Original EMREE questions on paediatrics, with explanations.
Short answer: 10 original multiple-choice practice questions on paediatrics for EMREE, the Emirates Medical Residency Entrance Examination, each with the correct answer and a full explanation. The blueprint gives this subject 15 percent of the exam. They are original and are not real exam items.
About these questions
Every question here is original. Meddex wrote it for exam preparation. None is a real, recalled or leaked exam item, and none comes from DHA, Prometric, UAE University or the NIHS.
Meddex is independent and is not affiliated with DHA, Prometric, UAE University or the NIHS.
Clinical review of the question bank is not complete yet. Treat the explanations as study aids and check official guidance before you rely on a fact.
This is a sample, not the whole bank, and doing well on it does not predict an exam result.
What paediatrics covers
Growth, development, neonatal care, childhood infection, immunisation and paediatric emergencies.
Age decides the likely diagnosis, the dose and the next step. Read the age and weight before you read the options.
Where it fits in the exam
The organiser's EMREE blueprint (November 2025 edition) gives Paediatrics 15 percent of the exam, which is about 18 of 120 questions. It says the distribution may differ by up to 5 percent in each category. These weights are official, and the question counts are our arithmetic.
The organiser does not state how many answer options its questions have or whether each has one best answer. Meddex practice items use four options with one best answer, as a practice format.
How to use these questions
Decide your answer before you press Show answer. Then read the reason for every option, including the ones you rejected. Note the idea you missed and come back to it in a few days.
Practice questions
Question 1
PaediatricsMedium
A 20-month-old boy is brought in two hours after a sudden episode of choking and coughing while eating peanuts. He is now comfortable: RR 34/min, SpO2 97% in air, with a unilateral expiratory wheeze and reduced air entry on the right. An expiratory chest radiograph shows hyperinflation of the right lung with mediastinal shift to the left. What is the most appropriate next step?
AOption A: Rigid bronchoscopy under general anaesthesia to retrieve the object
BOption B: Back blows followed by abdominal thrusts at the bedside
COption C: Chest physiotherapy and overnight observation with a repeat film
DOption D: Nebulised salbutamol and oral prednisolone for presumed viral wheeze
Show answer for question 1
Correct answer: A. Rigid bronchoscopy under general anaesthesia to retrieve the object
A witnessed choking episode with a unilateral wheeze and air trapping on an expiratory film indicates an aspirated airway foreign body, even when the child is stable. Rigid bronchoscopy under anaesthesia is both diagnostic and therapeutic. Bedside manoeuvres are for complete obstruction and bronchodilators will not clear a fixed obstruction.
Why B is wrong. Back blows and thrusts are for a child who is choking with a complete obstruction, not one who is breathing comfortably.
Why C is wrong. Physiotherapy risks moving the object and observation allows complications such as pneumonia and collapse.
Why D is wrong. Wheeze from a fixed foreign body does not respond to bronchodilators or steroids, and this delays retrieval.
Topic: Foreign body aspiration. Reference: APLS: Advanced Paediatric Life Support, Foreign body airway obstruction; Nelson Textbook of Pediatrics: Foreign bodies of the airway
Question 2
PaediatricsMedium
A 5-year-old girl weighing 18 kg has had 14 hours of fever and vomiting and is now drowsy. HR is 168/min, RR 38/min, BP 70/38 mmHg, capillary refill 5 seconds, with cold mottled peripheries, and glucose is 5.0 mmol/L. IV access is secured and antibiotics are being prepared. Which immediate intervention is most appropriate?
AOption A: Fluid limited to 5 mL/kg to avoid pulmonary oedema
BOption B: Hypotonic 0.18% saline in dextrose at 1.5 times maintenance
COption C: Peripheral noradrenaline infusion before any fluid bolus
DOption D: Rapid isotonic crystalloid boluses of 10 to 20 mL/kg, reassessing after each
Show answer for question 2
Correct answer: D. Rapid isotonic crystalloid boluses of 10 to 20 mL/kg, reassessing after each
This child has decompensated (hypotensive) septic shock with cold peripheries. Prompt isotonic crystalloid boluses of 10 to 20 mL/kg with reassessment after each, plus antibiotics within the first hour, are the foundation of resuscitation. Vasoactive agents are added when shock persists after adequate fluid, and hypotonic fluids are never used for resuscitation.
Why A is wrong. Fluid restriction applies to normotensive children in settings without intensive care and not to hypotensive shock.
Why B is wrong. Hypotonic fluid distributes into the intracellular space, does not restore volume, and risks hyponatraemia.
Why C is wrong. Vasoactive support is added after fluid-refractory shock, not used as the first step in a hypovolaemic child.
Topic: Septic shock: fluid resuscitation. Reference: Surviving Sepsis Campaign International Guidelines for Children; APLS: Advanced Paediatric Life Support, Shock; NICE NG51 Sepsis: recognition, diagnosis and early management
Question 3
PaediatricsEasy
A 3-year-old boy weighing 14 kg has had 3 days of fever to 39.0 °C and cough. He is alert and drinking well. RR is 42/min, SpO2 96% in air, and there are focal crackles at the right base. A chest radiograph shows right lower lobe consolidation without effusion. What is the most appropriate treatment?
AOption A: Oral azithromycin for three days as first-line therapy
BOption B: Admission for intravenous ceftriaxone for five days
COption C: Supportive care with antipyretics and no antibiotic
DOption D: Oral amoxicillin at high dose for five days at home
Show answer for question 3
Correct answer: D. Oral amoxicillin at high dose for five days at home
A well, previously healthy child with lobar consolidation most likely has pneumococcal pneumonia and can be treated at home. High-dose oral amoxicillin is the first-line antibiotic in WHO, BTS and IDSA guidance. Admission and intravenous therapy are reserved for hypoxia, poor intake, or failure of oral treatment.
Why A is wrong. Macrolides are reserved for suspected atypical pathogens or penicillin allergy and are not first-line at this age.
Why B is wrong. Intravenous therapy is not needed in a child who is drinking, saturating well and tolerating oral medicines.
Why C is wrong. Lobar consolidation with fever suggests bacterial disease, so withholding antibiotics is inappropriate.
Topic: Community-acquired pneumonia. Reference: BTS Guidelines for Community-Acquired Pneumonia in Children; WHO Pocket Book of Hospital Care for Children; IDSA/PIDS Pediatric Community-Acquired Pneumonia Guideline
Question 4
PaediatricsMedium
A newborn boy is examined before discharge. The urethral meatus opens on the underside of the glans, there is a hooded dorsal foreskin with a deficient ventral foreskin, and there is no chordee. The urine stream is directed downwards. His parents wish to have him circumcised for religious reasons before they leave. Which is the most appropriate advice?
AOption A: Perform the circumcision now, because it is a minor procedure in the newborn period
BOption B: Postpone circumcision and refer to paediatric urology, because the foreskin may be needed for the repair
COption C: Refer for repair only if urinary infections occur
DOption D: Offer circumcision with a Plastibell device, which is safe in hypospadias
Show answer for question 4
Correct answer: B. Postpone circumcision and refer to paediatric urology, because the foreskin may be needed for the repair
Hypospadias is a congenital condition in which the urethral opening lies on the underside of the penis. The hooded dorsal foreskin is a clue, and the foreskin tissue is often used in the urethroplasty, so circumcision before assessment can compromise repair. He should be referred to paediatric urology for assessment, with surgical repair usually planned in the first 18 months, and parents can be counselled about whether religious circumcision can be incorporated in the repair or later. Associated features such as bilateral undescended testes or severe forms need investigation for a disorder of sex development.
Why A is wrong. Circumcision before assessment may remove tissue needed for the repair.
Why C is wrong. Repair is planned for function and appearance, not only for infection, and referral should not wait for complications.
Why D is wrong. Any circumcision device removes foreskin that the surgeon may need, so it is not safe in hypospadias.
Topic: Paediatric urology: hypospadias and neonatal circumcision. Reference: European Association of Urology and European Society for Paediatric Urology guidelines on paediatric urology; Nelson Textbook of Pediatrics, hypospadias
Question 5
PaediatricsEasy
A 7-month-old infant is choking on a piece of grape. He is conscious, but he has a silent, ineffective cough and is turning blue. Which is the most appropriate immediate action?
AOption A: A blind finger sweep of the mouth to remove the grape, followed by rescue breaths if he does not improve
BOption B: Five back blows with the infant head-down on the forearm, followed by five chest thrusts if the obstruction persists
COption C: Abdominal thrusts as in an adult
DOption D: Offer sips of water to wash the object down
Show answer for question 5
Correct answer: B. Five back blows with the infant head-down on the forearm, followed by five chest thrusts if the obstruction persists
An ineffective cough with cyanosis in a conscious infant is severe airway obstruction, and the Resuscitation Council sequence is five back blows with the infant supported head-down, then five chest thrusts, repeated, and the infant is started on CPR if he becomes unresponsive. Abdominal thrusts are avoided in infants because of the risk of damage to abdominal organs, a blind finger sweep can push the object deeper, and fluids risk aspiration.
Why A is wrong. A blind sweep can impact the object further in the airway.
Why C is wrong. Abdominal thrusts risk liver and other organ injury in infants.
Why D is wrong. Drinking can cause aspiration and does not relieve a complete obstruction.
Topic: Paediatric emergency: choking in an infant. Reference: Resuscitation Council UK Paediatric Basic Life Support and choking guidance; European Resuscitation Council Guidelines 2021: paediatric life support
Question 6
PaediatricsEasy
A 5-year-old boy weighing 15 kg is nil by mouth for the next 24 hours after surgery. He has normal renal function and normal serum sodium. Using the Holliday-Segar method, what is his maintenance fluid volume over 24 hours (to be given as an isotonic solution)?
AOption A: 1000 mL
BOption B: 750 mL
COption C: 1250 mL
DOption D: 1500 mL
Show answer for question 6
Correct answer: C. 1250 mL
The Holliday-Segar method gives 100 mL/kg for the first 10 kg and 50 mL/kg for the next 10 kg, so 1000 mL plus 250 mL gives 1250 mL per day, about 52 mL/h. Isotonic fluid with dextrose is preferred to avoid hospital-acquired hyponatraemia. (NICE NG29 uses a lower figure of 25 to 30 mL/kg/day; the question specifies Holliday-Segar.) Maintenance volumes are adjusted for fever, losses and renal disease.
Why A is wrong. This gives the first 10 kg only and omits the extra 5 kg at 50 mL/kg.
Why B is wrong. This applies 50 mL/kg to the whole weight, which underestimates requirements by about 40%.
Why D is wrong. This applies 100 mL/kg to the whole weight and overestimates the requirement for a child above 10 kg.
Topic: Maintenance fluids. Reference: NICE NG29 Intravenous fluid therapy in children and young people in hospital; APLS: Advanced Paediatric Life Support, Fluid therapy; Nelson Textbook of Pediatrics: Maintenance fluid and electrolyte therapy
Question 7
PaediatricsMedium
A 13-year-old girl, who has not yet had her first period, is noticed to have asymmetric shoulders. On the Adams forward bend test there is a right thoracic rib hump, and radiographs show a Cobb angle of 28 degrees with a Risser grade of 1. Which is the most appropriate management?
AOption A: Observation only, as scoliosis in girls always resolves
BOption B: Immediate spinal fusion surgery, because a curve of this size will certainly progress without an operation soon
COption C: Physiotherapy alone, without bracing
DOption D: A brace with regular review, since she is skeletally immature with a Cobb angle of 28 degrees
Show answer for question 7
Correct answer: D. A brace with regular review, since she is skeletally immature with a Cobb angle of 28 degrees
Adolescent idiopathic scoliosis with a Cobb angle of 20 to 40 degrees in a skeletally immature child with remaining growth has a high risk of progression, and bracing reduces the likelihood of reaching the surgical threshold (about 45 to 50 degrees). She has not reached menarche and has a Risser grade of 1, so there is much growth left, and she needs bracing with radiographic monitoring. Observation alone is for smaller curves, surgery is reserved for large or progressing curves, and exercise alone does not alter the course.
Why A is wrong. Curves in skeletally immature children often progress, so observation alone is not adequate at this angle.
Why B is wrong. Surgery is reserved for larger or progressive curves, not for a 28-degree curve at first presentation.
Why C is wrong. Exercises alone have not been shown to stop curve progression.
Topic: Adolescent health: idiopathic scoliosis. Reference: Scoliosis Research Society and SOSORT guidelines on adolescent idiopathic scoliosis; BrAIST trial: Weinstein SL et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med 2013
Question 8
PaediatricsEasy
A 4-year-old girl weighing 15 kg has a generalised tonic-clonic seizure lasting 6 minutes. The airway is supported with oxygen, IV access is in place, and capillary glucose is 5.4 mmol/L. Using 0.1 mg/kg, what dose of intravenous lorazepam should she receive?
AOption A: 0.15 mg
BOption B: 1.5 mg
COption C: 7.5 mg
DOption D: 15 mg
Show answer for question 8
Correct answer: B. 1.5 mg
A benzodiazepine is first-line for a seizure lasting 5 minutes or more. Intravenous lorazepam is given at 0.1 mg/kg, which is 1.5 mg for 15 kg, and may be repeated once after 10 minutes. Maximum single dose is 4 mg.
Why A is wrong. This is a ten-fold underdose, probably from a decimal error.
Why C is wrong. This is 0.5 mg/kg, the order of the buccal midazolam dose, and is five times too high for lorazepam.
Why D is wrong. This is 1 mg/kg and would be a ten-fold overdose with risk of respiratory depression.
Topic: Status epilepticus: first-line drug dose. Reference: NICE NG217 Epilepsies in children, young people and adults; APLS: Advanced Paediatric Life Support, Status epilepticus algorithm; Nelson Textbook of Pediatrics: Seizures in childhood
Question 9
PaediatricsEasy
A healthy 13-year-old boy at Tanner stage 3 has 2 cm of firm, mildly tender subareolar breast tissue on both sides. His BMI is normal, there are no drugs or symptoms, and the testes are normal. Which is the most appropriate management?
AOption A: Urgent mammography and referral to the breast clinic, because a firm breast mass in a boy suggests malignancy
BOption B: Testicular ultrasound and karyotype immediately
COption C: Start tamoxifen
DOption D: Reassurance that it is usually physiological and resolves within 1 to 2 years
Show answer for question 9
Correct answer: D. Reassurance that it is usually physiological and resolves within 1 to 2 years
Bilateral firm subareolar tissue in a healthy boy in mid-puberty is physiological gynaecomastia, caused by a transient imbalance of oestrogen and androgen, and it affects up to half of pubertal boys. It resolves spontaneously in most within 1 to 2 years, so reassurance and follow-up are appropriate, with investigation reserved for rapid growth, unilateral hard masses, abnormal testes, drug exposure or systemic signs. Drug therapy and surgery are used only for persistent, severe gynaecomastia with distress.
Why A is wrong. Imaging is not needed in the typical physiological presentation.
Why B is wrong. Investigations are needed only if there are atypical features such as abnormal testes or other signs.
Why C is wrong. Drug treatment is unnecessary for a self-limiting condition.
Topic: Adolescent health: pubertal gynaecomastia. Reference: Endocrine Society clinical practice guideline on gynecomastia evaluation and management; Nelson Textbook of Pediatrics, disorders of puberty
Question 10
PaediatricsMedium
A 7-year-old girl has about 20 episodes a day of sudden staring and unresponsiveness lasting around 10 seconds, with no aura or post-ictal confusion, and the episodes are triggered by hyperventilation. EEG shows 3 Hz generalised spike-and-wave discharges. Which is the most appropriate first-line drug?
AOption A: Carbamazepine
BOption B: Ethosuximide
COption C: No treatment, with observation only
DOption D: Phenytoin
Show answer for question 10
Correct answer: B. Ethosuximide
Brief staring spells with abrupt onset and offset, no post-ictal state, provocation by hyperventilation and 3 Hz spike-and-wave on EEG are diagnostic of childhood absence epilepsy. Ethosuximide is the first-line drug (NICE NG217) when there is no risk of generalised tonic-clonic seizures, with sodium valproate or lamotrigine as alternatives, though valproate is avoided in girls and women of childbearing potential where possible. Carbamazepine and phenytoin can aggravate absence seizures, and untreated absences impair learning and safety.
Why A is wrong. Carbamazepine can worsen absence seizures and is contraindicated in this syndrome.
Why C is wrong. Frequent absences affect learning and safety, so treatment is needed.
Why D is wrong. Phenytoin can aggravate generalised spike-and-wave epilepsies.
Topic: Paediatric neurology: childhood absence epilepsy. Reference: NICE NG217 Epilepsies in children, young people and adults; ILAE classification of the epilepsy syndromes: childhood absence epilepsy
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Frequently asked questions
The blueprint gives Paediatrics 15 percent of the exam, about 18 of 120 questions, and says it may differ by up to 5 percent. It is the organiser's own figure from the November 2025 blueprint.
No. They are original practice questions written by Meddex for exam preparation. The organiser publishes a blueprint, not sample questions, and a confidentiality agreement covers the real exam, so we do not use or claim real or recalled items.
The Meddex app has the full bank, which you can practise by topic with a free account. These pages are a short sample, and the questions on them do not change.
No. Each question has a Show answer button. The answer, the explanation and the reason each wrong option is wrong are part of the page text, so they are there when you press it.