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Arab Board Family Medicine Part 1 study materials
Arab Board Family Medicine Part 1 study resources

Arab Board Family Medicine Part 1 practice questions

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Question 1Internal Medicine

A 24-year-old woman has fatigue, palpitations, and heat intolerance. TSH is suppressed and free T4 is elevated. Which finding on examination is most specific for Graves disease rather than toxic multinodular goitre?

  1. Bilateral fine tremor of the outstretched hands
  2. A single dominant nodule in the right lobe
  3. Diffuse, smooth goitre with an audible bruit Correct answer.
  4. Warm, moist skin with increased sweating

Explanation

A diffuse goitre with a vascular bruit reflects the diffuse hypervascularity of Graves disease, driven by TSH-receptor stimulating antibodies. Tremor, warm moist skin, and nodular findings are non-specific features of thyrotoxicosis that also occur in other causes.

Question 2Internal Medicine

Which electrocardiographic finding is most characteristic of hyperkalaemia?

  1. Peaked, narrow-based T waves Correct answer.
  2. Sawtooth flutter waves
  3. Prolonged QT interval
  4. Prominent U waves

Explanation

Hyperkalaemia classically produces tall, peaked, narrow-based T waves because increased extracellular potassium accelerates ventricular repolarisation. As severity increases, the QRS widens and P waves flatten.

Question 3Internal Medicine

A 58-year-old man with type 2 diabetes has an eGFR of 28 mL/min/1.73 m2. Which antihyperglycaemic agent should be stopped because of reduced clearance and risk of lactic acidosis?

  1. Metformin Correct answer.
  2. Empagliflozin
  3. Sitagliptin
  4. Insulin glargine

Explanation

Metformin is contraindicated when eGFR falls below about 30 mL/min/1.73 m2 because accumulation increases the risk of lactic acidosis. Most other agents require dose adjustment rather than outright withdrawal at this level.

Question 4Internal Medicine

A 70-year-old woman on warfarin for atrial fibrillation presents with melaena. Her INR is 6.5 and she is haemodynamically stable. In addition to stopping warfarin, what is the most appropriate immediate treatment?

  1. Protamine sulfate
  2. Fresh frozen plasma alone
  3. Intravenous vitamin K plus prothrombin complex concentrate Correct answer.
  4. Oral vitamin K alone

Explanation

For major bleeding with a markedly elevated INR, guidelines recommend intravenous vitamin K combined with a prothrombin complex concentrate for rapid reversal. Vitamin K alone acts too slowly, and FFP is slower and less effective than PCC.

Question 5Internal Medicine

Which feature of a headache most strongly suggests a secondary cause requiring urgent investigation?

  1. Bilateral throbbing pain worsened by stress
  2. Thunderclap onset reaching maximum intensity within one minute Correct answer.
  3. Recurrent attacks lasting 4 to 72 hours
  4. Photophobia with nausea and vomiting

Explanation

A thunderclap headache reaching peak intensity within a minute raises concern for subarachnoid haemorrhage and mandates urgent imaging. The other features describe typical migraine and do not by themselves indicate a secondary cause.

Question 6Internal Medicine

A 45-year-old man has a blood pressure of 168/104 mmHg on three separate visits. He has no diabetes, no proteinuria, and no target-organ damage. What is the most appropriate initial pharmacological therapy?

  1. Combination of three agents started simultaneously
  2. A thiazide-type diuretic, ACE inhibitor, or calcium channel blocker as monotherapy Correct answer.
  3. Alpha-blocker as first-line monotherapy
  4. Immediate referral for renal denervation

Explanation

For stage 2 hypertension without complications, any of the four major classes-thiazides, ACE inhibitors, ARBs, or calcium channel blockers-is appropriate first-line therapy. Beta-blockers and alpha-blockers are not preferred initial agents in uncomplicated hypertension.

Question 7Internal Medicine

Which laboratory pattern is typical of iron deficiency anaemia?

  1. Normal ferritin with low total iron-binding capacity
  2. High ferritin with normal transferrin saturation
  3. High ferritin with low total iron-binding capacity
  4. Low ferritin with raised total iron-binding capacity Correct answer.

Explanation

Iron deficiency lowers body iron stores, so ferritin falls, while the liver increases transferrin production, raising total iron-binding capacity. The anaemia of chronic disease shows the opposite pattern.

Question 8Internal Medicine

A 68-year-old smoker presents with progressive dyspnoea. Spirometry shows an FEV1/FVC ratio of 0.55 that does not improve after bronchodilator. What is the most likely diagnosis?

  1. Bronchial asthma
  2. Congestive heart failure
  3. Chronic obstructive pulmonary disease Correct answer.
  4. Idiopathic pulmonary fibrosis

Explanation

A post-bronchodilator FEV1/FVC below 0.70 defines persistent airflow obstruction, and in a smoker this indicates COPD. Asthma typically shows significant reversibility, while heart failure and fibrosis produce restrictive rather than obstructive physiology.

Question 9Internal Medicine

A 30-year-old woman has a serum calcium of 2.85 mmol/L, low phosphate, and an inappropriately elevated parathyroid hormone. What is the most likely diagnosis?

  1. Primary hyperparathyroidism Correct answer.
  2. Osteomalacia
  3. Hypoparathyroidism
  4. Secondary hyperparathyroidism from chronic kidney disease

Explanation

Hypercalcaemia with an inappropriately normal or high PTH and low phosphate is the hallmark of primary hyperparathyroidism. Secondary hyperparathyroidism occurs in the setting of low calcium, as in renal failure.

Question 10Internal Medicine

Which finding best distinguishes diabetic ketoacidosis from hyperosmolar hyperglycaemic state?

  1. Significant ketonaemia with metabolic acidosis Correct answer.
  2. Presence of polyuria and polydipsia
  3. Blood glucose above 30 mmol/L
  4. Serum osmolality above 320 mOsm/kg

Explanation

DKA is defined by ketone body accumulation and a high anion gap metabolic acidosis, which is minimal or absent in hyperosmolar hyperglycaemic state. Both conditions share severe hyperglycaemia, hyperosmolality, and osmotic symptoms.

Question 11Internal Medicine

A patient with acute decompensated heart failure is euvolaemic but has persistent dyspnoea. Which medication improves survival in heart failure with reduced ejection fraction?

  1. Digoxin
  2. Sacubitril-valsartan Correct answer.
  3. Furosemide
  4. Amlodipine

Explanation

Sacubitril-valsartan, an ARNI, reduces mortality and hospitalisation in heart failure with reduced ejection fraction and is a guideline-directed therapy. Furosemide, digoxin, and amlodipine relieve symptoms but do not confer a mortality benefit.

Question 12Internal Medicine

Which organism is the most common cause of community-acquired pneumonia in adults?

  1. Legionella pneumophila
  2. Streptococcus pneumoniae Correct answer.
  3. Mycoplasma pneumoniae
  4. Chlamydia psittaci

Explanation

Streptococcus pneumoniae remains the most frequently identified pathogen in community-acquired pneumonia. Atypical organisms such as Mycoplasma and Legionella cause a minority of cases.

Question 13Internal Medicine

A 55-year-old man has a creatinine of 220 micromol/L, urine protein-creatinine ratio of 350 mg/mmol, and haematuria with red cell casts. What is the most likely diagnosis?

  1. Glomerulonephritis Correct answer.
  2. Acute tubular necrosis
  3. Chronic pyelonephritis
  4. Pre-renal acute kidney injury

Explanation

Haematuria with red cell casts and significant proteinuria indicates glomerular inflammation, i.e. glomerulonephritis. Pre-renal injury and acute tubular necrosis typically show bland urine sediment.

Question 14Internal Medicine

Which antibody is most specific for systemic lupus erythematosus?

  1. Rheumatoid factor
  2. Anti-histone antibody
  3. Anti-double-stranded DNA Correct answer.
  4. Antinuclear antibody

Explanation

Anti-double-stranded DNA is highly specific for SLE and correlates with disease activity and lupus nephritis. Antinuclear antibody is sensitive but not specific, being positive in many autoimmune and healthy individuals.

Question 15Internal Medicine

A 62-year-old woman has proximal muscle weakness, a raised creatine kinase, and a heliotrope rash. Which diagnosis is most likely?

  1. Dermatomyositis Correct answer.
  2. Myasthenia gravis
  3. Polymyalgia rheumatica
  4. Hypothyroidism

Explanation

Proximal weakness with elevated creatine kinase and characteristic skin changes such as a heliotrope rash indicates dermatomyositis. Polymyalgia rheumatica causes pain and stiffness without marked enzyme elevation or rash.

Question 16Internal Medicine

A 34-year-old man has sudden severe abdominal pain with rigidity and free air under the diaphragm on erect chest radiograph. What is the most appropriate next step?

  1. Elective endoscopy in one week
  2. Discharge with analgesia
  3. Urgent surgical consultation Correct answer.
  4. Immediate oral contrast study

Explanation

Pneumoperitoneum with peritonitis indicates a perforated viscus and requires urgent surgical evaluation. Delay increases mortality from sepsis and peritonitis.

Question 17Internal Medicine

Which finding on liver biochemistry is most suggestive of alcohol-related liver disease?

  1. Low gamma-glutamyl transferase
  2. AST to ALT ratio greater than 2 Correct answer.
  3. Isolated rise in bilirubin with normal enzymes
  4. Predominant rise in alkaline phosphatase

Explanation

An AST/ALT ratio above 2 is characteristic of alcohol-related liver injury, partly because alcohol depletes pyridoxine needed for ALT synthesis. Alkaline phosphatase and GGT are also typically raised.

Question 18Internal Medicine

A patient with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the recommended management for stroke prevention?

  1. Long-term oral anticoagulation Correct answer.
  2. No antithrombotic therapy
  3. Clopidogrel monotherapy
  4. Aspirin alone

Explanation

A CHA2DS2-VASc score of 2 or more in men (3 or more in women) warrants oral anticoagulation, which is superior to antiplatelet therapy for stroke prevention in atrial fibrillation. Antiplatelets are not an adequate substitute.

Question 19Internal Medicine

Which clinical feature is most consistent with a diagnosis of Parkinson disease rather than essential tremor?

  1. Tremor that disappears during movement
  2. Head titubation without limb involvement
  3. Bilateral postural tremor improving with alcohol
  4. Resting tremor with bradykinesia and rigidity Correct answer.

Explanation

Parkinson disease is characterised by the triad of resting tremor, bradykinesia, and rigidity, often asymmetric. Essential tremor is typically a bilateral postural or action tremor that may improve with alcohol.

Question 20Internal Medicine

A 28-year-old woman has a blood pressure of 150/95 mmHg at 30 weeks of gestation with 3+ proteinuria. Which antihypertensive is preferred?

  1. Enalapril
  2. Atenolol
  3. Labetalol Correct answer.
  4. Losartan

Explanation

Labetalol is a first-line agent for hypertension in pregnancy because of its safety profile. ACE inhibitors and ARBs are contraindicated in pregnancy due to fetal renal and other toxicity.

Question 21Internal Medicine

Which is the most appropriate initial investigation for suspected pulmonary embolism in a haemodynamically stable patient with normal renal function?

  1. Ventilation-perfusion scan as first line
  2. D-dimer in all patients
  3. Echocardiography
  4. CT pulmonary angiography Correct answer.

Explanation

CT pulmonary angiography is the first-line imaging test for suspected PE in stable patients with normal renal function. D-dimer is useful only to rule out PE in low-probability patients.

Question 22Internal Medicine

A 50-year-old man has a haemoglobin of 180 g/L and a raised haematocrit. Which finding would suggest polycythaemia vera rather than secondary polycythaemia?

  1. Low serum erythropoietin with splenomegaly Correct answer.
  2. Normal oxygen saturation with high erythropoietin
  3. History of heavy smoking with normal spleen
  4. Elevated erythropoietin with chronic lung disease

Explanation

Polycythaemia vera is a myeloproliferative neoplasm with erythropoietin-independent red cell production, so erythropoietin is low and splenomegaly is common. Secondary polycythaemia has elevated erythropoietin driven by hypoxia or tumours.

Question 23Internal Medicine

Which feature suggests that a patient's breathlessness is due to heart failure rather than COPD?

  1. Orthopnoea with raised jugular venous pressure Correct answer.
  2. Wheezing relieved by salbutamol
  3. Prolonged expiratory phase
  4. Chronic productive cough

Explanation

Orthopnoea with elevated jugular venous pressure reflects raised left and right heart filling pressures, indicating heart failure. Wheeze, productive cough, and prolonged expiration point toward obstructive airway disease.

Question 24Internal Medicine

A 40-year-old man has recurrent kidney stones and a history of peptic ulcer disease. Serum calcium is elevated. Which additional finding would support primary hyperparathyroidism?

  1. High serum phosphate
  2. Low serum phosphate Correct answer.
  3. Metabolic alkalosis
  4. Low parathyroid hormone

Explanation

PTH increases renal phosphate excretion, so phosphate is typically low in primary hyperparathyroidism. Hypercalcaemia with a low phosphate and inappropriately elevated PTH confirms the diagnosis.

Question 25Internal Medicine

Which finding on cerebrospinal fluid analysis is most consistent with bacterial meningitis?

  1. Lymphocyte predominance with very high glucose
  2. Lymphocyte predominance with normal glucose
  3. Neutrophil predominance with low glucose and high protein Correct answer.
  4. Normal cell count with mildly raised protein

Explanation

Bacterial meningitis produces a neutrophilic pleocytosis, low CSF glucose, and elevated protein. Viral meningitis typically shows lymphocyte predominance with normal glucose.

Question 26Internal Medicine

A 58-year-old man with type 2 diabetes has an HbA1c of 7.4% on metformin monotherapy and no hypoglycaemia. Which add-on therapy offers weight loss and a low intrinsic risk of hypoglycaemia?

  1. Glibenclamide
  2. A glucagon-like peptide-1 receptor agonist Correct answer.
  3. Pioglitazone
  4. Insulin glargine

Explanation

GLP-1 receptor agonists lower HbA1c while promoting weight loss and carry a low intrinsic hypoglycaemia risk because their action is glucose-dependent. They are preferred add-ons when weight reduction is desirable.

Question 27Internal Medicine

A 26-year-old woman has palpitations and heat intolerance. Her TSH is suppressed and free T4 is elevated. Which finding would most strongly support Graves disease over a toxic nodule?

  1. Low antithyroid peroxidase antibody titre
  2. Diffuse increased uptake on radionuclide scanning Correct answer.
  3. Suppressed TSH with a normal free T4
  4. A single palpable thyroid nodule

Explanation

Graves disease produces a diffusely overactive gland, so radionuclide scanning shows uniform increased uptake. A toxic nodule instead shows focal uptake with suppression of the rest of the gland.

Question 28Internal Medicine

Which arterial blood gas pattern is expected in a patient with an acute severe asthma attack?

  1. Low PaO2 with low PaCO2 and metabolic acidosis
  2. High PaCO2 with metabolic alkalosis
  3. Normal PaO2 with high PaCO2 and respiratory acidosis
  4. Low PaO2 with low PaCO2 and respiratory alkalosis Correct answer.

Explanation

Acute asthma causes ventilation-perfusion mismatch with hypoxaemia, and hyperventilation drives down PaCO2 to produce a respiratory alkalosis. A rising or normal PaCO2 in severe asthma signals fatigue and impending respiratory failure.

Question 29Internal Medicine

A 72-year-old woman has sudden painless loss of vision in one eye described as a curtain descending. Which diagnosis should be considered first?

  1. Acute angle-closure glaucoma
  2. Vitreous haemorrhage
  3. Optic neuritis
  4. Central retinal artery occlusion Correct answer.

Explanation

A sudden painless curtain-like visual loss is the classic description of retinal artery occlusion, often from an embolus. It is an ocular emergency requiring urgent assessment for a cardioembolic or carotid source.

Question 30Internal Medicine

A 65-year-old man has resting tremor, rigidity and bradykinesia. Which medication should be avoided because it may worsen his motor symptoms?

  1. Metoclopramide Correct answer.
  2. Omeprazole
  3. Domperidone
  4. Lactulose

Explanation

Metoclopramide is a central dopamine antagonist and can precipitate or worsen parkinsonism. Antiemetics with peripheral action, such as domperidone, are preferred when dopamine blockade must be avoided.

Question 31Internal Medicine

A 24-year-old man has sudden severe headache peaking within seconds, neck stiffness and photophobia. Which investigation is the most appropriate next step?

  1. Non-contrast CT head followed by lumbar puncture if negative Correct answer.
  2. MRI of the cervical spine
  3. Carotid Doppler ultrasound
  4. Lumbar puncture immediately without imaging

Explanation

A thunderclap headache raises concern for subarachnoid haemorrhage, and CT is the first-line test, with lumbar puncture for xanthochromia if CT is negative and suspicion persists. Imaging before puncture also avoids the risk of herniation when raised intracranial pressure is present.

Question 32Internal Medicine

Which feature most strongly suggests that a patient's anaemia is due to chronic disease rather than iron deficiency?

  1. Presence of target cells and basophilic stippling
  2. Raised mean corpuscular volume with hypersegmented neutrophils
  3. Low serum ferritin with high total iron-binding capacity
  4. Normal or raised serum ferritin with low transferrin saturation Correct answer.

Explanation

Ferritin is an acute-phase reactant, so it is normal or elevated in anaemia of chronic disease despite low transferrin saturation. Iron deficiency instead gives a low ferritin with raised total iron-binding capacity.

Question 33Internal Medicine

A 70-year-old man has an eGFR of 35 mL/min/1.73 m2, a potassium of 5.8 mmol/L and ECG changes of peaked T waves. Which is the most appropriate immediate treatment?

  1. Oral potassium binder
  2. Oral sodium bicarbonate
  3. Intravenous calcium gluconate Correct answer.
  4. Intravenous furosemide alone

Explanation

Peaked T waves with hyperkalaemia indicate cardiac membrane instability, and intravenous calcium stabilises the myocardium within minutes. It does not lower potassium, so therapies to shift and remove potassium must follow.

Question 34Internal Medicine

Which finding is most consistent with a diagnosis of gout in an acutely inflamed first metatarsophalangeal joint?

  1. Positively birefringent rhomboid crystals in joint aspirate
  2. Negatively birefringent needle-shaped crystals in joint aspirate Correct answer.
  3. Elevated serum urate during the acute attack
  4. Gram-positive cocci on joint aspirate

Explanation

Gout is confirmed by needle-shaped monosodium urate crystals that are negatively birefringent under polarised light. Joint aspiration is definitive because serum urate may be normal during an acute flare.

Question 35Internal Medicine

A 55-year-old woman has a reduced forced vital capacity with a normal ratio of FEV1 to FVC and no history of parenchymal lung disease. Which diagnosis is most likely?

  1. Acute severe asthma
  2. Bronchiectasis
  3. Chronic obstructive pulmonary disease
  4. Restrictive lung disease from neuromuscular weakness Correct answer.

Explanation

A reduced FVC with a preserved FEV1/FVC ratio indicates a restrictive pattern, which can arise from neuromuscular weakness, chest wall disease or interstitial disease. Obstructive disorders instead reduce the ratio.

Question 36Internal Medicine

Which clinical feature is most characteristic of an anaphylactic reaction rather than a simple vasovagal faint?

  1. Isolated light-headedness on standing
  2. Rapid recovery on lying flat
  3. Bradycardia with pallor and sweating
  4. Urticaria with stridor and hypotension after a wasp sting Correct answer.

Explanation

Anaphylaxis is an IgE-mediated multisystem reaction with skin, airway and circulatory involvement, typically after an identifiable trigger. Vasovagal syncope instead produces bradycardia and resolves quickly when supine.

Question 37Internal Medicine

A 45-year-old man has a blood pressure of 158/96 mmHg and a fasting glucose of 6.9 mmol/L. Which lifestyle intervention has the strongest evidence for reducing progression to type 2 diabetes?

  1. Moderate weight loss with 150 minutes of exercise weekly Correct answer.
  2. Starting a very-low-calorie diet indefinitely
  3. Isolated reduction of dietary fat without weight change
  4. Routine antioxidant vitamin supplementation

Explanation

Randomised trials show that modest weight loss combined with regular moderate exercise substantially reduces progression from impaired glucose tolerance to diabetes. The benefit is mediated largely through weight reduction and improved insulin sensitivity.

Question 38Internal Medicine

A 30-year-old woman has a creatinine of 180 micromol/L, red cell casts on urine microscopy and a rising titre of anti-glomerular basement membrane antibody. Which diagnosis is most likely?

  1. Membranous nephropathy
  2. Goodpasture disease Correct answer.
  3. Minimal change disease
  4. IgA nephropathy

Explanation

Anti-glomerular basement membrane antibodies with rapidly progressive renal failure and red cell casts indicate Goodpasture disease, which may also cause pulmonary haemorrhage. Prompt plasmapheresis and immunosuppression are required.

Question 39Internal Medicine

Which finding best supports a diagnosis of infective endocarditis in a patient with a prosthetic valve and persistent fever?

  1. Three separate blood culture sets growing the same organism Correct answer.
  2. A raised C-reactive protein alone
  3. A single positive blood culture with a skin contaminant
  4. A new systolic murmur with a normal echocardiogram

Explanation

Persistent bacteraemia with the same organism in multiple separate blood cultures is a major diagnostic criterion for infective endocarditis. Contaminants in a single culture and non-specific inflammatory markers are insufficient.

Question 40Internal Medicine

A 60-year-old man has a haemoglobin of 105 g/L, a mean corpuscular volume of 72 fL and a raised platelet count. Which underlying cause should be considered?

  1. Hypothyroidism
  2. Chronic gastrointestinal blood loss Correct answer.
  3. Vitamin B12 deficiency
  4. Chronic liver disease

Explanation

Microcytic anaemia with reactive thrombocytosis suggests chronic iron deficiency, commonly from gastrointestinal blood loss in older adults. Iron studies and endoscopic evaluation are indicated to find the source.

Question 41Pediatrics

A 6-week-old infant is brought with projectile non-bilious vomiting after feeds and a palpable olive-shaped mass in the right upper abdomen. Which electrolyte disturbance is most typically found on initial blood testing?

  1. Hypochloremic hyperkalemic metabolic acidosis
  2. Hyperchloremic hyperkalemic metabolic acidosis
  3. Hypernatremic hyperchloremic metabolic acidosis
  4. Hypochloremic hypokalemic metabolic alkalosis Correct answer.

Explanation

Pyloric stenosis causes loss of gastric hydrochloric acid and potassium with volume depletion, producing a hypochloremic, hypokalemic metabolic alkalosis. The kidney compensates by excreting hydrogen ions and retaining bicarbonate, deepening the alkalosis.

Question 42Pediatrics

Which single finding is the most reliable early clinical indicator of dehydration in a young child?

  1. Sunken eyes
  2. Dry mucous membranes
  3. Capillary refill above 2 seconds
  4. Weight loss compared with a recent measurement Correct answer.

Explanation

Acute change in body weight is the most objective and sensitive measure of fluid deficit because it directly quantifies volume lost. Other signs such as sunken eyes and dry mucosa are less specific and often appear only after a larger deficit.

Question 43Pediatrics

A 3-year-old presents with fever, drooling, muffled voice and difficulty swallowing, sitting forward in a tripod position. Which initial step is most appropriate?

  1. Arrange immediate airway stabilization with an anaesthetist present Correct answer.
  2. Obtain a lateral neck radiograph before any airway intervention
  3. Give oral amoxicillin and reassess after two hours
  4. Inspect the throat with a tongue depressor

Explanation

The picture suggests acute epiglottitis with impending airway obstruction, so securing the airway takes priority over investigation. Throat inspection may precipitate complete obstruction and should be avoided.

Question 44Pediatrics

A 2-year-old has a barking cough, hoarse voice and inspiratory stridor that worsens at night. Which treatment is most likely to reduce the severity of symptoms?

  1. A single dose of oral dexamethasone Correct answer.
  2. Nebulized salbutamol
  3. Oral antihistamine
  4. Oral amoxicillin

Explanation

This is croup (laryngotracheobronchitis), and a single dose of corticosteroid reduces airway oedema and symptom severity. Steroids shorten illness and reduce return visits.

Question 45Pediatrics

A 4-year-old has sudden onset of cough and wheeze after choking on a peanut. Which finding on examination is most characteristic of an inhaled foreign body in one main bronchus?

  1. Pleural friction rub at the axilla
  2. Bilateral fine inspiratory crackles at the bases
  3. Unilateral wheeze with reduced breath sounds on the affected side Correct answer.
  4. Generalized expiratory rhonchi that clear with coughing

Explanation

An airway foreign body produces asymmetric findings, typically a unilateral wheeze or reduced air entry from partial obstruction and air trapping. Bilateral or generalized findings point to diffuse disease such as asthma or bronchiolitis.

Question 46Pediatrics

A 3-month-old has a respiratory rate of 62/min, subcostal recession and oxygen saturation of 88% in room air. Which action is most appropriate?

  1. Discharge with nasal saline drops and review in 48 hours
  2. Start supplemental oxygen and admit for monitoring Correct answer.
  3. Prescribe oral antibiotics and review in 24 hours
  4. Reassure the parents because infants normally breathe fast

Explanation

Hypoxaemia with marked work of breathing in a young infant indicates severe respiratory illness requiring oxygen and inpatient monitoring. Young infants deteriorate quickly and cannot be managed at home with these findings.

Question 47Pediatrics

Which organism is the most common bacterial cause of community-acquired pneumonia in children older than 5 years?

  1. Mycoplasma hominis
  2. Staphylococcus aureus
  3. Streptococcus pneumoniae Correct answer.
  4. Haemophilus influenzae type b

Explanation

Streptococcus pneumoniae is the leading bacterial pathogen of childhood community-acquired pneumonia across age groups. Atypical agents such as Mycoplasma pneumoniae become more frequent in older children but are not the commonest overall.

Question 48Pediatrics

A 5-year-old has a 3-day history of fever, sore throat and a fine sandpaper rash with circumoral pallor and a strawberry tongue. Which finding best confirms the diagnosis?

  1. Positive heterophile antibody test
  2. Throat swab culture growing group A beta-haemolytic streptococcus Correct answer.
  3. Positive Paul-Bunnell test
  4. Elevated antinuclear antibody titre

Explanation

The features describe scarlet fever, a streptococcal infection, and culture of group A streptococcus from the throat confirms it. Rapid antigen testing or culture guides treatment and prevention of rheumatic fever.

Question 49Pediatrics

A 2-year-old develops high fever, irritability and a petechial rash that does not blanch on pressure. Which diagnosis must be excluded first?

  1. Kawasaki disease
  2. Scarlet fever
  3. Roseola infantum
  4. Meningococcal septicaemia Correct answer.

Explanation

A non-blanching petechial rash with fever in a young child is a medical emergency because it may indicate meningococcal sepsis. Immediate assessment, blood cultures and parenteral antibiotics are required.

Question 50Pediatrics

A 6-year-old presents with fever and a rash that began on the face and spread downwards to the trunk and limbs. Koplik spots are seen on the buccal mucosa. Which complication is most characteristic of this infection?

  1. Subacute sclerosing panencephalitis Correct answer.
  2. Otitis media
  3. Erythema nodosum
  4. Nephrotic syndrome

Explanation

Koplik spots and a descending rash indicate measles, whose late neurological complication is subacute sclerosing panencephalitis. It develops years after infection and is progressive and fatal.