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UKOM Sp.A practice questions

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Question 1Neonatology and Perinatology

A term newborn is noted at 2 hours of life to have a respiratory rate of 72 breaths/min, nasal flaring and intercostal recessions. Which single finding best defines this as respiratory distress rather than transient tachypnoea of the newborn alone?

  1. Resolution of symptoms within 24 hours without intervention
  2. Respiratory rate above 60 breaths/min persisting beyond 6 hours
  3. Presence of grunting and recession indicating increased work of breathing Correct answer.
  4. Onset of tachypnoea within the first 2 hours of life

Explanation

Respiratory distress in the newborn is defined by signs of increased work of breathing-grunting, nasal flaring, recessions and tachypnoea-rather than by the isolated respiratory rate. Transient tachypnoea of the newborn characteristically resolves within 24–72 hours, so timing alone does not distinguish distress from a benign course.

Question 2Neonatology and Perinatology

A baby is born at 39 weeks after an uncomplicated pregnancy. Which parameter is used to assign the Apgar score at 1 and 5 minutes?

  1. Heart rate, respiratory effort, blood pressure, tone and colour
  2. Heart rate, respiratory effort, muscle tone, reflex irritability and colour Correct answer.
  3. Heart rate, blood pressure, oxygen saturation, tone and temperature
  4. Respiratory rate, glucose, tone, reflexes and capillary refill

Explanation

The Apgar score comprises five components: heart rate, respiratory effort, muscle tone, reflex irritability and colour, each scored 0–2. Blood pressure, temperature and oxygen saturation are not part of the score.

Question 3Neonatology and Perinatology

A 3-day-old term infant is jaundiced with a total serum bilirubin of 320 µmol/L and is clinically well, feeding, with a normal examination. Which investigation is most important to identify a treatable cause before starting phototherapy?

  1. Cranial ultrasound
  2. Urine culture
  3. Serum electrolytes and renal function
  4. Blood group and direct antiglobulin (Coombs) test with maternal and infant blood groups Correct answer.

Explanation

In a well, jaundiced newborn, haemolytic disease from ABO or Rh incompatibility is the most important treatable cause to exclude, so blood groups and a direct antiglobulin test are indicated alongside bilirubin measurement. Identifying haemolysis influences the threshold for phototherapy and the need for exchange transfusion.

Question 4Neonatology and Perinatology

A preterm infant of 28 weeks' gestation is being managed on the neonatal unit. Which intervention has the strongest evidence for reducing the risk of necrotising enterocolitis?

  1. Routine prophylactic antibiotics for the first week
  2. Feeding with own mother's expressed breast milk rather than formula Correct answer.
  3. Delaying all enteral feeding until 2 weeks of age
  4. Early introduction of full-volume enteral feeds within 24 hours

Explanation

Human milk feeding, particularly own mother's milk, is associated with a substantially lower incidence of necrotising enterocolitis compared with formula. Prolonged withholding of feeds and prophylactic antibiotics are not supported strategies and carry their own harms.

Question 5Neonatology and Perinatology

A newborn at 6 hours of life has a capillary glucose of 1.8 mmol/L and is asymptomatic. What is the most appropriate immediate management?

  1. Start an intravenous dextrose bolus of 10% glucose 2 mL/kg
  2. Admit to the neonatal unit for a full septic screen before treating
  3. Feed the baby and recheck the glucose within 30 minutes Correct answer.
  4. Reassure the parents and repeat the glucose in 24 hours

Explanation

For an asymptomatic hypoglycaemic newborn, the first step is to feed and recheck glucose within 30 minutes; intravenous therapy is reserved for persistent or symptomatic hypoglycaemia. A glucose of 1.8 mmol/L is below the usual treatment threshold and requires prompt correction.

Question 6Neonatology and Perinatology

Which clinical sign is most characteristic of respiratory distress syndrome in a preterm infant of 30 weeks' gestation?

  1. Meconium-stained liquor with a barrel-shaped chest
  2. Grunting with tachypnoea and increasing oxygen requirement in the first hours Correct answer.
  3. Inspiratory stridor present from birth
  4. Bilateral crackles with frothy oral secretions

Explanation

Respiratory distress syndrome results from surfactant deficiency and presents with grunting, tachypnoea, recessions and rising oxygen needs shortly after birth in preterm infants. Meconium aspiration, tracheomalacia and oesophageal atresia have different signature findings.

Question 7Neonatology and Perinatology

A term infant is noted to have a bluish discolouration of the hands and feet with central pink lips and trunk, and normal oxygen saturation on the right hand. How should this be interpreted?

  1. Polycythaemia requiring partial exchange transfusion
  2. Central cyanosis requiring urgent echocardiography
  3. Methemoglobinaemia requiring methylene blue
  4. Peripheral acrocyanosis, a normal finding in the first days of life Correct answer.

Explanation

Acrocyanosis confined to the extremities with a pink central trunk and normal preductal saturation is a benign, normal finding in the newborn. Central cyanosis would involve the lips and trunk and require urgent evaluation.

Question 8Neonatology and Perinatology

In a newborn resuscitation, what is the recommended initial inflation pressure and ratio of compressions to ventilations for a term infant requiring CPR?

  1. Continuous compressions without synchronised ventilation
  2. 30:2 ratio with 100 compressions per minute
  3. 15:2 ratio with 100 compressions per minute
  4. 3:1 compression-to-ventilation ratio with 30 compressions per minute Correct answer.

Explanation

Newborn resuscitation guidance recommends a 3:1 ratio of compressions to inflations, giving about 90 compressions and 30 breaths per minute. This differs from adult and paediatric CPR ratios because of the respiratory cause of most neonatal arrests.

Question 9Neonatology and Perinatology

A preterm infant at 26 weeks' gestation is 4 days old and develops abdominal distension, bilious aspirates and blood-stained stools. Which initial management step is most appropriate?

  1. Increase feed volume to promote gut maturation
  2. Start oral probiotics and observe for 24 hours
  3. Give an enema and continue feeds
  4. Stop enteral feeds, obtain abdominal radiograph and start broad-spectrum antibiotics Correct answer.

Explanation

The presentation suggests necrotising enterocolitis; management includes stopping enteral feeds, decompressing the gut, obtaining imaging and starting broad-spectrum antibiotics. Delaying treatment increases the risk of perforation and mortality.

Question 10Neonatology and Perinatology

Which of the following is the most reliable sign of effective ventilation during newborn resuscitation?

  1. Improvement in colour alone
  2. Presence of a pulse oximetry waveform
  3. Audible cry after the first inflation
  4. Rising heart rate with visible chest movement Correct answer.

Explanation

An increasing heart rate is the most sensitive indicator that ventilation is effective, supported by visible chest rise. Colour changes are unreliable and slow, and an audible cry may not occur immediately.

Question 11Neonatology and Perinatology

A term infant is born to a mother with prolonged rupture of membranes at 20 hours. The baby is well at birth. What is the most appropriate management?

  1. Perform a lumbar puncture on all babies before any treatment
  2. Start immediate broad-spectrum antibiotics in all such infants regardless of signs
  3. Discharge home at 6 hours without follow-up
  4. Observe closely for signs of sepsis and consider investigations per local protocol Correct answer.

Explanation

Prolonged rupture of membranes increases the risk of early-onset sepsis, so the infant should be observed closely with vital sign monitoring and investigated according to local guidance. Routine antibiotics for all well infants and universal lumbar puncture are not supported.

Question 12Neonatology and Perinatology

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

  1. Deficiency of glucose-6-phosphate dehydrogenase in all newborns
  2. Biliary atresia causing conjugated hyperbilirubinaemia
  3. Excess hepatic excretion of unconjugated bilirubin
  4. Increased red cell turnover combined with immature hepatic conjugation Correct answer.

Explanation

Physiological jaundice results from the combination of a high red cell mass with short red cell lifespan and immature hepatic glucuronidation, leading to unconjugated hyperbilirubinaemia. Biliary atresia and G6PD deficiency are pathological causes.

Question 13Neonatology and Perinatology

A newborn at 24 hours of life develops jaundice. Which feature should prompt urgent investigation rather than reassurance?

  1. Jaundice that resolves by day 10 in a term infant
  2. Jaundice peaking on day 4 in a breastfed term infant
  3. Mild jaundice in a well infant at 5 days
  4. Jaundice appearing within the first 24 hours of life Correct answer.

Explanation

Jaundice within the first 24 hours is always pathological and may indicate haemolysis or infection, so urgent bilirubin measurement and investigation are required. Later onset with a typical course in a well infant is usually physiological.

Question 14Neonatology and Perinatology

A preterm infant at 32 weeks' gestation has a haemoglobin of 85 g/L at 4 weeks of age with a normal reticulocyte count and no signs of haemolysis. What is the most likely diagnosis?

  1. Acute blood loss
  2. Anaemia of prematurity Correct answer.
  3. Haemolytic disease of the newborn
  4. Iron deficiency anaemia

Explanation

Anaemia of prematurity results from inadequate erythropoietin production and rapid growth, typically presenting at 4–8 weeks with low haemoglobin and inappropriately low reticulocytes. Haemolysis and acute blood loss would show different reticulocyte and clinical patterns.

Question 15Neonatology and Perinatology

Which finding on cranial ultrasound is most characteristic of severe intraventricular haemorrhage in a preterm infant?

  1. Echogenic material within the lateral ventricles with ventricular dilatation Correct answer.
  2. Generalised cerebral atrophy
  3. Periventricular echodensity consistent with cystic periventricular leukomalacia
  4. Normal appearance of the germinal matrix

Explanation

Intraventricular haemorrhage originates in the germinal matrix and appears as echogenic material in the ventricles, often with dilatation in severe grades. Periventricular leukomalacia is a separate white matter injury pattern.

Question 16Neonatology and Perinatology

Which of the following is the most appropriate first-line treatment for a preterm infant with a haemodynamically significant patent ductus arteriosus at 5 days of age?

  1. A cyclo-oxygenase inhibitor such as ibuprofen or indomethacin, if not contraindicated Correct answer.
  2. Fluid overload to increase pulmonary blood flow
  3. Diuretics alone as definitive therapy
  4. Immediate surgical ligation

Explanation

Cyclo-oxygenase inhibitors such as ibuprofen or indomethacin are first-line pharmacological treatment for a significant PDA in preterm infants when renal function and platelets allow. Surgery is reserved for failure or contraindications to medical treatment.

Question 17Neonatology and Perinatology

A term infant at 12 hours of life has a pre-ductal oxygen saturation of 88% on the right hand and 84% on the right foot. What does this suggest?

  1. Peripheral acrocyanosis of no clinical significance
  2. A possible duct-dependent congenital heart lesion requiring urgent assessment Correct answer.
  3. Normal transitional circulation with no further action needed
  4. Respiratory distress syndrome requiring surfactant

Explanation

A pre-ductal saturation below 90% with a difference of more than 3% between right hand and foot suggests a duct-dependent cardiac lesion or persistent pulmonary hypertension. Urgent echocardiography and specialist assessment are required.

Question 18Neonatology and Perinatology

A term infant has a birth weight of 4.6 kg and is born to a mother with gestational diabetes. Which complication should be anticipated in the first hours of life?

  1. Hyperglycaemia from pancreatic atrophy
  2. Polycythaemia due to maternal anaemia
  3. Hypoglycaemia from fetal hyperinsulinaemia Correct answer.
  4. Hypocalcaemia due to maternal hyperparathyroidism

Explanation

Infants of diabetic mothers develop fetal hyperinsulinaemia in response to maternal glucose, causing macrosomia and neonatal hypoglycaemia after delivery. Hyperglycaemia, maternal hyperparathyroidism and maternal anaemia are not the expected mechanisms.

Question 19Neonatology and Perinatology

Which of the following is the most appropriate management for a newborn with a suspected fractured clavicle and an asymmetric Moro reflex but no respiratory compromise?

  1. Immediate surgical fixation of the clavicle
  2. Conservative management with careful handling and analgesia as needed Correct answer.
  3. Immobilisation in a spica cast
  4. Routine antibiotics to prevent osteomyelitis

Explanation

Clavicular fractures in the newborn are managed conservatively with gentle handling and analgesia; they heal rapidly with callus formation. Surgery, casting and antibiotics are not indicated for uncomplicated fractures.

Question 20Neonatology and Perinatology

A preterm infant at 30 weeks' gestation is being ventilated and develops a sudden desaturation with poor chest movement and increased peak pressures. What is the most likely cause?

  1. Endotracheal tube obstruction or displacement Correct answer.
  2. Physiological anaemia
  3. Hyperkalaemia
  4. Patent ductus arteriosus

Explanation

Sudden deterioration with poor chest movement and rising airway pressures in a ventilated infant suggests tube obstruction or displacement, which requires immediate assessment and suction or repositioning. Metabolic and haematological causes do not produce this abrupt respiratory pattern.

Question 21Neonatology and Perinatology

Which of the following statements about surfactant administration in preterm infants is correct?

  1. Surfactant should be given only to term infants with meconium aspiration
  2. Surfactant is effective only if given after 72 hours of life
  3. Surfactant has no effect on the need for mechanical ventilation
  4. Early rescue surfactant reduces pneumothorax and mortality in respiratory distress syndrome Correct answer.

Explanation

Early rescue surfactant in preterm infants with respiratory distress syndrome reduces the severity of disease, pneumothorax and mortality. Timing after 72 hours or restriction to term infants is incorrect.

Question 22Neonatology and Perinatology

A term infant born by emergency caesarean section has a heart rate of 60/min at 30 seconds after birth, apnoea and poor tone despite effective ventilation. What is the next step?

  1. Give intravenous adrenaline immediately
  2. Suction the airway vigorously
  3. Start chest compressions coordinated with ventilation at a 3:1 ratio Correct answer.
  4. Continue ventilation alone for another minute

Explanation

When the heart rate remains below 60/min despite effective ventilation, chest compressions should begin with a 3:1 compression-to-ventilation ratio. Adrenaline is considered if the heart rate remains low despite adequate compressions.

Question 23Neonatology and Perinatology

Which of the following is the most appropriate approach to the prevention of group B streptococcal early-onset disease in a newborn?

  1. Routine neonatal lumbar puncture at 24 hours
  2. Universal neonatal antibiotic treatment at birth
  3. Maternal vaccination with the polysaccharide vaccine as standard care
  4. Intrapartum antibiotic prophylaxis for colonised mothers with risk factors Correct answer.

Explanation

The main preventive strategy is intrapartum antibiotic prophylaxis for women colonised with group B Streptococcus or with risk factors such as prolonged rupture of membranes or previous affected infant. Universal neonatal antibiotics and routine lumbar puncture are not recommended.

Question 24Neonatology and Perinatology

A preterm infant at 28 weeks' gestation is receiving total parenteral nutrition. Which monitoring is most important to detect a serious complication of this therapy?

  1. Daily electroencephalography
  2. Regular blood glucose and triglyceride monitoring Correct answer.
  3. Weekly cranial ultrasound only
  4. Monthly thyroid function testing

Explanation

Total parenteral nutrition can cause hyperglycaemia and hypertriglyceridaemia, so regular monitoring of glucose and triglycerides is essential. Cranial ultrasound, EEG and thyroid testing do not detect these metabolic complications.

Question 25Growth, Development, and Behavioral Pediatrics

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

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

Explanation

Independent sitting without support is a gross motor milestone usually reached between 6 and 8 months of age. Earlier head control and rolling precede it, while pulling to stand and cruising come later. Persistence of inability to sit by around 9 months warrants developmental assessment.

Question 26Growth, Development, and Behavioral Pediatrics

A 9-month-old is brought for review. Which finding is the clearest red flag for a social-communication developmental concern?

  1. Not yet using single words with meaning
  2. Still mouthing objects during play
  3. No response to name and absent joint attention Correct answer.
  4. Unable to walk independently

Explanation

Failure to respond to name and absent joint attention (shared gaze, pointing, showing) by 9 to 12 months are early social-communication red flags. Single words are not expected until around 12 months, and walking is a gross motor milestone around 12 to 15 months. Mouthing objects is normal exploratory behavior in infancy.

Question 27Growth, Development, and Behavioral Pediatrics

Which statement best describes the typical sequence of early language development in the first two years?

  1. Canonical babbling, then cooing, then two-word combinations, then single words
  2. Cooing, then canonical babbling, then single words, then two-word combinations Correct answer.
  3. Single words, then cooing, then babbling, then two-word phrases
  4. Two-word combinations, then single words, then babbling, then cooing

Explanation

Language milestones follow a predictable order: cooing in the first months, canonical babbling around 6 to 9 months, first meaningful words around 12 months, and two-word combinations around 18 to 24 months. Reversal of this sequence suggests an atypical pattern warranting assessment.

Question 28Growth, Development, and Behavioral Pediatrics

A 4-year-old is described as using 3- to 4-word sentences, being understood by strangers most of the time, and following two-step instructions. How should this be interpreted?

  1. Age-appropriate language development Correct answer.
  2. Receptive language disorder
  3. Speech sound disorder with poor intelligibility
  4. Expressive language delay requiring urgent referral

Explanation

By 4 years children typically speak in sentences of four or more words, are largely intelligible to unfamiliar listeners, and can follow multi-step directions. The described profile fits expected development. No referral for delay is indicated on these features alone.

Question 29Growth, Development, and Behavioral Pediatrics

Which primitive reflex typically persists longest into the first year and is used as a marker of neurological maturation?

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

Explanation

The Moro reflex appears at birth and normally integrates by around 3 to 6 months; persistence beyond this suggests neurological abnormality. Palmar grasp and asymmetric tonic neck reflexes integrate earlier, generally by 4 to 6 months. The positive support reflex also fades in the first half of the year.

Question 30Growth, Development, and Behavioral Pediatrics

A toddler is noted to have a persistent hand preference before 18 months of age. What does this most appropriately prompt?

  1. Reassurance, since early handedness is a normal variant
  2. Referral for vision testing only
  3. Assessment for a contralateral motor deficit such as hemiparesis Correct answer.
  4. No action unless the child is left-handed

Explanation

Consistent hand preference before about 18 months is unusual and may signal weakness of the opposite arm, such as in hemiparesis or cerebral palsy. Formal motor and neurological assessment is warranted. True handedness usually emerges between 2 and 3 years.

Question 31Growth, Development, and Behavioral Pediatrics

In Piaget's theory, which behavior is characteristic of the sensorimotor stage?

  1. Abstract hypothetical reasoning
  2. Conservation of number and volume
  3. Object permanence developing through sensory and motor exploration Correct answer.
  4. Understanding of reversibility in mathematics

Explanation

The sensorimotor stage (birth to about 2 years) is defined by learning through senses and actions, culminating in object permanence. Conservation and reversibility belong to the concrete operational stage, while abstract reasoning characterizes formal operations.

Question 32Growth, Development, and Behavioral Pediatrics

A 5-year-old insists that a tall narrow glass holds more juice than a short wide glass holding the same volume. This illustrates which cognitive phenomenon?

  1. Egocentrism
  2. Lack of conservation Correct answer.
  3. Animism
  4. Centration on a single dimension

Explanation

The child fails to recognize that quantity is conserved despite a change in appearance, which is the classic lack of conservation of the preoperational stage. Centration contributes to this, but the phenomenon being demonstrated is non-conservation. Conservation of liquid typically develops around 6 to 7 years.

Question 33Growth, Development, and Behavioral Pediatrics

According to Erikson's psychosocial theory, the central developmental task of toddlerhood is which of the following?

  1. Autonomy versus shame and doubt Correct answer.
  2. Initiative versus guilt
  3. Trust versus mistrust
  4. Industry versus inferiority

Explanation

Erikson placed autonomy versus shame and doubt in the toddler years, when children assert independence in self-care and choice. Trust versus mistrust belongs to infancy, initiative versus guilt to preschool years, and industry versus inferiority to school age.

Question 34Growth, Development, and Behavioral Pediatrics

A 3-year-old is asked to share toys with a peer and refuses, grabbing everything. How should this be interpreted developmentally?

  1. Evidence of emerging conduct disorder
  2. Indication of intellectual disability
  3. Sign of insecure attachment
  4. Age-typical egocentric behavior with sharing skills not yet developed Correct answer.

Explanation

Preschoolers are typically egocentric and have not yet developed reciprocal sharing, which emerges gradually with guidance. This behavior is expected at 3 years and is not diagnostic of psychopathology. Coaching and modeling support the development of prosocial behavior.

Question 35Growth, Development, and Behavioral Pediatrics

Which of the following best describes the concept of 'serve and return' in early child development?

  1. A physiotherapy protocol for motor delay
  2. A feeding schedule for preterm infants
  3. A structured classroom reading program
  4. Reciprocal back-and-forth interactions between caregiver and child that shape brain architecture Correct answer.

Explanation

Serve and return describes the responsive, contingent exchange in which a child signals and a caregiver responds, building neural connections. It is a core concept in early relational health. It is not a feeding, therapy, or curricular protocol.

Question 36Growth, Development, and Behavioral Pediatrics

A 15-month-old has fewer than five words and does not point to show interest. Which next step is most appropriate?

  1. Reassure and review at 3 years
  2. Prescribe a speech-generating device
  3. Advise reducing screen time and reassess in one year
  4. Refer for audiology and developmental evaluation now Correct answer.

Explanation

Limited vocabulary combined with absent showing/pointing at 15 months warrants prompt hearing assessment and developmental evaluation. Early identification enables early intervention. Deferring review for years risks missing a critical window.

Question 37Growth, Development, and Behavioral Pediatrics

Which hearing screening approach is most appropriate for a newborn as part of universal newborn hearing screening?

  1. Pure-tone audiometry with headphones
  2. Otoacoustic emissions or automated auditory brainstem response Correct answer.
  3. Behavioral observation audiometry
  4. Speech discrimination testing

Explanation

Universal newborn screening uses otoacoustic emissions or automated auditory brainstem response, which are objective and feasible in neonates. Behavioral and pure-tone methods require a child's active cooperation and are used later. Early detection supports language development.

Question 38Growth, Development, and Behavioral Pediatrics

A child raised in a deprived institution shows delays in language and social skills that improve substantially after placement in a responsive foster home. This best illustrates which concept?

  1. Developmental plasticity and the importance of sensitive periods Correct answer.
  2. Maturational invariance
  3. Genetic determinism
  4. Fixed temperament

Explanation

Improvement after enriching the caregiving environment demonstrates developmental plasticity, the capacity for recovery when experience changes. It also highlights sensitive periods during which environmental input strongly shapes outcomes. The other options imply fixed, environment-independent trajectories.

Question 39Growth, Development, and Behavioral Pediatrics

Which statement about brain development in the early years is most accurate?

  1. Myelination is complete at birth
  2. Experience-dependent synaptogenesis and pruning proceed together, with pruning refining circuits Correct answer.
  3. Synaptic pruning occurs before synapse formation
  4. Brain volume is fully mature by age 2

Explanation

Early brain development involves both exuberant synapse formation and activity-dependent pruning that refines neural circuits. Pruning follows rather than precedes synapse formation. Myelination continues into adulthood, and brain maturation extends well beyond age 2.

Question 40Growth, Development, and Behavioral Pediatrics

A 7-year-old with attention difficulties is described as having a 'good fit' with a structured classroom. This reflects which framework?

  1. Psychoanalytic theory
  2. Goodness of fit between temperament and environment Correct answer.
  3. Moral development stages
  4. Classical conditioning

Explanation

Goodness of fit describes how a child's temperament interacts with environmental demands; a structured setting may suit a child with high activity or low adaptability. It is a transactional model rather than a psychoanalytic or conditioning one. Matching environment to temperament supports adjustment.

Question 41Growth, Development, and Behavioral Pediatrics

Which of the following is the most reliable indicator of school readiness in a 5-year-old?

  1. A combination of social-emotional, language, cognitive, and self-regulation skills Correct answer.
  2. Age alone
  3. Ability to read simple sentences
  4. Handwriting neatness

Explanation

School readiness is multidimensional, encompassing social-emotional competence, language, cognition, and self-regulation such as attention and impulse control. Reading and neat handwriting are outcomes of schooling, not prerequisites. Chronological age alone is insufficient.

Question 42Growth, Development, and Behavioral Pediatrics

A parent reports that their 2-year-old has frequent tantrums, including holding breath until turning blue. What is the most appropriate response?

  1. Diagnose a disruptive mood disorder
  2. Start antipsychotic medication
  3. Refer urgently for epilepsy evaluation
  4. This is typical toddler behavior; counsel on consistent limits and safety Correct answer.

Explanation

Temper tantrums, including breath-holding spells, are common in toddlers and usually reflect normal emotional regulation immaturity. Management centers on consistent, calm limit-setting and ensuring safety during spells. Referral is reserved for atypical features such as prolonged unresponsiveness or developmental regression.

Question 43Growth, Development, and Behavioral Pediatrics

Which pattern of attachment is characterized by a child who shows little distress on separation and avoids or ignores the caregiver on reunion?

  1. Secure attachment
  2. Disorganized attachment
  3. Insecure-avoidant attachment Correct answer.
  4. Insecure-resistant attachment

Explanation

Insecure-avoidant attachment is marked by minimal separation distress and avoidance of the caregiver on reunion. Secure children seek comfort and are easily soothed, resistant children show ambivalence, and disorganized children show contradictory behaviors.

Question 44Growth, Development, and Behavioral Pediatrics

A 10-month-old born at 28 weeks' gestation is being assessed for motor delay. Which principle should guide interpretation of milestones?

  1. Ignore gestational age entirely
  2. Adjust only until 6 months corrected age
  3. Use chronological age without adjustment
  4. Adjust for prematurity until approximately 2 years of age Correct answer.

Explanation

For preterm infants, developmental milestones are best interpreted using corrected age, typically until about 2 years. This avoids over-diagnosing delay in a child whose development is appropriate for gestational age. After 2 years, chronological age is generally used.

Question 45Pediatric Nutrition and Metabolic Disorders

A 3-day-old term neonate has a blood glucose of 1.9 mmol/L (34 mg/dL) and is symptomatic with jitteriness. Which is the most appropriate immediate management?

  1. Intravenous 10% dextrose bolus of 2 mL/kg followed by continuous infusion Correct answer.
  2. Oral supplementary feeding with expressed breast milk only
  3. Subcutaneous glucagon injection followed by observation
  4. Intravenous 10% dextrose bolus of 10 mL/kg followed by continuous infusion

Explanation

Symptomatic neonatal hypoglycaemia is treated with an intravenous dextrose bolus of 2 mL/kg of 10% dextrose (200 mg/kg) followed by a continuous infusion to maintain normoglycaemia. Larger boluses risk rebound hypoglycaemia and hyperosmolality. Oral feeding alone is inadequate in a symptomatic baby.

Question 46Pediatric Nutrition and Metabolic Disorders

Which biochemical finding is characteristic of classical phenylketonuria before treatment is started?

  1. Low blood phenylalanine with low tyrosine
  2. Elevated blood phenylalanine with low tyrosine Correct answer.
  3. Low blood phenylalanine with elevated tyrosine
  4. Elevated blood phenylalanine with normal tyrosine

Explanation

Phenylalanine hydroxylase deficiency blocks conversion of phenylalanine to tyrosine, so phenylalanine accumulates while tyrosine becomes low or low-normal. This combination on newborn screening prompts confirmatory testing. Tyrosine is an essential amino acid in PKU and must be supplied in the diet.

Question 47Pediatric Nutrition and Metabolic Disorders

In a child with newly diagnosed coeliac disease, which serological test is the recommended first-line screening test?

  1. Anti-saccharomyces cerevisiae antibodies
  2. Antigliadin IgG antibodies
  3. Faecal calprotectin
  4. Anti-tissue transglutaminase IgA with total IgA Correct answer.

Explanation

IgA anti-tissue transglutaminase is the recommended first-line serological test, and total IgA must be measured because IgA deficiency can cause false-negative results. Antigliadin IgG is no longer recommended for screening. Anti-saccharomyces antibodies and faecal calprotectin are used in inflammatory bowel disease assessment.

Question 48Pediatric Nutrition and Metabolic Disorders

A breastfed 6-week-old presents with poor feeding, lethargy, and hepatomegaly. Galactosaemia is suspected. Which dietary change should be made immediately?

  1. Continue breastfeeding and add medium-chain triglycerides
  2. Stop breast milk and start a galactose-free formula such as a soya or elemental formula Correct answer.
  3. Stop breast milk and start a soya-based formula
  4. Switch to a lactose-free cow's milk formula

Explanation

Classical galactosaemia requires immediate exclusion of galactose and lactose, so breast milk and standard formulas must be stopped and replaced with a galactose-free formula. Delay increases the risk of sepsis, liver failure, and cataract formation. Lactose-free formula still contains galactose from cow's milk protein and is not adequate.

Question 49Pediatric Nutrition and Metabolic Disorders

Which growth chart is recommended by WHO for monitoring the growth of children from birth to 5 years?

  1. UK-WHO charts only for preterm infants
  2. WHO Child Growth Standards Correct answer.
  3. CDC 2000 growth charts
  4. Fenton preterm growth chart for all children

Explanation

The WHO Child Growth Standards describe how children should grow under optimal conditions and are recommended from birth to 5 years. CDC 2000 charts are reference-based rather than standard-based. Fenton charts apply to preterm infants, not all children.

Question 50Pediatric Nutrition and Metabolic Disorders

A 10-year-old with newly diagnosed type 1 diabetes is being started on a basal-bolus regimen. Which statement about carbohydrate counting is correct?

  1. Fat and protein content need not be considered at all
  2. Carbohydrate counting removes the need for basal insulin
  3. The insulin-to-carbohydrate ratio is fixed and never changes
  4. Carbohydrate counting allows mealtime insulin to be matched to intake Correct answer.

Explanation

Carbohydrate counting matches rapid-acting mealtime insulin to the grams of carbohydrate eaten, using an individual insulin-to-carbohydrate ratio. The ratio varies with age, time of day, and activity, and must be reviewed regularly. Basal insulin remains necessary, and fat and protein can affect postprandial glucose.