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TEP Pediatria study materials
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TEP Pediatria practice questions

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Question 1Pediatría general y atención primaria

A 6-month-old infant is brought for a routine well-child visit. Which feeding recommendation is most appropriate at this age?

  1. Introduction of iron-rich complementary foods alongside breast milk Correct answer.
  2. Switch to whole cow's milk as the main drink
  3. Introduction of honey-sweetened cereals
  4. Exclusive breastfeeding with no complementary foods

Explanation

Around 6 months, breast milk alone no longer meets energy and iron needs, so iron-rich complementary foods should be introduced while breastfeeding continues. Whole cow's milk and honey are both avoided in the first year for distinct reasons.

Question 2Pediatría general y atención primaria

A 3-year-old presents with fever, drooling, and a muffled voice with difficulty swallowing. He is sitting forward and appears toxic. What is the most appropriate immediate action?

  1. Prescribe oral amoxicillin and discharge home
  2. Inspect the throat with a tongue depressor
  3. Obtain a lateral neck radiograph before any treatment
  4. Urgent airway stabilization and evaluation for epiglottitis Correct answer.

Explanation

Drooling, muffled voice, and a toxic child sitting forward suggest epiglottitis with impending airway obstruction, which is an emergency requiring airway stabilization. Throat inspection or forced positioning can precipitate complete obstruction.

Question 3Pediatría general y atención primaria

A 4-year-old with a barking cough and inspiratory stridor at rest is diagnosed with croup. Which single intervention is most likely to produce rapid improvement?

  1. Nebulized epinephrine Correct answer.
  2. Nebulized salbutamol
  3. Oral antihistamine
  4. Oral amoxicillin

Explanation

Nebulized epinephrine reduces airway edema in moderate to severe croup and acts within minutes, providing rapid symptomatic relief. Corticosteroids are also given but act more slowly.

Question 4Pediatría general y atención primaria

A 2-year-old has a 3-day history of fever, runny nose, and a new rash. On examination there are small white spots on the buccal mucosa. Which diagnosis is most consistent with these findings?

  1. Roseola infantum
  2. Measles Correct answer.
  3. Scarlet fever
  4. Rubella

Explanation

Koplik spots on the buccal mucosa preceding a descending maculopapular rash after a febrile catarrhal phase are characteristic of measles. Rubella and roseola lack Koplik spots.

Question 5Pediatría general y atención primaria

A 5-year-old has a sore throat, fever, and tender anterior cervical lymphadenopathy without cough. A rapid antigen test is positive. What is the recommended treatment?

  1. Penicillin V for 10 days Correct answer.
  2. Azithromycin for 3 days
  3. Supportive care only
  4. Corticosteroids

Explanation

Confirmed group A streptococcal pharyngitis is treated with penicillin for 10 days to prevent acute rheumatic fever and suppurative complications. Narrow-spectrum penicillin remains first-line when the patient is not allergic.

Question 6Pediatría general y atención primaria

A 7-year-old with a 2-week history of fever, malaise, and a new holosystolic murmur at the apex is evaluated. Which investigation is most likely to confirm the diagnosis?

  1. Throat swab culture
  2. Blood cultures and echocardiography Correct answer.
  3. Serum antistreptolysin O titer
  4. Chest radiograph alone

Explanation

Fever with a new murmur suggests infective endocarditis, confirmed by blood cultures and echocardiography to identify the organism and vegetation. Antistreptolysin O titers support prior streptococcal exposure but do not diagnose endocarditis.

Question 7Pediatría general y atención primaria

A 1-year-old has a 2-day history of vomiting and diarrhea with decreased urine output. Which sign best indicates moderate dehydration?

  1. Moist mucous membranes
  2. Normal skin turgor
  3. Brisk capillary refill of 1 second
  4. Sunken eyes with delayed capillary refill Correct answer.

Explanation

Sunken eyes, delayed capillary refill, and reduced skin turgor are signs of moderate dehydration. Moist mucous membranes and brisk capillary refill indicate adequate hydration.

Question 8Pediatría general y atención primaria

A 4-year-old with acute gastroenteritis is mildly dehydrated and tolerating some oral fluids. What is the preferred initial management?

  1. Loperamide to reduce stool output
  2. Clear fluids only with no electrolytes
  3. Intravenous fluid bolus
  4. Oral rehydration solution given in small frequent amounts Correct answer.

Explanation

Oral rehydration solution is first-line for mild to moderate dehydration and should be given in small frequent amounts. Intravenous fluids are reserved for severe dehydration or failed oral therapy.

Question 9Pediatría general y atención primaria

A 6-week-old presents with projectile nonbilious vomiting after feeds and a palpable olive-shaped mass in the right upper abdomen. Which is the most likely diagnosis?

  1. Gastroesophageal reflux
  2. Pyloric stenosis Correct answer.
  3. Intussusception
  4. Malrotation with volvulus

Explanation

Projectile nonbilious vomiting in a 3- to 6-week-old with a palpable olive mass suggests hypertrophic pyloric stenosis, confirmed by ultrasound. Bilious vomiting would raise concern for malrotation.

Question 10Pediatría general y atención primaria

A 9-month-old has episodic inconsolable crying with drawing up of the legs and a red currant-jelly stool. What is the most likely diagnosis?

  1. Intussusception Correct answer.
  2. Gastroenteritis
  3. Hirschsprung disease
  4. Meckel diverticulum

Explanation

Episodic colicky pain with currant-jelly stools in an infant suggests intussusception, where bowel telescopes into adjacent bowel. Ultrasound is the preferred diagnostic study.

Question 11Pediatría general y atención primaria

A 3-year-old presents with fever, dysuria, and flank pain. Urinalysis shows pyuria and nitrites. Which is the most appropriate initial treatment approach?

  1. Immediate surgical referral
  2. Topical perineal care only
  3. Observation without antibiotics
  4. Oral antibiotics with urine culture and follow-up imaging Correct answer.

Explanation

Febrile urinary tract infection in a young child requires prompt antibiotics with urine culture, and follow-up imaging such as ultrasound to assess for structural anomalies. Observation risks progression to pyelonephritis or sepsis.

Question 12Pediatría general y atención primaria

A 10-year-old is brought after a generalized tonic-clonic seizure lasting 4 minutes that has now stopped. He is drowsy but breathing normally. What is the most appropriate next step?

  1. Maintain airway and monitor while arranging evaluation Correct answer.
  2. Immediately give a second-line antiepileptic load
  3. Start long-term daily anticonvulsants now
  4. Discharge home without assessment

Explanation

After a brief self-limited seizure, the priority is airway protection, monitoring, and evaluation for the cause. Long-term anticonvulsants are not started for a first unprovoked seizure without further assessment.

Question 13Pediatría general y atención primaria

A 2-year-old is found unresponsive and apneic. After calling for help, what is the recommended initial step in pediatric basic life support?

  1. Start chest compressions at 100-120 per minute Correct answer.
  2. Check a blood glucose level
  3. Give two rescue breaths
  4. Give five abdominal thrusts

Explanation

In pediatric cardiac arrest, high-quality chest compressions at 100-120 per minute with adequate depth are the foundation of resuscitation. Rescue breaths are integrated with compressions in a ratio appropriate to the number of rescuers.

Question 14Pediatría general y atención primaria

A 4-year-old with asthma has increased work of breathing and a peak flow below 50% of predicted despite repeated salbutamol. What is the most appropriate next step?

  1. Add ipratropium and systemic corticosteroids, consider magnesium Correct answer.
  2. Prescribe an oral antibiotic
  3. Start a long-acting beta-agonist inhaler
  4. Stop bronchodilators and observe

Explanation

Severe asthma exacerbation unresponsive to salbutamol warrants ipratropium, systemic corticosteroids, and consideration of intravenous magnesium. Long-acting beta-agonists are maintenance therapy and are not used for acute relief.

Question 15Pediatría general y atención primaria

A 6-year-old with asthma uses a short-acting beta-agonist inhaler. What is the most appropriate role of this medication?

  1. Prevention of respiratory infections
  2. Long-term control of airway inflammation
  3. Rapid relief of acute bronchospasm Correct answer.
  4. Daily maintenance to prevent symptoms

Explanation

Short-acting beta-agonists provide rapid bronchodilation for acute symptoms and are used as relievers. Inhaled corticosteroids, not beta-agonists, address underlying airway inflammation.

Question 16Pediatría general y atención primaria

A 5-year-old has a 3-day history of fever and a harsh, nonproductive cough with focal decreased breath sounds and dullness to percussion. What is the most likely diagnosis?

  1. Bronchiolitis
  2. Community-acquired pneumonia Correct answer.
  3. Asthma exacerbation
  4. Viral pharyngitis

Explanation

Fever with focal decreased breath sounds and dullness suggests community-acquired pneumonia with consolidation. Bronchiolitis typically presents in younger infants with diffuse wheeze.

Question 17Pediatría general y atención primaria

A 3-month-old has a 2-day history of runny nose, mild fever, and diffuse wheeze with crackles. What is the most likely diagnosis?

  1. Croup
  2. Bacterial pneumonia
  3. Bronchiolitis Correct answer.
  4. Epiglottitis

Explanation

Bronchiolitis affects infants under 2 years, most often caused by respiratory syncytial virus, presenting with coryza, wheeze, and crackles. Treatment is largely supportive.

Question 18Pediatría general y atención primaria

A 2-year-old with a known ventricular septal defect is noted to have cyanosis and squatting after exertion. What is the most likely explanation?

  1. New-onset asthma
  2. Iron deficiency anemia
  3. Eisenmenger syndrome with right-to-left shunt reversal Correct answer.
  4. Left-to-right shunt worsening

Explanation

Long-standing left-to-right shunts can cause pulmonary vascular disease leading to shunt reversal (Eisenmenger syndrome), producing cyanosis and clubbing. Squatting increases systemic vascular resistance and reduces right-to-left shunting.

Question 19Pediatría general y atención primaria

A newborn is noted to have a machinery-like murmur with bounding pulses and a wide pulse pressure. What is the most likely diagnosis?

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

Explanation

A continuous machinery murmur with bounding pulses and wide pulse pressure is characteristic of patent ductus arteriosus. Tetralogy of Fallot causes cyanosis and a systolic murmur, while coarctation causes weak femoral pulses.

Question 20Pediatría general y atención primaria

A 14-year-old presents with fatigue, pallor, and pica. Laboratory tests show microcytic anemia with low ferritin. What is the most appropriate treatment?

  1. Oral iron supplementation with dietary counseling Correct answer.
  2. Immediate blood transfusion
  3. Folic acid supplementation
  4. Vitamin B12 injections

Explanation

Microcytic anemia with low ferritin indicates iron deficiency, treated with oral iron and dietary counseling. Transfusion is reserved for severe symptomatic anemia.

Question 21Pediatría general y atención primaria

A 2-year-old of Mediterranean descent has pallor and jaundice during a febrile illness, with splenomegaly and a hemoglobin of 6 g/dL. What is the most likely underlying condition?

  1. Beta-thalassemia major Correct answer.
  2. Hereditary spherocytosis
  3. Sickle cell disease
  4. Iron deficiency anemia

Explanation

Beta-thalassemia major presents with severe microcytic anemia, jaundice, and splenomegaly in early childhood, often exacerbated by infection. Sickle cell disease typically presents with vaso-occlusive pain or acute chest syndrome.

Question 22Pediatría general y atención primaria

A 3-year-old with sickle cell disease presents with fever of 39°C and no other symptoms. What is the most appropriate immediate management?

  1. Elective transfusion of packed red cells
  2. Urgent blood cultures and empiric intravenous antibiotics Correct answer.
  3. Observation at home with follow-up
  4. Oral paracetamol only

Explanation

Fever in a child with sickle cell disease is a medical emergency because of the risk of overwhelming sepsis, particularly from encapsulated organisms. Blood cultures should be drawn and empiric intravenous antibiotics started promptly.

Question 23Pediatría general y atención primaria

A 5-year-old presents with periorbital edema, proteinuria, and hypoalbuminemia without hematuria or hypertension. What is the most likely diagnosis?

  1. Urinary tract infection
  2. Acute post-streptococcal glomerulonephritis
  3. Minimal change nephrotic syndrome Correct answer.
  4. Hemolytic uremic syndrome

Explanation

Nephrotic syndrome classically presents with periorbital edema, proteinuria, and hypoalbuminemia, and minimal change disease is the most common cause in children. Glomerulonephritis typically adds hematuria and hypertension.

Question 24Pediatría general y atención primaria

A 7-year-old has cola-colored urine, hypertension, and periorbital edema 2 weeks after a sore throat. What is the most likely diagnosis?

  1. Hemolytic uremic syndrome
  2. Minimal change nephrotic syndrome
  3. IgA nephropathy
  4. Acute post-streptococcal glomerulonephritis Correct answer.

Explanation

Cola-colored urine, hypertension, and edema after a recent streptococcal infection suggest acute post-streptococcal glomerulonephritis. Low complement levels and elevated streptococcal titers support the diagnosis.

Question 25Pediatría general y atención primaria

A 10-year-old is brought for a routine check-up and is found to have blood pressure above the 95th percentile for age and sex on repeated measurements. Which is the most appropriate initial management?

  1. Restrict all physical activity
  2. Lifestyle counseling with weight management and repeat monitoring Correct answer.
  3. No action until adulthood
  4. Immediate antihypertensive medication

Explanation

Primary hypertension in children is often related to obesity and responds to lifestyle modification with weight management and dietary changes. Pharmacotherapy is reserved for secondary causes, symptomatic hypertension, or failure of lifestyle measures.

Question 26Pediatría general y atención primaria

A 15-month-old is brought to the clinic for a routine visit. The parents report the child says three single words, does not point to show interest in objects, and does not follow a simple instruction such as 'give me the ball'. Which finding is the most concerning for a developmental delay requiring further evaluation?

  1. The child says three single words
  2. The child cannot yet speak in two-word phrases
  3. The child does not point to show interest in objects Correct answer.
  4. The child does not follow a one-step command without a gesture

Explanation

Joint attention behaviors such as pointing to share interest typically emerge by 12 to 14 months, and their absence is a red flag for autism spectrum disorder and global delay. A 15-month-old should have at least one or two meaningful words, so three words is reassuring rather than concerning. Two-word phrases are not expected until around 18 to 24 months, so their absence at this age is normal.

Question 27Pediatría general y atención primaria

A 2-month-old infant is seen for a well-child visit. Which immunization is recommended at this age according to the routine childhood schedule?

  1. Human papillomavirus vaccine
  2. Measles-mumps-rubella vaccine
  3. Diphtheria-tetanus-acellular pertussis containing vaccine Correct answer.
  4. Varicella vaccine

Explanation

Routine infant immunization begins at 2 months and includes a combination vaccine containing diphtheria, tetanus, and acellular pertussis, along with polio, Haemophilus influenzae type b, pneumococcal, and rotavirus vaccines. Measles-mumps-rubella and varicella are given later, typically at 12 to 15 months. Human papillomavirus vaccine is recommended in early adolescence.

Question 28Pediatría general y atención primaria

A 6-year-old is brought to the emergency department with a barking cough, hoarse voice, and inspiratory stridor that is present at rest. He is alert and has mild suprasternal retractions. What is the most appropriate initial management?

  1. Oral amoxicillin and observation for 24 hours
  2. Nebulized epinephrine and a single dose of oral dexamethasone Correct answer.
  3. Nebulized salbutamol alone
  4. Immediate endotracheal intubation

Explanation

This presentation is croup, and stridor at rest with retractions indicates moderate disease. Treatment is a systemic corticosteroid plus nebulized epinephrine for rapid reduction of airway edema, with observation afterward for possible rebound. Antibiotics have no role in a viral illness, and intubation is reserved for impending airway failure.

Question 29Pediatría general y atención primaria

A 4-year-old is brought for a routine visit. His mother reports he has been thriving well. Which statement best describes the recommended approach to screening for iron deficiency anemia in healthy young children?

  1. Universal hemoglobin screening is recommended around 12 months of age Correct answer.
  2. Serum ferritin is the preferred first-line screening test in all children
  3. Screening is only needed if the child has pica
  4. Screening should be delayed until school age

Explanation

Routine hemoglobin screening for anemia is recommended at approximately 12 months of age for all infants, with additional selective screening later in childhood based on risk factors. Pica is a symptom that may prompt testing but is not a prerequisite for screening. Ferritin is useful to confirm iron deficiency but is not the universal first-line screening test.

Question 30Pediatría general y atención primaria

A 3-year-old is brought after ingesting an unknown number of her grandmother's tablets about 30 minutes ago. She is lethargic, has deep rapid breathing, and vomited once. Which single measurement is most useful in guiding immediate management?

  1. Serum acetaminophen concentration
  2. Abdominal radiograph
  3. Arterial blood gas Correct answer.
  4. Serum salicylate concentration

Explanation

In an unknown ingestion with altered mental status and hyperventilation, an arterial blood gas rapidly identifies the acid-base disturbance, which directs antidote and supportive decisions. Acetaminophen and salicylate levels are useful but only when those specific agents are suspected, and they do not explain deep breathing on their own. An abdominal radiograph rarely changes acute management and is not the priority.

Question 31Neonatología

¿Cuál es la frecuencia cardiaca inicial recomendada para la reanimación neonatal de un recién nacido a término que no respira al nacer?

  1. 60 compresiones por minuto
  2. 90 compresiones por minuto
  3. 150 compresiones por minuto
  4. 120 compresiones por minuto Correct answer.

Explanation

El algoritmo neonatal establece una relación de 3 compresiones por cada ventilación, con una cadencia de 120 eventos por minuto, lo que equivale a 90 compresiones y 30 ventilaciones. Esta frecuencia se mantiene hasta recuperar la circulación espontánea o iniciar maniobras avanzadas.

Question 32Neonatología

En un recién nacido de 34 semanas con dificultad respiratoria, ¿qué hallazgo en la radiografía de tórax apoya mejor el diagnóstico de enfermedad de membrana hialina?

  1. Derrame pleural bilateral de gran volumen
  2. Hiperinsuflación con aplanamiento diafragmático
  3. Patrón de vidrio esmerilado con broncograma aéreo Correct answer.
  4. Neumotórax espontáneo a tensión

Explanation

La enfermedad de membrana hialina produce un patrón reticulogranular difuso con broncogramas aéreos por colapso alveolar y falta de surfactante. La prematuridad es el principal factor de riesgo. La hiperinsuflación y el derrame no son hallazgos típicos de esta entidad.

Question 33Neonatología

Un recién nacido de 39 semanas presenta ictericia a las 18 horas de vida con bilirrubina total de 15 mg/dL. ¿Cuál es la conducta más adecuada?

  1. Observación domiciliaria con control en 48 horas
  2. Iniciar fototerapia intensiva y estudiar la causa de hemólisis Correct answer.
  3. Administrar únicamente líquidos intravenosos
  4. Suspender la lactancia y reevaluar en una semana

Explanation

La ictericia que aparece antes de las 24 horas de vida es siempre patológica y obliga a descartar hemólisis, sepsis o enfermedad metabólica. Con cifras elevadas se requiere fototerapia inmediata y estudio etiológico. La observación diferida expone al riesgo de encefalopatía bilirrubínica.

Question 34Neonatología

¿Cuál es el umbral de peso al nacer que define el bajo peso para la edad gestacional en un recién nacido?

  1. Menos de 2500 g
  2. Por debajo del percentil 10 para su edad gestacional Correct answer.
  3. Menos de 1500 g
  4. Por debajo del percentil 50 para su edad gestacional

Explanation

El pequeño para la edad gestacional se define por un peso inferior al percentil 10 de las curvas de referencia para la edad gestacional. El punto de corte absoluto de 2500 g define bajo peso al nacer, no la restricción del crecimiento. Ambos conceptos pueden coexistir pero no son equivalentes.

Question 35Neonatología

En la exploración de un recién nacido a las 24 horas se palpa el pulso femoral débil y hay diferencia de presión entre brazos y piernas. ¿Qué cardiopatía debe sospecharse prioritariamente?

  1. Coartación de la aorta Correct answer.
  2. Comunicación interventricular pequeña
  3. Persistencia del conducto arterioso
  4. Estenosis pulmonar leve

Explanation

La coartación de la aorta produce pulsos femorales débiles e hipertensión en miembros superiores respecto a los inferiores. Es una cardiopatía ductus-dependiente que puede descompensarse al cerrarse el conducto. La sospecha exige valoración urgente con ecocardiografía.

Question 36Neonatología

¿Cuál es la concentración inicial de oxígeno recomendada al iniciar la reanimación de un recién nacido a término?

  1. 40 %
  2. 100 %
  3. 21 % Correct answer.
  4. 60 %

Explanation

En el recién nacido a término se recomienda iniciar la reanimación con aire ambiente y ajustar el oxígeno según la saturación preductal objetivo. El uso indiscriminado de oxígeno al 100 % se asocia a estrés oxidativo. En prematuros también se comienza con fracciones bajas y se titula.

Question 37Neonatología

Un neonato de 3 días con alimentación escasa presenta letargo, hipotonía y glucemia de 25 mg/dL. ¿Cuál es la primera medida terapéutica?

  1. Administrar glucosa oral y repetir la glucemia en 4 horas
  2. Suspender todas las tomas durante 12 horas
  3. Realizar punción lumbar antes de tratar
  4. Iniciar infusión intravenosa de glucosa y controlar estrechamente Correct answer.

Explanation

La hipoglucemia neonatal sintomática requiere corrección inmediata con glucosa intravenosa, ya que la vía oral puede ser insuficiente y el déficit prolongado daña el sistema nervioso. Debe monitorizarse la glucemia hasta estabilizarla. La punción lumbar se difiere hasta corregir la hipoglucemia.

Question 38Neonatología

¿Cuál de los siguientes es un factor de riesgo materno clásico para sepsis neonatal de inicio precoz?

  1. Hipertensión gestacional leve
  2. Presentación cefálica
  3. Corioamnionitis materna Correct answer.
  4. Multiparidad sin complicaciones

Explanation

La corioamnionitis, la rotura prolongada de membranas, la colonización por estreptococo del grupo B y la prematuridad son factores de riesgo de sepsis vertical. La fiebre materna intraparto también eleva el riesgo. El manejo incluye hemocultivo y antibióticos empíricos.

Question 39Neonatología

Un prematuro de 28 semanas recibe ventilación mecánica y a los 10 días presenta deterioro súbito con hipoxemia, bradicardia y abolición del murmullo vesicular derecho. ¿Cuál es la causa más probable?

  1. Edema pulmonar cardiogénico
  2. Atelectasia masiva bilateral
  3. Bronquiolitis viral
  4. Neumotórax Correct answer.

Explanation

El deterioro brusco con hipoxemia y abolición del murmullo vesicular en un prematuro ventilado sugiere neumotórax, frecuente por barotrauma y displasia broncopulmonar. La descompensación hemodinámica acompaña al neumotórax a tensión. La resolución requiere descompresión inmediata.

Question 40Neonatología

¿Qué prueba de cribado se realiza de forma universal en el recién nacido para detectar cardiopatías congénitas críticas?

  1. Electrocardiograma de 12 derivaciones
  2. Radiografía de tórax sistemática
  3. Pulsioximetría pre y posductal Correct answer.
  4. Ecocardiograma a todos los neonatos

Explanation

La pulsioximetría pre y posductal a las 24-48 horas detecta cardiopatías ductus-dependientes con buena sensibilidad y bajo costo. Una diferencia mayor del 3 % o saturaciones bajas obligan a valoración urgente. El ecocardiograma se reserva para casos positivos o sospecha clínica.

Question 41Neonatología

Un recién nacido de 41 semanas, hijo de madre diabética, presenta macrosomía y a las 2 horas de vida temblores con glucemia de 30 mg/dL. ¿Qué mecanismo explica mejor la hipoglucemia?

  1. Aumento de la gluconeogénesis hepática
  2. Hiperinsulinismo transitorio por hiperplasia de células beta Correct answer.
  3. Insuficiencia corticosuprarrenal congénita
  4. Déficit de glucagón permanente

Explanation

La hiperglucemia materna estimula la hiperplasia de células beta fetales, generando hiperinsulinismo que persiste tras el parto y provoca hipoglucemia. Es transitoria y responde a aporte de glucosa. El control precoz de la glucemia evita secuelas neurológicas.

Question 42Neonatología

¿Cuál es la edad gestacional mínima a partir de la cual se recomienda el cribado de retinopatía del prematuro?

  1. Cualquier prematuro con menos de 35 semanas
  2. Menos de 37 semanas o peso menor de 2500 g
  3. Menos de 28 semanas o peso menor de 1000 g
  4. Menos de 32 semanas o peso menor de 1500 g Correct answer.

Explanation

Se recomienda cribar a prematuros con edad gestacional menor de 32 semanas o peso al nacer menor de 1500 g, así como a otros con factores de riesgo. El examen se realiza con oftalmoscopia indirecta en las primeras semanas. La detección precoz permite tratar formas graves y prevenir ceguera.

Question 43Neonatología

Un neonato presenta a las 48 horas vómitos biliosos y abdomen distendido. ¿Cuál es la actitud inicial más correcta?

  1. Suspender la alimentación, colocar sonda nasogástrica y derivar urgentemente Correct answer.
  2. Administrar antieméticos y observar en planta
  3. Alta con control ambulatorio en 24 horas
  4. Iniciar alimentación con fórmula espesada

Explanation

Los vómitos biliosos en el neonato sugieren obstrucción intestinal, como malrotación con vólvulo o atresia, y constituyen una urgencia quirúrgica. Debe mantenerse en ayunas, descomprimir el estómago y trasladar a un centro con cirugía pediátrica. La demora aumenta el riesgo de isquemia intestinal.

Question 44Neonatología

¿Qué tipo de lactancia se recomienda de forma exclusiva durante los primeros 6 meses de vida?

  1. Lactancia artificial exclusiva
  2. Lactancia materna exclusiva Correct answer.
  3. Lactancia mixta desde el nacimiento
  4. Fórmula de inicio con agua azucarada

Explanation

La Organización Mundial de la Salud y las sociedades pediátricas recomiendan lactancia materna exclusiva hasta los 6 meses, con alimentación complementaria después. La leche materna aporta factores inmunológicos y nutricionales óptimos. La introducción de otros líquidos antes de esa edad reduce la protección inmunitaria.

Question 45Neonatología

Un recién nacido de 30 semanas presenta apnea recurrente y se inicia cafeína. ¿Cuál es el mecanismo principal de beneficio?

  1. Reducción directa de la producción de surfactante
  2. Relajación de la musculatura lisa bronquial
  3. Inhibición del reflejo de succión
  4. Estimulación del centro respiratorio y aumento de la respuesta al CO2 Correct answer.

Explanation

La cafeína estimula el centro respiratorio bulbar y mejora la respuesta ventilatoria a la hipercapnia, reduciendo las apneas de la prematuridad. También disminuye la necesidad de ventilación mecánica. Es un tratamiento de primera línea en prematuros con apnea.

Question 46Neonatología

¿Cuál es el signo clínico más precoz de sepsis neonatal de inicio tardío en un prematuro?

  1. Policitemia asintomática
  2. Inestabilidad térmica y rechazo de las tomas Correct answer.
  3. Aumento de peso progresivo
  4. Mejoría del estado general

Explanation

La sepsis neonatal se manifiesta de forma inespecífica con hipotermia o fiebre, rechazo alimentario, letargo y apneas. La inestabilidad térmica es un signo precoz frecuente en prematuros. Ante la sospecha se realiza hemocultivo y se inicia antibioterapia empírica.

Question 47Neonatología

Un neonato a término presenta a las 6 horas de vida cianosis central que no mejora con oxígeno y saturación preductal mayor que posductal. ¿Qué diagnóstico es más probable?

  1. Hipertensión pulmonar persistente leve
  2. Transposición de grandes arterias Correct answer.
  3. Insuficiencia cardiaca congestiva
  4. Comunicación interauricular restrictiva

Explanation

La cianosis que no responde al oxígeno sugiere cardiopatía congénita cianótica con mezcla sanguínea, y la transposición de grandes arterias es la más frecuente en el periodo neonatal. La diferencia de saturaciones refleja la fisiología ductal. Requiere prostaglandina y ecocardiografía urgente.

Question 48Neonatología

¿Cuál es la complicación metabólica más característica de un recién nacido hijo de madre diabética mal controlada?

  1. Hipoglucemia Correct answer.
  2. Hipernatremia
  3. Hipercalcemia
  4. Alcalosis metabólica

Explanation

La hiperglucemia materna provoca hiperinsulinismo fetal, que tras el nacimiento causa hipoglucemia. También son frecuentes la macrosomía, la policitemia y la hipocalcemia. El control glucémico neonatal precoz es esencial para prevenir secuelas.

Question 49Neonatología

En un neonato con sospecha de enterocolitis necrosante, ¿qué hallazgo radiológico es más específico de la enfermedad?

  1. Neumatosis intestinal Correct answer.
  2. Aumento del espacio intercostal
  3. Elevación del diafragma derecho
  4. Distensión gaseosa difusa aislada

Explanation

La neumatosis intestinal es un signo radiológico característico de enterocolitis necrosante y refleja isquemia de la pared intestinal. Puede progresar a perforación con neumoperitoneo. Su presencia obliga a suspender la alimentación e iniciar tratamiento médico-quirúrgico.

Question 50Neonatología

Un prematuro de 26 semanas recibe surfactante por enfermedad de membrana hialina y mejora la oxigenación. ¿Cuál es el objetivo principal de la administración precoz de surfactante?

  1. Aumentar la producción de moco bronquial
  2. Inhibir la respuesta inflamatoria sistémica
  3. Disminuir la tensión superficial alveolar y prevenir el colapso Correct answer.
  4. Reducir la resistencia vascular pulmonar

Explanation

El surfactante reduce la tensión superficial alveolar, evitando el colapso al final de la espiración y mejorando la compliance pulmonar. La administración precoz en prematuros con déficit disminuye la mortalidad y el barotrauma. Se complementa con ventilación no invasiva cuando es posible.