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Arab Board Family Medicine Clinical study materials
Arab Board Family Medicine Clinical study resources

Arab Board Family Medicine Clinical practice questions

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Question 1Internal Medicine in Family Practice

A 34-year-old man has a fasting plasma glucose of 6.4 mmol/L on two separate occasions. He is asymptomatic. What is the most appropriate diagnosis?

  1. Normal glucose tolerance
  2. Type 2 diabetes mellitus
  3. Impaired glucose tolerance
  4. Impaired fasting glucose Correct answer.

Explanation

A fasting plasma glucose between 5.6 and 6.9 mmol/L defines impaired fasting glucose (prediabetes). Diabetes requires a fasting value of 7.0 mmol/L or more, or a random value of 11.1 mmol/L or more with symptoms. Asymptomatic borderline values should be confirmed on a second sample.

Question 2Internal Medicine in Family Practice

Which single antihypertensive class is most strongly recommended as first-line therapy in a 58-year-old with stage 2 hypertension and no comorbidities?

  1. Alpha blockers
  2. Loop diuretics
  3. Central alpha-2 agonists
  4. Thiazide-type diuretics Correct answer.

Explanation

Guidelines recommend thiazide-type diuretics, ACE inhibitors, ARBs, or calcium channel blockers as first-line agents for uncomplicated hypertension. Thiazides are effective, inexpensive, and reduce cardiovascular events. Alpha blockers, loop diuretics, and central agonists are not preferred initial monotherapy.

Question 3Internal Medicine in Family Practice

A 26-year-old woman has a 3-day history of dysuria, frequency, and no fever or flank pain. Urine dipstick is positive for nitrites and leukocyte esterase. What is the most appropriate initial management?

  1. A 3-day course of oral nitrofurantoin Correct answer.
  2. Immediate renal ultrasound
  3. Await urine culture before any treatment
  4. A 7-day course of intravenous ceftriaxone

Explanation

Acute uncomplicated cystitis in a woman is treated empirically with a short course of an oral agent such as nitrofurantoin. Dipstick nitrite and leukocyte esterase positivity supports the diagnosis. Imaging and parenteral therapy are reserved for complicated or upper tract disease.

Question 4Internal Medicine in Family Practice

Which laboratory finding is most characteristic of iron deficiency anaemia?

  1. Low ferritin with high total iron-binding capacity Correct answer.
  2. High ferritin with high total iron-binding capacity
  3. Low ferritin with low total iron-binding capacity
  4. High ferritin with low total iron-binding capacity

Explanation

Iron deficiency produces low iron stores reflected by low ferritin and a compensatory rise in total iron-binding capacity. The transferrin saturation falls and the red cells become microcytic and hypochromic. Anaemia of chronic disease shows the opposite ferritin and TIBC pattern.

Question 5Internal Medicine in Family Practice

A 45-year-old man has sudden severe retrosternal chest pain radiating to the back, with a blood pressure difference of 25 mmHg between arms. What is the most likely diagnosis?

  1. Aortic dissection Correct answer.
  2. Pulmonary embolism
  3. Acute pericarditis
  4. Unstable angina

Explanation

Tearing chest pain radiating to the back with an inter-arm blood pressure difference suggests aortic dissection. Immediate imaging and blood pressure control are required. Pericarditis, angina, and pulmonary embolism do not typically produce inter-arm blood pressure discrepancy.

Question 6Internal Medicine in Family Practice

Which single feature most strongly suggests a diagnosis of migraine rather than tension-type headache?

  1. Bilateral pressing pain
  2. Pain lasting 30 minutes
  3. Photophobia with nausea and vomiting Correct answer.
  4. No aggravation by activity

Explanation

Migraine is characterised by photophobia, phonophobia, nausea, and vomiting, often with unilateral throbbing pain aggravated by activity. Tension-type headache is typically bilateral, pressing, and lacks these associated features. Duration of 30 minutes is too short for migraine, which usually lasts 4 to 72 hours.

Question 7Internal Medicine in Family Practice

A 60-year-old woman has a fasting lipid profile with LDL cholesterol of 4.9 mmol/L. She has no other cardiovascular risk factors. What is the most appropriate initial step after lifestyle advice?

  1. Start a fibrate
  2. Start ezetimibe monotherapy
  3. Repeat lipids in 5 years
  4. Start a statin Correct answer.

Explanation

Markedly elevated LDL cholesterol warrants statin therapy after lifestyle measures, given the established benefit for cardiovascular risk reduction. Fibrates and ezetimibe monotherapy are not first-line for isolated LDL elevation. Repeat testing in 5 years is too delayed for this level of elevation.

Question 8Internal Medicine in Family Practice

Which single finding is the most reliable indicator of chronic obstructive pulmonary disease on spirometry?

  1. An increased FEV1/FVC ratio
  2. A reduced peak expiratory flow alone
  3. A post-bronchodilator FEV1/FVC ratio below 0.70 Correct answer.
  4. A normal FEV1 with reduced FVC

Explanation

COPD is confirmed by a post-bronchodilator FEV1/FVC ratio below 0.70, indicating persistent airflow obstruction. Peak flow alone is non-specific, and a reduced FVC with normal FEV1 suggests restriction. An increased ratio is not consistent with obstruction.

Question 9Internal Medicine in Family Practice

A 70-year-old man with known heart failure presents with 3 days of worsening dyspnoea, orthopnoea, and bilateral basal crackles. Which initial therapy is most appropriate?

  1. Oral beta blocker
  2. Intravenous furosemide Correct answer.
  3. Intravenous calcium channel blocker
  4. Oral digoxin loading

Explanation

Acute decompensated heart failure with congestion is treated with intravenous loop diuretics to relieve volume overload. Beta blockers are not started during acute decompensation, and calcium channel blockers may worsen heart failure. Digoxin loading is not an acute diuretic strategy.

Question 10Internal Medicine in Family Practice

What is the recommended target blood pressure for most adults with hypertension and diabetes?

  1. Below 100/60 mmHg
  2. Below 130/80 mmHg Correct answer.
  3. Below 150/95 mmHg
  4. Below 180/110 mmHg

Explanation

Most guidelines recommend a blood pressure target below 130/80 mmHg for adults with diabetes to reduce cardiovascular and renal risk. Targets above this are too permissive, and very low targets risk hypotension and renal injury.

Question 11Internal Medicine in Family Practice

A 28-year-old woman has a positive urine pregnancy test, lower abdominal pain, and vaginal spotting. She is haemodynamically stable. What is the most appropriate first investigation?

  1. Transvaginal ultrasound with serum beta-hCG Correct answer.
  2. Endometrial biopsy
  3. Diagnostic laparoscopy
  4. Abdominal X-ray

Explanation

A stable patient with suspected ectopic pregnancy should first undergo transvaginal ultrasound with a quantitative serum beta-hCG. This allows location of the pregnancy and correlation with the discriminatory zone. Laparoscopy is reserved for unstable or clearly ruptured cases.

Question 12Internal Medicine in Family Practice

A 55-year-old man has a 3-month history of early satiety, weight loss, and epigastric pain. He has a family history of gastric cancer. What is the most appropriate next step?

  1. Serum amylase
  2. Abdominal ultrasound
  3. Empiric proton pump inhibitor for 6 months
  4. Upper gastrointestinal endoscopy Correct answer.

Explanation

Alarm features such as weight loss, early satiety, and a family history of gastric cancer mandate prompt upper endoscopy. Empiric acid suppression would delay diagnosis. Ultrasound and amylase do not evaluate the gastric mucosa.

Question 13Internal Medicine in Family Practice

Which single statement about the treatment of community-acquired pneumonia in a previously healthy adult is correct?

  1. All patients require admission for intravenous therapy
  2. Routine corticosteroids are indicated for all cases
  3. Antibiotics are withheld until blood cultures return
  4. Antibiotics should be started within 4 hours of presentation Correct answer.

Explanation

Early antibiotic administration, generally within 4 hours of presentation, improves outcomes in community-acquired pneumonia. Cultures should not delay treatment, and most low-risk patients can be managed orally as outpatients. Routine corticosteroids are not indicated for all cases.

Question 14Internal Medicine in Family Practice

A 40-year-old woman has a thyroid-stimulating hormone level that is low and a free T4 that is elevated. She has tremor and weight loss. What is the most likely diagnosis?

  1. Central hypothyroidism
  2. Primary hypothyroidism
  3. Primary hyperthyroidism Correct answer.
  4. Subclinical hypothyroidism

Explanation

Low TSH with elevated free T4 indicates primary hyperthyroidism, consistent with tremor and weight loss. Primary hypothyroidism shows high TSH and low T4. Subclinical hypothyroidism has high TSH with normal T4, and central hypothyroidism has low TSH with low T4.

Question 15Internal Medicine in Family Practice

A 32-year-old man has an acute monoarthritis of the knee with a joint aspirate showing needle-shaped negatively birefringent crystals. What is the most appropriate acute treatment?

  1. Intravenous antibiotics
  2. Allopurinol at high dose now
  3. Oral colchicine or NSAIDs Correct answer.
  4. Long-term prednisolone alone

Explanation

Acute gout is treated with colchicine, NSAIDs, or intra-articular corticosteroids to control inflammation. Allopurinol is not started during an acute attack without cover and does not treat acute inflammation. Antibiotics are used for septic arthritis, which shows different aspirate findings.

Question 16Internal Medicine in Family Practice

A 65-year-old woman has fatigue and a haemoglobin of 105 g/L with a mean corpuscular volume of 72 fL. Which single test is most useful to confirm iron deficiency?

  1. Reticulocyte count
  2. Serum folate
  3. Serum vitamin B12
  4. Serum ferritin Correct answer.

Explanation

A low serum ferritin is the most specific single test for iron deficiency, particularly in the setting of microcytic anaemia. Vitamin B12 and folate deficiencies cause macrocytic anaemia. Reticulocyte count assesses marrow response rather than iron stores.

Question 17Internal Medicine in Family Practice

Which single electrocardiographic finding is most consistent with acute pericarditis?

  1. Widespread concave ST elevation with PR depression Correct answer.
  2. Delta waves with a short PR interval
  3. Localised ST elevation with reciprocal depression
  4. Deep Q waves in contiguous leads

Explanation

Acute pericarditis typically shows widespread concave ST elevation with PR depression. Localised ST elevation with reciprocal changes suggests myocardial infarction. Delta waves indicate pre-excitation, and Q waves indicate prior infarction.

Question 18Internal Medicine in Family Practice

A 22-year-old woman has a 2-week history of generalised lymphadenopathy, sore throat, and fatigue. Blood film shows atypical lymphocytes, and a heterophile antibody test is positive. What is the most appropriate advice?

  1. Undergo immediate splenectomy
  2. Start amoxicillin
  3. Start acyclovir
  4. Avoid contact sports for several weeks Correct answer.

Explanation

Infectious mononucleosis carries a risk of splenic rupture, so contact sports should be avoided for several weeks. Amoxicillin can cause a rash in mononucleosis, and acyclovir is not routinely effective. Splenectomy is not indicated.

Question 19Internal Medicine in Family Practice

Which single measure most effectively prevents contrast-induced nephropathy in a patient with chronic kidney disease undergoing contrast imaging?

  1. Adequate intravenous isotonic saline hydration Correct answer.
  2. Oral furosemide
  3. Intravenous mannitol
  4. High-dose dopamine infusion

Explanation

Adequate isotonic saline hydration before and after contrast is the most established preventive measure. Mannitol, furosemide, and dopamine have not shown benefit and may cause harm. Minimising contrast volume is also important.

Question 20Internal Medicine in Family Practice

A 50-year-old man with a body mass index of 34 kg/m² has a fasting glucose of 7.8 mmol/L and HbA1c of 7.4%. Lifestyle measures alone have failed after 3 months. What is the most appropriate initial pharmacotherapy?

  1. Metformin Correct answer.
  2. A sulfonylurea
  3. Insulin glargine
  4. A thiazolidinedione

Explanation

Metformin is the recommended first-line pharmacotherapy for type 2 diabetes in most patients, especially with obesity, unless contraindicated. Insulin and sulfonylureas are generally added later or used in specific circumstances. Thiazolidinediones are not first-line because of adverse effects.

Question 21Internal Medicine in Family Practice

A 68-year-old man has atrial fibrillation with a CHA2DS2-VASc score of 4. What is the most appropriate management for stroke prevention?

  1. Clopidogrel alone
  2. No antithrombotic therapy
  3. Aspirin alone
  4. Oral anticoagulation Correct answer.

Explanation

A CHA2DS2-VASc score of 2 or more in men indicates oral anticoagulation for stroke prevention in atrial fibrillation. Aspirin and clopidogrel are inferior to anticoagulation for this purpose. Withholding antithrombotic therapy leaves a high stroke risk untreated.

Question 22Internal Medicine in Family Practice

A 58-year-old woman has a 2-week history of progressive proximal muscle weakness and a heliotrope rash around the eyes. What is the most likely diagnosis?

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

Explanation

Proximal muscle weakness with a heliotrope rash is characteristic of dermatomyositis. Myasthenia gravis causes fatigable weakness without a rash, and hypothyroidism causes generalised slowing without these features. Polymyalgia rheumatica causes pain and stiffness without a rash or marked weakness.

Question 23Internal Medicine in Family Practice

A 72-year-old man with type 2 diabetes on metformin and gliclazide presents with confusion, sweating, and a capillary glucose of 2.6 mmol/L. He is unable to swallow safely. What is the most appropriate immediate treatment?

  1. Oral metformin
  2. Intravenous glucose Correct answer.
  3. Oral glucose gel
  4. Subcutaneous insulin

Explanation

Severe hypoglycaemia with impaired swallowing requires intravenous glucose, such as dextrose, to correct the level rapidly. Oral glucose is unsafe when swallowing is compromised. Insulin and metformin would worsen hypoglycaemia.

Question 24Internal Medicine in Family Practice

A 30-year-old man has a blood pressure of 168/104 mmHg, a regular pulse, and no symptoms or papilloedema. What is the most appropriate initial management?

  1. No treatment and review in 1 year
  2. Sublingual nifedipine for rapid reduction
  3. Oral antihypertensive therapy with gradual control Correct answer.
  4. Immediate intravenous labetalol infusion

Explanation

Asymptomatic severe hypertension without end-organ damage is managed with oral therapy and gradual blood pressure reduction. Rapid parenteral or sublingual lowering risks organ hypoperfusion. Leaving it untreated for a year is unsafe.

Question 25Internal Medicine in Family Practice

A 45-year-old woman has a 6-month history of episodic palpitations, sweating, and headache with documented blood pressure spikes. Which single test is the most appropriate initial screening?

  1. Thyroid function tests
  2. Serum cortisol
  3. Plasma free metanephrines Correct answer.
  4. Serum aldosterone

Explanation

Episodic palpitations, sweating, headache, and blood pressure spikes suggest phaeochromocytoma, for which plasma free metanephrines are the preferred initial screening test. Cortisol, aldosterone, and thyroid tests address different conditions.

Question 26Internal Medicine in Family Practice

A 45-year-old man presents with a 3-day history of colicky right flank pain radiating to the groin, and microscopic haematuria. He is afebrile and has no urinary symptoms. What is the most appropriate initial imaging investigation?

  1. Ultrasound of the kidneys and bladder
  2. Magnetic resonance urography
  3. Non-contrast computed tomography of the kidneys, ureters, and bladder Correct answer.
  4. Intravenous urography

Explanation

Non-contrast CT KUB is the gold standard for suspected renal colic because it detects stones with high sensitivity and can identify alternative diagnoses. Ultrasound is preferred in pregnancy or when CT is unavailable, but it is less sensitive for small stones.

Question 27Internal Medicine in Family Practice

A 28-year-old woman with a history of well-controlled epilepsy on lamotrigine presents with a 2-week history of recurrent episodes of palpitations, sweating, and tremor. She has lost 5 kg. Examination reveals a diffuse goitre and fine tremor. Which single finding would best confirm the diagnosis?

  1. Elevated 24-hour urinary metanephrines
  2. Low thyroid-stimulating hormone with elevated free T4 Correct answer.
  3. Elevated thyroid-stimulating hormone with low free T4
  4. Positive thyroid peroxidase antibodies

Explanation

The clinical picture suggests thyrotoxicosis, and the diagnosis is confirmed by a suppressed TSH with elevated free T4 (or T3). Antibodies indicate autoimmune aetiology but do not confirm the presence of thyrotoxicosis.

Question 28Internal Medicine in Family Practice

A 62-year-old man with type 2 diabetes and a history of myocardial infarction presents with a 2-day history of progressive dyspnoea and orthopnoea. Examination reveals bibasal crackles and an elevated jugular venous pressure. Which single medication has been shown to reduce mortality in this condition?

  1. Furosemide
  2. Amlodipine
  3. Digoxin
  4. A beta-blocker Correct answer.

Explanation

Beta-blockers are one of the cornerstone therapies for heart failure with reduced ejection fraction and have been shown to reduce mortality. Diuretics relieve symptoms but do not improve survival.

Question 29Internal Medicine in Family Practice

A 24-year-old woman presents with a 3-day history of dysuria, frequency, and suprapubic discomfort. She is afebrile and has no vaginal discharge. Urine dipstick shows nitrites and leukocytes. What is the most appropriate management?

  1. Immediate referral for intravenous antibiotics
  2. A 3-day course of oral trimethoprim Correct answer.
  3. A 7-day course of oral ciprofloxacin
  4. Urine culture and await results before starting antibiotics

Explanation

Uncomplicated cystitis in a non-pregnant woman is typically treated empirically with a short course of antibiotics such as trimethoprim, nitrofurantoin, or fosfomycin. Culture is not routinely required for uncomplicated cases.

Question 30Internal Medicine in Family Practice

A 35-year-old man presents with a 2-day history of severe sore throat, fever, and difficulty swallowing. Examination reveals enlarged tonsils with a white exudate and tender anterior cervical lymphadenopathy. A rapid antigen test for group A streptococcus is positive. What is the most appropriate treatment?

  1. A 10-day course of oral penicillin V Correct answer.
  2. A 7-day course of oral co-amoxiclav
  3. A 5-day course of oral azithromycin
  4. Symptomatic treatment only with analgesia and fluids

Explanation

Penicillin V is the first-line treatment for streptococcal pharyngitis to prevent rheumatic fever and reduce complications. A full 10-day course is recommended to ensure eradication.

Question 31Internal Medicine in Family Practice

A 68-year-old woman with hypertension and diabetes presents with sudden onset of painless loss of vision in her right eye. Fundoscopy reveals a pale retina with a cherry-red spot at the macula. What is the most likely diagnosis?

  1. Central retinal vein occlusion
  2. Central retinal artery occlusion Correct answer.
  3. Retinal detachment
  4. Vitreous haemorrhage

Explanation

Central retinal artery occlusion classically presents with sudden painless monocular vision loss and a pale retina with a cherry-red spot at the fovea due to preserved choroidal circulation. It is an ophthalmological emergency associated with cardiovascular risk factors.

Question 32Internal Medicine in Family Practice

A 50-year-old man with a history of alcohol excess presents with confusion, ataxia, and ophthalmoplegia. Which single diagnosis is most likely?

  1. Hepatic encephalopathy
  2. Wernicke encephalopathy Correct answer.
  3. Subdural haematoma
  4. Alcohol withdrawal delirium

Explanation

Wernicke encephalopathy is caused by thiamine deficiency and classically presents with the triad of confusion, ataxia, and ophthalmoplegia. It is a medical emergency requiring immediate thiamine replacement.

Question 33Internal Medicine in Family Practice

A 30-year-old woman presents with a 2-week history of fatigue, arthralgia, and a malar rash. She has oral ulcers and a history of photosensitivity. Which single investigation is most specific for the suspected diagnosis?

  1. Antinuclear antibody test
  2. Erythrocyte sedimentation rate
  3. Anti-double-stranded DNA antibody test Correct answer.
  4. Rheumatoid factor

Explanation

Anti-double-stranded DNA antibodies are highly specific for systemic lupus erythematosus and correlate with disease activity. Antinuclear antibodies are sensitive but not specific.

Question 34Internal Medicine in Family Practice

A 55-year-old man with a 30-pack-year smoking history presents with a 3-month history of a persistent cough and weight loss. Chest radiograph shows a right hilar mass. Which single investigation is most appropriate to obtain a tissue diagnosis?

  1. Sputum cytology
  2. Bronchoscopy with biopsy Correct answer.
  3. CT-guided percutaneous biopsy
  4. Video-assisted thoracoscopic surgery

Explanation

Bronchoscopy with biopsy is the preferred initial investigation for a central hilar mass as it allows direct visualisation and sampling of endobronchial lesions. It also enables staging and assessment of operability.

Question 35Internal Medicine in Family Practice

A 40-year-old woman presents with a 6-month history of episodic palpitations, sweating, and headache. She has documented hypertension during episodes. Which single test is most appropriate to confirm the diagnosis?

  1. 24-hour urinary metanephrines Correct answer.
  2. Overnight dexamethasone suppression test
  3. Plasma renin and aldosterone ratio
  4. Serum chromogranin A

Explanation

The episodic symptoms suggest phaeochromocytoma, and measurement of urinary metanephrines (or plasma free metanephrines) is the most reliable screening test. It has high sensitivity for detecting catecholamine-secreting tumours.

Question 36Internal Medicine in Family Practice

A 70-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 4. He has no contraindications to anticoagulation. What is the most appropriate management for stroke prevention?

  1. Clopidogrel 75 mg daily
  2. Aspirin 75 mg daily
  3. No antithrombotic therapy
  4. Apixaban 5 mg twice daily Correct answer.

Explanation

A CHA2DS2-VASc score of 4 indicates a high risk of stroke, and oral anticoagulation is recommended. Direct oral anticoagulants such as apixaban are preferred over warfarin in non-valvular atrial fibrillation due to a better safety profile.

Question 37Internal Medicine in Family Practice

A 45-year-old woman presents with a 2-week history of progressive proximal muscle weakness and a heliotrope rash around the eyes. She also has Gottron's papules on the knuckles. Which single investigation is most useful to confirm the diagnosis?

  1. Muscle biopsy
  2. Antinuclear antibody test
  3. Erythrocyte sedimentation rate
  4. Serum creatine kinase Correct answer.

Explanation

The clinical picture is classic for dermatomyositis, and an elevated creatine kinase reflects muscle inflammation. It is a sensitive marker of muscle damage and is useful for monitoring response to treatment.

Question 38Internal Medicine in Family Practice

A 72-year-old man with type 2 diabetes on metformin and gliclazide presents with confusion, sweating, and a capillary glucose of 2.8 mmol/L. He is conscious and able to swallow. What is the most appropriate immediate management?

  1. Administer 15–20 g of oral glucose Correct answer.
  2. Administer intramuscular glucagon
  3. Withhold food and recheck glucose in 1 hour
  4. Administer intravenous dextrose 50%

Explanation

For a conscious patient with hypoglycaemia who can swallow, oral glucose is the first-line treatment. It is quick, safe, and effective.

Question 39Internal Medicine in Family Practice

A 30-year-old man has a blood pressure of 168/104 mmHg on two separate occasions. He is asymptomatic and has no papilloedema. What is the most appropriate initial management?

  1. Refer for urgent specialist assessment
  2. Lifestyle modification and start an ACE inhibitor Correct answer.
  3. Start a thiazide diuretic immediately
  4. Lifestyle modification and recheck in 3 months

Explanation

Stage 2 hypertension (≥160/100 mmHg) warrants prompt pharmacological treatment in addition to lifestyle modification. An ACE inhibitor is a suitable first-line agent in a young patient, especially if there is no contraindication.

Question 40Internal Medicine in Family Practice

A 58-year-old man with a history of gout presents with a 2-day history of a painful, swollen right knee. Joint aspiration reveals needle-shaped, negatively birefringent crystals. What is the most appropriate treatment for the acute attack?

  1. Allopurinol
  2. Febuxostat
  3. Probenecid
  4. Colchicine Correct answer.

Explanation

Colchicine is effective for acute gout and is a first-line option, especially when NSAIDs are contraindicated. It should be started early in the attack for maximum benefit.

Question 41Pediatrics and Adolescent Medicine

A 6-month-old infant is brought for a routine visit. Which finding on physical examination is most consistent with a normal developmental milestone at this age?

  1. Walking with one hand held
  2. Using a pincer grasp
  3. Sitting without support
  4. Rolling from back to front Correct answer.

Explanation

Rolling over (front to back around 4–5 months, back to front around 5–6 months) is an expected milestone by 6 months. Independent sitting typically emerges around 8 months, cruising/walking with support around 9–12 months, and a pincer grasp around 9–12 months.

Question 42Pediatrics and Adolescent Medicine

A 3-year-old presents with fever, sore throat, and a sandpaper-like rash with circumoral pallor. Throat swab confirms group A streptococcus. Which antibiotic is the first-line treatment of choice?

  1. Trimethoprim-sulfamethoxazole
  2. Ciprofloxacin
  3. Azithromycin
  4. Amoxicillin Correct answer.

Explanation

Penicillin or amoxicillin is first-line for group A streptococcal pharyngitis because resistance has never been documented and it is effective, narrow-spectrum and inexpensive. Macrolides are reserved for true penicillin allergy, and sulfonamides and fluoroquinolones are not appropriate first-line agents for streptococcal pharyngitis.

Question 43Pediatrics and Adolescent Medicine

A 2-year-old has a 3-day history of diarrhoea and vomiting and is clinically dehydrated. Which fluid regimen is the preferred first step in management?

  1. Rapid intravenous bolus of 20 mL/kg normal saline
  2. Oral rehydration solution given in small frequent sips Correct answer.
  3. Withholding all fluids until vomiting stops
  4. Immediate blood transfusion

Explanation

For mild to moderate dehydration from acute gastroenteritis, oral rehydration solution is the preferred route because it is as effective as intravenous therapy, less invasive and associated with fewer adverse events. Intravenous boluses are reserved for severe dehydration or shock, and fluids should never be withheld.

Question 44Pediatrics and Adolescent Medicine

Which vaccine is contraindicated in a child with a confirmed severe anaphylactic reaction to a previous dose of the same vaccine?

  1. Inactivated polio vaccine
  2. Tetanus toxoid
  3. Hepatitis B vaccine
  4. Any vaccine containing the same antigen Correct answer.

Explanation

A severe anaphylactic reaction to a vaccine or one of its components is an absolute contraindication to further doses of that specific vaccine. Other vaccines that do not share the antigen or component remain safe to give.

Question 45Pediatrics and Adolescent Medicine

A 4-year-old is brought with a 2-day history of low-grade fever, runny nose and a barking cough that is worse at night. Which diagnosis is most likely?

  1. Croup Correct answer.
  2. Foreign body aspiration
  3. Bronchiolitis
  4. Epiglottitis

Explanation

Croup (laryngotracheobronchitis) typically presents in children aged 6 months to 3 years with a barking cough, hoarse voice and inspiratory stridor, often preceded by a coryzal illness. Epiglottitis causes high fever, drooling and a muffled voice without a barking cough, and bronchiolitis presents with wheeze and crackles in infants.

Question 46Pediatrics and Adolescent Medicine

At what age is a child typically expected to have a pincer grasp?

  1. 12 months Correct answer.
  2. 3 months
  3. 18 months
  4. 6 months

Explanation

A pincer grasp using thumb and index finger typically develops around 9–12 months. It represents fine motor maturation that follows the earlier palmar grasp seen in the first half of infancy.

Question 47Pediatrics and Adolescent Medicine

A 5-year-old presents with periorbital swelling, dark urine and hypertension 10 days after a sore throat. Which laboratory finding is most characteristic of acute post-streptococcal glomerulonephritis?

  1. Marked eosinophilia
  2. Low serum complement C3 Correct answer.
  3. Hyperkalaemia with metabolic alkalosis
  4. Elevated serum C3

Explanation

Acute post-streptococcal glomerulonephritis is characterised by activation of the alternative complement pathway, producing a transient fall in serum C3 that normalises within 6–8 weeks. Hyperkalaemia and metabolic acidosis may occur only if renal failure is severe, and eosinophilia is not a feature.

Question 48Pediatrics and Adolescent Medicine

A 9-year-old with asthma uses a salbutamol inhaler more than three times per week despite good adherence. Which step is most appropriate according to standard asthma management?

  1. Start long-term oral corticosteroids
  2. Add a low-dose inhaled corticosteroid Correct answer.
  3. Add a long-acting beta-agonist alone
  4. Stop the salbutamol inhaler

Explanation

Frequent reliever use indicates inadequate control, and persistent asthma in children requires controller therapy with an inhaled corticosteroid. A long-acting beta-agonist should never be used as monotherapy in asthma because of the risk of increased mortality without an inhaled corticosteroid.

Question 49Pediatrics and Adolescent Medicine

A 3-week-old exclusively breastfed infant is jaundiced with pale stools and a palpable right upper quadrant mass. Which investigation is most important to confirm the diagnosis?

  1. Serum electrolytes
  2. Fractionated serum bilirubin
  3. Abdominal ultrasound Correct answer.
  4. Direct Coombs test

Explanation

Pale stools, persistent jaundice and a right upper quadrant mass in a neonate suggest biliary atresia, for which abdominal ultrasound is the initial imaging test to assess the biliary tree. Fractionated bilirubin confirms conjugated hyperbilirubinaemia but does not establish the cause.

Question 50Pediatrics and Adolescent Medicine

A 10-year-old girl has short stature, a webbed neck, widely spaced nipples and primary amenorrhoea. Which karyotype is most likely?

  1. 46,XY
  2. 47,XXY
  3. 45,X Correct answer.
  4. 47,XX,+21

Explanation

Turner syndrome results from complete or partial loss of one X chromosome, most commonly 45,X, and presents with short stature, webbed neck, shield chest and gonadal dysgenesis with primary amenorrhoea. 47,XXY causes Klinefelter syndrome in males, and trisomy 21 causes Down syndrome.