A 2-year-old is brought in two days after a scald.
Which single feature would most strongly suggest a non-accidental (inflicted) injury?
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Paediatric for FRCS (Plast)
Paediatric covers conditions in which the child’s age, growth and safeguarding change the answer. Paediatric burns bring different fluid needs, including maintenance fluid with glucose alongside resuscitation, toxic shock syndrome after small burns, and recognition of non-accidental injury. Congenital melanocytic naevi raise questions of melanoma risk by size, neurocutaneous melanosis, and the timing and method of treatment. Hypospadias and genital anomalies cover classification by meatal position, associated anomalies and the timing of repair. Paediatric vascular anomalies revisit infantile haemangioma and vascular malformations, with emphasis on natural history, propranolol and when to intervene. Expect the best answer to depend on the child’s age and on spotting the one finding in the stem that changes the plan, such as a burn pattern that does not fit the history.
67 questions in the bank · 4 topics Updated 3 October 2026
Topics in this domain
- Paediatric burns22
- Congenital naevi12
- Hypospadias & genitalia18
- Paediatric vascular anomalies15
What the paper tends to test
- Expect paediatric burns fluid questions that include maintenance fluid and age-appropriate urine output targets.
- The paper tends to test recognition of non-accidental injury from the burn pattern and the history.
- Expect toxic shock syndrome as the diagnosis in a child who becomes unwell a few days after a small burn.
- Congenital naevus questions usually ask about melanoma risk, imaging for neurocutaneous melanosis and treatment options.
- Hypospadias questions test associated findings and why circumcision must be avoided before repair.
Classic traps and discriminators
- Children need maintenance fluid containing glucose in addition to resuscitation fluid, and their urine output target (around 1 ml/kg/h) is higher than an adult’s.
- Immersion scalds with sharp, symmetrical glove-and-stocking margins and sparing of flexural creases suggest non-accidental injury; a safeguarding referral is part of the correct answer.
- Fever, rash, diarrhoea and irritability a few days after a small burn is toxic shock syndrome until proven otherwise; a small burn does not exclude it.
- Hypospadias with bilateral undescended testes needs investigation for a difference of sex development before any surgery, and circumcision is avoided because the foreskin is used in the repair.
- A large congenital naevus with multiple satellite lesions raises the risk of neurocutaneous melanosis, and MRI is the investigation.
Free paediatric practice question
From the free sample — original, referenced, with the full explanation. Rate your confidence first.
Paediatric questions, answered
What urine output target is used in children with burns?
Around 1 ml/kg/h in children, compared with 0.5 ml/kg/h in adults, with maintenance fluid containing glucose given in addition to the resuscitation volume.
Which features of a scald suggest non-accidental injury?
Immersion patterns with sharp, symmetrical margins, a glove-and-stocking distribution, sparing of flexural creases or of skin pressed against the bath, uniform depth, and a history that does not fit the injury or the child’s development.
Why is circumcision avoided in hypospadias?
Because the foreskin is a key source of tissue for the urethroplasty and skin cover. A boy with hypospadias should be assessed by the reconstructive team before circumcision is considered.
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