SMLE Paediatrics 1 — Questions and Answers
Question 1: According to the Saudi national immunisation schedule, at what age should the first dose of measles-mumps-rubella (MMR) vaccine be administered?
- 6 months
- 9 months
- 12 months (Correct answer)
- 18 months
Correct answer: 12 months
Per the Saudi Ministry of Health national immunisation schedule and SCFHS guidelines, the first dose of MMR vaccine is administered at 12 months of age, with a second dose at 18 months.
Question 2: A 3-year-old child presents with barking cough, inspiratory stridor, and a 'steeple sign' on anteroposterior neck X-ray. What is the most likely diagnosis?
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Foreign body aspiration
- Bacterial tracheitis
Correct answer: Croup (laryngotracheobronchitis)
Croup (acute laryngotracheobronchitis) is characterised by a barking cough, inspiratory stridor, and hoarseness. The 'steeple sign' on AP neck X-ray represents subglottic narrowing, which is the hallmark radiographic finding.
Question 3: A 6-month-old infant presents with olive-shaped mass in the right upper quadrant, non-bilious projectile vomiting, and visible peristalsis. What is the most likely diagnosis?
- Intussusception
- Pyloric stenosis (Correct answer)
- Duodenal atresia
- Malrotation with volvulus
Correct answer: Pyloric stenosis
Infantile hypertrophic pyloric stenosis classically presents between 2-8 weeks of age (can present later) with non-bilious projectile vomiting, a palpable 'olive-shaped' mass in the right upper quadrant, and visible gastric peristalsis.
Question 4: A 5-year-old child presents with periorbital oedema, proteinuria (4+), and hypoalbuminaemia. Serum cholesterol is elevated. What is the most likely diagnosis?
- Acute glomerulonephritis
- Nephrotic syndrome (minimal change disease) (Correct answer)
- Henoch-Schönlein purpura
- Haemolytic uraemic syndrome
Correct answer: Nephrotic syndrome (minimal change disease)
Nephrotic syndrome in children is characterised by heavy proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia. Minimal change disease is the most common cause in children (80%), and it typically responds well to corticosteroid therapy.
Question 5: A neonate born at 32 weeks gestation develops respiratory distress within minutes of birth. Chest X-ray shows ground-glass opacification with air bronchograms. What is the most likely diagnosis?
- Transient tachypnoea of the newborn
- Respiratory distress syndrome (hyaline membrane disease) (Correct answer)
- Meconium aspiration syndrome
- Congenital pneumonia
Correct answer: Respiratory distress syndrome (hyaline membrane disease)
Respiratory distress syndrome (RDS) occurs in premature infants due to surfactant deficiency. The typical chest X-ray shows bilateral ground-glass opacification with air bronchograms. Treatment includes surfactant replacement and supportive ventilation.
Question 6: A 4-year-old child presents with a purpuric rash on the buttocks and lower extremities, abdominal pain, and joint swelling. Urinalysis shows haematuria and proteinuria. What is the most likely diagnosis?
- Idiopathic thrombocytopenic purpura
- Henoch-Schönlein purpura (IgA vasculitis) (Correct answer)
- Meningococcaemia
- Kawasaki disease
Correct answer: Henoch-Schönlein purpura (IgA vasculitis)
Henoch-Schönlein purpura (IgA vasculitis) is characterised by palpable purpura (typically on buttocks and lower limbs), arthralgia, abdominal pain, and renal involvement (haematuria/proteinuria). Platelet count is normal, distinguishing it from ITP.
SMLE Paediatrics 1
According to the Saudi national immunisation schedule, at what age should the first dose of measles-mumps-rubella (MMR) vaccine be administered?