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Egyptian Board Pediatrics study materials
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Egyptian Board Pediatrics practice questions

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Question 1Growth, Development and Behavioral Pediatrics

A 9-month-old infant born at term is brought for routine follow-up. Which developmental milestone is most consistent with normal gross motor development at this age?

  1. Sitting without support for several minutes Correct answer.
  2. Rolling from supine to prone only
  3. Walking independently across the room
  4. Standing on one foot briefly

Explanation

Independent sitting is typically achieved between 6 and 9 months, so a 9-month-old who sits steadily without support is developmentally appropriate. Rolling is an earlier milestone, while independent walking and single-leg stance occur much later in the second year.

Question 2Growth, Development and Behavioral Pediatrics

At what age does a typically developing child usually begin to use two-word phrases such as 'mama go'?

  1. 10 to 12 months
  2. 18 to 24 months Correct answer.
  3. 6 to 9 months
  4. 30 to 36 months

Explanation

Two-word combinations emerge in the second half of the second year, typically between 18 and 24 months, alongside a vocabulary of roughly 50 words. Single words appear around the first birthday, and sentences of three or more words follow after 2 years.

Question 3Growth, Development and Behavioral Pediatrics

A mother reports that her 15-month-old uses only 3 words, does not point to indicate interest, and does not respond to his name. Which statement best reflects the appropriate clinical interpretation?

  1. Vocabulary size is the only feature that requires further evaluation
  2. The child should be referred for hearing and developmental assessment Correct answer.
  3. These findings are within normal limits for a 15-month-old boy
  4. The child should be observed again at 3 years of age

Explanation

Fewer than 10 words at 15 months combined with absent pointing and failure to respond to name are red flags for language delay and possible autism spectrum disorder. Early audiological and developmental evaluation is indicated because intervention outcomes are better when started early.

Question 4Growth, Development and Behavioral Pediatrics

A 6-month-old infant has a birth weight of 3.0 kg. Using the rule that birth weight doubles by about 5 months and triples by about 12 months, which weight is expected at 6 months?

  1. 4.5 kg
  2. 12.0 kg
  3. 6.0 kg Correct answer.
  4. 9.0 kg

Explanation

Doubling of birth weight by roughly 5 months means a 3.0 kg newborn should weigh about 6.0 kg at 6 months. Tripling to about 9.0 kg is expected near 12 months, and 4.5 kg would represent only a 50 percent gain.

Question 5Growth, Development and Behavioral Pediatrics

A 4-year-old boy is brought for evaluation of short stature. His height is below the 3rd percentile, his weight is proportionate, and his growth velocity over the past year was normal. His mid-parental height is also below the 3rd percentile. Which diagnosis is most likely?

  1. Celiac disease
  2. Growth hormone deficiency
  3. Turner syndrome
  4. Familial short stature Correct answer.

Explanation

Familial short stature is characterized by short stature with a normal growth velocity, proportionate weight, and a mid-parental height that is also low. Growth hormone deficiency and chronic disease such as celiac disease typically cause a decline in growth velocity rather than parallel growth.

Question 6Growth, Development and Behavioral Pediatrics

Which finding on a growth chart most strongly suggests a pathologic cause of short stature rather than constitutional delay?

  1. Height consistent with mid-parental height
  2. Height below the 3rd percentile with crossing of percentile lines downward Correct answer.
  3. Bone age delayed by 1 year with normal height velocity
  4. Height between the 10th and 25th percentile with normal velocity

Explanation

Crossing height percentiles downward indicates a falling growth velocity, which points to an acquired or endocrine cause rather than a benign variant. Constitutional delay usually shows a delayed bone age with growth parallel to the normal curve.

Question 7Growth, Development and Behavioral Pediatrics

A 14-year-old girl has not yet developed breast buds. Which term describes this presentation?

  1. Precocious puberty
  2. Delayed puberty Correct answer.
  3. Gynecomastia
  4. Primary amenorrhea

Explanation

Absence of breast development by 13 to 14 years in girls defines delayed puberty and warrants evaluation for constitutional delay, chronic disease, or hypogonadism. Primary amenorrhea refers specifically to absence of menses by 15 to 16 years in the presence of normal secondary sexual development.

Question 8Growth, Development and Behavioral Pediatrics

Which sequence of pubertal changes is typical in girls?

  1. Breast budding, then menarche, then pubic hair
  2. Breast budding, then pubic hair, then menarche Correct answer.
  3. Menarche, then breast budding, then pubic hair
  4. Pubic hair, then menarche, then breast budding

Explanation

In girls, thelarche (breast budding) is usually the first sign, followed by pubarche and then menarche about 2 to 2.5 years later. Menarche typically occurs after the peak growth spurt and after most breast development is complete.

Question 9Growth, Development and Behavioral Pediatrics

A 9-year-old girl presents with breast development and pubic hair. Which finding would most strongly suggest a central rather than peripheral cause of precocious puberty?

  1. Isolated premature thelarche
  2. Progressive pubertal changes with elevated basal LH Correct answer.
  3. A palpable ovarian cyst
  4. Suppressed gonadotropin levels

Explanation

Central precocious puberty is gonadotropin-dependent, so it shows pubertal progression with elevated basal or GnRH-stimulated LH. Peripheral causes such as ovarian cysts or exogenous estrogen suppress gonadotropins and may cause isolated findings.

Question 10Growth, Development and Behavioral Pediatrics

Which of the following is the most appropriate first step in evaluating a 2-year-old with suspected global developmental delay?

  1. Brain MRI under general anesthesia
  2. Serum growth hormone measurement
  3. Sleep study
  4. Audiologic evaluation and standardized developmental screening Correct answer.

Explanation

Hearing assessment and standardized developmental screening are the essential first steps because hearing impairment can mimic or compound language and cognitive delay. Neuroimaging is reserved for children with focal neurologic findings, regression, or specific indications.

Question 11Growth, Development and Behavioral Pediatrics

A 3-year-old child is reported to have lost previously acquired language and social skills over the past 4 months. Which diagnosis should be highest on the differential?

  1. Autism spectrum disorder with regression Correct answer.
  2. Attention-deficit/hyperactivity disorder
  3. Specific language impairment
  4. Normal variation in language development

Explanation

Loss of previously acquired language and social skills is a red flag for autistic regression and requires urgent developmental evaluation. Specific language impairment and ADHD do not involve loss of established skills.

Question 12Growth, Development and Behavioral Pediatrics

Which feature is most characteristic of attention-deficit/hyperactivity disorder in a school-aged child?

  1. Symptoms beginning after age 12 years
  2. Symptoms explained by a psychotic disorder
  3. Symptoms present in multiple settings for at least 6 months Correct answer.
  4. Symptoms present only in the classroom

Explanation

ADHD requires developmentally inappropriate symptoms of inattention and/or hyperactivity-impulsivity present in more than one setting for at least 6 months. The symptoms must begin before age 12 and must not be better explained by another condition.

Question 13Growth, Development and Behavioral Pediatrics

A 10-year-old boy has a full-scale IQ of 68, adaptive deficits in communication and self-care, and onset during the developmental period. Which diagnosis best fits?

  1. Specific learning disorder
  2. Autism spectrum disorder
  3. Borderline intellectual functioning
  4. Intellectual disability Correct answer.

Explanation

Intellectual disability requires deficits in intellectual functioning (typically IQ about 70 or below) together with deficits in adaptive functioning with onset during the developmental period. Both domains must be affected, which is the case here.

Question 14Growth, Development and Behavioral Pediatrics

A 7-year-old child of normal intelligence reads far below the expected level despite adequate instruction and has no sensory or neurologic deficit. Which diagnosis is most appropriate?

  1. Expressive language disorder
  2. Specific learning disorder with impairment in reading Correct answer.
  3. Intellectual disability
  4. Dyscalculia

Explanation

Specific learning disorder with reading impairment (dyslexia) is diagnosed when reading achievement is substantially below age expectations despite adequate instruction and normal intelligence. Dyscalculia concerns mathematics, and intellectual disability involves global cognitive deficits.

Question 15Growth, Development and Behavioral Pediatrics

A 5-year-old child has nighttime bedwetting three times per week. Which statement about nocturnal enuresis is correct?

  1. It is considered abnormal before age 5 years
  2. It often resolves spontaneously with age Correct answer.
  3. It always indicates an underlying renal anomaly
  4. It is more common in girls than boys

Explanation

Nocturnal enuresis is common in young children and has a high rate of spontaneous resolution with increasing age. It is more common in boys, is not considered abnormal before about 5 years, and usually occurs without structural renal disease.

Question 16Growth, Development and Behavioral Pediatrics

Which advice is most appropriate for parents of a 2-year-old regarding toilet training?

  1. Delay training until 5 years of age in all children
  2. Punish accidents to speed up learning
  3. Begin intensive training as soon as the child can walk
  4. Start when the child shows readiness signs such as dry periods and interest Correct answer.

Explanation

Toilet training is most successful when started after signs of readiness, including awareness of a full bladder, dry intervals, and interest in the toilet. Coercive or punitive approaches increase resistance and prolong training.

Question 17Growth, Development and Behavioral Pediatrics

A 12-year-old girl has a body mass index at the 97th percentile. Which statement about adolescent obesity is most accurate?

  1. Obesity in adolescence increases the risk of adult metabolic disease Correct answer.
  2. BMI percentile is not useful for screening in adolescence
  3. Weight loss should never be attempted during puberty
  4. Obesity in adolescence has no association with psychosocial problems

Explanation

Adolescent obesity tracks into adulthood and increases the risk of type 2 diabetes, hypertension, and dyslipidemia. BMI percentile is the recommended screening tool, and psychosocial consequences such as bullying and low self-esteem are common.

Question 18Growth, Development and Behavioral Pediatrics

A 16-year-old presents with fatigue, cold intolerance, and weight gain. Which growth-related finding would most support a diagnosis of hypothyroidism?

  1. Tall stature with long limbs
  2. Normal growth with early menarche
  3. Decelerated linear growth with delayed bone age Correct answer.
  4. Accelerated linear growth with advanced bone age

Explanation

Hypothyroidism slows linear growth and delays skeletal maturation, so bone age lags behind chronologic age. Hyperthyroidism, by contrast, accelerates growth and bone maturation.

Question 19Growth, Development and Behavioral Pediatrics

Which statement about the use of growth charts in Egyptian children is most appropriate?

  1. Only international charts should be used for all children
  2. Growth charts are unnecessary if the child appears healthy
  3. Charts should be appropriate for the population and the child's age and sex Correct answer.
  4. A single height measurement is sufficient to assess growth

Explanation

Growth should be assessed using charts appropriate for the population and for the child's age and sex, and serial measurements are needed to evaluate velocity. A single measurement cannot distinguish normal variation from faltering growth.

Question 20Growth, Development and Behavioral Pediatrics

A 4-year-old child is brought with a 3-month history of recurrent abdominal pain, poor sleep, and aggressive outbursts. Which approach best reflects a biopsychosocial assessment in behavioral pediatrics?

  1. Exploring family stressors, school adjustment, and sleep patterns alongside physical symptoms Correct answer.
  2. Ordering extensive imaging before any history taking
  3. Restricting the child from school until symptoms resolve
  4. Concluding that the symptoms are fabricated

Explanation

Behavioral pediatrics emphasizes a biopsychosocial formulation that integrates physical symptoms with family, school, and emotional factors. This approach guides targeted intervention and avoids unnecessary investigations or dismissal of the child's distress.

Question 21Neonatology and Perinatal Medicine

A term newborn is noted at delivery to have a heart rate of 80 beats per minute, irregular gasping respirations, and central cyanosis despite stimulation and airway clearing. According to the Neonatal Resuscitation Program, what is the most appropriate next step?

  1. Begin chest compressions
  2. Give intravenous epinephrine
  3. Start positive-pressure ventilation Correct answer.
  4. Place the infant under a radiant warmer and observe

Explanation

An apneic or gasping newborn with a heart rate below 100 beats per minute requires positive-pressure ventilation as the first corrective step. Chest compressions are reserved for a heart rate below 60 after effective ventilation has been established.

Question 22Neonatology and Perinatal Medicine

Which parameter is the most sensitive and reliable indicator of the need for resuscitation in the newly born infant?

  1. Skin colour
  2. Heart rate Correct answer.
  3. Reflex irritability
  4. Limb tone

Explanation

Heart rate is the most sensitive clinical indicator of neonatal condition at birth and guides every step of resuscitation. Tone, colour, and reflexes are supportive but slower and less reliable for decision-making.

Question 23Neonatology and Perinatal Medicine

A newborn at 30 weeks' gestation develops respiratory distress within the first hours of life. Chest radiograph shows a reticulogranular pattern with air bronchograms and low lung volumes. What is the most likely diagnosis?

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

Explanation

Prematurity with early distress, low lung volumes, and a reticulogranular ground-glass pattern with air bronchograms is classic for respiratory distress syndrome due to surfactant deficiency. Surfactant administration is a key component of management.

Question 24Neonatology and Perinatal Medicine

Physiological jaundice of the newborn most commonly appears during which time frame?

  1. After 14 days of age
  2. Within the first 6 hours of life
  3. After 24 hours of age Correct answer.
  4. At birth

Explanation

Physiological jaundice characteristically appears after the first 24 hours, peaks around day 3 to 5 in term infants, and resolves without treatment. Jaundice present at birth or within 24 hours is always pathological and requires urgent investigation.

Question 25Neonatology and Perinatal Medicine

A term infant born to a mother with prolonged rupture of membranes develops lethargy, poor feeding, and temperature instability at 12 hours of age. Which organism is the most common cause of early-onset neonatal sepsis?

  1. Staphylococcus epidermidis
  2. Group B Streptococcus Correct answer.
  3. Listeria monocytogenes
  4. Pseudomonas aeruginosa

Explanation

Group B Streptococcus remains the leading cause of early-onset neonatal sepsis, particularly with prolonged rupture of membranes and maternal colonisation. Empiric therapy typically includes ampicillin plus an aminoglycoside.

Question 26Neonatology and Perinatal Medicine

Which finding in a newborn is most characteristic of hypoglycaemia?

  1. Persistent cyanosis unresponsive to oxygen
  2. Bile-stained vomiting
  3. Bulging anterior fontanelle
  4. Jitteriness that resolves with feeding Correct answer.

Explanation

Neonatal hypoglycaemia commonly presents with jitteriness, tremors, lethargy, and poor feeding, and symptoms often improve after glucose administration. Confirmation requires a bedside glucose measurement.

Question 27Neonatology and Perinatal Medicine

A newborn is noted to have a bluish discolouration of the hands and feet with pink central mucous membranes shortly after birth. What is the most appropriate interpretation?

  1. Polycythaemia requiring partial exchange transfusion
  2. Acrocyanosis, a normal finding in the first hours of life Correct answer.
  3. Central cyanosis requiring immediate oxygen
  4. Methemoglobinaemia requiring methylene blue

Explanation

Acrocyanosis is a benign, self-limiting finding caused by peripheral vasoconstriction and is common in the first hours after birth. Central cyanosis involving the mucous membranes would instead require urgent cardiopulmonary evaluation.

Question 28Neonatology and Perinatal Medicine

A term infant develops respiratory distress with grunting and tachypnoea at 4 hours of life. The mother is diabetic and the infant was delivered by caesarean section. Chest radiograph shows increased perihilar streaking and fluid in the fissures with normal lung volumes. What is the most likely diagnosis?

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

Explanation

Transient tachypnoea of the newborn is common after caesarean delivery without labour and in infants of diabetic mothers, showing perihilar streaking and fluid in the fissures with normal or increased lung volumes. It typically resolves within 48 to 72 hours with supportive care.

Question 29Neonatology and Perinatal Medicine

A newborn at 39 weeks' gestation is meconium-stained and limp at delivery. After initial stabilisation under a radiant warmer with airway positioning, the infant remains apnoeic with a heart rate of 70. What is the correct immediate action?

  1. Give surfactant through the endotracheal tube
  2. Begin chest compressions before ventilation
  3. Provide positive-pressure ventilation Correct answer.
  4. Perform immediate tracheal suction before any ventilation

Explanation

Current guidance emphasises initiating positive-pressure ventilation promptly in a non-vigorous meconium-stained infant rather than routine tracheal suctioning. Suction is reserved for suspected airway obstruction.

Question 30Neonatology and Perinatal Medicine

A preterm infant receiving total parenteral nutrition develops abdominal distension, bilious aspirates, and blood-stained stools. Abdominal radiograph shows pneumatosis intestinalis. What is the most likely diagnosis?

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

Explanation

Pneumatosis intestinalis with feeding intolerance, bilious aspirates, and bloody stools in a preterm infant is diagnostic of necrotising enterocolitis. Management includes stopping feeds, nasogastric decompression, and antibiotics.

Question 31Neonatology and Perinatal Medicine

A newborn has bilious vomiting on the first day of life. Abdominal radiograph shows a double-bubble sign with no distal gas. What is the most likely diagnosis?

  1. Pyloric stenosis
  2. Malrotation with volvulus
  3. Jejunoileal atresia
  4. Duodenal atresia Correct answer.

Explanation

The double-bubble sign with absent distal gas reflects a proximal obstruction at the duodenum, typical of duodenal atresia. It is strongly associated with Down syndrome and requires early surgical referral.

Question 32Neonatology and Perinatal Medicine

Which maternal factor most strongly increases the risk of early-onset neonatal sepsis?

  1. Maternal asthma
  2. Gestational diabetes
  3. Intrapartum fever with prolonged rupture of membranes Correct answer.
  4. Maternal hypothyroidism

Explanation

Intrapartum maternal fever and prolonged rupture of membranes are key risk factors for early-onset sepsis because they promote ascending colonisation of the amniotic fluid. Gestational diabetes and maternal endocrine or respiratory disease are not established sepsis risk factors.

Question 33Neonatology and Perinatal Medicine

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

  1. Hepatitis B vaccine and hepatitis B immunoglobulin within 12 to 24 hours Correct answer.
  2. Hepatitis B vaccine alone at 2 months of age
  3. Hepatitis B immunoglobulin alone
  4. No intervention if the mother is asymptomatic

Explanation

Infants born to hepatitis B surface antigen positive mothers should receive both vaccine and immunoglobulin within 12 to 24 hours of birth to prevent vertical transmission. This is followed by completion of the vaccine series.

Question 34Neonatology and Perinatal Medicine

A preterm infant of 28 weeks' gestation is started on enteral feeds. Which feeding strategy best reduces the risk of necrotising enterocolitis?

  1. Rapid advancement of formula feeds
  2. Early full-volume formula feeding
  3. Withholding all enteral feeds for 4 weeks
  4. Trophic feeds with human milk and slow advancement Correct answer.

Explanation

Trophic feeding with human milk and gradual advancement supports gut maturation while reducing the risk of necrotising enterocolitis. Human milk confers additional protective benefit over formula.

Question 35Neonatology and Perinatal Medicine

Which is the most common cause of prolonged unconjugated hyperbilirubinaemia in a breastfed infant who is otherwise thriving?

  1. Biliary atresia
  2. Galactosaemia
  3. Hypothyroidism
  4. Breast milk jaundice Correct answer.

Explanation

Breast milk jaundice causes prolonged unconjugated hyperbilirubinaemia in an otherwise thriving breastfed infant and is generally benign. Biliary atresia, galactosaemia, and hypothyroidism cause conjugated or mixed hyperbilirubinaemia and require investigation.

Question 36Neonatology and Perinatal Medicine

A term newborn presents with cyanosis and a single second heart sound. Hyperoxia test shows no improvement in oxygen saturation. Which congenital heart lesion is most likely?

  1. Patent ductus arteriosus
  2. Transposition of the great arteries Correct answer.
  3. Atrial septal defect
  4. Ventricular septal defect

Explanation

Cyanosis unresponsive to oxygen with a single second heart sound suggests a duct-dependent cyanotic lesion such as transposition of the great arteries. Prostaglandin E1 is used to maintain ductal patency until surgical correction.

Question 37Neonatology and Perinatal Medicine

A newborn of a mother with poorly controlled diabetes is macrosomic and develops hypoglycaemia at 1 hour of life. What is the underlying mechanism?

  1. Transient hyperinsulinaemia Correct answer.
  2. Glycogen storage disease
  3. Glucagon excess
  4. Cortisol deficiency

Explanation

Maternal hyperglycaemia drives fetal hyperinsulinaemia, which persists after delivery and causes transient neonatal hypoglycaemia. Early feeding and glucose monitoring are essential in these infants.

Question 38Neonatology and Perinatal Medicine

A preterm infant on nasal continuous positive airway pressure develops abdominal distension and bloody stools. Which complication should be suspected?

  1. Retinopathy of prematurity
  2. Pneumothorax
  3. Bronchopulmonary dysplasia
  4. Necrotising enterocolitis Correct answer.

Explanation

Abdominal distension with bloody stools in a preterm infant on respiratory support should prompt evaluation for necrotising enterocolitis. Prompt cessation of feeds and abdominal imaging are indicated.

Question 39Neonatology and Perinatal Medicine

Which of the following best describes the mechanism of physiological jaundice in the newborn?

  1. Immature hepatic conjugation with increased bilirubin load Correct answer.
  2. Increased renal excretion of unconjugated bilirubin
  3. Obstruction of the biliary tree
  4. Excessive hepatic conjugation of bilirubin

Explanation

Physiological jaundice results from a high bilirubin load from red cell turnover combined with immature hepatic glucuronidation. This combination produces a transient rise in unconjugated bilirubin after the first day.

Question 40Neonatology and Perinatal Medicine

A 32-week preterm infant is being managed on mechanical ventilation. Which intervention has been shown to reduce the incidence of bronchopulmonary dysplasia?

  1. Antenatal corticosteroids and early surfactant with lung-protective ventilation Correct answer.
  2. High tidal volume ventilation from birth
  3. Delayed surfactant administration after 72 hours
  4. Routine high-dose oxygen therapy

Explanation

Antenatal corticosteroids, early surfactant, and lung-protective ventilation strategies reduce the incidence and severity of bronchopulmonary dysplasia. High tidal volumes and hyperoxia worsen lung injury.

Question 41Neonatology and Perinatal Medicine

A preterm infant of 26 weeks' gestation is being screened for retinopathy of prematurity. Which factor is most strongly associated with its development?

  1. Term gestation with normal birth weight
  2. Early full enteral feeding
  3. Maternal hypertension alone
  4. Prolonged supplemental oxygen and extreme prematurity Correct answer.

Explanation

Retinopathy of prematurity is driven by extreme prematurity and exposure to supplemental oxygen, which disrupts retinal vascular development. Screening is recommended for infants below 30 weeks or 1500 g.

Question 42Neonatology and Perinatal Medicine

A newborn presents with a bulging fontanelle, seizures, and lethargy on day 3 of life. Cerebrospinal fluid shows pleocytosis with low glucose. Which organism is most likely in a late-onset presentation?

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

Explanation

Group B Streptococcus remains a leading cause of neonatal meningitis, including late-onset disease, and typically produces seizures and cerebrospinal fluid pleocytosis with low glucose. Empiric therapy includes ampicillin and a third-generation cephalosporin.

Question 43Neonatology and Perinatal Medicine

A term infant born after an uncomplicated pregnancy develops severe jaundice at 18 hours of life with a rapidly rising bilirubin and anaemia. Direct antiglobulin test is positive. What is the most likely cause?

  1. Physiological jaundice
  2. Gilbert syndrome
  3. Rh isoimmunisation Correct answer.
  4. Breast milk jaundice

Explanation

Early severe jaundice with a positive direct antiglobulin test and anaemia indicates immune-mediated haemolysis, classically Rh isoimmunisation. Prompt phototherapy and, if needed, exchange transfusion are required.

Question 44Neonatology and Perinatal Medicine

A newborn with a prenatal diagnosis of congenital diaphragmatic hernia develops respiratory distress shortly after birth. Which immediate management step is most appropriate?

  1. Immediate surgical repair before stabilisation
  2. Bag-mask ventilation with high pressures
  3. Feeding to improve nutrition
  4. Endotracheal intubation with gentle ventilation and nasogastric decompression Correct answer.

Explanation

Initial management of congenital diaphragmatic hernia prioritises stabilisation with endotracheal intubation, gentle ventilation, and nasogastric decompression to avoid bowel distension. Surgery is delayed until physiological stabilisation.

Question 45Pediatric Infectious Diseases and Immunization

A 4-year-old child presents with fever, painful vesicular lesions on the gingiva and tongue, and drooling. The mother reports similar lesions appeared on the child's fingers two days later. Which is the most likely causative organism?

  1. Herpes simplex virus type 1 Correct answer.
  2. Epstein-Barr virus
  3. Coxsackievirus A16
  4. Varicella-zoster virus

Explanation

Primary herpetic gingivostomatitis is caused by herpes simplex virus type 1 and classically presents with fever, painful oral vesicles and ulcers, and drooling in young children. Auto-inoculation to the fingers produces herpetic whitlow, which fits the described sequence.

Question 46Pediatric Infectious Diseases and Immunization

According to the Egyptian national immunization schedule, at what age is the first dose of the measles-containing vaccine (MMR) routinely administered?

  1. At 9 months Correct answer.
  2. At 4 years
  3. At birth
  4. At 18 months

Explanation

Egypt's routine schedule gives the first measles-containing dose at 9 months of age, followed by a second dose later in childhood. Early administration at 9 months is used because measles morbidity and mortality are high in infancy in this setting.

Question 47Pediatric Infectious Diseases and Immunization

A 6-year-old child has a positive tuberculin skin test with an induration of 12 mm, a normal chest radiograph, and no symptoms. He has no known contact with a tuberculosis case and has not been BCG vaccinated. What is the most appropriate management?

  1. No treatment, repeat the test in one year
  2. Reassurance only, because the chest radiograph is normal
  3. Isoniazid preventive therapy Correct answer.
  4. Four-drug antituberculous therapy

Explanation

A tuberculin induration of 10 mm or more in a child without BCG vaccination indicates latent tuberculosis infection when the chest radiograph is normal and there are no symptoms. Isoniazid preventive therapy is the standard treatment to prevent progression to active disease.

Question 48Pediatric Infectious Diseases and Immunization

Which clinical feature best distinguishes dengue from other acute febrile illnesses in a child during an outbreak?

  1. Generalized lymphadenopathy with hepatosplenomegaly
  2. Copious purulent nasal discharge
  3. Parotid swelling with a painful opening of the mouth
  4. Retro-orbital pain with a positive tourniquet test Correct answer.

Explanation

Dengue classically causes retro-orbital pain, myalgia, and a positive tourniquet test reflecting increased capillary fragility. These features help distinguish it from respiratory and other viral illnesses during an outbreak.

Question 49Pediatric Infectious Diseases and Immunization

A 3-year-old child develops sudden onset of high fever, drooling, and difficulty swallowing, and sits in a tripod position with stridor. Which organism is the most likely cause?

  1. Haemophilus influenzae type b Correct answer.
  2. Staphylococcus aureus
  3. Streptococcus pneumoniae
  4. Moraxella catarrhalis

Explanation

The combination of high fever, drooling, dysphagia, tripod positioning, and stridor suggests acute epiglottitis. Haemophilus influenzae type b is the classic cause, and this presentation remains important in populations with incomplete immunization.

Question 50Pediatric Infectious Diseases and Immunization

A neonate born to a mother with chronic hepatitis B infection receives the hepatitis B vaccine and immunoglobulin within 12 hours of birth. What is the main purpose of the immunoglobulin?

  1. To prevent transmission of hepatitis C virus
  2. To replace the infant's deficient immunoglobulin production
  3. To provide passive immunity until the vaccine induces active immunity Correct answer.
  4. To sterilize the maternal blood before delivery

Explanation

Hepatitis B immunoglobulin provides immediate passive antibody protection during the window before the infant mounts an active immune response to the vaccine. Combined with vaccination at birth, it substantially reduces perinatal transmission.