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Iraqi Board Pediatrics practice questions

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Question 1General Pediatrics and Growth & Development

A healthy term newborn is examined at 24 hours of life. Which finding is most consistent with a normal newborn examination rather than a sign of disease?

  1. A single palmar crease with hypotonia and a weak cry
  2. Mild jaundice confined to the face appearing on day 2 of life Correct answer.
  3. Absent red reflex in both eyes
  4. Greenish vomiting after the first feed

Explanation

Physiological jaundice in term infants typically appears after 24 hours, peaks around days 3 to 5, and is initially facial. Jaundice present within the first 24 hours is always pathological and needs urgent bilirubin measurement. The other listed findings are red flags requiring investigation.

Question 2General Pediatrics and Growth & Development

A 6-month-old infant is brought for routine review. Which developmental milestone is most appropriate to expect at this age?

  1. Sitting without support
  2. Rolling from front to back Correct answer.
  3. Transferring objects hand to hand
  4. Walking with one hand held

Explanation

Rolling over, usually front to back first, is achieved around 4 to 6 months and is a reliable 6-month milestone. Sitting without support is expected nearer 8 months, object transfer around 7 to 8 months, and walking with one hand held around 12 months.

Question 3General Pediatrics and Growth & Development

A 3-year-old child is brought to the clinic. At what age does a normally developing child typically achieve daytime bladder and bowel control?

  1. Between 18 and 30 months Correct answer.
  2. By 9 months
  3. By 12 months
  4. Only after 5 years

Explanation

Daytime bowel and bladder control usually develops between about 18 and 30 months, with night dryness often later. Readiness depends on neurological maturation plus behavioural cues, not on chronological age alone.

Question 4General Pediatrics and Growth & Development

A term newborn is weighed on day 5 of life. Which weight change is expected and reassuring?

  1. A gain of 10 percent above birth weight
  2. A loss of 7 percent of birth weight with regain beginning Correct answer.
  3. No change from birth weight since delivery
  4. A loss of 15 percent of birth weight from birth weight

Explanation

Term infants commonly lose up to about 7 to 10 percent of birth weight in the first days and regain it by 10 to 14 days. A loss exceeding 10 percent, or failure to regain, warrants feeding assessment.

Question 5General Pediatrics and Growth & Development

A mother asks about the recommended sleeping position for her healthy 2-month-old. Which advice best reflects current guidance?

  1. Place the infant supine on a firm surface for every sleep Correct answer.
  2. Place the infant prone to strengthen the neck
  3. Place the infant on the side with a pillow for support
  4. Let the infant sleep in the parents' bed to aid monitoring

Explanation

Supine sleeping on a firm, flat surface reduces the risk of sudden infant death and is recommended for every sleep. Prone and side positions and soft bedding increase risk. Bed sharing is discouraged, particularly for young infants.

Question 6General Pediatrics and Growth & Development

A 4-year-old is seen for a well-child visit. Which immunization is most appropriately due at this age in a standard schedule?

  1. Third dose of hepatitis B vaccine
  2. First dose of human papillomavirus vaccine
  3. Second dose of measles-containing vaccine and booster polio Correct answer.
  4. First dose of measles-containing vaccine

Explanation

Many schedules give the second measles-containing dose and polio boosters at around 4 to 6 years, before school entry. First measles dose is usually at 9 or 12 months, hepatitis B is completed in infancy, and HPV is given in adolescence.

Question 7General Pediatrics and Growth & Development

A 10-month-old is growing along the 50th percentile for weight but the 3rd percentile for length. Which interpretation is most appropriate?

  1. Normal because weight is average
  2. Normal because length percentiles are unreliable before 2 years
  3. Concerning for a disproportionate growth disorder requiring assessment Correct answer.
  4. Concerning only if head circumference is also below the 3rd percentile

Explanation

Weight and length percentiles should roughly track together; a large discrepancy suggests disproportionate growth such as skeletal dysplasia, endocrine disease, or chronic illness. Isolated short stature with normal weight deserves evaluation regardless of head circumference.

Question 8General Pediatrics and Growth & Development

A 9-month-old has not yet developed a pincer grasp. Which statement about this milestone is most accurate?

  1. A palmar grasp is abnormal at this age
  2. Absence at 9 months always indicates cerebral palsy
  3. A pincer grasp is expected by 4 months
  4. A pincer grasp normally appears around 9 to 12 months Correct answer.

Explanation

The neat pincer grasp using thumb and index finger emerges between roughly 9 and 12 months, replacing the earlier raking and palmar grasp. Its absence at 9 months alone is not diagnostic of cerebral palsy.

Question 9General Pediatrics and Growth & Development

A 2-year-old presents with a 3-day history of fever, coryza, and a barking cough worse at night. Which diagnosis is most likely?

  1. Croup (laryngotracheobronchitis) Correct answer.
  2. Foreign body aspiration
  3. Acute epiglottitis
  4. Bronchiolitis

Explanation

Croup typically follows a viral upper respiratory illness and produces a barking cough with hoarseness and inspiratory stridor, worse at night. Epiglottitis causes drooling and toxicity, bronchiolitis causes wheeze in infants, and aspiration is usually sudden in onset.

Question 10General Pediatrics and Growth & Development

A 5-year-old is brought after a generalized tonic-clonic seizure lasting 2 minutes, associated with a fever of 39.5 degrees Celsius. He is now alert and has no meningeal signs. What is the most appropriate next step?

  1. Order an urgent electroencephalogram before discharge
  2. Identify and treat the source of fever and give antipyretics Correct answer.
  3. Arrange immediate lumbar puncture in all cases
  4. Start long-term daily anticonvulsant therapy

Explanation

A simple febrile seizure is brief, generalized, and occurs once in 24 hours in a child aged 6 months to 5 years without signs of meningitis. Management focuses on finding the fever source; routine anticonvulsants, lumbar puncture, and EEG are not indicated in a well child.

Question 11General Pediatrics and Growth & Development

A 3-year-old presents with a 4-day history of fever, bilateral conjunctivitis, red cracked lips, and a rash. Which finding would most support the suspected diagnosis?

  1. A petechial rash on the trunk
  2. A systolic murmur with cardiomegaly on echocardiography
  3. A unilateral swollen parotid gland
  4. Peeling of the skin on the fingertips and perineum in the second week Correct answer.

Explanation

Kawasaki disease is diagnosed clinically with fever plus mucocutaneous features, and later desquamation of the fingers and perineum is characteristic. Cardiac involvement is coronary artery dilation, not a systolic murmur with cardiomegaly.

Question 12General Pediatrics and Growth & Development

A 12-month-old has not yet started walking. On examination he pulls to stand, cruises along furniture, and has normal tone and reflexes. What is the most appropriate advice?

  1. Refer urgently for magnetic resonance imaging of the spine
  2. Reassure, as independent walking is expected by 18 months Correct answer.
  3. Diagnose cerebral palsy and start physiotherapy
  4. Order serum creatine kinase immediately

Explanation

Independent walking normally occurs between about 12 and 18 months, and cruising is an appropriate precursor. Normal tone and reflexes with continued progression support reassurance and review rather than urgent investigation.

Question 13General Pediatrics and Growth & Development

A 6-week-old presents with projectile non-bilious vomiting after feeds and a palpable olive-shaped mass in the right upper abdomen. Which finding best confirms the diagnosis?

  1. Bilious vomiting with abdominal distension
  2. Metabolic acidosis with hyperkalaemia
  3. Blood in the stool with diarrhoea
  4. Metabolic alkalosis with hypochloraemia on blood gas Correct answer.

Explanation

Hypertrophic pyloric stenosis causes non-bilious projectile vomiting leading to loss of gastric acid, producing hypochloraemic hypokalaemic metabolic alkalosis. Ultrasound confirms the diagnosis, but the characteristic biochemistry supports it.

Question 14General Pediatrics and Growth & Development

A 4-year-old child is noted to have a systolic blood pressure above the 99th percentile for age, sex, and height on three separate visits. Which aetiology is most likely in this age group?

  1. Essential hypertension
  2. Renal parenchymal disease Correct answer.
  3. Phaeochromocytoma
  4. Coarctation of the aorta

Explanation

In prepubertal children, secondary causes dominate hypertension, and renal parenchymal disease is the commonest. Essential hypertension is more typical in adolescents with obesity, while coarctation and phaeochromocytoma are less frequent causes.

Question 15General Pediatrics and Growth & Development

A 15-month-old is brought with a 2-day history of fever and painful vesicular lesions on the tongue and buccal mucosa. Which advice is most appropriate?

  1. Maintain hydration with fluids and give paracetamol for pain Correct answer.
  2. Start broad-spectrum antibiotics immediately
  3. Undertake urgent intubation to protect the airway
  4. Prescribe oral aciclovir routinely for all cases

Explanation

Primary herpetic gingivostomatitis is usually self-limiting, and management centres on analgesia and maintaining oral intake to prevent dehydration. Antivirals are reserved for severe or immunocompromised cases, and antibiotics are not indicated for viral disease.

Question 16General Pediatrics and Growth & Development

A 7-year-old is found to have a body mass index above the 97th percentile for age and sex. Which additional finding is most consistent with metabolic syndrome?

  1. Haemoglobin of 13 g/dL
  2. Fasting blood glucose of 4.2 mmol/L
  3. Waist circumference above the 90th percentile with acanthosis nigricans Correct answer.
  4. Blood pressure at the 40th percentile

Explanation

Central obesity with acanthosis nigricans and insulin resistance supports metabolic syndrome in a child with obesity. Normal fasting glucose, normal haemoglobin, and normotensive readings do not add to the diagnosis.

Question 17General Pediatrics and Growth & Development

A 10-year-old presents with short stature, and a bone age radiograph shows a delay of 3 years compared with chronological age. Which condition best fits this picture?

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

Explanation

Constitutional delay shows delayed bone age with a predicted adult height in the normal range and a family history of late puberty. Familial short stature has a bone age matching chronological age, while growth hormone excess and precocious puberty advance bone age.

Question 18General Pediatrics and Growth & Development

A 2-year-old is brought after a first episode of wheeze triggered by a viral cold. He has no history of atopy and is otherwise thriving. What is the most appropriate initial management?

  1. Supportive care with a trial of bronchodilator if distress is present Correct answer.
  2. Commence a leukotriene receptor antagonist
  3. Start inhaled corticosteroids for long-term control
  4. Refer for allergy testing before any treatment

Explanation

Viral wheeze in a toddler without atopy is usually self-limiting, and supportive care with a bronchodilator trial for distress is appropriate. Long-term inhaled corticosteroids or leukotriene antagonists are not indicated after a single episode.

Question 19General Pediatrics and Growth & Development

A 6-year-old is brought with a 2-week history of periorbital puffiness, dark urine, and hypertension following a sore throat. Which finding would most support the suspected diagnosis?

  1. Eosinophilia on full blood count
  2. Low antistreptolysin O titre with normal complement
  3. Raised antistreptolysin O titre with low complement C3 Correct answer.
  4. Hyperkalaemia with metabolic acidosis

Explanation

Post-streptococcal glomerulonephritis follows a streptococcal infection and shows raised antistreptolysin O titres with a transiently low C3. Hyperkalaemia and acidosis would suggest renal failure rather than the typical presentation.

Question 20General Pediatrics and Growth & Development

A 5-year-old is diagnosed with iron deficiency anaemia. Which finding on history is most likely to explain the anaemia?

  1. Excessive cow's milk intake with a low-iron diet Correct answer.
  2. A diet rich in red meat and green vegetables
  3. A family history of thalassaemia trait
  4. Recent treatment with oral antibiotics

Explanation

Excessive cow's milk displaces iron-rich foods and impairs iron absorption, a common cause of iron deficiency in young children. A diet rich in iron would not cause deficiency, and thalassaemia trait is a separate cause of microcytosis.

Question 21General Pediatrics and Growth & Development

A 2-year-old is brought with a 1-week history of fever, irritability, and a swollen, warm knee that he refuses to move. Which investigation is most important before starting treatment?

  1. Joint aspiration for Gram stain and culture Correct answer.
  2. Serum uric acid measurement
  3. Antinuclear antibody testing
  4. Plain radiograph of the knee

Explanation

Septic arthritis requires urgent joint aspiration for Gram stain and culture before antibiotics, along with blood cultures. Plain radiographs are usually normal early, and autoimmune or metabolic tests do not diagnose bacterial infection.

Question 22General Pediatrics and Growth & Development

A 3-day-old term infant is jaundiced and has a total serum bilirubin of 320 micromol/L. Which feature most strongly suggests pathological rather than physiological jaundice?

  1. The infant is breastfed and gaining weight
  2. The jaundice is confined to the face and sclera
  3. The jaundice appeared within the first 24 hours of life Correct answer.
  4. The infant passes meconium stools normally

Explanation

Jaundice appearing within the first 24 hours is always pathological and suggests haemolysis, infection, or metabolic disease. Physiological jaundice appears after 24 hours and is usually less severe. Breastfeeding, facial distribution, and normal stools do not indicate pathology.

Question 23General Pediatrics and Growth & Development

A 4-year-old has a history of recurrent respiratory infections and failure to thrive, and a sweat chloride test is 65 mmol/L on two occasions. Which additional feature is most consistent with the diagnosis?

  1. A raised serum immunoglobulin E level
  2. A low sweat chloride on a third sample
  3. A positive newborn screening for immunoreactive trypsinogen Correct answer.
  4. A normal chest radiograph

Explanation

A sweat chloride above 60 mmol/L on two occasions supports cystic fibrosis, and a positive newborn screening for immunoreactive trypsinogen is consistent with the diagnosis. Normal imaging and low IgE are not typical, and a low third sweat chloride would argue against the diagnosis.

Question 24General Pediatrics and Growth & Development

A 9-year-old presents with a 3-week history of weight loss, polyuria, and polydipsia, and a random blood glucose of 18 mmol/L. Which statement about initial management is most correct?

  1. Oral hypoglycaemic agents are the first-line treatment
  2. Insulin can be withheld until fasting glucose is confirmed
  3. Intravenous fluids and insulin are indicated if there is ketoacidosis Correct answer.
  4. Dietary restriction alone is sufficient initially

Explanation

New-onset type 1 diabetes with significant hyperglycaemia requires insulin, and if ketoacidosis is present, intravenous fluids and insulin are needed urgently. Oral agents and dietary restriction alone are not appropriate for type 1 diabetes.

Question 25General Pediatrics and Growth & Development

A 7-year-old is brought with a 2-month history of poor school performance, daytime sleepiness, and loud snoring. Which finding on examination would most support the diagnosis?

  1. Bilateral crackles at the lung bases
  2. Tonsillar hypertrophy with a narrow oropharynx Correct answer.
  3. A palpable spleen
  4. A systolic murmur at the apex

Explanation

Obstructive sleep apnoea in children commonly results from adenotonsillar hypertrophy, causing snoring, sleep fragmentation, and daytime somnolence. A murmur, crackles, or splenomegaly do not explain this clinical picture.

Question 26General Pediatrics and Growth & Development

A 4-month-old infant is brought to the clinic for a routine check. The mother reports that the baby has begun to smile responsively, coo, and hold the head steady when pulled to sit. Which statement best describes these milestones for a 4-month-old?

  1. Head control is expected, but social smiling usually appears only after 6 months
  2. All three are expected developmental achievements at this age Correct answer.
  3. These milestones suggest global developmental delay and require investigation
  4. Cooing is expected, but responsive smiling normally appears at around 2 months

Explanation

Social (responsive) smiling typically emerges at around 6 to 8 weeks, cooing and vocalization by 2 to 3 months, and steady head control in the sitting position is usually achieved by 4 months. All three findings therefore fall within the normal range for a 4-month-old. Recognizing the expected timing prevents both false reassurance and unnecessary investigation.

Question 27General Pediatrics and Growth & Development

A 7-year-old boy is brought for a school entry assessment. His height is on the 50th percentile and his weight is on the 97th percentile, with a BMI above the 95th percentile for age and sex. His father has type 2 diabetes and his mother has hypertension. Which single feature in this child most strongly increases the likelihood of metabolic complications?

  1. Height on the 50th percentile
  2. Age of 7 years
  3. Family history of type 2 diabetes and hypertension Correct answer.
  4. Male sex at this age

Explanation

In a child with obesity, a first-degree family history of type 2 diabetes and hypertension increases the risk of insulin resistance and related metabolic disease. This guides screening with fasting glucose or HbA1c and lipid profile. Male sex, average height, and young age are not themselves risk factors for metabolic complications.

Question 28General Pediatrics and Growth & Development

A 3-year-old girl is brought because she has frequent temper tantrums, resists toilet training, and says 'no' to most requests. She eats and sleeps well, plays alongside other children, and has age-appropriate language. Which interpretation of her behaviour is most appropriate?

  1. These behaviours are typical of the autonomy-seeking stage of early childhood Correct answer.
  2. This pattern suggests oppositional defiant disorder and needs referral
  3. The child requires investigation for a pervasive developmental disorder
  4. The presentation indicates a language disorder causing frustration

Explanation

Negativism, temper tantrums, and resistance to toilet training are characteristic of the autonomy versus shame and doubt stage of toddlerhood, typically peaking around 2 to 3 years. Normal eating, sleep, play, and language support a normative behavioural pattern rather than a disorder. Anticipatory guidance and consistent limits are the appropriate response.

Question 29General Pediatrics and Growth & Development

A 15-month-old boy is brought for a routine visit. He walks independently, says three single words, points to indicate what he wants, and can stack two blocks. Which statement about his development is most accurate?

  1. Isolated pointing suggests a social communication disorder
  2. His language and motor skills are within the expected range for age Correct answer.
  3. He should be referred because block stacking is not expected until 2 years
  4. He shows delay because he should be using two-word phrases by 15 months

Explanation

At 15 months, walking independently, using a few single words, pointing to express needs, and stacking a couple of blocks are all expected. Two-word phrases usually emerge around 18 to 24 months, not at 15 months. Pointing is a normal communicative gesture that supports, rather than undermines, social communication.

Question 30General Pediatrics and Growth & Development

A 6-year-old boy is referred for short stature. His height is below the 3rd percentile, his growth velocity over the past year is normal, and his bone age is delayed by about 2 years. Examination shows no dysmorphism, and his parents are of average height with the father having had late puberty. Which single finding most strongly supports constitutional delay of growth and puberty?

  1. Male sex of the child
  2. Height below the 3rd percentile
  3. Absence of dysmorphic features
  4. Normal growth velocity with delayed bone age and a family history of late puberty Correct answer.

Explanation

Constitutional delay is characterized by a normal growth velocity, delayed bone age consistent with the child's height age, and often a family history of delayed puberty. The combination of these features is what supports the diagnosis. Short stature alone, absence of dysmorphism, or male sex are non-specific and do not distinguish constitutional delay from other causes.

Question 31Neonatology and Perinatology

At 1 minute of life, a term newborn has a heart rate of 90 beats/min, slow irregular respirations, some flexion of the limbs, a grimace on suctioning, and central cyanosis. What Apgar score should be assigned?

  1. 6
  2. 4 Correct answer.
  3. 5
  4. 3

Explanation

The Apgar components here score as follows: heart rate below 100 gives 1 point, slow irregular breathing gives 1 point, some limb flexion gives 1 point, grimace gives 1 point, and central cyanosis gives 0 points. The total is therefore 4. Note that the score summarises condition at a fixed time point and does not by itself dictate resuscitation, which follows the newborn algorithm.

Question 32Neonatology and Perinatology

Which finding in a newborn most strongly suggests persistent pulmonary hypertension of the newborn rather than cyanotic congenital heart disease?

  1. A continuous murmur over the left infraclavicular area
  2. Cyanosis that improves substantially with crying
  3. A normal chest radiograph with clear lung fields
  4. A preductal oxygen saturation that rises markedly while the postductal saturation stays low Correct answer.

Explanation

In persistent pulmonary hypertension, right-to-left shunting across the ductus arteriosus produces a difference between preductal (right arm) and postductal (lower limb) saturations, often exceeding 5 to 10 percent. This differential cyanosis pattern with a healthier preductal value points to suprasystemic pulmonary vascular resistance. Structural cyanotic heart disease usually causes more uniform hypoxaemia unless ductal-dependent mixing is present.

Question 33Neonatology and Perinatology

A term neonate develops jaundice at 18 hours of age with a total bilirubin of 12 mg/dL. Which is the most appropriate immediate step?

  1. Reassure the family and recheck bilirubin in one week
  2. Stop breastfeeding permanently and give formula
  3. Begin intensive phototherapy while arranging investigations for haemolysis Correct answer.
  4. Arrange routine outpatient follow-up in 48 hours

Explanation

Jaundice appearing within the first 24 hours is always pathological and requires urgent evaluation for haemolytic disease, sepsis, and other causes. Bilirubin at this level at 18 hours plots well above the hour-specific treatment threshold, so intensive phototherapy should start immediately while blood group, direct antiglobulin test, haematocrit, and sepsis workup are arranged. Delay risks acute bilirubin encephalopathy.

Question 34Neonatology and Perinatology

Which maternal condition is most classically associated with neonatal thrombocytopenia due to immune destruction?

  1. Maternal pre-eclampsia
  2. Maternal immune thrombocytopenic purpura Correct answer.
  3. Maternal hypothyroidism
  4. Maternal gestational diabetes

Explanation

In maternal immune thrombocytopenic purpura, maternal antiplatelet IgG crosses the placenta and destroys fetal platelets, producing neonatal thrombocytopenia that may be severe enough to cause bleeding. Platelet counts should be checked at birth and monitored for several days because the nadir may occur after delivery. Pre-eclampsia, diabetes, and hypothyroidism are not classic immune causes of neonatal thrombocytopenia.

Question 35Neonatology and Perinatology

A preterm infant at 28 weeks gestation is being managed for respiratory distress syndrome. Which intervention has the strongest evidence for reducing mortality and bronchopulmonary dysplasia when given early?

  1. Routine postnatal corticosteroids within the first 24 hours
  2. Prophylactic antibiotics for 10 days
  3. Early nasal continuous positive airway pressure with selective surfactant Correct answer.
  4. Daily furosemide from day one

Explanation

Early nasal continuous positive airway pressure combined with selective, early surfactant administration reduces the need for mechanical ventilation and lowers rates of bronchopulmonary dysplasia and death in preterm infants with respiratory distress syndrome. This approach avoids volutrauma from invasive ventilation. Routine early postnatal steroids and diuretics have not shown comparable benefit and carry important harms.

Question 36Neonatology and Perinatology

Which is the single most effective intervention for preventing early-onset group B streptococcal disease in newborns?

  1. Intrapartum antibiotic prophylaxis for colonised or at-risk mothers Correct answer.
  2. Delayed cord clamping for two minutes
  3. Universal neonatal penicillin prophylaxis at birth
  4. Routine maternal vaccination in the third trimester

Explanation

Intrapartum antibiotic prophylaxis, usually intravenous penicillin, given to women who are colonised or who have risk factors substantially reduces vertical transmission of group B streptococcus and early-onset disease. Neonatal prophylaxis is not the standard approach. Maternal vaccination is under development but is not yet a routine prevention strategy.

Question 37Neonatology and Perinatology

A newborn born to a mother with hepatitis B surface antigen positivity receives hepatitis B vaccine and immunoglobulin within 12 hours. What is the recommended timing for serological testing to confirm protection?

  1. At 9 to 12 months of age, after completing the vaccine series Correct answer.
  2. At 3 months of age
  3. At 1 month of age
  4. Immediately before hospital discharge

Explanation

Post-vaccination serology for hepatitis B surface antigen and antibody should be performed at 9 to 12 months, after completion of the three-dose series. Testing earlier can be confounded by passively transferred maternal antibody and by incomplete immunisation. Infants who are not protected require revaccination.

Question 38Neonatology and Perinatology

A term infant is noted to have a sacral dimple 3 mm in diameter, more than 2.5 cm from the anal verge, with a small skin tag but no visible tract. What is the most appropriate next step?

  1. No imaging needed; routine newborn care
  2. Magnetic resonance imaging under general anaesthesia
  3. Surgical referral for immediate closure
  4. Ultrasound of the spine to exclude occult spinal dysraphism Correct answer.

Explanation

Simple sacral dimples located within 2.5 cm of the anal verge and without other markers usually need no imaging. Features such as a distance greater than 2.5 cm, a skin tag, a tract, hair tuft, or overlying haemangioma raise concern for occult spinal dysraphism, and spinal ultrasound is the appropriate first test in a neonate. Ultrasound is preferred because the posterior elements are not yet ossified.

Question 39Neonatology and Perinatology

Which statement about physiological anaemia of infancy is correct?

  1. It is caused by iron deficiency and requires routine iron therapy
  2. It is associated with a raised reticulocyte count
  3. The nadir occurs earlier and is more profound in term than in preterm infants
  4. Haemoglobin reaches its nadir at about 2 to 3 months in term infants Correct answer.

Explanation

In term infants, haemoglobin falls after birth as erythropoietin production declines, reaching a nadir of about 9 to 11 g/dL at 2 to 3 months. This is a normal adaptation to the relatively hyperoxic extrauterine environment. Preterm infants have an earlier and deeper nadir because of lower iron stores and more rapid growth.

Question 40Neonatology and Perinatology

A 3-hour-old term infant born by elective caesarean section has a blood glucose of 28 mg/dL and is jittery. Which action is most appropriate?

  1. Give an intravenous dextrose bolus followed by a continuous infusion Correct answer.
  2. Observe and recheck in two hours
  3. Give intramuscular glucagon
  4. Start oral formula feeding only

Explanation

A glucose of 28 mg/dL with symptoms is a medical emergency. Treatment is an intravenous bolus of 10 percent dextrose followed by a continuous infusion to maintain normoglycaemia, with frequent monitoring. Oral feeding alone is inadequate in a symptomatic infant and risks worsening neuroglycopenia.

Question 41Neonatology and Perinatology

Which feature best distinguishes transient tachypnoea of the newborn from respiratory distress syndrome on a chest radiograph?

  1. Unilateral tension pneumothorax
  2. Prominent perihilar streaking with fluid in the horizontal fissure Correct answer.
  3. Air bronchograms extending to the periphery
  4. Low lung volumes with a ground-glass appearance

Explanation

Transient tachypnoea of the newborn shows increased perihilar markings, prominent fissure fluid, and sometimes mild hyperinflation reflecting delayed clearance of fetal lung fluid. Respiratory distress syndrome instead shows low volumes, a reticulogranular pattern, and air bronchograms from surfactant deficiency. The distinction guides the need for surfactant.

Question 42Neonatology and Perinatology

What is the recommended initial inspiratory oxygen concentration for positive pressure ventilation of a term newborn at birth?

  1. 21 percent Correct answer.
  2. 30 percent
  3. 100 percent
  4. 40 percent

Explanation

For term newborns requiring respiratory support at birth, ventilation should begin with air (21 percent oxygen) and the concentration titrated to the preductal saturation targets. Starting with 100 percent oxygen is associated with increased oxidative stress and mortality. Preterm infants are managed with a slightly higher initial concentration, typically 21 to 30 percent, with titration.

Question 43Neonatology and Perinatology

A neonate born to a mother with untreated syphilis has a reactive non-treponemal test but a negative treponemal test. What is the most likely explanation?

  1. Congenital syphilis infection requiring treatment
  2. Laboratory error requiring no follow-up
  3. Passive transfer of maternal antibodies Correct answer.
  4. Maternal HIV co-infection

Explanation

Maternal IgG crosses the placenta, so a non-treponemal test can be reactive in an uninfected infant. A negative treponemal test in the infant, together with maternal history, suggests passive antibody transfer rather than infection. Serial non-treponemal titres should be followed until they become negative; rising or persistently high titres would prompt treatment.

Question 44Neonatology and Perinatology

Which is the most common cause of neonatal conjunctivitis presenting within the first 24 to 48 hours of life?

  1. Staphylococcus aureus
  2. Chlamydia trachomatis
  3. Chemical irritation from prophylaxis Correct answer.
  4. Neisseria gonorrhoeae

Explanation

Chemical conjunctivitis from silver nitrate prophylaxis classically presents within 24 to 48 hours and is self-limited. Gonococcal conjunctivitis appears at 2 to 5 days and is an emergency because of the risk of corneal ulceration. Chlamydial conjunctivitis typically presents at 5 to 14 days.

Question 45Neonatology and Perinatology

A preterm infant at 32 weeks gestation is being fed enterally. Which feeding strategy is most strongly associated with a reduced risk of necrotising enterocolitis?

  1. Routine fasting for the first week
  2. Slow advancement of feeds with human milk Correct answer.
  3. Withholding all enteral feeds until 34 weeks corrected gestation
  4. Early full-volume formula feeding

Explanation

Human milk feeding with cautious advancement of volumes reduces the incidence of necrotising enterocolitis compared with formula feeding and rapid advancement. Human milk provides immunoprotective factors and better tolerance. Prolonged fasting has no protective benefit and delays nutritional support.

Question 46Neonatology and Perinatology

Which cardiac lesion typically presents with cyanosis that worsens as the ductus arteriosus closes in the first days of life?

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

Explanation

In transposition of the great arteries, the parallel circulations require mixing through a patent ductus arteriosus or atrial communication. As the ductus constricts after birth, cyanosis deepens and prostaglandin infusion may be needed to maintain patency until an atrial septostomy or arterial switch operation. The other lesions listed are acyanotic.

Question 47Neonatology and Perinatology

A newborn is noted to have a unilateral absent red reflex. What is the most important diagnosis to exclude?

  1. Congenital cataract Correct answer.
  2. Physiological anisocoria
  3. Conjunctival haemorrhage
  4. Retinopathy of prematurity

Explanation

An absent red reflex in a newborn raises concern for congenital cataract, which obscures the visual axis and can cause irreversible amblyopia if not treated promptly. Other causes include retinoblastoma, retinal detachment, and vitreous haemorrhage, so urgent ophthalmological assessment is required. The red reflex examination is a standard part of newborn screening.

Question 48Neonatology and Perinatology

A term infant develops seizures on day 3 of life. Which is the most common identifiable cause in this age group?

  1. Pyridoxine dependency
  2. Inborn error of metabolism
  3. Hypoxic-ischaemic encephalopathy Correct answer.
  4. Hypocalcaemia

Explanation

Hypoxic-ischaemic encephalopathy is the most common cause of neonatal seizures, particularly in term infants, and the timing of presentation often reflects the insult around delivery. Hypocalcaemia, hypoglycaemia, and infection are important reversible causes that should be excluded. Metabolic disorders are rare but should be considered when seizures are refractory or the history is atypical.

Question 49Neonatology and Perinatology

What is the most appropriate management of a healthy term newborn with a small, uncomplicated cephalohaematoma?

  1. Reassurance and observation Correct answer.
  2. Aspiration to relieve pressure
  3. Application of pressure dressings
  4. Immediate neurosurgical referral

Explanation

Cephalohaematomas are subperiosteal collections that resolve spontaneously over weeks. They should be observed without aspiration because of the risk of introducing infection and causing anaemia. Skull radiographs or imaging are reserved for cases with concerning features such as a growing mass or neurological signs.

Question 50Neonatology and Perinatology

Which statement about the ductus arteriosus in a preterm infant is correct?

  1. Functional closure usually occurs within the first 24 hours in term infants but is delayed in preterm infants Correct answer.
  2. It closes primarily because of falling oxygen tension after birth
  3. It is kept open by prostaglandin E2 and closes with indomethacin
  4. Anatomical closure is complete by 48 hours of life

Explanation

In term infants, functional closure of the ductus arteriosus typically occurs within the first day of life, while anatomical closure takes weeks. In preterm infants, the ductus is less responsive to oxygen and more responsive to prostaglandins, so closure is often delayed. This underlies the high incidence of patent ductus arteriosus in very preterm infants.