Saudi Board Pediatrics Final Written Exam (SCFHS)

A 2-day-old male infant born at 31 weeks gestation experiences recurrent episodes of apnea lasting 22 seconds, associated with cyanosis and a drop in heart rate to 80 bpm. Sepsis workup is normal, and physical exam is otherwise unremarkable. What is the most appropriate first-line pharmacologic treatment?

• ACaffeine citrate
• BTheophylline
• CAlbuterol nebulization
• DPhenobarbital

A male infant born at 29 weeks gestation develops grunting, nasal flaring, and chest retractions immediately after birth. A chest radiograph shows diffuse reticulogranular 'ground-glass' patterns and air bronchograms. Which of the following prenatal interventions is most effective in preventing this condition?

• AMaternal administration of betamethasone 24-48 hours before delivery
• BMaternal administration of magnesium sulfate immediately before delivery
• CProphylactic administration of indomethacin to the neonate within 2 hours of life
• DMaternal administration of progesterone during the second trimester

A full-term male infant born via elective Cesarean section without labor presents with tachypnea (RR 82 bpm) and mild intercostal retractions at 1 hour of life. Chest radiograph shows prominent perihilar vascular markings and fluid lines in the interlobar fissures. What is the primary pathophysiologic mechanism of this condition?

• ADelayed clearance of fetal lung fluid via lymphatic and pulmonary circulation
• BDeficiency of alveolar surfactant leading to microatelectasis
• CMeconium obstruction of small airways leading to air trapping
• DBacterial colonization of the lower respiratory tract

According to the 2022 AAP Hyperbilirubinemia Guidelines, which of the following is considered a major hyperbilirubinemia neurotoxicity risk factor that lowers the threshold for phototherapy and exchange transfusion?

• AGlucose-6-phosphate dehydrogenase (G6PD) deficiency
• BGestational age of 38 weeks
• CExclusive breastfeeding with weight loss of 5%
• DCephalohematoma

A 12-hour-old term neonate develops lethargy, temperature instability (temp 35.9 C), and poor feeding. The maternal history is positive for Group B Streptococcus (GBS) colonization with inadequate intrapartum antibiotic prophylaxis. What is the most appropriate empiric antimicrobial regimen?

• AAmpicillin and Gentamicin
• BCeftriaxone and Vancomycin
• CCefotaxime and Clindamycin
• DPiperacillin-Tazobactam and Gentamicin

A term female infant is born via emergency Cesarean section for abruption placentae. Apgar scores are 2, 4, and 5 at 1, 5, and 10 minutes respectively. Cord pH is 6.9, and base deficit is 18 mmol/L. The infant is lethargic with hypotonia and absent reflexes. Which of the following is correct regarding therapeutic hypothermia for this neonate?

• AIt should be initiated within 6 hours of birth and maintain a core temperature of 33.5 C…
• BIt should be initiated within 12 hours of birth and maintain a core temperature of 35.0 C…
• CIt is contraindicated in patients with a base deficit greater than 15 mmol/L
• DIt should be initiated only after the first 24 hours of life to assess long-term deficits

A preterm infant born at 27 weeks gestation on post-op day 14 of life develops abdominal distension, feeding intolerance, and bloody stools. An abdominal radiograph demonstrates subserosal gas bubbles within the bowel wall (pneumatosis intestinalis). According to Bell's Staging Criteria, which stage does this represent?

• AStage II (Proven Necrotizing Enterocolitis)
• BStage I (Suspected Necrotizing Enterocolitis)
• CStage IIIa (Advanced Bowel Dysfunction, Intact Bowel)
• DStage IIIb (Advanced Bowel Dysfunction, Perforated Bowel)

A term female neonate is born via Cesarean section following prolonged rupture of membranes. Shortly after birth, she develops severe respiratory distress, hypoxemia, and labile oxygen saturations. Echocardiography shows right-to-left shunting through the patent ductus arteriosus (PDA) and patent foramen ovale (PFO). What is the key diagnostic finding that supports Persistent Pulmonary Hypertension of the Newborn (PPHN)?

• AA pre-ductal and post-ductal oxygen saturation gradient of >10%
• BAn increase in arterial oxygen tension (PaO2) of >100 mmHg during a 100% hyperoxia test
• CA pulmonary-to-systemic pressure ratio of <0.5
• DLeft ventricular hypertrophy on chest radiograph

An infant is born at 26 weeks gestation weighing 850 grams. According to standard screening guidelines, when should the first screening head ultrasound (HUS) be performed to detect Intraventricular Hemorrhage (IVH)?

• AAt 7 to 10 days of life
• BWithin the first 24 hours of life
• CAt 4 weeks of life
• DOnly if the infant develops a sudden drop in hematocrit

A term infant is born with a prenatal diagnosis of left-sided Congenital Diaphragmatic Hernia (CDH). In the delivery room, the infant exhibits severe respiratory distress, cyanosis, and a scaphoid abdomen. What is the most critical immediate step in resuscitation?

• AImmediate endotracheal intubation and placement of an orogastric tube
• BInitiation of positive pressure ventilation via bag-mask
• CAdministration of bolus surfactant
• DImmediate umbilical vein catheterization and administration of epinephrine

A 10-day-old female infant is brought to the emergency department with a history of poor feeding, vomiting, and lethargy. Physical examination reveals hyperpigmented skin and ambiguous genitalia. Serum electrolytes reveal: Sodium 118 mEq/L, Potassium 7.2 mEq/L. Which enzyme deficiency is the most common cause of this condition?

• A21-hydroxylase
• B11-beta-hydroxylase
• C17-alpha-hydroxylase
• D3-beta-hydroxysteroid dehydrogenase

A term 3.8 kg male infant is born to a mother with gestational diabetes. At 2 hours of life, the infant is noted to be jittery and has poor sucking. A bedside glucose test shows a blood glucose level of 1.8 mmol/L (32.4 mg/dL). What is the most appropriate next step in management?

• AAdminister an intravenous bolus of 2 mL/kg of 10% dextrose (D10W), followed by a continuo…
• BEncourage the mother to breastfeed immediately and recheck glucose in 1 hour
• CAdminister 2 mL/kg of 50% dextrose (D50W) intravenously
• DGive 10 mL/kg of formula milk via nasogastric tube

A male infant is born with an abdominal wall defect. The bowel loops are herniated to the right of the umbilical cord insertion, are not covered by a peritoneal membrane, and appear erythematous and edematous. What is the most likely diagnosis?

• AGastroschisis
• BOmphalocele
• CUmbilical hernia
• DPrune belly syndrome

A post-term neonate is delivered via emergency Cesarean section for fetal distress. Thick meconium-stained amniotic fluid is noted. In the NICU, the infant is ventilated for Meconium Aspiration Syndrome (MAS). The infant develops sudden hypotension and unilateral decrease in breath sounds. Which of the following is the most likely acute complication?

• APneumothorax
• BPulmonary hemorrhage
• CTracheoesophageal fistula
• DBilateral pleural effusions

A mother brings her 9-month-old infant for a well-child visit. Which of the following developmental milestones is most appropriate for this age?

• APulls to stand and uses a crude pincer grasp
• BWalks independently and speaks 3-5 words
• CBuilds a tower of 2 blocks and uses a spoon
• DRolls from prone to supine and smiles socially

A 18-month-old boy is brought to the clinic for a routine checkup. The pediatrician administers the Modified Checklist for Autism in Toddlers (M-CHAT). Which of the following developmental behaviors is expected at this age?

• APoints to show interest in an object and climbs up stairs with help
• BKicks a ball and copies a circle
• CStands on one foot for 2 seconds and buttons clothes
• DWalks backward and says 50 words

During a developmental assessment of a 2-year-old child, which social and language milestone should be present?

• ACombines 2 or more words in a phrase and demonstrates parallel play
• BTells simple stories and plays cooperatively in groups
• CDefines words and understands rules of games
• DUses 4-word sentences and shares toys willingly

A 4-year-old girl is assessed in the clinic. Which of the following fine motor and gross motor milestone combinations is appropriate for a healthy 4-year-old?

• AHops on one foot and copies a cross (+)
• BSkips and writes first name
• CBuilds a tower of 6 cubes and runs well
• DTies shoelaces and cuts shapes with scissors

A newborn male is diagnosed with Trisomy 21 (Down Syndrome). Which of the following cardiac anomalies is most strongly associated with this condition and requires immediate screening via echocardiography?

• AComplete Atrioventricular Septal Defect (AVSD)
• BCoarctation of the Aorta
• CTetralogy of Fallot
• DTransposition of the Great Arteries

A 2-week-old infant presents with jaundice, hepatomegaly, and poor weight gain since starting breast milk. Urinalysis reveals positive reducing substances but is negative for glucose. The infant is at high risk for sepsis caused by which pathogen?

• AEscherichia coli
• BListeria monocytogenes
• CGroup B Streptococcus
• DStaphylococcus aureus

A 14-month-old female is brought to the clinic with fever (38.8 C) and severe right ear pain. Otoscopic examination reveals a bulging, erythematous tympanic membrane with poor mobility. She has no history of recurrent ear infections or drug allergies. What is the first-line antibiotic treatment?

• AAmoxicillin 80-90 mg/kg/day divided into two doses
• BAmoxicillin-clavulanate 45 mg/kg/day
• CCefdinir 14 mg/kg/day
• DAzithromycin 10 mg/kg on day 1, followed by 5 mg/kg

A 6-year-old boy presents with sore throat, fever of 39 C, and painful swallowing. On examination, he has tonsillar exudates and tender anterior cervical lymphadenopathy. A rapid antigen detection test (RADT) is positive for Group A Streptococcus. Antibiotic therapy is primarily indicated to prevent which of the following complications?

• AAcute Rheumatic Fever
• BPost-Streptococcal Glomerulonephritis
• CStreptococcal Toxic Shock Syndrome
• DPANDAS syndrome

A 3-year-old girl is admitted with a 6-day history of high fever (39.5 C). Physical examination reveals bilateral non-purulent conjunctivitis, dry cracked lips, strawberry tongue, polymorphous rash, and edema of the hands. Which of the following is the most appropriate initial management to prevent coronary artery aneurysms?

• AIntravenous Immunoglobulin (IVIG) 2 g/kg as a single infusion and high-dose Aspirin
• BHigh-dose Methylprednisolone and Low-molecular-weight heparin
• CInfliximab and low-dose Aspirin
• DBroad-spectrum antibiotics and Ibuprofen

A 10-year-old boy presents with joint pain, fever, and a new heart murmur. Two weeks ago, he had an untreated sore throat. On examination, he has migratory polyarthritis affecting the knees and ankles. The clinician suspects Acute Rheumatic Fever. According to the revised Jones Criteria, which of the following is considered a major manifestation?

• ACarditis
• BFever
• CArthralgia
• DElevated erythrocyte sedimentation rate (ESR)

A 9-month-old female infant is diagnosed with her first febrile Urinary Tract Infection (UTI), which resolves after a 7-day course of cephalexin. According to the AAP guidelines, what is the most appropriate imaging recommendation?

• APerform a renal and bladder ultrasound (RBUS) to evaluate for structural abnormalities
• BPerform a voiding cystourethrogram (VCUG) immediately to rule out vesicoureteral reflux (…
• CPerform a DMSA renal scan to assess for acute pyelonephritis
• DNo imaging is indicated unless she develops a second febrile UTI

A 4-year-old boy presents with high fever, headache, photophobia, and neck stiffness. On exam, he is lethargic and has a positive Kernig sign. Lumbar puncture is performed. CSF analysis reveals: WBC 2,500/mm3 (90% neutrophils), Protein 1.8 g/L, Glucose 1.1 mmol/L (serum glucose 6.0 mmol/L). What is the most appropriate empiric antibiotic therapy?

• ACeftriaxone and Vancomycin
• BAmpicillin and Gentamicin
• CCeftazidime and Amikacin
• DMeropenem alone

A 10-day-old male infant presents to the emergency department with fever, poor feeding, and a bulging fontanelle. The clinician performs a lumbar puncture and suspects neonatal bacterial meningitis. Which of the following describes the most appropriate empiric antimicrobial selection and the rationale for avoiding ceftriaxone?

• AAmpicillin and Cefotaxime; Ceftriaxone is avoided because it displaces bilirubin from alb…
• BAmpicillin and Gentamicin; Ceftriaxone is avoided because it does not cover Group B Strep…
• CCeftriaxone and Vancomycin; Ceftriaxone is the drug of choice because it has superior CSF…
• DMeropenem and Vancomycin; Ceftriaxone is avoided because it is ineffective against Lister…

A 5-year-old girl is brought to the clinic due to sudden onset of right hip pain and limping. On examination, she is febrile (38.8 C), holds her right hip in flexion, abduction, and external rotation, and refuses to bear weight. Laboratory investigation reveals WBC 13,500/mm3, ESR 45 mm/hr, and CRP 30 mg/L. Which of the following is the most likely diagnosis according to the Kocher Criteria?

• ASeptic arthritis of the hip
• BTransient synovitis of the hip
• CLegg-Calve-Perthes disease
• DSlipped Capital Femoral Epiphysis (SCFE)

A 2-year-old boy presents with a 2-day history of runny nose, low-grade fever, and a harsh, barking cough. On examination in the emergency department, he has inspiratory stridor at rest and mild chest wall retractions. What is the most appropriate management?

• AAdminister oral dexamethasone and nebulized racemic epinephrine
• BAdminister nebulized albuterol and oral prednisolone
• CPerform immediate endotracheal intubation
• DPrescribe oral amoxicillin and discharge home

A 4-year-old unimmunized boy is brought to the emergency department with high fever, sore throat, drooling, and difficulty breathing. He is sitting in a 'tripod' position (leaning forward with hands on knees). Which of the following is the most critical first step in management?

• ASecure the airway under controlled conditions in the operating room
• BPerform a thorough examination of the oral cavity and throat using a tongue depressor
• CObtain a lateral neck radiograph to confirm the 'thumbprint' sign
• DEstablish intravenous access and administer cephalosporins

An 8-week-old infant is diagnosed with pertussis. The mother asks about post-exposure prophylaxis for the household, which includes the father and a 4-year-old sister who is fully immunized. What is the most appropriate recommendation?

• AAdminister oral Azithromycin to all household contacts regardless of immunization status
• BAdminister Azithromycin only to the infant, as the other household members are older or i…
• CIsolate the infant from the sister for 14 days without giving antibiotics
• DGive Azithromycin only to household contacts who develop symptoms

A 10-month-old infant is brought to the clinic due to a 3-day history of rhinorrhea, low-grade fever, cough, and wheezing. On examination, the infant has bilateral diffuse wheezing, mild subcostal retractions, and oxygen saturation of 94% on room air. What is the recommended management?

• ASupportive care including nasal suctioning, maintaining hydration, and monitoring
• BAdminister nebulized salbutamol and oral prednisolone
• CStart oral amoxicillin-clavulanate for 5 days
• DAdminister nebulized hypertonic saline and refer for hospitalization

A 3-year-old child is screened for tuberculosis because his grandfather was recently diagnosed with active pulmonary TB. The child is asymptomatic. A Tuberculin Skin Test (TST) is performed, and the induration measures 12 mm after 48 hours. What is the most appropriate next step in management?

• AObtain a chest radiograph to rule out active tuberculosis disease
• BInitiate 9 months of Isoniazid therapy immediately
• CReassure the parents that the test is negative because the induration is less than 15 mm
• DRepeat the TST in 2 weeks to confirm the results

A 15-month-old child presents with a 4-day history of high fever, cough, coryza, conjunctivitis, and a maculopapular rash that started on the face and spread to the trunk and extremities. The physician suspects measles (rubeola). In addition to supportive care, which of the following interventions is recommended by the World Health Organization (WHO) and AAP?

• AVitamin A supplementation
• BIntravenous Ribavirin
• CHigh-dose Vitamin C
• DProphylactic Acyclovir

A 6-year-old child who has never received the varicella vaccine is exposed to a classmate with active chickenpox. The exposure occurred 48 hours ago. The child is healthy and immunocompetent. What is the most appropriate post-exposure prophylaxis?

• AAdminister a dose of the Varicella vaccine as soon as possible
• BAdminister Varicella-Zoster Immunoglobulin (VZIG) within 10 days of exposure
• CStart oral acyclovir for 7 days
• DNo intervention is needed; monitor for symptoms and treat with paracetamol if rash develo…

A 10-year-old boy from a rural area in Saudi Arabia presents with a 3-week history of fluctuating ('undulant') fever, night sweats, generalized arthralgia, and lower back pain. His father mentions that the boy routinely drinks unpasteurized camel's milk. On examination, he has mild hepatosplenomegaly. What is the most appropriate first-line treatment for this patient?

• AOral Doxycycline and oral Rifampin for 6 weeks
• BOral Amoxicillin and oral Clarithromycin for 10 days
• COral Trimethoprim-Sulfamethoxazole alone for 3 weeks
• DIntravenous Ceftriaxone for 14 days

A 9-year-old child presents with a painless, crusted ulcer on his left forearm that has been slowly enlarging over the past month. He recently returned from a trip to the Al-Ahsa region in Saudi Arabia. The border of the ulcer is raised and indurated. What is the vector responsible for transmitting the pathogen causing this condition?

• APhlebotomus sandfly
• BAnopheles mosquito
• CIxodes tick
• DTsetse fly

A 15-year-old male adolescent presents with fever, sore throat, severe fatigue, and bilateral posterior cervical lymphadenopathy. Physical examination reveals tonsillar hypertrophy with exudates and palpable splenomegaly. A Monospot test is positive. What is the most critical guidance regarding activity restriction for this patient?

• AAvoid all contact sports for a minimum of 3 to 4 weeks to prevent splenic rupture
• BAvoid school attendance for 14 days to prevent airborne transmission
• CStrict bed rest is required until liver enzymes return to normal
• DRestrict physical activity until the rash resolves completely

A 9-month-old infant is brought to the clinic because of a sudden rash. For the past 4 days, the infant had a high fever (39.5 C) but otherwise appeared active and well. Today, the fever resolved abruptly, and a rose-pink maculopapular rash appeared on the trunk, spreading to the neck and extremities. What is the most likely pathogen?

• AHuman Herpesvirus 6 (HHV-6)
• BParvovirus B19
• CCoxsackievirus A16
• DRubella virus

A 2-year-old child presents with painful ulcers in the mouth and a non-pruritic maculopapular and vesicular rash on the palms of the hands, soles of the feet, and buttocks. The child is active, but has decreased oral intake due to mouth pain. What is the most appropriate management strategy?

• AProvide supportive care focusing on pain relief and hydration
• BInitiate oral Acyclovir for 5 days
• CAdminister topical steroids to the oral lesions
• DStart oral Amoxicillin to prevent secondary bacterial infection

A 5-year-old boy with a known peanut allergy accidentally ingests a cookie containing nuts. Within 10 minutes, he develops generalized urticaria, facial swelling, inspiratory stridor, and wheezing. What is the most appropriate immediate intervention?

• AAdminister Intramuscular Epinephrine (1:1000) 0.01 mg/kg in the anterolateral thigh
• BGive oral Diphenhydramine (antihistamine) and monitor in the clinic
• CAdminister inhaled Salbutamol via spacer
• DAdminister Intravenous Hydrocortisone

A 12-year-old girl with Type 1 Diabetes Mellitus presents to the emergency department with vomiting, deep rapid breathing (Kussmaul respiration), and abdominal pain. Laboratory analysis shows: Blood glucose 26 mmol/L (468 mg/dL), arterial pH 7.12, bicarbonate 8 mmol/L, and strong ketones in urine. She has signs of mild dehydration but is hemodynamically stable. What is the recommended fluid resuscitation and insulin management protocol?

• AAdminister a 10-20 mL/kg bolus of 0.9% Normal Saline, followed by a continuous infusion o…
• BAdminister an immediate intravenous bolus of regular insulin 0.1 U/kg, followed by rapid…
• CInfuse continuous insulin at 0.5 U/kg/hour and restrict intravenous fluids to avoid cereb…
• DAdminister a fluid bolus of 5% Dextrose in water and start subcutaneous insulin glargine

A 3-year-old girl is brought to the emergency department in the middle of a generalized tonic-clonic seizure. The seizure has lasted for 15 minutes. She has an intravenous line in place. What is the first-line medication of choice to abort the seizure?

• AIntravenous Lorazepam 0.1 mg/kg
• BIntravenous Phenytoin 20 mg/kg
• CIntramuscular Phenobarbital 15 mg/kg
• DIntravenous Levetiracetam 40 mg/kg

A 14-month-old boy is brought to the emergency department with a history of sudden choking followed by persistent coughing and unilateral wheezing. Examination reveals decreased breath sounds on the right side. What is the most definitive diagnostic and therapeutic management?

• ARigid bronchoscopy
• BFlexible bronchoscopy
• CChest radiograph followed by oral corticosteroids
• DInhaled salbutamol and chest physiotherapy

A 15-year-old girl is brought to the emergency department by her parents after she ingested an unknown quantity of acetaminophen (paracetamol) approximately 4 hours ago in a self-harm attempt. A serum acetaminophen level is drawn. Which of the following is correct regarding the use of the Rumack-Matthew Nomogram and treatment?

• AThe nomogram is used to assess hepatotoxicity risk starting at 4 hours post-ingestion; if…
• BNAC should only be given if the patient develops elevated transaminases
• CThe nomogram is reliable for chronic, repeated ingestions over 48 hours
• DActivated charcoal should be withheld because it neutralizes NAC

A 2-year-old child is brought to the emergency department after ingesting his mother's prenatal iron supplements 3 hours ago. He has vomited twice and is lethargic. Serum iron level is drawn and measures 110 micromol/L (approx. 615 mcg/dL). What is the specific antidote of choice and its key administration indicator?

• AIntravenous Deferoxamine; indicated for serum iron levels >90 micromol/L (500 mcg/dL) or…
• BOral Deferasirox; indicated for any history of iron ingestion
• CIntravenous Calcium EDTA; indicated for iron-induced metabolic acidosis
• DIntravenous British Anti-Lewisite (BAL); indicated for serum iron levels >50 micromol/L

A 14-year-old girl is brought to the emergency department after an intentional overdose of aspirin (salicylates). She is tachypneic and has tinnitus. Arterial blood gas reveals a mixed respiratory alkalosis and metabolic acidosis. Which of the following is a primary treatment strategy to enhance salicylate excretion?

• AUrine alkalinization with intravenous Sodium Bicarbonate
• BUrine acidification with Ammonium Chloride
• CIntravenous loop diuretics (Furosemide) to induce forced diuresis
• DIntravenous N-acetylcysteine