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Arab Board Pediatrics Clinical Exam study materials
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Arab Board Pediatrics Clinical Exam practice questions

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Question 1General Pediatrics and Growth & Development

At what age does a normally developing infant typically achieve independent sitting without support?

  1. Around 15 months
  2. Around 2 months
  3. Around 6 to 8 months Correct answer.
  4. Around 12 months

Explanation

Independent sitting without support is a gross motor milestone usually attained between 6 and 8 months, following head control and rolling. It precedes pulling to stand and walking in the normal sequence of gross motor development.

Question 2General Pediatrics and Growth & Development

A 10-month-old infant is brought for a routine visit. Which finding most strongly suggests a delay in gross motor development?

  1. Unable to sit without support Correct answer.
  2. Unable to walk independently
  3. Unable to feed with a spoon
  4. Unable to say two words with meaning

Explanation

Independent sitting is expected by about 8 months, so inability to sit unsupported at 10 months indicates gross motor delay. Walking is not expected until around 12 to 15 months, so that alone is not delayed at this age.

Question 3General Pediatrics and Growth & Development

A 4-month-old infant should normally demonstrate which of the following?

  1. Transferring objects between hands
  2. Walking with one hand held
  3. Pincer grasp
  4. Social smile and head control Correct answer.

Explanation

By 4 months infants show a social smile, good head control in a supported position, and regard their hands. Pincer grasp, object transfer, and assisted walking are later milestones.

Question 4General Pediatrics and Growth & Development

Which primitive reflex normally disappears by about 4 to 6 months of age?

  1. Palmar grasp reflex
  2. Positive support reflex
  3. Parachute reflex
  4. Moro reflex Correct answer.

Explanation

The Moro reflex is present at birth and normally integrates by about 4 to 6 months. Persistence beyond this period suggests a central nervous system abnormality.

Question 5General Pediatrics and Growth & Development

A newborn is noted to have a persistent asymmetric tonic neck reflex at 8 months of age. This finding is most concerning for which condition?

  1. Benign sleep myoclonus
  2. Normal variation of infant posture
  3. Physiological hypertonia of the newborn
  4. Cerebral palsy Correct answer.

Explanation

The asymmetric tonic neck reflex normally disappears by about 4 to 6 months. Persistence beyond this age, especially with asymmetry, is a red flag for cerebral palsy or other central motor disorder.

Question 6General Pediatrics and Growth & Development

A 12-month-old child has a length that is 2 standard deviations below the mean for age and a weight-for-length that is normal. The most likely explanation is which of the following?

  1. Failure to thrive from undernutrition
  2. Growth hormone deficiency
  3. Familial short stature Correct answer.
  4. Constitutional growth delay

Explanation

In familial short stature, height is below the mean but weight-for-height is preserved and the child grows along a normal curve. Undernutrition would typically reduce weight relative to length.

Question 7General Pediatrics and Growth & Development

A healthy term infant typically regains birth weight by which age?

  1. 4 weeks
  2. 7 days
  3. 3 days
  4. 10 to 14 days Correct answer.

Explanation

Term infants usually lose up to 7 to 10 percent of birth weight in the first days and regain it by about 10 to 14 days. Failure to regain by 2 weeks warrants evaluation for feeding problems or illness.

Question 8General Pediatrics and Growth & Development

A 2-year-old child's weight is plotted on the growth chart. Which statement best describes the expected pattern of weight gain in early childhood?

  1. Weight doubles between 1 and 2 years
  2. Weight triples between 2 and 3 years
  3. Weight remains static until the pubertal spurt
  4. Weight gain is about 2 kg per year between ages 1 and 5 Correct answer.

Explanation

After infancy, growth velocity slows; children gain roughly 2 kg per year between ages 1 and 5. Birth weight doubles by about 5 months and triples by about 1 year.

Question 9General Pediatrics and Growth & Development

A 6-year-old child's mid-parental height is calculated. Which formula correctly estimates the target height for a boy?

  1. (Father's height + Mother's height) / 2
  2. (Father's height + Mother's height - 13 cm) / 2
  3. (Father's height + Mother's height + 13 cm) / 2 Correct answer.
  4. (Father's height - Mother's height) / 2

Explanation

For boys, mid-parental height is the average of the parents' heights plus 6.5 cm (13 cm divided by 2). For girls, 6.5 cm is subtracted from the average parental height.

Question 10General Pediatrics and Growth & Development

A 9-month-old infant is unable to bear weight on the legs and has not yet rolled over. Which additional history is most important in evaluating this delay?

  1. Immunization status for measles
  2. Dietary intake of iron
  3. Family history of atopy
  4. Birth history including prematurity and perinatal asphyxia Correct answer.

Explanation

Motor delay in infancy requires evaluation for prenatal and perinatal risk factors such as prematurity, hypoxia, and infection, which are major causes of cerebral palsy. These details guide further neurological assessment.

Question 11General Pediatrics and Growth & Development

Which of the following is the most appropriate initial screening tool for developmental delay in a 2-year-old during a well-child visit?

  1. Formal IQ testing
  2. Electroencephalogram
  3. Standardized developmental screening questionnaire Correct answer.
  4. Brain MRI

Explanation

Standardized developmental screening tools are recommended at scheduled well-child visits to identify children needing further evaluation. Imaging and EEG are reserved for specific indications after screening or clinical suspicion.

Question 12General Pediatrics and Growth & Development

A 3-year-old child speaks fewer than 50 words and does not combine two words. Which condition should be considered first?

  1. Stuttering
  2. Selective mutism
  3. Normal language variation
  4. Hearing impairment Correct answer.

Explanation

Significant expressive language delay warrants hearing assessment as the first step, because hearing loss is a common and treatable cause. Early identification improves language outcomes.

Question 13General Pediatrics and Growth & Development

At what age does a child typically begin to use two-word phrases?

  1. 36 months
  2. 18 to 24 months Correct answer.
  3. 30 months
  4. 12 months

Explanation

Two-word combinations typically emerge between 18 and 24 months. By 24 months, most children have a vocabulary of at least 50 words and begin combining them.

Question 14General Pediatrics and Growth & Development

A 5-year-old child is noted to have a vocabulary appropriate for age but consistently omits final consonants and substitutes sounds. This finding is best described as which of the following?

  1. Intellectual disability
  2. Autism spectrum disorder
  3. Speech sound (articulation) disorder Correct answer.
  4. Receptive language disorder

Explanation

Speech sound disorders involve difficulty producing sounds correctly while language comprehension and vocabulary remain intact. Articulation errors are common and often improve with therapy.

Question 15General Pediatrics and Growth & Development

A 15-month-old child can stack two cubes and scribble with a crayon. These skills primarily reflect development in which domain?

  1. Gross motor
  2. Language
  3. Fine motor Correct answer.
  4. Social

Explanation

Stacking cubes and scribbling require hand-eye coordination and dexterity, which are fine motor skills. These typically emerge between 12 and 18 months.

Question 16General Pediatrics and Growth & Development

A 4-year-old child is unable to copy a circle and cannot draw a person with more than one body part. Which developmental domain is most likely delayed?

  1. Gross motor
  2. Fine motor and visual-motor integration Correct answer.
  3. Receptive language
  4. Social-emotional

Explanation

Copying shapes and drawing a person are visual-motor and fine motor tasks expected to progress through early childhood. Difficulty in these areas suggests delay in that domain rather than in language or gross motor skills.

Question 17General Pediatrics and Growth & Development

Which of the following is an expected social-emotional milestone for a 2-year-old child?

  1. Playing simple board games with turn-taking
  2. Parallel play alongside other children Correct answer.
  3. Cooperative play with shared rules
  4. Having a best friend

Explanation

Toddlers around 2 years engage in parallel play, playing beside rather than with peers. Cooperative play and rule-based games develop later in the preschool and school years.

Question 18General Pediatrics and Growth & Development

A 6-month-old infant does not turn toward sound and does not babble. Which action is most appropriate?

  1. Schedule routine follow-up in 6 months
  2. Reassure the parents that babbling begins at 1 year
  3. Prescribe iron supplementation
  4. Refer for audiological evaluation Correct answer.

Explanation

Lack of response to sound and absence of babbling at 6 months are red flags for hearing loss. Prompt audiological assessment is indicated because early intervention improves outcomes.

Question 19General Pediatrics and Growth & Development

A 7-year-old child is brought for evaluation of poor school performance and short attention span. Which of the following is the most appropriate first step in assessment?

  1. Start stimulant medication
  2. Order a brain MRI
  3. Perform psychological testing immediately
  4. Obtain a detailed history from parents and teachers Correct answer.

Explanation

The diagnosis of attention-deficit/hyperactivity disorder requires a detailed history from multiple settings, including school reports, and assessment of impairment. Medication and imaging are not first steps without a structured evaluation.

Question 20General Pediatrics and Growth & Development

Which of the following best describes the expected developmental course of a child with a typical pattern of growth in the first year?

  1. Length triples by 12 months
  2. Length increases by about 50 percent by 12 months Correct answer.
  3. Length doubles by 12 months
  4. Length increases by 10 percent by 12 months

Explanation

Infants typically increase length by about 50 percent by 12 months, reflecting rapid linear growth in the first year. Weight, by contrast, triples by 12 months.

Question 21General Pediatrics and Growth & Development

A newborn has a birth weight of 3.2 kg. At 6 months, which weight would be most consistent with normal growth?

  1. 4.8 kg
  2. 4.0 kg
  3. 6.4 kg Correct answer.
  4. 9.6 kg

Explanation

Birth weight typically doubles by about 5 months and triples by 12 months, so a 6-month weight near 6.4 kg is expected. Values far below or above this range suggest undergrowth or overgrowth.

Question 22General Pediatrics and Growth & Development

A 3-year-old child is noted to have a head circumference that has crossed from the 50th to the 97th percentile over 6 months. Which of the following is the most appropriate next step?

  1. Measure height and weight only
  2. Prescribe a multivitamin
  3. Refer for neuroimaging Correct answer.
  4. Reassure the family and recheck in 1 year

Explanation

A rapidly increasing head circumference crossing percentile lines suggests hydrocephalus or another intracranial process and warrants prompt neuroimaging. Serial measurement and clinical correlation are essential.

Question 23General Pediatrics and Growth & Development

A 4-year-old child has a vocabulary of about 1,500 words and can tell a short story. This is best described as which of the following?

  1. Expressive language delay
  2. Age-appropriate language development Correct answer.
  3. Speech sound disorder
  4. Receptive language disorder

Explanation

By 4 years, children typically have vocabularies of over 1,000 words and can relate simple narratives. This pattern reflects normal language development.

Question 24General Pediatrics and Growth & Development

A child is brought for a well-child visit at 18 months. Which of the following findings would most warrant further developmental evaluation?

  1. Stacks three cubes
  2. Does not point to show interest and has no joint attention Correct answer.
  3. Uses 10 single words and points to desired objects
  4. Walks independently and climbs stairs with help

Explanation

Joint attention and pointing to share interest are key social communication milestones expected by 12 to 18 months. Their absence is a red flag for autism spectrum disorder and warrants further evaluation.

Question 25General Pediatrics and Growth & Development

Which of the following best explains why a child with a chronic illness may show delayed growth?

  1. Increased caloric requirements and malabsorption Correct answer.
  2. Accelerated bone maturation
  3. Decreased need for sleep
  4. Enhanced growth hormone secretion

Explanation

Chronic illness can increase metabolic demands and impair nutrient absorption, leading to poor growth. This is often termed failure to thrive secondary to underlying disease.

Question 26General Pediatrics and Growth & Development

A 4-year-old child is brought for a routine visit. The parent reports that the child can ride a tricycle, use scissors, and draw a person with three body parts. Which developmental domain is primarily being assessed by these skills?

  1. Language
  2. Social-emotional
  3. Gross motor
  4. Fine motor Correct answer.

Explanation

Fine motor skills involve precise use of the hands and fingers, such as cutting with scissors and drawing detailed figures. Gross motor skills involve large muscle movements like riding a tricycle, but the question asks about the combination of skills, with fine motor being most specific to scissor use and drawing.

Question 27General Pediatrics and Growth & Development

A 2-year-old child is brought to the clinic. The child's weight and height are at the 50th percentile, but the head circumference has increased from the 50th to the 90th percentile over the past 6 months. The child is otherwise healthy and developing normally. What is the most appropriate next step?

  1. Reassure the parent and continue routine monitoring Correct answer.
  2. Refer to pediatric neurosurgery
  3. Obtain a developmental assessment
  4. Order a head ultrasound

Explanation

A head circumference that crosses percentiles but remains within the normal range (up to the 97th percentile) can be normal, especially if the child is asymptomatic and development is appropriate. Routine monitoring is recommended unless there are other concerning signs.

Question 28General Pediatrics and Growth & Development

A 10-month-old infant is brought for a well-child visit. The infant was born at term with a birth weight of 3.0 kg. The parent asks how much the infant should weigh now. Which weight is most consistent with normal growth?

  1. 6.0 kg
  2. 10.5 kg
  3. 9.0 kg Correct answer.
  4. 7.5 kg

Explanation

Birth weight typically doubles by 4-5 months and triples by 12 months. At 10 months, a weight of about 9.0 kg (triple the birth weight) is expected.

Question 29General Pediatrics and Growth & Development

A 5-year-old child is brought for evaluation of short stature. The child's height is below the 3rd percentile. The mid-parental height is calculated to be at the 25th percentile. The child has no dysmorphic features and a normal physical examination. Which of the following is the most likely diagnosis?

  1. Hypothyroidism
  2. Constitutional delay of growth and puberty
  3. Familial short stature Correct answer.
  4. Growth hormone deficiency

Explanation

Familial short stature is characterized by a height below the 3rd percentile but consistent with the mid-parental height, and normal growth velocity. Constitutional delay typically presents with delayed bone age and a history of late puberty in the family.

Question 30General Pediatrics and Growth & Development

A 15-month-old child is brought for a routine visit. The child was born at 28 weeks' gestation. The parent asks about the child's developmental progress. The child can walk independently, say three words, and use a pincer grasp. Which statement best interprets these findings?

  1. The child shows signs of developmental delay
  2. The child's development is advanced for corrected age
  3. The child's development is appropriate for corrected age Correct answer.
  4. The child's development cannot be assessed until 2 years of age

Explanation

For children born preterm, developmental milestones should be assessed using corrected age until 2 years. At 15 months chronological age, the corrected age is about 12.5 months, and walking independently, saying a few words, and using a pincer grasp are appropriate for that corrected age.

Question 31Neonatology and Perinatal Medicine

A term newborn is born through meconium-stained amniotic fluid and is vigorous, crying, and has good muscle tone. What is the most appropriate immediate step in management?

  1. Perform immediate endotracheal intubation and suction the trachea
  2. Provide routine initial steps of newborn care under a radiant warmer Correct answer.
  3. Administer intramuscular vitamin K before drying the infant
  4. Begin chest compressions before assessing the heart rate

Explanation

A vigorous infant born through meconium-stained fluid does not require routine tracheal suctioning; standard initial steps (warming, drying, stimulation, clearing the airway as needed) are indicated, with further resuscitation guided by the response. Tracheal suctioning is reserved for the non-vigorous infant with an obstruction.

Question 32Neonatology and Perinatal Medicine

Which of the following is the most important determinant of heat loss in a naked newborn placed in a cool, draught-free room?

  1. Convection to still air
  2. Conduction to the mattress
  3. Radiation to cooler surrounding surfaces Correct answer.
  4. Evaporation from wet skin

Explanation

In a draught-free environment with a warm mattress, radiation to cooler walls and surfaces is the dominant route of heat loss from a naked newborn. Evaporation becomes dominant only when the skin is wet, and convection requires air movement.

Question 33Neonatology and Perinatal Medicine

A newborn at 36 weeks' gestation develops respiratory distress with grunting and tachypnoea shortly after birth. A chest radiograph shows diffuse fine reticulogranular opacities with air bronchograms and low lung volumes. What is the most likely diagnosis?

  1. Meconium aspiration syndrome
  2. Congenital diaphragmatic hernia
  3. Transient tachypnoea of the newborn
  4. Respiratory distress syndrome Correct answer.

Explanation

Fine reticulogranular ('ground-glass') opacities with air bronchograms and low lung volumes are the classic radiographic features of respiratory distress syndrome due to surfactant deficiency, which is common in late preterm infants.

Question 34Neonatology and Perinatal Medicine

Which intervention is most strongly supported for reducing the risk of intraventricular haemorrhage in a very preterm infant in the first days of life?

  1. Prophylactic indomethacin given to all preterm infants
  2. Routine prophylactic fresh frozen plasma transfusion
  3. Antenatal maternal corticosteroid administration Correct answer.
  4. Delayed clamping of the umbilical cord beyond five minutes

Explanation

Antenatal corticosteroids accelerate fetal maturation and reduce the incidence of intraventricular haemorrhage, along with respiratory distress syndrome and mortality, in preterm infants. Other listed measures are either not routinely recommended or not established for this purpose.

Question 35Neonatology and Perinatal Medicine

A 3-day-old breastfed term infant is jaundiced. Which finding would most strongly suggest pathological rather than physiological jaundice?

  1. Resolution of jaundice by day 10
  2. Jaundice confined to the face and upper trunk
  3. Peak bilirubin level of 180 micromol/L on day 3
  4. Direct (conjugated) bilirubin fraction of 40 micromol/L Correct answer.

Explanation

A conjugated (direct) bilirubin fraction above about 25 micromol/L, or more than 20% of the total, is always pathological and requires investigation for cholestasis or liver disease. Physiological jaundice is unconjugated, appears after 24 hours, and resolves within about two weeks.

Question 36Neonatology and Perinatal Medicine

Which of the following is the most sensitive early clinical sign of hypoglycaemia in a newborn infant?

  1. A high-pitched cry
  2. Generalised convulsions
  3. Jitteriness that stops when the limb is held
  4. Poor feeding and lethargy Correct answer.

Explanation

Hypoglycaemia in newborns is often asymptomatic or presents non-specifically with poor feeding, lethargy, and irritability; these subtle signs are more common early than seizures. Jitteriness that stops on holding suggests a benign tremor rather than hypoglycaemia.

Question 37Neonatology and Perinatal Medicine

A newborn is noted to have a single umbilical artery at delivery. Which associated finding should prompt particular concern?

  1. Congenital renal and cardiac anomalies Correct answer.
  2. Caput succedaneum after a prolonged labour
  3. Mild physiological weight loss in the first week
  4. Physiological jaundice on day 3

Explanation

A single umbilical artery is associated with an increased risk of congenital anomalies, particularly of the renal and cardiovascular systems, so careful examination and screening are warranted. The other listed findings are common and unrelated to this association.

Question 38Neonatology and Perinatal Medicine

A term infant is born after prolonged rupture of membranes of 30 hours. The mother had no antenatal antibiotics. What is the most appropriate initial management of the asymptomatic newborn?

  1. Give a single dose of oral antibiotic and review in one week
  2. Discharge home without further assessment
  3. Observe with vital signs for 48 hours without any investigations
  4. Perform a full sepsis screen and start empirical intravenous antibiotics Correct answer.

Explanation

Prolonged rupture of membranes beyond 18 hours is a major risk factor for early-onset neonatal sepsis. Guidelines support a full sepsis evaluation and empirical intravenous antibiotics while awaiting culture results, even in an asymptomatic infant.

Question 39Neonatology and Perinatal Medicine

A preterm infant at 30 weeks' gestation is being managed with nasal continuous positive airway pressure. Which finding indicates that the support is failing and that intubation should be considered?

  1. An oxygen saturation of 94% on 25% oxygen
  2. Mild subcostal recession
  3. A rising fraction of inspired oxygen requirement with persistent apnoeas Correct answer.
  4. A respiratory rate of 60 breaths per minute

Explanation

Escalating oxygen requirement together with recurrent apnoeas despite CPAP indicates failure of non-invasive support and the need for intubation and mechanical ventilation. Stable saturations and mild recession suggest the infant is coping.

Question 40Neonatology and Perinatal Medicine

Which of the following best describes the mechanism of physiological anaemia of prematurity?

  1. Inadequate erythropoietin response with a low nadir at 4 to 8 weeks Correct answer.
  2. Iron deficiency from inadequate antenatal stores
  3. Chronic intrauterine blood loss
  4. Increased red cell destruction by maternal antibodies

Explanation

Preterm infants have an exaggerated and earlier fall in haemoglobin because their erythropoietin response to anaemia is blunted and their red cell survival is shorter, with a nadir around 4 to 8 weeks. This is distinct from immune haemolysis or iron deficiency.

Question 41Neonatology and Perinatal Medicine

A neonate presents with bilious vomiting and a scaphoid abdomen on the first day of life. A radiograph shows a double-bubble sign without distal gas. What is the most likely diagnosis?

  1. Hirschsprung disease
  2. Malrotation with volvulus
  3. Hypertrophic pyloric stenosis
  4. Duodenal atresia Correct answer.

Explanation

The double-bubble sign with absent distal gas is the classic appearance of duodenal atresia, which presents with bilious vomiting early in life. Malrotation with volvulus also causes bilious vomiting but typically shows a different radiographic pattern and is a surgical emergency.

Question 42Neonatology and Perinatal Medicine

A 2-day-old term infant becomes lethargic and feeds poorly. Examination shows hepatomegaly and poor perfusion. Which inborn error of metabolism classically presents this way and requires urgent treatment?

  1. Gaucher disease
  2. Urea cycle defect Correct answer.
  3. Galactosaemia
  4. Phenylketonuria

Explanation

Urea cycle defects typically present in the first days of life with poor feeding, lethargy, and hyperammonaemia after protein intake begins, and require urgent treatment to prevent encephalopathy. Other conditions listed present differently or later.

Question 43Neonatology and Perinatal Medicine

A newborn of a mother with poorly controlled diabetes has a haematocrit of 72%. Which complication is most directly related to this finding?

  1. Hypoglycaemia
  2. Respiratory distress syndrome
  3. Necrotising enterocolitis
  4. Hyperbilirubinaemia and poor perfusion Correct answer.

Explanation

Polycythaemia increases blood viscosity, impairing perfusion and increasing red cell breakdown, which raises bilirubin and causes jaundice. Hypoglycaemia and respiratory distress in infants of diabetic mothers are related to hyperinsulinaemia and delayed surfactant maturation, not directly to the haematocrit.

Question 44Neonatology and Perinatal Medicine

Which of the following is a recognised cause of unconjugated hyperbilirubinaemia in the newborn?

  1. Neonatal hepatitis
  2. Choledochal cyst
  3. G6PD deficiency Correct answer.
  4. Biliary atresia

Explanation

G6PD deficiency causes haemolysis and unconjugated hyperbilirubinaemia. Biliary atresia, neonatal hepatitis, and choledochal cysts cause conjugated (obstructive) jaundice.

Question 45Neonatology and Perinatal Medicine

A term infant has a heart rate of 50 beats per minute at 30 seconds after birth despite effective positive pressure ventilation with a well-fitting mask. What is the next most appropriate step?

  1. Perform endotracheal intubation before compressions
  2. Give intravenous adrenaline immediately
  3. Continue ventilation and reassess in two minutes
  4. Start chest compressions coordinated with ventilation Correct answer.

Explanation

When the heart rate remains below 60 beats per minute despite effective ventilation, chest compressions should be started, coordinated with ventilation at a ratio of 3:1. Continued ventilation alone or delayed compressions risks hypoxic injury.

Question 46Neonatology and Perinatal Medicine

Which of the following is the most appropriate initial management of a newborn with a suspected congenital diaphragmatic hernia who is in respiratory distress?

  1. Immediate bag-mask ventilation with high pressures
  2. Pass a nasogastric tube and provide gentle ventilation Correct answer.
  3. Place the infant in the Trendelenburg position
  4. Urgent surgical repair before stabilisation

Explanation

Initial management of congenital diaphragmatic hernia includes decompression of the stomach with a nasogastric tube and gentle ventilation to avoid barotrauma to the hypoplastic lung. Surgery is deferred until physiological stabilisation, and high-pressure bagging worsens lung injury.

Question 47Neonatology and Perinatal Medicine

A newborn born to a mother with untreated hepatitis B surface antigen positivity should receive which intervention at birth?

  1. Hepatitis B immunoglobulin alone
  2. No intervention until 6 weeks of age
  3. Hepatitis B vaccine alone
  4. Both hepatitis B vaccine and immunoglobulin within 12 to 24 hours Correct answer.

Explanation

Infants of hepatitis B surface antigen-positive mothers should receive both the vaccine and immunoglobulin as soon as possible, ideally within 12 to 24 hours of birth, to prevent perinatal transmission. Delaying or giving only one component reduces protection.

Question 48Neonatology and Perinatal Medicine

A preterm infant at 28 weeks' gestation is being fed enterally. Which feeding strategy is most appropriate to reduce the risk of necrotising enterocolitis?

  1. Routine early formula feeding to promote growth
  2. Withholding all enteral feeds for four weeks
  3. Rapid advancement of full-volume feeds
  4. Slow advancement of small-volume feeds with human milk Correct answer.

Explanation

Slow advancement of small-volume feeds, preferably with human milk, is associated with a lower risk of necrotising enterocolitis in very preterm infants. Rapid advancement and formula feeding increase risk, while prolonged withholding delays gut maturation.

Question 49Neonatology and Perinatal Medicine

Which of the following findings on cranial ultrasound in a preterm infant most strongly predicts later neurodevelopmental impairment?

  1. Isolated choroid plexus cyst
  2. Grade 2 intraventricular haemorrhage
  3. Grade 1 intraventricular haemorrhage
  4. Grade 4 intraventricular haemorrhage with parenchymal involvement Correct answer.

Explanation

Higher-grade haemorrhage with parenchymal involvement (grade 4) and periventricular leukomalacia carry the greatest risk of long-term neurodevelopmental impairment. Lower grades have a more favourable prognosis.

Question 50Neonatology and Perinatal Medicine

A newborn is noted to have a bluish discolouration of the hands and feet with a pink central trunk and normal oxygen saturation. What is the most likely explanation?

  1. Methaemoglobinaemia
  2. Peripheral cyanosis due to vasomotor instability Correct answer.
  3. Severe respiratory distress
  4. Central cyanosis from a cyanotic heart defect

Explanation

Acrocyanosis is common in the first hours to days of life and reflects peripheral vasoconstriction and vasomotor instability with normal central oxygenation. Central cyanosis, methaemoglobinaemia, and respiratory distress would affect the trunk and mucous membranes and alter saturation.