Paediatrics
Practice questions with explanations

A. Short courses are safe and effective, given in the morning where practical, with parents told to expect appetite and behaviour changes

Short courses do not require tapering and their benefits in croup and asthma exacerbations are substantial. Parents commonly report irritability, hyperactivity and increased appetite, and warning them prevents alarm and unnecessary presentations. Repeated frequent courses are a signal that maintenance therapy needs review.

C. Organ maturity, body composition and clearance change with age, so children are not small adults pharmacokinetically

Neonates have immature glucuronidation and renal function and a high proportion of body water; toddlers often clear some drugs faster per kilogram than adults because of relatively large liver mass. Body surface area is used for narrow-index drugs such as cytotoxics. This is why paediatric dosing comes from age- and weight-banded references rather than from arithmetic on the adult dose.

D. Many cases resolve without antibiotics, so analgesia with a review or delayed prescription is often appropriate

Most acute otitis media is self-limiting, and adequate analgesia is what the child needs most. Immediate antibiotics are indicated in children under 6 months, in systemically unwell children, in bilateral disease in the very young, with discharge, and in Aboriginal and Torres Strait Islander children, where the risk of chronic suppurative otitis media and hearing loss is much higher.