score < -3 SD ;
Moderate Wasting: Z-score -3 to -2 SD ; No
Wasting: Z-score > -2 SD.
155. Question: How is stunting (chronic
malnutrition) classified using height/length-for-age
Z-scores?
Answer: Severe Stunting: Z-score < -3 SD ;
Moderate Stunting: Z-score -3 to -2 SD ; No
Stunting: Z-score > -2 SD.
156. Question: How is underweight classified using
weight-for-age Z-scores?
Answer: Severe Underweight: Z-score < -3 SD ;
Moderate Underweight: Z-score -3 to -2 SD ; No
Underweight: Z-score > -2 SD.
157. Question: How is oedema assessed and what
does it indicate?
Answer: Assess by pressing thumb on top of both
feet for 3 seconds. Pitting oedema indicates severe
malnutrition.
158. Question: What are the 10 routine steps for
managing complicated severe acute malnutrition?
Answer: 1. Treat/prevent hypoglycemia. ; 2.
Treat/prevent hypothermia. ; 3. Treat/prevent
dehydration. ; 4. Correct electrolyte imbalance. ; 5.
Treat infection. ; 6. Correct micronutrient
deficiencies. ; 7. Cautious feeding. ; 8. Achieve
catch-up growth. ; 9. Provide sensory stimulation &
emotional support. ; 10. Prepare for follow-up after
recovery.
159. Question: What are the immediate life-
threatening complications to address in SAM?
Answer: Hypoglycemia ; Hypothermia ; Severe
dehydration ; Septic shock ; Severe anaemia.
160. Question: What is the recommended antibiotic
for SAM with no obvious infection focus?
Answer: Amoxicillin (oral) or Ampicillin/Gentamicin
(IV/IM) if very sick.
161. Question: What is the recommended antibiotic
for SAM if a child has a definite infection (e.g.,
pneumonia, meningitis)?
Answer: Ceftriaxone or Gentamicin +
Ampicillin/Cefotaxime, depending on local
resistance patterns and suspected source.
162. Question: What is the recommended dose of
Vitamin A for SAM children 6-12 months?
Answer: 100,000 IU stat (oral).
163. Question: What is the recommended dose of
Vitamin A for SAM children >12 months?
Answer: 200,000 IU stat (oral).
164. Question: What is the recommended dose of
Folic Acid for SAM children?
Answer: 5mg daily.
165. Question: What minerals are essential to give
to all SAM children?
Answer: Potassium and Magnesium (given in
F-75/F-100/ReSoMal).
166. Question: What is the management approach
for hypothermia in SAM?
Answer: Rewarm the child slowly, skin-to-skin
contact, warm blankets, radiant warmer.
167. Question: What is the management approach
for hypoglycemia in SAM?
Answer: Give 5-10% Dextrose (5ml/kg) IV bolus,
then start F-75 feed.
168. Question: When should ORS be used in SAM
with diarrhoea?
Answer: For children with some dehydration or no
dehydration, or as maintenance during recovery
phase.
169. Question: What is the rate of rehydration with
ORS for SAM with dehydration?
Answer: Give ORS at 5ml/kg every 30 minutes for
the first 2 hours, then 5-10ml/kg/hour, based on
reassessment.
170. Question: What is the recommended IV fluid
for SAM with severe dehydration, and what is its
composition?
Answer: ReSoMal (Rehydration Solution for
Malnutrition). It is a special ORS with lower sodium
and higher potassium.
171. Question: What is the rate of IV fluid
administration for SAM with severe dehydration?
Answer: Give 15-20 ml/kg of ReSoMal slowly over 1
hour.
172. Question: How often should the child be
reassessed during rehydration in SAM?
Answer: Every 30 minutes for the first 2 hours,
then hourly for the next 4-6 hours, monitoring for
signs of improvement or overhydration.
173. Question: What is the risk of overhydration in
SAM?
Answer: Overhydration leading to cardiac failure
due to already expanded extracellular fluid in SAM.
174. Question: What is the initial phase of feeding
for SAM children called?
Answer: Stabilization phase.
175. Question: What is the initial feed
recommended for SAM children?
Answer: F-75 (Starter Formula).
176. Question: What is the target energy and
protein intake for the initial feeding phase (F-75)?
Answer: Energy: 75 kcal/kg/day, Protein: 0.8-1
g/kg/day.
177. Question: How frequently should F-75 be
given?
Answer: Every 2-3 hours, day and night.
178. Question: When should a child transition from
F-75 to F-100 (transition phase)?
Answer: When oedema has resolved, appetite
returns, and the child is clinically stable and alert.
179. Question: What is the target energy and
protein intake for the rehabilitation phase (F-100)?
Answer: Energy: 100-120 kcal/kg/day, Protein: 2-3
g/kg/day.
180. Question: How frequently should F-100 be
given?
Answer: Every 3-4 hours, gradually increasing
amounts.
181. Question: When should a child be discharged
from the hospital in SAM management?
Answer: When weight-for-height/length Z-score is
> -2 SD, or when the child reaches 90% of their
median weight-for-height, and is eating well and
active.
182. Question: What nutritional counseling should
be given at discharge for SAM?
Answer: Advise on healthy feeding practices,
hygiene, micronutrient supplementation, follow-up
schedule, and early return if danger signs appear.
183. Question: What are the cardinal signs of
pneumonia in children?
Answer: Fast breathing ; chest indrawing ; fever ;
cough.
184. Question: What are the classifications of
pneumonia severity (No Pneumonia, Pneumonia,
Severe Pneumonia, Very Severe Pneumonia)?
Answer: No Pneumonia: Cough or cold, but no fast
breathing or chest indrawing. ; Pneumonia: Fast
breathing, no chest indrawing. ; Severe
Pneumonia: Fast breathing + chest indrawing or
danger signs (e.g., inability to drink, unconscious,
convulsions). ; Very Severe Pneumonia: Any
danger sign.
185. Question: What is the treatment for
Pneumonia (non-severe)?
Answer: Oral Amoxicillin for 5 days.
186. Question: What is the treatment for Severe
Pneumonia?
Answer: First dose of IV/IM Ampicillin or Penicillin G
(or Ceftriaxone), then continue IV/IM or switch to
oral Amoxicillin. Oxygen if SpO2 < 90%.
187. Question: What is the treatment for Very
Severe Pneumonia?
Answer: IV/IM Ceftriaxone or Ampicillin +
Gentamicin. Oxygen, supportive care.
188. Question: What is the duration of antibiotic
treatment for pneumonia?
Answer: Usually 5 days for uncomplicated
pneumonia, 7-10 days for severe pneumonia,
longer for very severe or complicated cases.
189. Question: What defines "Pneumonia
Treatment Failure" after 48 hours of treatment?
Answer: Not improving (e.g., continued fever, fast
breathing, chest indrawing) after 48 hours of
appropriate antibiotic treatment, OR worsening, OR
developing new danger signs.
190. Question: What steps should be taken if
pneumonia treatment failure is suspected?
Answer: Reassess, check for complications (e.g.,
pleural effusion, empyema), switch to second-line
antibiotics (e.g., Ceftriaxone), investigate other
causes, consider referral.
191. Question: What are the key clinical features
suggestive of asthma in children?
Answer: Recurrent wheezing ; cough (especially
nocturnal or exertional) ; shortness of breath ;
chest tightness ; family history of asthma/atopy.
192. Question: What is the initial management for
a child presenting with a possible asthma
exacerbation?
Answer: Initial assessment (ABC, vital signs,
severity) ; administer Salbutamol (nebulized or
pMDI with spacer) ; oxygen if hypoxaemic.
193. Question: What is the recommended
nebulized bronchodilator for acute asthma
exacerbation?
Answer: Salbutamol.
194. Question: What is the typical dose for
nebulized Salbutamol in acute asthma
exacerbation?
Answer: 2.5 mg nebulized (or 4-10 puffs via
spacer) repeated every 20 minutes for up to 1
hour, then less frequently.
195. Question: What is the role of oral
corticosteroids (e.g.,
Prednisolone/Dexamethasone) in acute asthma
exacerbation?
Answer: To reduce airway inflammation and
prevent relapse. Given orally for 3-5 days.
196. Question: When should oxygen be given for
asthma exacerbation?
Answer: If SpO2 < 90% or signs of severe
respiratory distress.
197. Question: What are the criteria for discharge
for a child with asthma exacerbation?
Answer: No signs of respiratory distress, SpO2 >
90% on room air, able to take oral medications and
fluids, caretaker understands home care plan.
198. Question: What is the long-term management
strategy for children with recurrent
wheezing/asthma?
Answer: Avoid triggers, regular inhaled
corticosteroids (if persistent asthma), written
asthma action plan, education for family.
199. Question: What are the key clinical features
suggesting TB in children?
Answer: Persistent cough (>2 weeks) ; unexplained
fever ; weight loss/failure to thrive ; night sweats ;
fatigue ; unexplained lymphadenopathy ; contact
with adult TB case.
200. Question: What investigations are used for TB
diagnosis in children?
Answer: Tuberculin Skin Test (TST) ; Interferon-
Gamma Release Assays (IGRAs) ; Chest X-ray ;
Sputum/gastric aspirate/lymph node biopsy for
microscopy, culture, or GeneXpert.
201. Question: What is the role of a chest X-ray in
TB diagnosis?
Answer: Suggestive findings (e.g., hilar
lymphadenopathy, parenchymal infiltrates) but not
diagnostic alone.
202. Question: What is the role of sputum
microscopy/GeneXpert in paediatric TB?
Answer: Often negative in children due to
paucibacillary disease, but important if positive to
confirm diagnosis and resistance.
203. Question: What is the standard first-line
treatment regimen for drug-sensitive TB in children
(initial phase)?
Answer: 2 months of Isoniazid (H), Rifampicin (R),
Pyrazinamide (Z), and Ethambutol (E) [HRZE].
204. Question: What is the standard first-line
treatment regimen for drug-sensitive TB in children
(continuation phase)?
Answer: 4 months of Isoniazid (H) and Rifampicin
(R) [HR].
205. Question: What are the doses for Isoniazid
(H), Rifampicin (R), Pyrazinamide (Z), and
Ethambutol (E) in paediatric TB treatment?
Answer: Isoniazid (H): 10 mg/kg (max 300 mg)
daily ; Rifampicin (R): 15 mg/kg (max 600 mg)
daily ; Pyrazinamide (Z): 30-40 mg/kg (max 2g)
daily ; Ethambutol (E): 20 mg/kg (max 1.2g) daily.
206. Question: What are the potential side effects
of anti-TB drugs that require monitoring?
Answer: Hepatotoxicity (jaundice, dark urine,
abdominal pain) ; peripheral neuropathy (with
Isoniazid) ; optic neuritis (Ethambutol) ; rash ;
gastrointestinal upset.
207. Question: How is treatment response
monitored in paediatric TB?
Answer: Clinical improvement (weight gain,
resolution of symptoms) ; sputum conversion (if
applicable) ; follow-up chest X-ray.
208. Question: What is the duration of treatment
for uncomplicated pulmonary TB in children?
Answer: 6 months.
209. Question: What is the duration of treatment
for severe forms of TB (e.g., TB meningitis, bone
TB)?
Answer: 9-12 months (e.g., TB meningitis), or
longer based on specific guidelines.