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Arab Board Pediatrics Final Written study materials
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Arab Board Pediatrics Final Written practice questions

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Question 1General Pediatrics and Well-Child Care

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

  1. 18 months
  2. 12 to 14 months
  3. 6 to 8 months Correct answer.
  4. 2 to 3 months

Explanation

Independent sitting is a gross motor milestone normally reached between about 6 and 8 months, reflecting adequate truncal control and strength. Persistence of inability to sit by around 9 months warrants developmental assessment.

Question 2General Pediatrics and Well-Child Care

A healthy 4-month-old is brought for a routine visit. Which primitive reflex is expected to have disappeared by this age?

  1. Asymmetric tonic neck reflex
  2. Moro reflex Correct answer.
  3. Plantar grasp
  4. Positive support reflex

Explanation

The Moro reflex normally fades by about 3 to 4 months as cortical control matures. Its persistence beyond 4 to 6 months suggests a central nervous system abnormality.

Question 3General Pediatrics and Well-Child Care

According to standard immunization schedules, at what age is the first dose of measles-containing vaccine usually recommended?

  1. 9 months Correct answer.
  2. At birth
  3. 6 weeks
  4. 24 months

Explanation

In many national schedules, including those in regions with high measles burden, the first measles-containing dose is given at 9 months, with a second dose later. Earlier dosing may be used in outbreaks but is not the routine first dose.

Question 4General Pediatrics and Well-Child Care

A 6-month-old exclusively breastfed infant is not yet receiving iron-rich complementary foods. Which problem is most likely to develop?

  1. Essential fatty acid deficiency
  2. Hypernatremic dehydration
  3. Iron deficiency anemia Correct answer.
  4. Vitamin K deficiency bleeding

Explanation

Breast milk has low iron content, and fetal iron stores are largely depleted by about 4 to 6 months, so iron-rich solids or supplementation are needed. Without them, iron deficiency anemia is the expected consequence.

Question 5General Pediatrics and Well-Child Care

A 10-month-old has a hemoglobin of 8.5 g/dL with microcytic, hypochromic indices. Which dietary factor is the most likely contributor?

  1. Use of iron-fortified cereal
  2. Excessive cow's milk intake Correct answer.
  3. Early introduction of pureed vegetables
  4. Prolonged breastfeeding beyond 6 months

Explanation

Large volumes of cow's milk displace iron-rich foods, impair iron absorption, and can cause occult gastrointestinal blood loss, leading to iron deficiency. Limiting cow's milk and providing iron-rich foods corrects the problem.

Question 6General Pediatrics and Well-Child Care

Which of the following is the most appropriate first-line treatment for a healthy 2-year-old with uncomplicated acute otitis media and no drug allergy?

  1. Topical antibiotic ear drops
  2. Intramuscular ceftriaxone
  3. Observation without antibiotics
  4. High-dose amoxicillin Correct answer.

Explanation

High-dose amoxicillin is first-line for uncomplicated acute otitis media because it covers the common pathogens, including many penicillin-resistant pneumococci. Observation may be considered in selected older children with mild disease, but antibiotics are standard for young children.

Question 7General Pediatrics and Well-Child Care

A 3-year-old presents with fever, drooling, and a muffled voice, sitting forward and refusing to lie down. What is the most appropriate immediate action?

  1. Inspect the throat with a tongue depressor
  2. Obtain a lateral neck radiograph before any airway support
  3. Give oral amoxicillin and discharge home
  4. Keep the child calm and prepare for controlled airway management Correct answer.

Explanation

The picture suggests epiglottitis with impending airway obstruction; any throat instrumentation can precipitate complete obstruction. The priority is to keep the child calm and arrange controlled airway management in an equipped setting.

Question 8General Pediatrics and Well-Child Care

A 4-year-old has a 2-day history of low-grade fever, barky cough, and inspiratory stridor that worsens at night. What is the most likely diagnosis?

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

Explanation

Croup (laryngotracheobronchitis) causes a barking cough, hoarseness, and inspiratory stridor, often worse at night, typically in children aged 6 months to 5 years. It is usually viral and responds to corticosteroids.

Question 9General Pediatrics and Well-Child Care

A 5-year-old with asthma uses a salbutamol inhaler more than twice weekly for symptom relief. What does this indicate?

  1. Need to stop the reliever immediately
  2. Poorly controlled asthma requiring step-up therapy Correct answer.
  3. Normal expected use of a reliever
  4. Well-controlled asthma

Explanation

Reliever use more than twice a week (excluding exercise pre-treatment) signals inadequate control and indicates the need to review and step up controller therapy. Frequent reliance on a short-acting beta-agonist is a marker of risk.

Question 10General Pediatrics and Well-Child Care

A 6-week-old presents with projectile non-bilious vomiting and a palpable olive-shaped mass in the right upper abdomen. What is the most likely diagnosis?

  1. Gastroesophageal reflux
  2. Pyloric stenosis Correct answer.
  3. Duodenal atresia
  4. Intussusception

Explanation

Projectile non-bilious vomiting in a 3- to 6-week-old with a palpable 'olive' and visible peristalsis is classic for hypertrophic pyloric stenosis. Ultrasound confirms the diagnosis before surgical pyloromyotomy.

Question 11General Pediatrics and Well-Child Care

A 2-year-old has a 3-day history of vomiting and diarrhea with reduced urine output. On examination there is lethargy, sunken eyes, and prolonged capillary refill. What is the most appropriate initial management?

  1. Withhold fluids for 6 hours
  2. Oral loperamide
  3. Oral rehydration solution only
  4. Rapid intravenous isotonic fluid bolus Correct answer.

Explanation

Signs of severe dehydration with lethargy and delayed capillary refill require prompt intravenous isotonic fluid resuscitation. Oral rehydration is reserved for mild to moderate dehydration in alert children.

Question 12General Pediatrics and Well-Child Care

A 3-year-old is brought after ingesting an unknown number of iron tablets. Which finding best indicates serious toxicity?

  1. Vomiting and abdominal pain within hours Correct answer.
  2. Transient mild nausea that resolves
  3. A metallic taste only
  4. Normal serum iron level at 4 hours

Explanation

Early vomiting and abdominal pain after iron ingestion indicate significant gastrointestinal injury and possible systemic toxicity. Severe poisoning can progress to shock, metabolic acidosis, and hepatic failure, requiring urgent assessment and chelation.

Question 13General Pediatrics and Well-Child Care

What is the recommended sleeping position to reduce the risk of sudden infant death syndrome?

  1. Prone on a soft surface
  2. Supine on a firm surface Correct answer.
  3. Prone with head turned to one side
  4. Side-lying with a pillow

Explanation

Placing infants supine on a firm, flat surface for every sleep significantly reduces SIDS risk. Soft bedding and prone or side positions increase the risk.

Question 14General Pediatrics and Well-Child Care

A 12-month-old has not yet had any immunizations. Which statement about catch-up immunization is correct?

  1. All doses must be restarted from birth
  2. Only live vaccines can be given as catch-up
  3. Catch-up schedules are not possible after 1 year
  4. Catch-up should follow age-appropriate schedules without restarting completed series Correct answer.

Explanation

Children who are behind schedule should receive catch-up immunization using age-appropriate schedules; doses already given are counted and series are not restarted. This maximizes protection without unnecessary repeat doses.

Question 15General Pediatrics and Well-Child Care

A 4-year-old is noted to have a heart murmur. Which feature most suggests an innocent murmur?

  1. Murmur with an abnormal second heart sound
  2. Soft systolic murmur that varies with position and is loudest at the left sternal edge Correct answer.
  3. Diastolic murmur
  4. Murmur associated with a thrill

Explanation

Innocent murmurs are typically soft, systolic, vary with posture, and lack thrills or abnormal heart sounds. Diastolic murmurs, thrills, and abnormal S2 suggest structural heart disease.

Question 16General Pediatrics and Well-Child Care

A newborn has a bluish discoloration of the hands and feet with a pink central body and normal oxygen saturation. What is the most likely explanation?

  1. Cyanotic congenital heart disease
  2. Methemoglobinemia
  3. Sepsis
  4. Acrocyanosis, a normal newborn finding Correct answer.

Explanation

Acrocyanosis is a benign, common finding in the first days of life caused by peripheral vasoconstriction and immature circulation. It resolves spontaneously and does not require intervention when central color and saturation are normal.

Question 17General Pediatrics and Well-Child Care

A 9-month-old is brought for a well-child visit. Which developmental finding is most concerning for a developmental delay?

  1. Unable to walk independently
  2. Unable to feed with a spoon
  3. Unable to sit without support Correct answer.
  4. Unable to speak two-word phrases

Explanation

Independent sitting is expected by about 8 to 9 months; failure to sit unsupported at 9 months is a red flag for delay. Walking, two-word phrases, and spoon feeding are later milestones.

Question 18General Pediatrics and Well-Child Care

A 2-year-old has a history of recurrent wheezing triggered by viral infections and no eczema. Which diagnosis is most likely?

  1. Cystic fibrosis
  2. Primary ciliary dyskinesia
  3. Viral-induced wheeze (preschool wheeze) Correct answer.
  4. Foreign body aspiration

Explanation

Recurrent wheezing triggered by viral respiratory infections in a preschool child without atopy is typical of viral-induced wheeze. It usually improves with age, though some children later develop asthma.

Question 19General Pediatrics and Well-Child Care

Which of the following is the best measure of adequate growth in a healthy infant?

  1. Single weight measurement above the 50th percentile
  2. Length at birth only
  3. Head circumference alone
  4. Weight gain along a consistent growth percentile Correct answer.

Explanation

Serial measurements plotted on growth charts, with weight gain following a consistent percentile, best reflect adequate growth. A single value or birth length alone is not informative.

Question 20General Pediatrics and Well-Child Care

A 6-year-old is brought with a 2-day history of sore throat, fever, and tonsillar exudate without cough. Which test is most appropriate to guide antibiotic use?

  1. Serology for Epstein-Barr virus
  2. Throat swab for viral culture
  3. Chest radiograph
  4. Rapid antigen detection or throat culture for group A streptococcus Correct answer.

Explanation

Clinical features suggesting streptococcal pharyngitis should be confirmed by rapid antigen testing or culture before antibiotics. This avoids unnecessary antibiotic use and limits resistance.

Question 21General Pediatrics and Well-Child Care

A 3-year-old has a fever of 39.5°C and is alert and playful. Which antipyretic approach is most appropriate?

  1. Give aspirin to reduce fever
  2. Give paracetamol or ibuprofen at recommended doses for comfort Correct answer.
  3. Alternate paracetamol and ibuprofen every 2 hours
  4. Withhold antipyretics unless fever exceeds 40°C

Explanation

Antipyretics are given for comfort rather than solely to normalize temperature, using weight-based doses of paracetamol or ibuprofen. Alternating regimens and aspirin are not recommended in young children.

Question 22General Pediatrics and Well-Child Care

A 7-year-old has a BMI at the 97th percentile. Which initial intervention is most appropriate?

  1. Immediate pharmacotherapy with metformin
  2. Family-based lifestyle modification with diet and activity counseling Correct answer.
  3. No intervention until adulthood
  4. Bariatric surgery referral

Explanation

For childhood obesity, the cornerstone of management is family-based lifestyle change emphasizing nutrition, physical activity, and behavior modification. Pharmacotherapy and surgery are reserved for selected severe cases.

Question 23General Pediatrics and Well-Child Care

A newborn is noted to have a sacral dimple with a small tuft of hair and no visible tract. What is the most appropriate next step?

  1. Surgical referral for excision
  2. Ultrasound of the spine to evaluate for occult spinal dysraphism Correct answer.
  3. Reassure and discharge without further evaluation
  4. Immediate MRI under general anesthesia

Explanation

A sacral dimple with a hair tuft raises concern for occult spinal dysraphism; spinal ultrasound is the initial screening test in young infants. MRI is reserved for abnormal ultrasound or high-risk features.

Question 24General Pediatrics and Well-Child Care

A 2-month-old has a heart rate of 150 beats per minute and a respiratory rate of 50 breaths per minute while asleep. How should these findings be interpreted?

  1. Both abnormal, suggesting sepsis
  2. Tachycardia requiring investigation
  3. Normal for age Correct answer.
  4. Tachypnea requiring investigation

Explanation

Normal resting heart rate in a 2-month-old may be up to about 160 beats per minute, and respiratory rates up to about 50 to 60 per minute can be normal. These values fall within the expected range for age.

Question 25Neonatology and Perinatology

A term newborn is born through meconium-stained amniotic fluid and is vigorous with a strong cry and good tone. What is the most appropriate immediate management of the airway?

  1. Routine oropharyngeal suctioning before drying
  2. Suction of the mouth then nose with a bulb syringe
  3. Dry, stimulate and provide routine newborn care Correct answer.
  4. Tracheal intubation and suction below the cords

Explanation

Current neonatal resuscitation guidance advises that a vigorous newborn with meconium-stained fluid does not require routine intubation or tracheal suctioning; standard initial steps (warming, drying, stimulation) are provided and the baby is observed. Suctioning is reserved for babies who are not vigorous or who have airway obstruction.

Question 26Neonatology and Perinatology

Which parameter is the most sensitive indicator used to assess the effectiveness of positive-pressure ventilation during neonatal resuscitation?

  1. Capillary refill time
  2. Oxygen saturation
  3. Respiratory rate
  4. Heart rate response Correct answer.

Explanation

Heart rate is the key vital sign that reflects the adequacy of ventilation and oxygenation in the newborn; a rising heart rate indicates effective ventilation. Saturations lag and may be unreliable in the first minutes, and respiratory rate is not a resuscitation target.

Question 27Neonatology and Perinatology

In a newborn receiving positive-pressure ventilation, which finding best indicates that the face-mask seal and airway position are adequate?

  1. Abdominal distension with each breath
  2. A rising heart rate with visible chest movement Correct answer.
  3. Audible grunting between breaths
  4. Persistent cyanosis of the extremities

Explanation

Effective mask ventilation produces visible chest rise and an improvement in heart rate. Abdominal distension with each breath suggests oesophageal gas entry, and grunting or persistent cyanosis suggest inadequate ventilation.

Question 28Neonatology and Perinatology

A newborn at birth has a heart rate of 50 beats per minute after 30 seconds of effective positive-pressure ventilation with 100% oxygen and chest compressions have been started. What is the recommended compression-to-ventilation ratio for a newborn?

  1. 15:2
  2. 30:2
  3. 3:1 Correct answer.
  4. 5:1

Explanation

Neonatal resuscitation uses a 3:1 compression-to-ventilation ratio, giving about 90 compressions and 30 breaths per minute, because asphyxia-related bradycardia is usually due to inadequate ventilation. Adult ratios such as 30:2 are not used in newborns.

Question 29Neonatology and Perinatology

Which arterial blood gas pattern is most characteristic of respiratory distress syndrome in a preterm infant?

  1. Metabolic alkalosis with hypoxaemia
  2. Metabolic acidosis with normal oxygenation
  3. Hypercapnia with hypoxaemia and metabolic acidosis Correct answer.
  4. Respiratory alkalosis with low bicarbonate

Explanation

Surfactant deficiency causes alveolar collapse, reduced functional residual capacity and ventilation-perfusion mismatch, producing hypoxaemia and hypercapnia with a superimposed metabolic acidosis from tissue hypoxia. Pure respiratory alkalosis or metabolic alkalosis is not typical.

Question 30Neonatology and Perinatology

Which chest radiograph finding is most typical of respiratory distress syndrome in a preterm newborn?

  1. Bilateral perihilar streaking with normal lung volumes
  2. Unilateral hyperlucency with mediastinal shift
  3. Coarse patchy infiltrates with pleural effusions
  4. Ground-glass opacity with air bronchograms and low lung volumes Correct answer.

Explanation

RDS produces a diffuse fine reticulogranular (ground-glass) pattern with air bronchograms and reduced lung volumes due to surfactant deficiency. Unilateral hyperlucency suggests pneumothorax or congenital lung malformation, and coarse infiltrates with effusions suggest pneumonia or other pathology.

Question 31Neonatology and Perinatology

A preterm infant of 28 weeks gestation develops increasing oxygen requirement, apnoea and a falling platelet count on day 3 of life. Which condition should be most strongly suspected?

  1. Early-onset bacterial sepsis Correct answer.
  2. Transient tachypnoea of the newborn
  3. Respiratory distress syndrome alone
  4. Congenital diaphragmatic hernia

Explanation

Late deterioration after an initial stable period, with apnoea, increased oxygen need and thrombocytopenia, suggests nosocomial or early-onset sepsis in a preterm infant. RDS alone usually presents immediately after birth and does not cause thrombocytopenia, and TTN is a self-limiting condition of term infants.

Question 32Neonatology and Perinatology

Which organism is the most common cause of early-onset neonatal sepsis acquired from the maternal genital tract?

  1. Staphylococcus epidermidis
  2. Listeria monocytogenes
  3. Escherichia coli
  4. Group B Streptococcus Correct answer.

Explanation

Group B Streptococcus (Streptococcus agalactiae) remains the leading cause of early-onset neonatal sepsis acquired vertically from the maternal genital tract, followed by E. coli. Listeria is much less common and S. epidermidis is typically a late-onset, catheter-related organism.

Question 33Neonatology and Perinatology

A newborn born at 39 weeks to a mother with prolonged rupture of membranes develops grunting and respiratory distress at 6 hours of age. Which initial investigation is most useful in guiding management?

  1. Blood culture and full blood count Correct answer.
  2. Urine culture
  3. Cranial ultrasound
  4. Serum bilirubin

Explanation

In suspected early-onset sepsis, a blood culture and full blood count (with CRP if available) are the key initial investigations before starting antibiotics. Bilirubin, cranial ultrasound and urine culture do not address the acute septic screen.

Question 34Neonatology and Perinatology

Which finding is most consistent with physiological jaundice in a term breastfed newborn?

  1. Pale stools and dark urine
  2. Unconjugated jaundice peaking on days 3 to 5 with a healthy infant Correct answer.
  3. Jaundice appearing within the first 12 hours of life
  4. Conjugated hyperbilirubinaemia at 3 weeks

Explanation

Physiological jaundice is unconjugated, appears after 24 hours, peaks around days 3 to 5 in term infants and resolves without treatment in an otherwise well baby. Jaundice within 24 hours, conjugated hyperbilirubinaemia or pale stools with dark urine indicate pathological causes.

Question 35Neonatology and Perinatology

A term newborn at 36 hours of age has a total serum bilirubin of 340 micromol/L with a normal blood group and negative direct Coombs test. Which is the most appropriate next step?

  1. Reassure and repeat bilirubin in 1 week
  2. Stop breastfeeding permanently
  3. Transfuse packed red cells immediately
  4. Start intensive phototherapy without delay Correct answer.

Explanation

A bilirubin of 340 micromol/L at 36 hours in a term infant is well above the treatment threshold for phototherapy and requires prompt intensive phototherapy with close monitoring for exchange transfusion thresholds. Reassurance alone is unsafe, and exchange transfusion is reserved for levels above the exchange threshold or with signs of acute bilirubin encephalopathy.

Question 36Neonatology and Perinatology

Which mechanism best explains kernicterus in a newborn with severe unconjugated hyperbilirubinaemia?

  1. Bilirubin-induced renal tubular damage
  2. Immune-mediated destruction of neurons
  3. Conjugated bilirubin accumulating in the liver
  4. Deposition of unconjugated bilirubin in the basal ganglia Correct answer.

Explanation

Free unconjugated bilirubin crosses the blood-brain barrier and deposits in the basal ganglia and brainstem, causing acute bilirubin encephalopathy and chronic kernicterus. Conjugated bilirubin is water-soluble and does not cause this pattern, and the injury is not immune-mediated.

Question 37Neonatology and Perinatology

A preterm infant born at 30 weeks has not passed meconium by 48 hours and develops bilious vomiting and abdominal distension. Which diagnosis is most likely?

  1. Necrotising enterocolitis Correct answer.
  2. Meconium ileus
  3. Hirschsprung disease
  4. Duodenal atresia

Explanation

In a preterm infant, delayed meconium passage with bilious vomiting and abdominal distension after the first days of life is most consistent with necrotising enterocolitis. Duodenal atresia presents on day 1 with a double-bubble sign, and meconium ileus is usually associated with cystic fibrosis in term infants.

Question 38Neonatology and Perinatology

Which feeding strategy reduces the risk of necrotising enterocolitis in a very low birth weight infant?

  1. Routine prophylactic oral antibiotics
  2. Early full-volume formula feeding
  3. Human milk feeding with a cautious advancement schedule Correct answer.
  4. Exclusive parenteral nutrition for 2 weeks

Explanation

Human milk, preferably the mother's own, together with a cautious and standardised advancement of feeds, is the strategy best supported by evidence for reducing NEC risk. Rapid full-volume formula feeding and prolonged withholding of enteral feeds increase risk, and prophylactic antibiotics are not recommended.

Question 39Neonatology and Perinatology

What is the main pathophysiological consequence of a patent ductus arteriosus in a very preterm infant?

  1. Reduced pulmonary blood flow with hypoxia
  2. Right-to-left shunting with cyanosis
  3. Increased systemic vascular resistance
  4. Pulmonary overcirculation with systemic hypoperfusion Correct answer.

Explanation

A left-to-right ductal shunt in a preterm infant causes pulmonary overcirculation and reduced systemic perfusion, which can contribute to pulmonary oedema, poor renal and cerebral perfusion and feeding intolerance. Cyanosis from right-to-left shunting is typical of persistent pulmonary hypertension, not a simple PDA.

Question 40Neonatology and Perinatology

Which clinical sign in a newborn most strongly suggests persistent pulmonary hypertension of the newborn?

  1. Differential cyanosis with preductal saturation higher than postductal Correct answer.
  2. Generalised cyanosis improving with 100% oxygen
  3. Expiratory grunting with normal saturations
  4. Bradycardia responding to stimulation

Explanation

PPHN causes right-to-left shunting across the ductus arteriosus, giving higher preductal (right arm) saturation than postductal (lower limb) saturation. Cyanosis that improves readily with oxygen suggests a pulmonary cause rather than PPHN, which often shows a poor response to oxygen.

Question 41Neonatology and Perinatology

Which is the most appropriate first-line ventilation strategy for a term newborn with severe persistent pulmonary hypertension of the newborn and hypoxaemia?

  1. Hyperventilation to achieve a PaCO2 below 20 mmHg
  2. Gentle conventional ventilation targeting adequate lung recruitment and avoiding hyperoxia Correct answer.
  3. High-frequency oscillatory ventilation alone
  4. Permissive hypercapnia with minimal oxygen

Explanation

Management aims to achieve adequate lung recruitment and oxygenation while avoiding hyperoxia, hypocapnia and lung injury; gentle conventional ventilation is usually first line, with inhaled nitric oxide added for persistent hypoxaemia. Aggressive hyperventilation is harmful, and permissive hypercapnia worsens pulmonary vascular resistance.

Question 42Neonatology and Perinatology

A term infant is noted to have a sacral dimple. Which feature would most strongly indicate the need for spinal imaging?

  1. A dimple in the natal cleft that is shallow
  2. A dimple with a tuft of hair and a skin tag above the gluteal cleft Correct answer.
  3. A dimple 2 mm in diameter within the intergluteal cleft
  4. A single midline dimple without other features

Explanation

Simple sacral dimples within the intergluteal cleft, small and shallow, are usually benign. Features such as a hair tuft, skin tag, lipoma, deviated gluteal cleft, or a dimple higher than the gluteal cleft raise concern for occult spinal dysraphism and warrant imaging.

Question 43Neonatology and Perinatology

Which finding on newborn examination is most suggestive of developmental dysplasia of the hip in a 6-week-old infant?

  1. Bilateral clicking on hip movement
  2. Limited abduction of the affected hip Correct answer.
  3. Ortolani and Barlow tests both negative
  4. Symmetrical thigh creases

Explanation

Limited hip abduction, especially unilateral, is a classic sign of developmental dysplasia of the hip after the neonatal period, along with leg length discrepancy and asymmetric skin creases. Symmetrical creases and negative Ortolani and Barlow tests are reassuring, and benign clicking alone is common.

Question 44Neonatology and Perinatology

Which congenital infection is classically associated with chorioretinitis, intracranial calcifications and hydrocephalus?

  1. Herpes simplex virus
  2. Toxoplasmosis Correct answer.
  3. Rubella
  4. Cytomegalovirus

Explanation

The classic triad of congenital toxoplasmosis is chorioretinitis, diffuse intracranial calcifications and hydrocephalus. Congenital CMV typically causes periventricular calcifications and sensorineural hearing loss, rubella causes cataracts and cardiac defects, and HSV presents with vesicular lesions and encephalitis.

Question 45Neonatology and Perinatology

Which is the most appropriate approach to a newborn born to a mother with active untreated pulmonary tuberculosis?

  1. Evaluation for congenital tuberculosis and consideration of preventive therapy Correct answer.
  2. Immediate treatment with four antituberculous drugs regardless of findings
  3. No evaluation and routine care
  4. Separation from the mother and BCG vaccination at birth

Explanation

A newborn exposed to active maternal tuberculosis requires evaluation for congenital or perinatally acquired infection, and preventive therapy is considered according to findings and local guidance. Routine care without evaluation is unsafe, and starting full four-drug treatment without evidence of disease is not appropriate.

Question 46Neonatology and Perinatology

Which is the strongest risk factor for early-onset group B streptococcal disease in a newborn?

  1. Maternal intrapartum fever Correct answer.
  2. Caesarean delivery before labour
  3. Male infant sex
  4. Maternal age over 35 years

Explanation

Maternal intrapartum fever, along with prolonged rupture of membranes and previous infant with GBS disease, is a recognised risk factor for early-onset GBS disease. Maternal age, infant sex and elective caesarean delivery before labour are not established risk factors.

Question 47Neonatology and Perinatology

A preterm infant at 26 weeks gestation is being managed on the neonatal unit. Which measure is most effective in reducing the risk of severe intraventricular haemorrhage?

  1. Delayed clamping of the cord for 5 minutes in all preterm infants
  2. Antenatal corticosteroids and avoiding fluctuations in cerebral blood flow Correct answer.
  3. Rapid volume expansion at birth
  4. Routine prophylactic fresh frozen plasma

Explanation

Antenatal corticosteroids mature the germinal matrix vasculature, and avoiding rapid volume shifts, hypercapnia and blood pressure swings reduces the risk of intraventricular haemorrhage. Prophylactic fresh frozen plasma is not effective, and rapid volume expansion may worsen bleeding.

Question 48Neonatology and Perinatology

Which finding is most characteristic of hypoglycaemia in a newborn infant of a diabetic mother?

  1. Onset after 1 week of age with seizures
  2. Onset within the first few hours after birth with jitteriness Correct answer.
  3. Persistent hyperglycaemia requiring insulin
  4. Polycythaemia as the only sign

Explanation

Infants of diabetic mothers have fetal hyperinsulinaemia, which causes hypoglycaemia typically within the first hours after birth, presenting with jitteriness, poor feeding, lethargy or seizures. It is transient and does not usually present after the first week.

Question 49Pediatric Cardiology

A healthy 4-year-old child is brought for a routine visit. On auscultation a soft systolic murmur is heard at the left upper sternal border, and it disappears when the child sits upright. Which of the following best describes this finding?

  1. A feature of an atrial septal defect with fixed split second sound
  2. A sign of moderate pulmonary valve stenosis needing urgent referral
  3. A benign flow murmur that requires no further cardiac evaluation Correct answer.
  4. An indicator of a small ventricular septal defect requiring closure

Explanation

Soft systolic murmurs confined to the upper left sternal edge that vary with posture, fever, or anaemia in an otherwise asymptomatic child are innocent flow murmurs. They have normal intensity, no diastolic component, and normal heart sounds, so no investigation is needed. Pathological murmurs are typically louder, holosystolic or diastolic, or associated with abnormal heart sounds or symptoms.

Question 50Pediatric Cardiology

Which congenital heart lesion classically produces cyanosis that worsens with crying and improves with squatting?

  1. Tetralogy of Fallot Correct answer.
  2. Atrial septal defect
  3. Patent ductus arteriosus
  4. Ventricular septal defect

Explanation

Tetralogy of Fallot is a cyanotic lesion with right-to-left shunting across the VSD; crying increases right-sided pressures and worsens the shunt, while squatting increases systemic vascular resistance and reduces the right-to-left flow. This is the classic mechanism behind hypercyanotic spells. Lesions with left-to-right shunting are typically acyanotic.