Revision aid, not clinical advice. This page is educational material written for exam preparation. It is not a substitute for the current guideline or for clinical judgement, and must not be relied on for the care of any individual. Always check up-to-date national guidance and verify independently before acting on anything here.

GP Diplomas
DCH
GP Diplomas

The DCH Diploma

A calm, structured route through the Diploma in Child Health (DCH) — the Royal College of Paediatrics and Child Health (RCPCH) qualification many GPs take to formalise their skills in caring for children. Here is what the exam involves, area by area, and the revision toolkit that comes with it. The DCH theory paper is the MRCPCH Foundation of Practice paper, and everything here — including a timed 100-question, two-hour mock — is built for exactly that paper.

Two componentsTheory + clinical
7-year windowSit them in any order

The DCH is part of our GP Diplomas track — qualifications GPs commonly take alongside the membership exams. It sits on its own track because it is a separate RCPCH qualification with its own assessments, not part of the AKT, MSRA or SCA.

What the exam involves

Two components, taken in any order

The DCH is awarded by the RCPCH and is made up of two separate assessments. You can sit them in whichever order suits you, and you have up to seven years to pass both. One tests your knowledge; the other tests how you apply it with children and families.

Component 1 · Theory

Foundation of Practice (FOP)

  • Format: 100 single-best-answer (best-of-five) questions.
  • Time: 2 hours, computer-based at a test centre (online invigilation for eligible candidates).
  • Sittings: usually three a year (typically February, June and October).
  • Shared paper: this is the same FOP theory paper used in the MRCPCH membership exam.
Component 2 · Clinical

DCH Clinical

  • Format: a circuit of eight 9-minute stations, each with 4 minutes’ reading time; no real child is examined.
  • Delivery: online (remotely) — the clinical exam has run remotely since 2020.
  • Length: around 1 hour 50 minutes per session.
  • Sittings: usually two exam periods a year; some stations use role-players.
Practicalities · Dates

Windows & fees

  • Next FOP dates: 17 February, 23 June and 13 October 2027. Applications for February open on 30 November and close on 4 December (7 December at a test centre).
  • DCH Clinical: 17–25 November 2026, then 19–27 May and 16–25 November 2027.
  • Fees (2026, UK): FOP £365 + DCH Clinical £640 = £1,005 in total. The DCH Clinical fee is £660 in 2027.
  • The window: both components must be passed within seven years.
Who it’s for

Getting ready

  • GPs, GP trainees and other clinicians who care for children and want a recognised child-health qualification.
  • Recommended (not required): around 4–6 months of paediatric experience.
  • A primary medical qualification or registration with the General Medical Council. No English language test is required, though the RCPCH strongly recommends proficiency equivalent to IELTS level 7.
  • Always confirm the current format, fees and dates on the RCPCH website before you apply.

The DCH syllabus

The breadth of child health

The theory paper ranges across the whole of paediatrics and child health. These are the official RCPCH syllabus topic areas — expand the list to see them all.

The official syllabus topic areas

Twenty-six areas make up the current Foundation of Practice syllabus (RCPCH theory syllabi v3, February 2026), from adolescent health to the science of practice.

Adolescent health
Behavioural & psychiatry
Cardiology
Dermatology
Diabetes
Emergency medicine (incl. accidents & poisoning)
Endocrinology & growth
Ethics & law
Gastroenterology & hepatology
Genetics & dysmorphology
Haematology & oncology
Infection, immunology & allergy
Metabolism
Musculoskeletal
Neonatology
Nephro-urology
Neurodevelopment & neurodisability
Neurology
Nutrition
Ophthalmology
Palliative care & pain
Patient safety & governance
Pharmacology
Respiratory & ENT
Safeguarding
Science of practice

Your DCH revision toolkit

Everything for the diploma, in one place

The same toolkit that powers our AKT revision, focused on the DCH. Every part of it is built and included with your membership.

Question bank

The Child Health Question Bank

661 single-best-answer questions across the whole DCH syllabus — neonatology, infection, respiratory, safeguarding, emergencies and more — each with a plain-English summary and an expandable deep dive.Open the question bank →

Revision Guide

The DCH Revision Guide

Twelve chapters — the seriously unwell child, neonatology, respiratory, safeguarding and the DCH Clinical.Open the guide →

Resources

DCH Core Resources

Straight from the college — the official exam page, syllabus, key guidance and recommended reading.Open resources →

Revise & drill

Drill a single topic

Filter by any of the 26 modules, which follow the RCPCH syllabus areas, and pick your length. Practice mode gives feedback as you go; test mode holds the answers until the end.Choose an area →

Timed mock

A full mock paper

Sit 100 questions in 120 minutes, mirroring the RCPCH Foundation of Practice paper, then review every answer with the reasoning in full.Sit a mock →

Now live

The DCH toolkit is ready

The question bank, topic drills and the timed mock are built and open to members. This page explains the exam — the question bank is where you revise for it

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Exam details from the RCPCH (rcpch.ac.uk); correct at the time of writing — always confirm with the RCPCH.

Core Revision is an independent revision resource and is not affiliated with or endorsed by the RCPCH.

Try before you buy

Try ten DCH questions, free

One question from each of ten DCH modules, with the same explanation members see after every answer: the Core Lens, a Deep Dive and a Founder’s Tip. No sign-up, no timer, nothing saved.

DCH · Adolescent MedicineQuestion 1 of 10 · single best answer

The confidential consultation with a young person

Scenario: A 14-year-old girl attends her GP surgery with her mother, who booked the appointment because her daughter has had recurrent headaches and has missed several days of school. The mother answers almost every question herself. The girl is quiet, avoids eye contact and looks at her phone. Examination, including neurological examination and blood pressure, is normal and there are no red flag features in the history.

Question: What is the most appropriate approach to this consultation?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is C.

Core Lens: High-Yield Takeaways

  • Offer time alone as routine: part of every adolescent consultation should be offered without a parent, framed as normal practice rather than suspicion about this family.
  • State the limits before the disclosure: what she says stays confidential unless she or someone else is at risk of serious harm.
  • Screen psychosocially: HEEADSSS covers Home, Education, Eating, Activities, Drugs, Sexuality, Suicide and self-harm, and Safety.
  • Capacity is assessed, not assumed from age: a Gillick-competent under-16 can consent to treatment.
Click here for Deep Dive

Why adolescence changes the consultation

Somatic symptoms in a teenager, especially when paired with school absence, are frequently the presenting face of a psychosocial problem: bullying, low mood, self-harm, family conflict, substance use or an unwanted sexual experience. None of these will surface while a parent answers the questions. GMC 0-18 years: guidance for all doctors is explicit that young people should be given the opportunity to be seen without a parent and involved in decisions about their care to the extent of their competence.

Confidentiality and where it stops

The script is short and is given before the history, not afterwards. Confidentiality applies to under-16s just as to adults, but it is not absolute: information may be shared where there is a risk of serious harm to the young person or another person. Common triggers include current suicidal intent, a much older partner, sexual activity under 13 years, and exploitation. A promise of unconditional secrecy is one you cannot keep, and breaking it later damages trust far more than an honest caveat at the start.

HEEADSSS as a working tool

HEEADSSS deliberately moves from neutral to sensitive territory, so rapport is built before questions about drugs, sex or self-harm. It is a screen, not an interrogation, and a partial HEEADSSS beats none. Document that time alone was offered, that confidentiality was explained, and what was screened.

Why This Is the Right Move

This girl has unexplained headaches, school absence, a normal examination and a mother speaking for her. Seeing her alone, explaining what will and will not be kept private, then working through HEEADSSS is most likely to reveal the real problem and is the approach expected by GMC 0-18 years. It respects her autonomy without excluding her mother, who is brought back for the plan.

Why the Other Options Don’t Fit

  • Option A: Consulting entirely through the parent guarantees the psychosocial history is never obtained and ignores her right to be involved in her own care.
  • Option B: Time alone is right but the promise is wrong; unconditional confidentiality cannot be offered and the limits must be stated before she discloses.
  • Option D: A leaflet and a one-month review delays assessment of a child already missing school and gives her no chance to speak today.
  • Option E: School nursing is a useful ally, not a substitute for a psychosocial history you can take now in the room.

“Red Flags” and Key Decision Points

  • Current suicidal thoughts or recent self-harm: undertake a same-day risk assessment and discuss urgent CAMHS referral.
  • A much older partner or sexual activity under 13 years: refer to children’s social care under local safeguarding procedures.
  • Persistent school non-attendance: treat as a marker of mental health, bullying or safeguarding difficulty, not a discipline issue.
  • A parent who refuses to leave: explain that seeing every young person alone is standard practice, and record the conversation if they still decline.

Relevance to UK Practice

Adolescents are the age group least likely to attend primary care and most likely to leave without saying what actually brought them. A DCH-level clinician is expected to offer time alone by default, deliver the confidentiality statement fluently, and screen psychosocially alongside the presenting complaint.

Founder’s Tip

Learn one sentence by heart for the confidentiality caveat and say it the same way every time; once it is automatic, the histories get much better.

Core Summary: Offer a young person part of the consultation alone, explain that confidentiality holds unless someone is at risk of serious harm, and use a HEEADSSS screen rather than promising unconditional secrecy.

DCH · DermatologyQuestion 2 of 10 · single best answer

Localised non-bullous impetigo

Scenario: A 5-year-old boy is brought to the GP surgery with four small lesions around his right nostril and upper lip that appeared three days ago. They began as tiny blisters and now have a golden-yellow adherent crust on an erythematous base. He is afebrile, eating normally and playing happily in the waiting room. He has no eczema, no immunosuppression and no other rash, and his three siblings are unaffected.

Question: What is the most appropriate management?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is E.

Core Lens: High-Yield Takeaways

  • Localised non-bullous impetigo is treated topically: NICE NG153 makes hydrogen peroxide 1% cream first-line in a well child who is not systemically unwell.
  • Topical antibiotics are second-line: fusidic acid 2% is reserved for lesions unsuitable for or unresponsive to hydrogen peroxide, to limit resistance.
  • Oral antibiotics are for widespread, bullous or systemic disease: flucloxacillin is the usual UK first choice when systemic treatment is genuinely needed.
  • Exclusion advice matters: UKHSA guidance excludes the child from school until lesions are crusted and healed, or for 48 hours after starting antibiotic treatment.
Click here for Deep Dive

Recognising the classic picture

Non-bullous impetigo accounts for the large majority of cases and is caused by Staphylococcus aureus, sometimes with Streptococcus pyogenes. Thin-walled vesicles rupture within hours, leaving the characteristic golden adherent crust on an erythematous base, typically around the nose and mouth or on exposed limbs, in a child who is systemically well. Bullous impetigo produces flaccid blisters that leave a collarette of scale, is staphylococcal, and is more likely to make an infant unwell.

The NICE NG153 treatment ladder

NICE NG153 (Impetigo: antimicrobial prescribing) recommends hydrogen peroxide 1% cream for localised non-bullous impetigo in a person who is not systemically unwell and not at high risk of complications, applied two or three times daily for five days. If hydrogen peroxide is unsuitable or ineffective, use a short course of topical fusidic acid 2%. Oral antibiotics, usually flucloxacillin (or clarithromycin if penicillin-allergic), are reserved for bullous impetigo, widespread non-bullous disease, systemic illness or high risk of complications. This antibiotic-sparing ladder exists because topical antibiotic resistance in the UK is a real problem.

Hygiene, exclusion and recurrence

Impetigo is highly contagious by direct contact and fomites. Advise handwashing, not sharing towels, flannels or bedding, keeping nails short and not picking lesions. UKHSA guidance on infection control in schools excludes an affected child until the lesions are crusted and healed, or until 48 hours after antibiotic treatment has started. Recurrent impetigo should prompt a search for nasal staphylococcal carriage and for underlying eczema, scabies or head lice.

Why This Is the Right Move

This boy has a handful of typical golden-crusted lesions in one small perinasal area, is afebrile and is systemically well, with no eczema or immunosuppression. That is textbook localised non-bullous impetigo in a low-risk child, so NICE NG153 puts hydrogen peroxide 1% cream first, paired with correct exclusion advice until the lesions have crusted and healed, or 48 hours after treatment begins.

Why the Other Options Don’t Fit

  • Option A: Oral flucloxacillin is unnecessary for four localised lesions in a well child, and a fixed week off school is longer than UKHSA advice requires.
  • Option B: Clarithromycin is the alternative only in penicillin allergy and only when systemic treatment is indicated, and advising no exclusion is wrong for a highly contagious condition.
  • Option C: Impetigo does often self-resolve, but treatment shortens the illness and reduces spread, and immediate return to school ignores infection control advice.
  • Option D: Swabs are reserved for recurrent, widespread or treatment-failing disease; delaying treatment while awaiting culture serves no purpose in a straightforward case.

“Red Flags” and Key Decision Points

  • Fever, malaise or spreading cellulitis: Switch to a systemic antibiotic and reassess for deeper soft tissue infection.
  • Flaccid bullae or a rapidly peeling, tender erythroderma: Think bullous impetigo or staphylococcal scalded skin syndrome and admit young children.
  • Impetigo on top of eczema, or in an immunosuppressed child: Treat as higher risk and use systemic therapy with a lower threshold.
  • Recurrent or non-resolving lesions: Swab lesions and nose, treat any underlying skin disease and consider decolonisation.

Relevance to UK Practice

Impetigo is one of the commonest skin infections presenting to UK general practice and school nurses, and the DCH-level skill is prescribing proportionately rather than reaching reflexively for an oral antibiotic. Getting the exclusion advice right matters too, because families are often as concerned about nursery and school as about the rash.

Founder’s Tip

Localised and well means topical; widespread, bullous or unwell means oral — that single distinction answers almost every impetigo question you will meet.

Core Summary: Localised non-bullous impetigo in a systemically well child is treated with hydrogen peroxide 1% cream under NICE NG153, with exclusion from school until the lesions are crusted and healed or 48 hours after treatment starts.

DCH · Endocrinology, Diabetes and GrowthQuestion 3 of 10 · single best answer

Annual review in established type 1 diabetes

Scenario: An 11-year-old boy with type 1 diabetes diagnosed three years ago attends his annual review at the paediatric diabetes clinic. He uses multiple daily injections with a continuous glucose monitor and his HbA1c today is 62 mmol/mol. Over the past 18 months his height has drifted from the 50th to the 25th centile, and he describes intermittent abdominal bloating with more frequent unexplained hypoglycaemia. His injection sites are normal and his feet are healthy.

Question: Which screening is most appropriate at this annual review?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is C.

Core Lens: High-Yield Takeaways

  • The NICE NG18 target is an HbA1c of 48 mmol/mol or lower, measured at least four times a year.
  • Thyroid function is checked at diagnosis and annually; coeliac serology at diagnosis and again whenever growth or gut symptoms suggest it.
  • Retinopathy, albuminuria and blood pressure monitoring all begin at 12 years, not before.
  • A falling height centile with unexplained hypoglycaemia in type 1 diabetes is coeliac disease until proven otherwise.
Click here for Deep Dive

What NICE NG18 asks for, and when

NICE NG18 separates two kinds of surveillance. Associated autoimmune conditions are monitored from diagnosis: thyroid function at diagnosis and annually until transfer to adult services, and coeliac screening at diagnosis, repeated if suggestive symptoms or growth concerns appear. Microvascular complications are monitored from 12 years: annual retinopathy screening through the diabetic eye screening programme, an annual early morning urinary albumin to creatinine ratio, and annual blood pressure measurement. This boy is 11, so the age-12 tests are not yet due.

Why coeliac disease matters in type 1 diabetes

Coeliac disease affects several per cent of children with type 1 diabetes and is frequently silent. When it does declare itself the clues are exactly those described here: a height centile drifting downwards, vague bloating, iron deficiency and, characteristically, erratic glycaemia with unexplained hypoglycaemia from variable carbohydrate absorption. Serology must be taken while the child is still eating gluten, in line with NICE NG20, and a positive result leads to gastroenterology referral rather than an immediate gluten-free diet.

The rest of the annual review

The consultation is more than a blood form. Growth and BMI are plotted, injection sites examined for lipohypertrophy, glucose data reviewed with time in range, and carbohydrate counting revisited with the dietitian. Psychological wellbeing, school support and immunisations belong here. An HbA1c of 62 mmol/mol is above target, so check he has been offered a hybrid closed loop system under NICE TA943 and explore what is getting in the way.

Why This Is the Right Move

At 11 years he is due his annual thyroid function test, and his falling height centile, bloating and unexplained hypoglycaemia make coeliac serology clearly indicated now rather than later. Retinopathy screening, the albumin to creatinine ratio and blood pressure surveillance start at 12 years under NG18, so deferring them is correct, not negligent.

Why the Other Options Don’t Fit

  • Option A: Retinopathy screening and albuminuria testing are not indicated until 12 years, and this plan omits the coeliac serology his symptoms demand.
  • Option B: Thyroid function is right, but annual blood pressure surveillance does not start until 12 years, and deferring coeliac serology in a child losing height centiles with unexplained hypoglycaemia misses the likely diagnosis.
  • Option D: Coeliac serology is appropriate, but retinopathy screening is premature and thyroid function is due annually from diagnosis, not from 12 years.
  • Option E: Doing nothing ignores both the annual thyroid check and a clinical picture that points strongly to coeliac disease.

“Red Flags” and Key Decision Points

  • Falling height or weight centiles: Screen for coeliac and thyroid disease and review insulin adequacy and eating behaviour.
  • Recurrent unexplained hypoglycaemia: Consider coeliac disease, Addison’s disease or insulin omission and overcorrection.
  • Persistently raised HbA1c or missed appointments: Explore diabetes distress and family stress, and consider safeguarding.
  • Recurrent diabetic ketoacidosis: Treat as a marker of unmet psychosocial need rather than simple non-adherence.

Relevance to UK Practice

Paediatric diabetes care in the UK is delivered by multidisciplinary teams and audited through the National Paediatric Diabetes Audit, which reports exactly these processes: HbA1c, thyroid and coeliac screening, and the age-12 complication checks. A trainee who knows which test is due at which age can support the annual review properly and recognise when a child’s growth curve is saying something the glucose data is not.

Founder’s Tip

Remember the number twelve for eyes, kidneys and blood pressure, and every year from day one for thyroid, and the annual review checklist writes itself.

Core Summary: At 11 he needs his annual thyroid check plus coeliac serology prompted by falling growth and unexplained hypoglycaemia, with retinopathy, albuminuria and blood pressure monitoring starting at 12 years, while the team works towards the NICE NG18 HbA1c target of 48 mmol/mol or lower.

DCH · Genetics and DysmorphologyQuestion 4 of 10 · single best answer

Autosomal recessive inheritance counselling

Scenario: A 10-week-old boy has been confirmed to have medium-chain acyl-CoA dehydrogenase deficiency after a positive newborn blood spot screening result, with two pathogenic ACADM variants, one inherited from each parent. Both parents are healthy and unrelated, and their 3-year-old daughter is well. At the GP surgery they ask how likely it is that a future baby would be affected, and whether anything can be tested in a future pregnancy.

Question: What is the most appropriate counselling for the parents?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is C.

Core Lens: High-Yield Takeaways

  • Two healthy carrier parents give a 1 in 4 risk in every pregnancy: 1 in 4 affected, 2 in 4 carriers and 1 in 4 neither, whatever happened in previous pregnancies.
  • Recessive conditions typically appear with no family history, because carriers are healthy and a single variant is silent.
  • An unaffected sibling has a 2 in 3 chance of being a carrier, since being affected has already been excluded.
  • Refer to clinical genetics: cascade carrier testing, prenatal diagnosis and preimplantation testing can be discussed before conceiving again.
Click here for Deep Dive

How autosomal recessive inheritance works

Both parents carry one pathogenic variant and one working copy, so both are healthy. At each conception one allele is inherited independently from each parent, giving a 1 in 4 chance of two pathogenic copies, a 2 in 4 chance of carrier status and a 1 in 4 chance of neither. The commonest counselling error is to imply the risk is used up: chance has no memory, so one affected child does not protect the next three.

What this means for the wider family

His sister’s normal newborn screen, not simply being well, excludes the diagnosis, so her carrier chance is 2 in 3 rather than 1 in 2. Carrier status matters only for her future reproductive choices, and UK guidance is that carrier testing of children is normally deferred until they can decide for themselves, in line with GMC 0-18 years. Each parent’s siblings have a 1 in 2 chance of carrying the same variant, so cascade testing is offered through genetics.

Reproductive options in the UK

Because both familial variants are already known, targeted testing is straightforward. Options include prenatal diagnosis by chorionic villus sampling from about 11 weeks or amniocentesis from about 15 weeks, preimplantation genetic testing where NHS eligibility criteria are met, donor gametes, adoption, or accepting the risk untested. Testing is arranged through the NHS Genomic Medicine Service under the National Genomic Test Directory.

Why This Is the Right Move

The child has two pathogenic variants, one from each healthy parent: a textbook autosomal recessive pedigree. The accurate figure is a 1 in 4 recurrence in every future pregnancy, and the right primary care action is to give that number plainly and refer to clinical genetics for cascade testing and prenatal or preimplantation options.

Why the Other Options Don’t Fit

  • Option A: A 1 in 2 risk describes autosomal dominant transmission from an affected parent, and prenatal diagnosis is in fact available here.
  • Option B: X-linked recessive disease is transmitted by carrier mothers to sons; it cannot explain a variant inherited from the father as well.
  • Option D: Recessive conditions occur precisely in healthy couples; once both are known carriers their risk is far above background.
  • Option E: A karyotype cannot detect single-gene variants, and balanced translocations cause miscarriage or unbalanced rearrangements.

“Red Flags” and Key Decision Points

  • Consanguinity or a known founder population: Refer for genetic counselling; the couple may share other recessive variants.
  • A parent already pregnant when the diagnosis is made: Refer urgently so prenatal options remain open within gestational limits.
  • Request to test the well sibling for carrier status: Discuss with genetics; testing is usually deferred until the child can consent.
  • Intercurrent illness with poor feeding in the affected child: Start the emergency regimen and seek urgent paediatric advice.

Relevance to UK Practice

GPs are often the first people a family asks after a newborn screening diagnosis, and what they need is a number and a route. Saying 1 in 4 for each pregnancy and 2 in 3 for a screen-negative sibling, then referring to genetics, is core DCH-level competence and prevents both false reassurance and needless alarm about a healthy carrier.

Founder’s Tip

Sketch the four-box square on the back of the clinic letter; parents grasp 1 in 4 far faster when they can see the boxes than when they hear a percentage.

Core Summary: Two healthy carrier parents face a 1 in 4 recurrence risk in every pregnancy, and the right action is to state that figure clearly and refer to clinical genetics for cascade carrier testing and prenatal or preimplantation options.

DCH · Metabolic MedicineQuestion 5 of 10 · single best answer

MCAD deficiency during an intercurrent illness

Scenario: A father telephones the out-of-hours service at 22:30 about his 3-year-old son, who weighs 15 kg and has medium-chain acyl-CoA dehydrogenase deficiency diagnosed on newborn screening. The boy has had fever and coryza for a day, vomited twice this evening and refused his supper. He is miserable and clingy but fully alert and interactive, and has taken a few sips of squash. His temperature is 38.6°C. The emergency regimen letter is on the fridge.

Question: What is the most appropriate advice?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A.

Core Lens: High-Yield Takeaways

  • Fasting is the danger, not the infection: in MCAD deficiency a missed meal during illness can cause hypoketotic hypoglycaemia, coma or death.
  • Every child has a written emergency regimen: frequent glucose polymer drinks day and night replace normal food at the first sign of illness.
  • Two vomited drinks means hospital: failure of the oral regimen is the trigger for intravenous 10% glucose.
  • Between illnesses they are normal children: no drug treatment is needed, only avoidance of prolonged fasting.
Click here for Deep Dive

What goes wrong when the child stops eating

MCAD deficiency is the commonest fatty acid oxidation disorder, affecting roughly one in ten thousand UK births and screened for on the newborn blood spot card since 2009. Once glycogen stores are exhausted, healthy children switch to burning fat and making ketones; these children cannot. The result is hypoketotic hypoglycaemia with encephalopathy, liver dysfunction and arrhythmia. Before screening, many died or were brain-injured at first presentation during an ordinary viral illness.

The emergency regimen in practice

Every UK family is issued with a BIMDG-based emergency regimen letter specifying an age-appropriate glucose polymer concentration and volume, given as small drinks every two to three hours around the clock, replacing normal meals until the child is well and eating again. It is started at the first vomit, fever or refusal of food, not once the child looks unwell. Waking the child overnight to drink is part of the plan, which is exactly why an undisturbed night is unsafe.

When home management is no longer safe

The regimen is only protective if it stays down. Vomiting two drinks, refusing them, drowsiness, or an illness that is clearly worsening all mean immediate hospital assessment for intravenous 10% glucose. Families should take the letter with them and show it at the door; it authorises glucose before any diagnostic workup, and treatment should not wait for a metabolic opinion.

Why This Is the Right Move

This boy is already vomiting, febrile and refusing food — precisely the catabolic state MCAD deficiency cannot tolerate. Starting the glucose polymer drinks now supplies carbohydrate before hypoglycaemia develops, and setting an explicit safety net of two vomited drinks gives his father an unambiguous threshold to act on at 03:00. It is safe, evidence-based and matches what his own written plan says.

Why the Other Options Don’t Fit

  • Option B: An overnight fast with antipyretics is the classic fatal error; paracetamol treats the fever but does nothing about the energy deficit.
  • Option C: Protein is not the issue in a fatty acid oxidation defect, and he is vomiting; he needs frequent carbohydrate drinks, not a meal.
  • Option D: Oral rehydration solution contains far too little carbohydrate to prevent decompensation, and waiting a day is unsafe.
  • Option E: An immediate ambulance is disproportionate for an alert child taking fluids; the regimen is tried first, with clear rules for escalation.

“Red Flags” and Key Decision Points

  • Vomiting two emergency drinks: Go straight to hospital for intravenous 10% glucose.
  • Drowsiness, floppiness or a seizure: Treat as decompensation and call 999.
  • Any child with MCAD deficiency attending hospital: Check the glucose and start glucose early rather than waiting.
  • Planned fasting for surgery or an anaesthetic: Requires a metabolic plan and intravenous glucose cover.

Relevance to UK Practice

Because MCAD deficiency is screened for, most GPs will have such a child on their list, and the contact will almost always be a phone call about a routine viral illness. The DCH-level skill is recognising that the ordinary advice of fluids, paracetamol and review tomorrow is dangerous here, and that the family already hold the correct plan.

Founder’s Tip

Ask the parent to read their emergency regimen letter to you over the phone — it is the most important prescription the family owns, and it turns a worrying call into a script you can both follow.

Core Summary: A febrile, vomiting child with MCAD deficiency should start the written emergency regimen of frequent glucose polymer drinks immediately and attend hospital for intravenous glucose if two drinks are vomited, never fast overnight.

DCH · NeonatologyQuestion 6 of 10 · single best answer

Bilious vomiting in a neonate (malrotation with volvulus)

Scenario: A 3-day-old boy born at term is brought to the emergency department having vomited three times in the past 6 hours. The vomit is bright green. He had fed well until this morning and passed meconium normally on day one. On examination he is irritable, with a heart rate of 176 beats/min, capillary refill of 3 seconds and a soft, only minimally distended abdomen with no palpable mass. He is afebrile and the hernial orifices are normal.

Question: What is the most appropriate immediate management?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is A.

Core Lens: High-Yield Takeaways

  • Green vomit in a neonate is obstruction until proved otherwise: NICE NG1 lists bile-stained vomiting as a red symptom requiring urgent referral.
  • Malrotation with midgut volvulus is the diagnosis to exclude first: the entire midgut can infarct within hours.
  • A soft abdomen is not reassurance: early volvulus often has minimal distension and no mass, and distension is a late sign.
  • Resuscitate, decompress and refer before imaging: the definitive test is an urgent upper gastrointestinal contrast study.
Click here for Deep Dive

Why the colour of the vomit matters

Bile enters the duodenum below the ampulla, so bile-stained vomiting implies obstruction distal to that point. In a neonate the differential includes malrotation with volvulus, duodenal or jejunal atresia, meconium ileus, Hirschsprung disease, an incarcerated inguinal hernia and necrotising enterocolitis. NICE NG1 (Gastro-oesophageal reflux disease in children and young people) separates bile-stained vomit from reflux and lists it among the red symptoms mandating urgent referral.

Malrotation and midgut volvulus

In malrotation the midgut fails to rotate and fix normally, leaving a narrow mesenteric base. The bowel can twist around the superior mesenteric artery, and once it does the whole midgut is ischaemic within hours. Around half present in the first month, classically as sudden bilious vomiting in a previously well-feeding baby. Early on the abdomen is often soft and flat, which is why the diagnosis is missed; distension, blood per rectum, peritonism and shock are late findings signalling necrotic bowel.

Resuscitate, decompress, refer, then image

Immediate management is nil by mouth, a nasogastric tube on free drainage, intravenous fluid resuscitation with 10 mL/kg boluses if perfusion is poor, bloods including gas, glucose and electrolytes, and an urgent call to the paediatric surgical team. The confirmatory test is an upper gastrointestinal contrast study assessing the duodenojejunal flexure, but a shocked or peritonitic baby goes to theatre for a Ladd procedure without waiting.

Why This Is the Right Move

A previously well 3-day-old with bright green vomiting, tachycardia and delayed capillary refill has a surgical obstruction until proved otherwise. Nil by mouth with nasogastric decompression prevents distension and aspiration, intravenous fluids treat the developing shock, and urgent surgical referral starts the clock on the contrast study or laparotomy. Every hour of delay costs viable bowel.

Why the Other Options Don’t Fit

  • Option B: Thickeners treat reflux, which never causes bile-stained vomiting, and community review would allow a volvulus to infarct.
  • Option C: Pyloric stenosis causes non-bilious projectile vomiting at around 4 to 6 weeks; oral fluids are unsafe in obstruction.
  • Option D: Cow’s milk protein allergy presents with rashes, blood or mucus in stool and unsettledness, not sudden green vomiting with shock.
  • Option E: Posseting is small, milky and effortless; describing green vomit as normal is the classic fatal error in this presentation.

“Red Flags” and Key Decision Points

  • Any bile-stained vomit under one month: Discuss with paediatric surgery the same hour, whatever the abdomen feels like.
  • Abdominal distension, tenderness or blood per rectum: Suspect established ischaemia and escalate straight to theatre discussion.
  • Shock, metabolic acidosis or rising lactate: Resuscitate and operate; do not delay for a contrast study.
  • No meconium passed in the first 24 to 48 hours: Consider Hirschsprung disease or another distal obstruction.

Relevance to UK Practice

Vomiting babies fill GP surgeries and emergency departments, and the overwhelming majority have reflux or overfeeding. The single discriminator that a DCH-level clinician must never fumble is colour: green means the surgeons, not a prescription. Because not all district general hospitals have on-site paediatric surgery, early recognition also triggers the transfer conversation, and that lead time often determines how much bowel survives.

Founder’s Tip

Ask what colour the vomit was before you ask anything else — in the first month, green earns a phone call to the surgeons every time.

Core Summary: Bilious vomiting in a neonate is malrotation with midgut volvulus until proved otherwise, so keep the baby nil by mouth, decompress with a nasogastric tube, resuscitate with fluids and refer urgently for surgery and an upper gastrointestinal contrast study.

DCH · NeurologyQuestion 7 of 10 · single best answer

Duchenne muscular dystrophy

Scenario: A 4-year-old boy is brought to the GP because he cannot keep up with the other children at nursery. He walked independently at 20 months and has always been slow on stairs, taking them one step at a time holding the rail. He falls several times a day and his speech is mildly delayed. His calves look bulky and feel firm. He has a waddling gait, and to stand from the floor he rolls prone and pushes himself up by walking his hands along his thighs. Tone, reflexes and sensation are normal.

Question: What is the most appropriate next investigation?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is D.

Core Lens: High-Yield Takeaways

  • Gowers sign is the giveaway: climbing up the legs to stand means pelvic girdle weakness until proven otherwise.
  • Creatine kinase is the gateway test: it is cheap, available from every UK GP lab and grossly raised in Duchenne.
  • Late walkers need a CK: any boy not walking independently by 18 months should have one checked, particularly with language delay.
  • Delay has consequences: earlier diagnosis brings glucocorticoids, cardiac and respiratory surveillance and genetic counselling for the family.
Click here for Deep Dive

Reading the gait and the calves

This boy shows the classic cluster: delayed walking, a waddling gait, difficulty with stairs, frequent falls, calf pseudohypertrophy from fatty replacement of muscle, and a positive Gowers sign. Around a third also have speech or global delay, because dystrophin is expressed in brain as well as muscle. Reflexes are preserved early and sensation is always normal, separating a myopathy from a neuropathy or cord lesion.

Why creatine kinase comes first

Duchenne is an X-linked recessive dystrophinopathy in which membrane fragility lets creatine kinase leak from muscle. Levels are typically tens of thousands of units per litre against a normal of a few hundred, so a genuinely normal CK makes the diagnosis very unlikely. Confirmation is by genetic testing of the dystrophin gene, with muscle biopsy reserved for unclear cases.

What the diagnosis unlocks

A grossly raised CK triggers urgent referral to a paediatric neuromuscular service, not a repeat test in three months. Confirmed Duchenne opens access to glucocorticoids to prolong ambulation, cardiac surveillance with echocardiography, respiratory and spinal monitoring, physiotherapy for contractures, carrier counselling for the mother and sisters, and mutation-specific therapies. It also flags anaesthetic risk: suxamethonium and volatile agents can precipitate rhabdomyolysis and hyperkalaemic arrest.

Why This Is the Right Move

Delayed walking, calf hypertrophy and a Gowers sign in a 4-year-old boy is Duchenne muscular dystrophy until disproved. A serum creatine kinase answers the question this week, costs almost nothing and needs no sedation. Every other option either delays the answer or investigates a system the examination has already shown to be normal.

Why the Other Options Don’t Fit

  • Option A: Physiotherapy is part of long-term care, but a three-month watch-and-wait in a boy with a Gowers sign delays a diagnosis that is already overdue.
  • Option B: Vitamin D deficiency can cause proximal myopathy and a waddling gait, but it does not produce calf pseudohypertrophy and should not displace the CK.
  • Option C: A cord or root lesion would give abnormal reflexes, sensory signs or bladder symptoms; MRI here means a general anaesthetic for a normal scan.
  • Option E: Nerve conduction studies and EMG target neuropathy or anterior horn cell disease, are distressing for a 4-year-old and are unnecessary when CK and genetics answer it.

“Red Flags” and Key Decision Points

  • A boy not walking independently by 18 months: send a serum creatine kinase rather than simply monitoring.
  • Gowers sign at any age: assume proximal weakness and investigate rather than reassure.
  • Unexplained raised ALT or AST in a boy: think muscle before liver and check a CK.
  • Grossly raised CK: refer urgently to a paediatric neuromuscular service and flag anaesthetic risk.

Relevance to UK Practice

Almost every boy with Duchenne first presents to a GP, health visitor or community paediatrician, yet UK diagnosis is still often made around school entry, years after the first concerns. NICE NG127 (Suspected neurological conditions: recognition and referral) covers when motor problems in children need investigation and referral, and in UK practice the creatine kinase is the first-line test that changes a family’s whole pathway.

Founder’s Tip

Make it a habit: any boy with unexplained motor delay, big calves or a raised transaminase gets a CK on the same form, and you will never miss this diagnosis.

Core Summary: A 4-year-old boy with late walking, calf hypertrophy and a Gowers sign needs a serum creatine kinase first, because a grossly raised level makes Duchenne muscular dystrophy the working diagnosis and triggers urgent neuromuscular referral.

DCH · OphthalmologyQuestion 8 of 10 · single best answer

Leukocoria and the absent red reflex

Scenario: An 8-month-old boy is brought to the GP by his parents, who have noticed that his left pupil looks white in several recent flash photographs on their phone. He is thriving, has no eye discharge and they have not noticed a squint. In a darkened room you examine him with a direct ophthalmoscope at arm’s length: the right eye shows a normal red reflex but no red reflex is seen on the left. The eye is white and not inflamed.

Question: What is the most appropriate next step?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is C.

Core Lens: High-Yield Takeaways

  • Leukocoria is retinoblastoma until proven otherwise: a white pupil or absent red reflex needs urgent specialist assessment, never watchful waiting.
  • NICE NG12 names this finding: a child with an absent red reflex goes urgently on the suspected cancer pathway.
  • Parents notice it first: a white pupil seen repeatedly in flash photographs is evidence, not a camera artefact.
  • Timing changes outcome: UK survival exceeds 95% with early treatment, but delay costs eyes and vision.
Click here for Deep Dive

What the red reflex actually tests

The red reflex appears when light from the ophthalmoscope passes through clear ocular media and reflects off the vascular retina. Anything clouding the visual axis — cornea, lens or vitreous — or replacing normal retina blunts or abolishes it. In the UK it is checked under the NHS Newborn and Infant Physical Examination (NIPE) programme at the newborn check and at 6 to 8 weeks, in a darkened room from about 30 cm with both eyes compared. A reflex that is white, dull or asymmetrical is abnormal.

The differential diagnosis of leukocoria

Retinoblastoma is the commonest intraocular malignancy of childhood, with roughly 40 to 50 new UK cases a year, most before age five. Other causes include congenital cataract, persistent fetal vasculature, Coats disease and retinopathy of prematurity. None is safe to observe: congenital cataract also needs surgery within weeks to prevent deprivation amblyopia. No primary care test separates them, which is why referral goes to a specialist rather than to optometry.

What happens after the referral

Children are seen by a supraregional retinoblastoma service — Birmingham Children’s Hospital or the Royal London Hospital — for examination under anaesthesia with indirect ophthalmoscopy and imaging. Treatment may involve systemic, intra-arterial or intravitreal chemotherapy, laser, cryotherapy or enucleation. About 40% of cases are heritable and almost all bilateral disease is, so RB1 testing guides screening of siblings.

Why This Is the Right Move

This baby has a parent-observed white pupil that a clinician has confirmed as a unilateral absent red reflex in a quiet, white eye — a positive screening finding for serious intraocular pathology with retinoblastoma at the top of the list. NICE NG12 (Suspected cancer: recognition and referral), recommendation 1.12.2, advises referral for ophthalmological assessment using a suspected cancer pathway referral for retinoblastoma in a child with an absent fundal (‘red’) reflex, and UK retinoblastoma services usually see these children within days.

Why the Other Options Don’t Fit

  • Option A: Photographic artefact is symmetrical and red, not white; the absent reflex is confirmed on examination, so reassurance risks a fatal delay.
  • Option B: Chloramphenicol treats bacterial conjunctivitis and is irrelevant to a white, quiet eye; optometry cannot exclude an intraocular tumour.
  • Option D: Orthoptists assess eye movements, squint and vision, but a routine wait is far too long and cannot exclude retinoblastoma.
  • Option E: Imaging helps with staging, but it needs general anaesthesia in an infant and is arranged by the specialist team after examination.

“Red Flags” and Key Decision Points

  • Absent or asymmetrical red reflex: Make the suspected cancer pathway referral to ophthalmology the same day, without further primary care investigation.
  • Parent reports a white pupil in photographs: Refer even if your own examination looks normal, as the reflex varies with gaze angle.
  • New squint in a child under five: Refer for assessment, since retinoblastoma can present as strabismus rather than leukocoria.
  • Family history of retinoblastoma: Ensure the newborn is booked for specialist screening through the supraregional service.

Relevance to UK Practice

GPs, health visitors and paediatric SHOs perform the NIPE red reflex check and field worried parents holding a phone photograph. Leukocoria is one of very few primary care findings that justifies interrupting a clinic to refer the same morning.

Founder’s Tip

Ask the parents to email you the photograph — a white pupil captured on camera is genuine evidence and makes your referral letter almost write itself.

Core Summary: A white pupil or absent red reflex in a child is retinoblastoma until proven otherwise and mandates urgent referral for specialist ophthalmological assessment under NICE NG12.

DCH · Pharmacology and TherapeuticsQuestion 9 of 10 · single best answer

Yellow Card reporting of an adverse drug reaction

Scenario: A 13-month-old girl is reviewed by her GP after a paediatric admission. Three weeks after her first MMRV vaccination she developed widespread petechiae and spontaneous bruising, and was found to have a platelet count of 18 × 109/L. Immune thrombocytopenia was diagnosed, she was managed conservatively and observed overnight, and her count is now recovering. She is otherwise well. Her mother asks whether anyone outside the hospital needs to know what happened.

Question: What is the most appropriate action?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is D.

Core Lens: High-Yield Takeaways

  • Suspicion is enough: the Yellow Card scheme asks for suspected reactions and does not require proof of causality.
  • Vaccines count: the MHRA scheme covers vaccines, devices and defective products, not just conventional medicines.
  • Children have a lower threshold: report all suspected reactions in children, and every reaction to a black triangle product.
  • Reporting is additional: it never replaces treating the child, documenting in the notes and advising the family.
Click here for Deep Dive

What the Yellow Card scheme is for

The MHRA Yellow Card scheme is the UK’s spontaneous reporting system for suspected adverse drug reactions. It collects reports on medicines, vaccines, medical devices, blood products and defective or counterfeit products. Its purpose is signal detection: reports are aggregated so that rare associations, which no pre-licensing trial is large enough to detect, become visible. Reports may be submitted by any healthcare professional, and equally by parents and young people, online or through the Yellow Card app.

What to report and how sure you must be

For an established medicine or vaccine, report any suspected serious reaction — one that is fatal, life-threatening, disabling, causes or prolongs hospital admission, results in congenital abnormality, or is otherwise medically significant. For any product carrying the inverted black triangle, report every suspected reaction however minor. Critically for child health, the MHRA asks for all suspected reactions in children to be reported, whatever the severity and whether or not the medicine is licensed for that age group.

What reporting does not replace

A Yellow Card is a surveillance return, not a clinical record. The child still needs appropriate management and follow-up, the episode must be documented in the notes and coded, the family need an explanation, and the reaction should be recorded against the immunisation record. It is also separate from local incident reporting and from notification of infectious disease to the UKHSA health protection team. Where a further dose of the vaccine is due, specialist immunisation advice should be sought.

Why This Is the Right Move

This infant had a serious event requiring hospital assessment, temporally associated with a vaccine, in a child. That meets the reporting threshold several times over, and the scheme is designed precisely for situations where causality is uncertain. Submitting a Yellow Card is quick, adds to the safety signal for a recently introduced schedule change, and sits alongside — not instead of — her ongoing paediatric follow-up.

Why the Other Options Don’t Fit

  • Option A: Waiting for confirmed causality defeats the purpose of the scheme, which exists to gather suspicions and test them in aggregate.
  • Option B: A reaction being recognised does not exempt it; continued reporting is how the MHRA tracks frequency and risk factors.
  • Option C: Health protection teams handle notifiable infections and outbreaks, not pharmacovigilance.
  • Option E: Black triangle status widens reporting to all reactions; it does not restrict the scheme to those products.

“Red Flags” and Key Decision Points

  • Anaphylaxis after a vaccine: Give intramuscular adrenaline first, then report and refer for specialist immunisation advice.
  • Any suspected reaction in a child: Report it, even for a long-established medicine.
  • Inverted black triangle on the product: Report every suspected reaction, however trivial it seems.
  • Further doses of the implicated vaccine due: Seek specialist advice before proceeding.

Relevance to UK Practice

Children are under-represented in licensing trials and much paediatric prescribing is off-label, so post-marketing surveillance carries more weight in child health than in adult practice. With the immunisation schedule revised in 2026, frontline reports are the main route by which new safety signals reach the MHRA.

Founder’s Tip

If the thought crosses your mind that a medicine might be to blame, that is the threshold — submit the card and let the MHRA weigh it.

Core Summary: A suspected serious reaction to a vaccine in a child should be reported to the MHRA Yellow Card scheme on suspicion alone, in addition to clinical management, documentation and specialist advice on future doses.

DCH · Science of PracticeQuestion 10 of 10 · single best answer

Choosing the right study design

Scenario: A paediatric hepatology network is concerned about a rare form of acute liver failure in children under 5 years, of which around 12 cases are recognised across the UK each year. Several parents have independently volunteered that they had given their child an over-the-counter herbal preparation in the preceding six months. The team has 12 months, modest funding and wants to establish whether the exposure is genuinely associated with the outcome.

Question: Which study design is most appropriate?

Pick an answer to reveal the explanation.

CorrectIncorrect

The correct answer is E.

Core Lens: High-Yield Takeaways

  • Rare outcome, earlier exposure: start from the disease and look backwards — that is a case-control study.
  • Case-control gives an odds ratio — never an incidence, an absolute risk or a number needed to harm.
  • Randomising a suspected harm is unethical: harm questions are answered observationally, not by trial.
  • Recall and selection bias are the price: affected families remember harder, so prefer record-based exposure data.
Click here for Deep Dive

Matching the design to the question

The hierarchy of evidence is not a ladder to be climbed regardless of context. The right design turns on three things: how frequent the outcome is, whether the exposure can ethically be allocated, and the direction in which you must reason. Here the outcome is extremely rare, the exposure is a suspected toxin, and it preceded the illness by months. Trials answer questions about benefit; observational designs answer questions about harm.

Why case-control suits rare outcomes

A case-control study begins with the outcome. Investigators assemble the children who developed acute liver failure, recruit controls from the same source population matched for age and other confounders, then look backwards at who was exposed. Because cases are ascertained retrospectively rather than waited for, the roughly 36 children notified over the past three years can be studied alongside 108 matched controls inside the year available, and the measure of association is the odds ratio. This is how the aspirin and Reye’s syndrome link was established, leading to UK advice against aspirin in under-16s.

The trade-offs you must declare

Recall bias is the main vulnerability, strongest when parents of a seriously ill child have already been hunting for an explanation; structured questionnaires, blinded interviewers and pharmacy-record data all mitigate it. Selection bias is the second hazard, because controls must come from the population that would have become cases had they developed the disease. Reporting should follow the STROBE statement.

Why This Is the Right Move

With roughly 12 UK cases a year, an exposure that cannot be randomised and a latency of months, a case-control study is the only design that yields an interpretable measure of association within the time and budget available. It starts from the small pool of affected children and uses a comparison group, so a genuine association can be separated from background exposure prevalence.

Why the Other Options Don’t Fit

  • Option A: Allocating children to a preparation suspected of causing liver failure is unethical; no research ethics committee would approve it.
  • Option B: A cohort design is valid but hopelessly inefficient; an outcome this rare needs tens of thousands of children followed for years.
  • Option C: A cross-sectional survey measures exposure and outcome at one moment, so it cannot show which came first and captures almost no cases.
  • Option D: A case series has no comparison group, so it describes the affected children but cannot show whether exposure is unusually common.

“Red Flags” and Key Decision Points

  • A very rare outcome: start from the cases; a cohort or trial would need impractical numbers and years of follow-up.
  • A potentially harmful exposure: randomisation is off the table, so choose an observational design and declare confounding.
  • Months between exposure and outcome: cross-sectional data cannot establish temporality, so cannot support causation.
  • Any suspected medicine or supplement reaction: submit an MHRA Yellow Card now; reporting must not wait for a study.

Relevance to UK Practice

Rare paediatric conditions in the UK are tracked through the RCPCH British Paediatric Surveillance Unit, which asks consultant paediatricians each month to report specified rare diagnoses, while safety signals for medicines and herbal products run through the MHRA Yellow Card Scheme. DCH candidates need not design studies, but must know which design answers which question, that an odds ratio is not an absolute risk, and to report suspected harms promptly.

Founder’s Tip

Ask one question: am I starting from the outcome or the exposure? Outcome first is case-control; exposure first is cohort.

Core Summary: When the outcome is rare, the exposure cannot be randomised and it preceded the illness, a case-control study is the efficient design — cases, matched controls, an odds ratio.

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Quick answers about the DCH

Checked against the RCPCH's own pages on 16 October 2026.

When is the next DCH exam?

The FOP theory exam is on Wednesday 17 February 2027. Applications open at 09:30 on Monday 30 November 2026 and close on Friday 4 December for online sittings or Monday 7 December for test centres. The next DCH Clinical you can apply for runs on 19 to 21 and 25 to 27 May 2027, with applications from 1 to 26 February 2027.

How much does the DCH cost?

The FOP is £365 for UK candidates or £455 for international candidates. The DCH Clinical is £660 in 2027. Both parts together come to £1,025 in the UK.

What does the DCH involve?

Two exams, sat in either order. The Foundation of Practice (FOP) is 100 questions in two hours, usually at a test centre. The DCH Clinical is eight stations, sat online. The FOP is the same paper MRCPCH candidates sit.

Who can sit the DCH?

Doctors with a primary medical qualification, in the UK or overseas. The RCPCH recommends four to six months of paediatric experience but does not require it.

How is the DCH theory exam marked?

The pass mark is set by the modified Angoff method, so you are judged against a standard rather than against other candidates. Results come about six to seven weeks after the exam.

How many attempts do I get at the DCH?

From 1 November 2026, up to six at each part, then one more with evidence of further educational experience. Attempts before 1 November 2026 do not count.

What do I get with Core Revision's DCH access?

661 questions across all 26 syllabus areas, a timed mock of 100 questions in two hours and the twelve-chapter revision guide, whose last chapter covers the DCH Clinical. You also get Core Tools, the Core 10 and the Core Calendar. Access is £49.99 for 12 months as a one-off payment. You can try ten questions free first.

Our free guides to the DCH

Dates, fees, format and revision plans, checked against the college’s own pages. Newest first. Still choosing a diploma? Compare all eight side by side.