كوز اليومي hospital training
pediatric دكتورة اسراء ناثر.
1. A 5-day-old preterm neonate (28 weeks GA) presents with temperature instability (36.2°C), poor feeding, apnea episodes, and bulging fontanelle. Mother had prolonged rupture of membranes (>18 hrs). What is the MOST likely diagnosis?
A. Apnea of prematurity
B. Late-onset neonatal sepsis
C. Early-onset neonatal sepsis✅
D. Congenital TORCH infection
E. Necrotizing enterocolitis
2. A 2-week-old presents with chorioretinitis, intracranial calcifications, microcephaly, thrombocytopenia, and hepatosplenomegaly. Mother had cat exposure during pregnancy. What is the treatment regimen?
A. Acyclovir IV
B. Ganciclovir IV
C. Pyrimethamine + sulfadiazine + leucovorin✅
D. Ampicillin + gentamicin
E. IVIG 2 g/kg
3. A 900g preterm infant develops abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray after formula feeds. What is the INITIAL management priority?
A. Start TPN and NPO
B. Bowel rest + NG decompression✅
C. Surgery immediately
D. Antibiotics only
E. Increase feeds
4. A 3-day-old term infant has bilirubin 18 mg/dL (high-risk zone), no haemolysis, and breastfeeding well. What is the MOST appropriate management?
A. Exchange transfusion
B. Phenobarbital
C. Stop breastfeeding
D. IVIG 0.5 g/kg
E. Intensive phototherapy✅
5. A 5-year-old and 22 kg presented with diarrhoea and showed delayed capillary refill (4 sec), sunken fontanelle, and poor skin turgor. Estimate the maintenance fluid needs using the body weight 4, 2, 1 method?
A. 40 ml/hr
B. 40 ml/24 hrs
C. 60 ml/hr✅
D. 62 ml/hr
E. 65 ml/hr
6. An 18-month-old has a first generalized tonic-clonic seizure lasting 3 min during fever (39.2°C). No focal signs, first episode. What is the MOST appropriate management?
A. Start phenobarbital daily
B. Lumbar puncture
C. Oral diazepam prophylaxis
D. Fever control✅
7. A 3-year-old with 7 days of fever, strawberry tongue, conjunctivitis, rash, and cervical lymphadenopathy. The ECHO shows coronary dilation. What is the FIRST-LINE treatment?
A. IVIG 400 mg/kg × 4 days
B. Steroids
C. Infliximab 5 mg/kg
D. IVIG 2 g/kg single dose + aspirin✅
E. Observation
8. A 750g preterm (PNA 5 days) has symptomatic Patent ductus arteriosus. What is the PREFERRED pharmacologic closure agent?
A. Ibuprofen IV 10-5-5 mg/kg
B. Indomethacin IV 0.2-0.1-0.1 mg/kg
C. Acetaminophen IV✅
D. Surgical ligation
E. Watchful waiting
9. A 4-year-old presents with periorbital oedema, proteinuria (60 mg/kg/day), serum albumin 2.2 g/dL, and cholesterol 320 mg/dL. What is the INITIAL steroid regimen?
A. Prednisolone 1 mg/kg/day × 4 weeks
B. Prednisolone 2 mg/kg/day × 4-6 weeks✅
C. Cyclophosphamide
D. ACE inhibitor
E. Loop Diuretics only
10. A 4-year-old on prednisone 2 mg/kg/day × 4 weeks shows no response (proteinuria 70 mg/kg/day). Renal biopsy shows Focal segmental glomerulosclerosis. What is the steroid duration before declaring Steroid Resistance Nephrotic Syndrome?
A. 4 weeks
B. 6 weeks
C. 8 weeks
D. 12 weeks✅
E. Until remission
