Free Practice Questions for Perinatal-Neonatal Medicine Board

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1A male infant born at 28 weeks gestation (birth weight 1050 g) is stabilized on continuous positive airway pressure (CPAP) of 6 cmH2O in the delivery room. At 2 hours of life in the neonatal intensive care unit, he has marked subcostal retractions and his fraction of inspired oxygen (FiO2) requirement increases to 0.38 to maintain a preductal SpO2 between 90% and 94%. According to international consensus guidelines for respiratory distress syndrome (RDS), what is the most appropriate management?

A.Increase CPAP pressure to 9 cmH2O and continue observation for 4 more hours

B.Perform endotracheal intubation, administer surfactant, and continue mandatory mechanical ventilation for 48 hours

C.Administer exogenous surfactant via less invasive surfactant administration (LISA) while maintaining spontaneous breathing

D.Initiate high-frequency oscillatory ventilation without surfactant administration

Explanation: Consensus guidelines for RDS recommend exogenous surfactant administration in preterm infants on CPAP who require an FiO2 of 0.30 or greater with a CPAP of at least 6 cmH2O. Less invasive surfactant administration (LISA) using a thin vascular catheter or feeding tube during spontaneous breathing on CPAP reduces the need for mechanical ventilation, bronchopulmonary dysplasia, and mortality compared to intubation and mechanical ventilation.

2A preterm infant born at 24 weeks gestation is ventilator-dependent on Day 18 of life with high ventilatory settings (mean airway pressure 11 cmH2O, FiO2 0.55). Multiple extubation attempts have failed due to severe bronchopulmonary dysplasia (BPD) with significant parenchymal haziness and atelectasis on chest radiograph. Sepsis workup is negative. According to evidence from randomized clinical trials (such as the DART protocol), what is the most appropriate systemic corticosteroid regimen?

A.High-dose dexamethasone at 0.5 mg/kg/day for 28 days

B.Low-dose dexamethasone tapering course totaling 0.89 mg/kg over 10 days

C.Inhaled fluticasone alone without systemic corticosteroids

D.Intravenous hydrocortisone at physiological replacement doses (1 mg/kg/day) for 3 days

Explanation: The DART trial demonstrated that a low-dose, 10-day tapering course of dexamethasone (starting at 0.15 mg/kg/day and tapering to total 0.89 mg/kg) facilitates successful extubation and reduces supplemental oxygen dependence in ventilator-dependent infants without causing the severe neurodevelopmental deficits (cerebral palsy) previously seen with early, high-dose dexamethasone courses.

3A term female neonate is born with prenatally diagnosed left-sided congenital diaphragmatic hernia (CDH). She is immediately intubated in the delivery room without bag-mask ventilation. In the NICU, which mechanical ventilation strategy is most appropriate according to CDH EURO Consortium guidelines?

A.Routine continuous administration of neuromuscular blockade and sedation to eliminate spontaneous breathing

B.Vigorous hyperventilation targeting PaCO2 < 30 mmHg to induce cerebral and pulmonary vasodilation

C.Immediate high-frequency oscillatory ventilation targeting 100% preductal and postductal SpO2

D.Gentle conventional ventilation: preductal SpO2 85-95%, PIP < 25 cmH2O, permissive hypercapnia

Explanation: Modern management of CDH focuses on 'gentle ventilation' to minimize barotrauma and volutrauma in hypoplastic, vulnerable lungs. Target parameters include peak inspiratory pressure (PIP) below 25 cmH2O, preductal SpO2 85-95%, and permissive hypercapnia with PaCO2 50-70 mmHg, avoiding lung overdistension and secondary pulmonary damage.

4A term infant delivered via Cesarean section for meconium-stained amniotic fluid develops severe hypoxemia on mechanical ventilation (mean airway pressure 14 cmH2O, FiO2 1.0). Arterial blood gas shows: pH 7.28, PaCO2 44 mmHg, PaO2 48 mmHg. Echocardiography demonstrates suprasystemic right ventricular pressure with right-to-left shunting across the ductus arteriosus and foramen ovale. What is the calculated Oxygenation Index (OI) and the most appropriate next intervention?

A.OI is 12; increase PEEP to 12 cmH2O

B.OI is 18; initiate intravenous milrinone infusion

C.OI is 29; initiate inhaled nitric oxide (iNO) at 20 ppm

D.OI is 24; perform emergent cardiac catheterization

Explanation: The Oxygenation Index (OI) is calculated as (Mean Airway Pressure x FiO2 x 100) / PaO2 = (14 x 1.0 x 100) / 48 = 29.2. An OI of 20 or greater in a term or near-term infant with echocardiographically confirmed persistent pulmonary hypertension of the newborn (PPHN) is the evidence-based threshold for initiating inhaled nitric oxide (iNO) at 20 ppm to improve systemic oxygenation and reduce the need for extracorporeal membrane oxygenation (ECMO).

5A 41-week infant delivered through thick particulate meconium develops severe meconium aspiration syndrome (MAS) requiring invasive mechanical ventilation. Which of the following best describes the pathophysiological impact of aspirated meconium on endogenous pulmonary surfactant, and the therapeutic rationale for exogenous surfactant administration?

A.Meconium stimulates hypersecretion of surfactant, leading to surfactant accumulation and alveolar plugging

B.Meconium free fatty acids, bilirubin and inflammatory proteins inactivate surfactant

C.Meconium directly destroys Type I pneumocytes while completely sparing Type II pneumocytes and surfactant function

D.Meconium causes pure mechanical airway obstruction without any chemical pneumonitis or surfactant alteration

Explanation: Aspirated meconium induces chemical pneumonitis, direct alveolar injury, and acute surfactant inactivation. Meconium components, specifically free fatty acids, cholesterol, and bile salts, displace and degrade surfactant protein complexes (SP-A and SP-B), leading to marked alveolar collapse and ventilation-perfusion mismatch. Exogenous surfactant replacement or diluted surfactant lavage restores surface tension properties, improves oxygenation, and reduces the requirement for ECMO.

6A preterm infant born at 27 weeks gestation is ready for extubation on Day 10 of life after a successful spontaneous breathing trial. The clinical team considers post-extubation non-invasive respiratory support using heated, humidified high-flow nasal cannula (HFNC) versus continuous positive airway pressure (NCPAP). Based on randomized controlled trials in preterm neonates, what is the established comparison between HFNC and NCPAP?

A.HFNC has significantly higher extubation failure rates compared to NCPAP across all clinical settings

B.HFNC delivers a precise, measurable, fixed positive end-expiratory pressure identical to closed-circuit CPAP regardless of mouth leak

C.HFNC is contraindicated in infants born before 32 weeks gestation due to high risk of pneumothorax

D.HFNC (at flow rates of 4 to 8 L/min) has non-inferior extubation failure rates compared to NCPAP with significantly less nasal trauma

Explanation: Randomised non-inferiority trials of HFNC as post-extubation support in preterm infants (Manley 2013; Collins 2013) and the Cochrane review of HFNC versus NCPAP show that HFNC at flows of 4 to 8 L/min gives extubation-failure rates non-inferior to NCPAP while causing significantly less nasal mucosal trauma and allowing easier handling and parental contact. The HIPSTER trial, by contrast, tested HFNC as primary support from birth and found a higher treatment-failure rate than NCPAP, so the non-inferiority finding applies to post-extubation support rather than to all clinical settings.

7A preterm male infant born at 30 weeks gestation experiences recurrent episodes of apnea of prematurity (cessation of breathing for > 20 seconds accompanied by desaturations to 78% and bradycardia to 75 bpm). Sepsis workup is negative. He is started on caffeine citrate. What is the primary molecular mechanism of action of caffeine in treating apnea of prematurity, and what is the typical postmenstrual age (PMA) for considering its discontinuation?

A.Direct stimulation of GABA-A receptors in the medulla; discontinue at 36 weeks PMA regardless of clinical events

B.Non-selective adenosine A1/A2A antagonism in the brainstem; stop at 33-34 weeks PMA

C.Selective inhibition of phosphodiesterase type 5 (PDE-5); discontinue at 40 weeks PMA

D.Agonism of beta-2 adrenergic receptors on alveolar type II pneumocytes; discontinue 24 hours after birth

Explanation: Caffeine citrate stimulates the central respiratory center primarily through non-selective competitive antagonism of inhibitory adenosine A1 and A2A receptors. This increases medullary sensitivity to hypercapnia, enhances central respiratory drive, and improves diaphragmatic contractility. In clinical practice, caffeine is typically discontinued around 33 to 34 weeks postmenstrual age (PMA), provided the infant has been free of significant apnea and bradycardia events for 5 to 7 consecutive days.

8A 25-week preterm infant on synchronized intermittent mandatory ventilation develops sudden acute deterioration: severe bradycardia (heart rate 55 bpm), cyanosis with SpO2 55%, marked hypotension, and asymmetry of chest wall excursion. Breath sounds are severely diminished on the right hemithorax, and heart sounds are displaced to the left side. What is the most appropriate immediate life-saving intervention?

A.Obtain an urgent portable chest radiograph to confirm the location of the endotracheal tube

B.Perform immediate needle thoracostomy in the right 2nd intercostal space at the midclavicular line

C.Administer an intravenous push of epinephrine (0.02 mg/kg) via the umbilical venous catheter

D.Perform endotracheal suctioning and administer a dose of surfactant

Explanation: The clinical presentation of acute cardiovascular collapse, displaced heart sounds, absent unilateral breath sounds, and severe hypoxemia in a ventilated preterm infant is diagnostic of tension pneumothorax. Waiting for a chest radiograph causes fatal cardiac arrest. Emergent needle thoracostomy (inserting a 20- or 22-gauge angiocatheter in the 2nd intercostal space midclavicular line or 4th/5th intercostal space anterior axillary line) decompresses the pleural space immediately and restores venous return to the heart.

9A 39-week male infant delivered by elective Cesarean section without labor develops tachypnea (respiratory rate 88 breaths/min), mild intercostal retractions, and grunting at 30 minutes of life. A chest radiograph demonstrates prominent perihilar streaking, fluid within the horizontal fissure, and mild hyperinflation without focal consolidation. Which molecular mechanism explains the underlying pathophysiology of this condition?

A.Delayed clearance of fetal lung liquid from inadequate ENaC activation

B.Premature degradation of surfactant protein B (SP-B) by maternal autoantibodies

C.Congenital absence of pulmonary lymphatic vessels within the visceral pleura

D.Microvascular thrombosis within the pulmonary capillaries induced by maternal hypercoagulability

Explanation: Transient Tachypnea of the Newborn (TTN) results from delayed resorption of fetal lung fluid. During labor, surges in maternal epinephrine and glucocorticoids trigger a critical phenotypic switch in alveolar epithelial sodium channels (ENaC), converting the alveolar epithelium from active chloride and fluid secretion to active sodium and fluid absorption. Elective Cesarean delivery without labor bypasses this catecholamine surge, impairing ENaC activation and leading to transient fluid retention in alveolar and interstitial spaces.

10A 24-week infant on Day 3 of life has received two doses of exogenous surfactant for severe RDS. Over the past hour, the infant experiences sudden catastrophic deterioration with profound desaturations (SpO2 60%), hypotension, and continuous bright red blood pouring from the endotracheal tube. What is the most significant underlying vascular risk factor for acute pulmonary hemorrhage in this setting, and what is the immediate ventilatory intervention?

A.Right-to-left shunting across a restrictive foramen ovale; decrease PEEP to 3 cmH2O

B.Pulmonary vein thrombosis; initiate emergent systemic thrombolysis

C.Large left-to-right PDA shunt causing capillary hyperperfusion; increase PEEP

D.Congenital pulmonary arteriovenous fistula; perform immediate rigid bronchoscopy

Explanation: Acute neonatal pulmonary hemorrhage typically occurs on Days 2 to 4 of life following surfactant therapy in extremely preterm infants with a large left-to-right PDA shunt. Rapid reduction in pulmonary vascular resistance after surfactant increases left-to-right ductal shunting, producing massive pulmonary capillary engorgement, alveolar filtration, and stress failure of the capillary-alveolar membrane. Immediate management involves increasing PEEP (to 8-10 cmH2O) to create a mechanical tamponade effect against capillary bleeding, suctioning the airway, and administering intratracheal epinephrine.

About the Perinatal-Neonatal Medicine Board Exam

Independent English-language MCQ study adaptation by OpenExamPrep. This independent practice exam provides preparation for the Saudi Fellowship Final Written Examination in Perinatal-Neonatal Medicine. It covers respiratory, cardiovascular, maternal-fetal medicine, neonatal resuscitation, genetics, metabolism, nutrition, endocrinology, nephrology, gastroenterology, infectious diseases, hematology, neurology, biostatistics, and neonatal pharmacology.

Exam sponsor: Saudi Commission for Health Specialties (SCFHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

One paper of 80–120 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

Time Limit

Not published by SCFHS

Passing Score

70% (lowered to minimum 65% if pass rate under 70%)

Exam / Certification Fees

Not published by SCFHS

Exam sponsor website

Reported exam pass rate: Not published by SCFHS. SCFHS publishes no candidate pass rate. The blueprint instead sets the passing score at 70% and, if fewer than 70% of candidates pass before final approval, lowers that score one mark at a time until a 70% pass rate is reached or the score reaches 65%, whichever comes first; it is never lowered below 65%. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

13%

Respiratory

Respiratory distress syndrome, bronchopulmonary dysplasia, persistent pulmonary hypertension, and advanced mechanical ventilation.

Cardiovascular

Congenital heart disease, patent ductus arteriosus, neonatal arrhythmias, and targeted neonatal echocardiography.

13%

Maternal-Fetal Medicine, Asphyxia and Resuscitation

NRP guidelines, fetal-maternal conditions, hypoxic-ischemic encephalopathy, and therapeutic hypothermia protocols.

Genetics, Metabolic and Orthopedic

Inborn errors of metabolism, chromosomal abnormalities, skeletal dysplasias, and neonatal orthopedic conditions.

Nutrition

Total parenteral nutrition, human milk fortification, metabolic bone disease, and trophic feeding regimens.

Endocrine and Skin

Congenital adrenal hyperplasia, neonatal hypoglycemia, thyroid disorders, and neonatal dermatology.

Renal and Eye/Ear

Neonatal acute kidney injury, congenital urinary tract anomalies, retinopathy of prematurity, and hearing screening.

Gastroenterology

Necrotizing enterocolitis, intestinal malrotation, biliary atresia, and Hirschsprung disease.

Immunology and Infections

Early- and late-onset neonatal sepsis, congenital TORCH infections, and antimicrobial stewardship.

Hematology and Bilirubin

Hyperbilirubinemia guidelines, hemolytic disease, neonatal alloimmune thrombocytopenia, and coagulation disorders.

Neurology

Intraventricular hemorrhage, periventricular leukomalacia, neonatal seizures, and brain MRI interpretation.

Statistics and Research

Diagnostic test evaluation, biostatistics, clinical trial interpretation, and epidemiology in neonatal medicine.

Pharmacology

Neonatal pharmacokinetics, therapeutic drug monitoring, cardiovascular inotropes, and sedative-analgesic regimens.

Preparing for the Perinatal-Neonatal Medicine Board Exam

What You Need to Know

Passing score: 70% (lowered to minimum 65% if pass rate under 70%)
Assessment: One paper of 80–120 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.
Time limit: Not published by SCFHS
Exam / certification fees: Not published by SCFHS Official sources

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Frequently Asked Questions

What is the format of the Saudi Fellowship Final Written Examination in Perinatal-Neonatal Medicine?

One paper of 80–120 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

What is the passing score for the fellowship written exam?

The standard passing score established by SCFHS is 70%. If the overall candidate pass rate is below 70%, the passing mark may be lowered by one percentage point at a time toward a 70% pass rate, down to a minimum passing score of 65%.

Is this practice question bank affiliated with or endorsed by SCFHS?

No. This practice question bank is an independent English-language MCQ study adaptation developed by OpenExamPrep for self-study and fellowship board exam preparation. It is not affiliated with, sponsored by, or endorsed by the Saudi Commission for Health Specialties.

Free Practice Questions for Perinatal-Neonatal Medicine Board

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