100+ Free Cert ID(SA) Paed Practice Questions

Explanation: According to the South African NDoH Paediatric TB Guidelines, children with confirmed pulmonary TB who are HIV-infected or have severe/extensive disease should receive a 4-drug intensive phase consisting of Rifampicin (R), Isoniazid (H), Pyrazinamide (Z), and Ethambutol (E) for 2 months, followed by a 4-month continuation phase of Rifampicin and Isoniazid (RH). Ethambutol is included in HIV-infected children to prevent treatment failure due to potential initial drug resistance.

Explanation: South African National ART guidelines recommend Abacavir (ABC) + Lamivudine (3TC) + Dolutegravir (DTG 10mg dispersible tablets) as the preferred first-line regimen for all newly diagnosed HIV-infected infants and children aged at least 4 weeks and weighing at least 3 kg. DTG dispersible tablets provide superior virological suppression, higher barrier to resistance, and better tolerability compared to LPV/r.

Explanation: In Tuberculous Meningitis (TBM), adjunctive systemic corticosteroid therapy (Dexamethasone 0.4 mg/kg/day or Prednisolone 2 mg/kg/day tapered over 4–6 weeks) significantly reduces mortality and severe neurological deficits by reducing basal meningeal exudates, cerebral edema, and vasculitis-induced infarcts.

Explanation: This presentation is characteristic of Unmasking Tuberculous Immune Reconstitution Inflammatory Syndrome (TB-IRIS) following rapid immune recovery on DTG. The correct management is to continue ART, initiate standard 4-drug anti-TB treatment (RHZE), and add systemic corticosteroids (prednisolone 1-2 mg/kg/day) to control severe inflammatory manifestations.

Explanation: In South Africa, all household child contacts under 5 years of age exposed to a confirmed case of drug-susceptible pulmonary TB must receive TB Preventive Therapy (TPT) after excluding active TB disease, regardless of HIV status or TST result. Recommended regimens include 3RH (daily rifampicin + isoniazid for 3 months) or 3HP (weekly rifapentine + isoniazid for 12 weeks in children ≥2 years).

Explanation: Bedaquiline is a diarylquinoline antimycobacterial agent approved by WHO and SA NDoH for inclusion in all-oral paediatric MDR-TB treatment regimens for children of all ages (including infants from birth/0 years). Bedaquiline inhibits mycobacterial ATP synthase and replaces injectable agents (like amikacin/capreomycin).

Explanation: First-line treatment for acute severe Pneumocystis jirovecii pneumonia (PJP) in children is high-dose intravenous Cotrimoxazole (15-20 mg/kg/day of trimethoprim component in 3-4 divided doses) for 21 days. In children with moderate-to-severe PJP (PaO2 <70 mmHg or SpO2 <92%), early adjunctive corticosteroid therapy (prednisolone 1-2 mg/kg/day tapered over 21 days) significantly reduces respiratory failure and mortality.

Explanation: In a child on a Dolutegravir-based first-line regimen with an unsuppressed viral load (VL >50 copies/mL), the initial step is to thoroughly evaluate adherence, administration technique, and weight-based dosing accuracy, provide targeted adherence support, and recheck the viral load in 3 months. DTG has a high genetic barrier to resistance, and virological rebound or delayed suppression is most frequently driven by adherence/dosing gaps rather than resistance mutations.

Explanation: Non-suppurative BCG lymphadenitis (ipsilateral axillary or supraclavicular lymph node enlargement <3 cm without fluctuation or systemic symptoms) is a benign self-limiting reaction to BCG vaccination. Recommended management is conservative observation and parental reassurance; it resolves spontaneously over several months.

Explanation: WHO cryptococcal meningitis treatment guidelines recommend induction therapy with Liposomal Amphotericin B (3-4 mg/kg/day IV) combined with Oral Flucytosine (100 mg/kg/day in 4 divided doses) for 2 weeks (or single high-dose Liposomal Ampho B 10 mg/kg on day 1 plus 14 days of flucytosine + fluconazole), followed by consolidation therapy with Fluconazole (12 mg/kg/day up to 800 mg) for 8 weeks.