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Saudi Board Part One Examination – Pediatrics: free practice test

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Practice test questions with answers and explanations

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01A 13-year-old boy is brought because he is the shortest in his class. He was born at term with normal weight. His height has followed the 3rd percentile since age 3 with a normal growth velocity. He has no signs of puberty. His father had his growth spurt at 17 years. Bone age is 11 years. What is the most likely diagnosis?

Practice question Unit: General Paediatrics / Growth & Development

  1. AFamilial (genetic) short stature

    Familial short stature has a bone age equal to chronological age and short parents, not a delayed bone age.

  2. BIsolated GH deficiency

    Growth hormone deficiency causes a falling growth velocity that crosses percentiles, which is absent here.

  3. CAcquired primary hypothyroidism

    Acquired hypothyroidism causes growth deceleration with weight gain, not a steady normal velocity.

  4. DConstitutional delay of growth and puberty ✓ Correct answer

    Normal growth velocity, delayed bone age, delayed puberty and a family history of late puberty are typical of constitutional delay.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: General Paediatrics / Growth & Development; Nelson Textbook of Pediatrics, 22nd ed., chapter: Short Stature

02A 15-year-old boy attends with his mother for a routine visit. What is the most appropriate approach to the interview?

Practice question Unit: Adolescent and Behavioural / Ambulatory

  1. AKeep the mother present throughout

    A parent's continuous presence limits disclosure of sensitive issues.

  2. BInterview the mother, who gives consent

    Adolescents need direct communication and an opportunity to speak privately.

  3. CSee him privately for part of the visit ✓ Correct answer

    Seeing the adolescent alone for part of the visit, after explaining confidentiality and its limits, encourages honest disclosure.

  4. DPromise him unconditional confidentiality

    Confidentiality has limits, such as risk of serious harm, so it cannot be promised absolutely.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Adolescent and Behavioural / Ambulatory; Nelson Textbook of Pediatrics, 22nd ed., chapter: Adolescent Medicine: Overview

03A 3-year-old with 2 days of vomiting and diarrhoea is irritable, with cool extremities, capillary refill 3 seconds, heart rate 165/min and blood pressure 94/60 mmHg. Which statement best describes his state?

Practice question Unit: Acute Care (PICU/ED/NICU)

  1. ANo shock while blood pressure is normal

    Normal blood pressure does not exclude shock in children.

  2. BCardiogenic shock

    There are no features of cardiac dysfunction.

  3. CHypotensive septic shock

    His blood pressure is normal for age and the history suggests fluid loss.

  4. DCompensated hypovolaemic shock ✓ Correct answer

    Tachycardia and poor perfusion with maintained blood pressure indicate compensated shock; hypotension is a late sign.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Acute Care (PICU/ED/NICU); Nelson Textbook of Pediatrics, 22nd ed., chapter: Shock; 2025 American Heart Association Guidelines for CPR and ECC: Pediatric Advanced Life Support

04A 5-year-old girl has a soft ejection systolic murmur at the left upper sternal border and a widely split second heart sound that does not vary with respiration. ECG shows right axis deviation and incomplete right bundle branch block. What is the most likely diagnosis?

Practice question Unit: Cardiology

  1. ASecundum atrial septal defect ✓ Correct answer

    Fixed splitting of S2 with a pulmonary flow murmur and right ventricular volume load on ECG indicate a secundum ASD.

  2. BInnocent flow murmur

    Innocent murmurs do not cause fixed splitting or ECG changes.

  3. CSmall restrictive ventricular defect

    A small VSD causes a holosystolic murmur at the lower left sternal border.

  4. DMild aortic valve stenosis

    Aortic stenosis causes a right upper sternal murmur and an ejection click.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Cardiology; Nelson Textbook of Pediatrics, 22nd ed., chapter: Congenital Heart Disease

05A 6-month-old boy has clusters of sudden flexion of the trunk and arms with head nodding, mostly on waking. He has lost his social smile. EEG shows chaotic high-voltage slow waves with multifocal spikes. What is the most likely diagnosis?

Practice question Unit: Neurology

  1. AInfant colic with evening crying

    Colic does not cause regression or EEG changes.

  2. BInfantile epileptic spasms syndrome ✓ Correct answer

    Clusters of flexor spasms on waking, developmental regression and hypsarrhythmia define infantile spasms (West syndrome).

  3. CSandifer syndrome from gastro-oesophageal reflux

    Sandifer posturing relates to feeds and has a normal EEG.

  4. DBenign sleep myoclonus of early infancy

    Benign sleep myoclonus occurs only in sleep with a normal EEG and normal development.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Neurology; Nelson Textbook of Pediatrics, 22nd ed., chapter: Seizures in Childhood

06A 3-year-old boy had bloody diarrhoea a week ago. Now he is pale, irritable and has passed little urine for a day. Haemoglobin 70 g/L with fragmented red cells, platelets 40×10⁹/L, creatinine 210 µmol/L. What is the most likely diagnosis?

Practice question Unit: Gastroenterology / Nutrition

  1. AAcute lymphoblastic leukaemia

    Leukaemia does not cause fragmented red cells with renal failure after diarrhoea.

  2. BPre-renal azotaemia from dehydration

    Dehydration does not cause fragmented red cells and thrombocytopenia.

  3. CHaemolytic uraemic syndrome ✓ Correct answer

    Microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury after bloody diarrhoea define typical (STEC) haemolytic uraemic syndrome.

  4. DImmune thrombocytopenic purpura

    ITP does not cause haemolysis or renal failure.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Gastroenterology / Nutrition; Nelson Textbook of Pediatrics, 22nd ed., chapter: Hemolytic-Uremic Syndrome

07A 9-year-old girl using budesonide from a pressurised metered-dose inhaler has white plaques on her tongue and palate that can be scraped off. Which advice best prevents recurrence?

Practice question Unit: Pulmonary / Allergy & Immunology

  1. ASwitch to a dry powder inhaler

    Dry powder inhalers also deposit steroid in the mouth; spacer use and rinsing reduce candidiasis.

  2. BUse a spacer then rinse the mouth ✓ Correct answer

    Oral candidiasis from ICS is reduced by using a spacer and rinsing and spitting after each dose; the episode is treated with topical antifungals.

  3. CNystatin drops after each dose

    Nystatin treats thrush, but routine prophylaxis is unnecessary once technique is corrected.

  4. DTake the inhaler after meals

    Timing relative to meals does not reduce oral steroid deposition.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Pulmonary / Allergy & Immunology; Nelson Textbook of Pediatrics, 22nd ed., chapter: Childhood Asthma

08A 10-year-old boy has persistent microscopic haematuria and mild proteinuria. He failed a school hearing test showing bilateral high-frequency sensorineural loss. His maternal uncle needed dialysis at 30. What is the most likely diagnosis?

Practice question Unit: Nephrology / Rheumatology / Dermatology

  1. APolycystic kidney disease

    ADPKD presents with cysts, not deafness.

  2. BAlport syndrome ✓ Correct answer

    X-linked Alport syndrome (type IV collagen, COL4A5) causes haematuria progressing to kidney failure in males, sensorineural deafness and eye changes such as anterior lenticonus.

  3. CThin basement membrane nephropathy

    Isolated thin-basement-membrane haematuria does not explain the associated hearing loss and strong family history of early kidney failure.

  4. DBerger IgA nephropathy

    IgA nephropathy is not associated with deafness.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Nephrology / Rheumatology / Dermatology; Nelson Textbook of Pediatrics, 22nd ed., chapter: Alport Syndrome

09A fully immunised 15-month-old girl has had fever 39.3°C for 2 days without a source. She looks well. What is the most important investigation?

Practice question Unit: Infectious Diseases / Preventive Medicine / Immunization

  1. ACatheter urine test and culture ✓ Correct answer

    In immunised children 3–36 months with fever without source, UTI is the commonest serious bacterial infection, especially in girls under 2 years.

  2. BBlood culture with no other tests

    Occult bacteraemia is rare after conjugate vaccines.

  3. CSpinal tap for CSF

    LP is not indicated in a well child without meningeal signs.

  4. DChest X-ray and blood count

    Chest X-ray is reserved for respiratory signs or very high WBC.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Infectious Diseases / Preventive Medicine / Immunization; Nelson Textbook of Pediatrics, 22nd ed., chapter: Fever Without a Focus

10A 10-year-old with new type 1 diabetes has glucose 26 mmol/L, venous pH 7.05, bicarbonate 4 mmol/L and blood ketones 6 mmol/L. According to ISPAD (2022), how is this DKA classified?

Practice question Unit: Endocrinology / Genetics & Metabolic

  1. ALow-grade DKA

    Mild DKA has less severe acidosis than the pH 7.05 and bicarbonate 4 shown here.

  2. BModerate DKA

    These results cross the severe thresholds, so calling the episode merely moderate understates its severity.

  3. CHyperosmolar hyperglycaemic state

    Marked ketonaemia and acidosis support DKA; isolated HHS has little ketosis and much less acidosis.

  4. DSevere DKA ✓ Correct answer

    pH below 7.1 or bicarbonate below 5 mmol/L places DKA in the severe category in the cited ISPAD criteria.

Reference: SCFHS Saudi Board Part One Blueprint – Pediatrics (2024–27), section: Endocrinology / Genetics & Metabolic; Nelson Textbook of Pediatrics, 22nd ed., chapter: Diabetic Ketoacidosis

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