Prometric Exam Questions for Paediatrics Specialists 2026: 15 Practice MCQs with Answers and Rationale for the PED5391 Paper

The paediatrics specialist paper (PED5391; consultants sit PED5712) tests registrar-level management of the sick child: the neonate, the feverish infant, the wheezy toddler, the child with a rash, and the one who is not growing. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 60 to 70% depending on the title and authority.

The fifteen questions below follow that blueprint. Allow about 70 seconds each. The exam leans on age-specific normal values, vaccination schedules and the red flags that separate a well child from a sick one.

For titles and the route, read the paediatrician guide. For timed papers use the Paediatrics specialist bank, about 3,700 questions, or the consultant bank.

Neonatology

Question 1

A term newborn at one minute has a heart rate of 80/min, is gasping, and is blue. After drying and stimulation the heart rate remains 80. The next step is:

1. Chest compressions
2. Five inflation breaths, then reassess heart rate
3. Intravenous adrenaline
4. Wait another minute

Answer: B. Newborn resuscitation is ventilation-led. Effective lung inflation usually raises the heart rate; compressions at 3:1 are started only if the heart rate stays below 60 despite good ventilation, and adrenaline follows if that fails.

Question 2

A 3-day-old term baby has a total serum bilirubin of 320 micromol/L, is well, and is exclusively breastfed. Direct bilirubin is normal. The most appropriate action is:

1. Stop breastfeeding permanently
2. Plot on the gestation-specific treatment chart and start phototherapy if above the threshold, supporting feeding
3. Exchange transfusion immediately
4. Reassure and discharge without follow-up

Answer: B. Management follows the age-in-hours and gestation thresholds on the treatment chart. Phototherapy is started above the phototherapy line; exchange transfusion is for levels above the exchange line or signs of encephalopathy. Breastfeeding continues.

Question 3

A preterm infant at 29 weeks develops respiratory distress within hours of birth with a ground-glass appearance on chest x-ray. The most likely diagnosis is:

1. Meconium aspiration
2. Respiratory distress syndrome from surfactant deficiency
3. Transient tachypnoea of the newborn
4. Congenital pneumonia only

Answer: B. Surfactant deficiency is the classic cause in preterm infants, treated with CPAP or ventilation and surfactant replacement. Antenatal steroids reduce the risk. Meconium aspiration is a term or post-term problem.

Growth and development

Question 4

Which developmental finding at 18 months should prompt referral?

1. Not yet speaking in sentences
2. Not walking independently
3. Not toilet trained
4. Unable to ride a tricycle

Answer: B. Independent walking is expected by 18 months; later walking needs assessment for neuromuscular disease, hip problems or global delay. Two-word phrases are expected by about 2 years, tricycle riding by 3 and toilet training is variable.

Question 5

A 6-year-old boy has weight on the 90th centile, height on the 10th centile, and a bone age delayed by two years. The most likely cause of short stature is:

1. Familial short stature
2. An endocrine cause such as hypothyroidism or growth hormone deficiency
3. Constitutional delay
4. Normal variation

Answer: B. Short stature with relative overweight and delayed bone age points to an endocrine cause. Familial short stature has a normal bone age; constitutional delay has delayed bone age with a thin build and a family history of late puberty.

Infectious disease and immunisation

Question 6

A 6-week-old infant presents with a temperature of 38.5 °C and is otherwise well-looking. The appropriate management is:

1. Paracetamol and review in 48 hours
2. Full septic screen including blood, urine and CSF cultures, and empirical intravenous antibiotics pending results
3. Oral antibiotics
4. Reassure the parents

Answer: B. Fever in an infant under 3 months carries a high risk of serious bacterial infection that cannot be excluded clinically. Investigate fully and treat empirically until cultures are negative.

Question 7

A 4-year-old has had five days of fever, bilateral non-purulent conjunctivitis, cracked red lips, a polymorphous rash, cervical lymphadenopathy and swollen hands. The treatment that reduces coronary complications is:

1. Oral antibiotics
2. Intravenous immunoglobulin with aspirin
3. Antivirals
4. Steroids alone

Answer: B. This is Kawasaki disease. IVIG within 10 days of fever onset markedly reduces coronary aneurysms; aspirin is given alongside, and echocardiography is performed at diagnosis and in follow-up.

Question 8

According to typical Gulf national immunisation schedules, which vaccine is given at birth?

1. Measles
2. BCG and hepatitis B
3. Pneumococcal conjugate vaccine
4. Varicella

Answer: B. BCG and the first hepatitis B dose are given at birth in the UAE, Saudi, Qatari and most regional schedules. Measles-containing vaccine starts at 9 to 12 months. Check the exact schedule for the authority you are sitting under.

Respiratory and gastroenterology

Question 9

A 9-month-old has coryza, cough, wheeze, fine crackles and feeding difficulty with saturations of 90% in air. The management is:

1. Antibiotics and oral steroids
2. Supportive care: supplemental oxygen to keep saturations above about 90 to 92%, nasogastric or intravenous fluids if feeding is poor, and minimal handling
3. Regular salbutamol nebulisers
4. Chest physiotherapy

Answer: B. Bronchiolitis is viral and self-limiting; bronchodilators, steroids and antibiotics do not help. Admission is for hypoxia, poor feeding or apnoea, with high-flow support if needed.

Question 10

A 6-week-old has forceful non-bilious vomiting after every feed and a palpable olive-shaped mass. The expected electrolyte picture is:

1. Hyperchloraemic metabolic acidosis
2. Hypochloraemic, hypokalaemic metabolic alkalosis
3. Hyperkalaemia
4. Normal electrolytes

Answer: B. Pyloric stenosis causes loss of gastric acid and chloride. Correct fluids and electrolytes first, then pyloromyotomy. Bilious vomiting would suggest malrotation and is a surgical emergency.

Question 11

A 2-year-old with gastroenteritis has sunken eyes, reduced skin turgor and a capillary refill of 3 seconds but is alert and drinking. The best rehydration approach is:

1. Oral rehydration solution 50 to 100 mL/kg over 4 hours plus ongoing losses
2. Intravenous bolus immediately
3. Nil by mouth for 24 hours
4. Antidiarrhoeal drugs

Answer: A. Moderate dehydration in a child who can drink is treated orally, with zinc in low-resource settings. Intravenous fluids are for shock or failure of oral rehydration. Antidiarrhoeals are avoided in children.

Nephrology, endocrinology and haematology

Question 12

A 4-year-old has generalised oedema, proteinuria of 4 g/day, serum albumin 18 g/L and normal renal function. First-line treatment is:

1. Renal biopsy before any treatment
2. Oral corticosteroids, with a course of prednisolone
3. Cyclophosphamide
4. Diuretics only

Answer: B. Nephrotic syndrome at this age is usually minimal change disease and steroid-sensitive, so steroids are started without biopsy. Biopsy is reserved for atypical features or steroid resistance.

Question 13

A 10-year-old with type 1 diabetes presents in DKA. Which complication must be monitored for most carefully during treatment?

1. Hyperglycaemia
2. Cerebral oedema, especially in the first 12 hours, presenting with headache, falling heart rate and altered consciousness
3. Hypertension
4. Constipation

Answer: B. Cerebral oedema is the main cause of death in paediatric DKA. Cautious fluid rates, delayed insulin start after fluids, and hourly neurological observations reduce risk; hypertonic saline or mannitol is given if it develops.

Question 14

A 2-year-old of Arab descent with sickle cell disease presents with fever, cough, chest pain and a new infiltrate on chest x-ray. The management includes:

1. Antibiotics covering typical and atypical organisms, oxygen, analgesia, cautious fluids and transfusion if hypoxic or deteriorating
2. Fluid restriction and observation
3. Discharge with oral antibiotics
4. Steroids alone

Answer: A. This is acute chest syndrome, a leading cause of death in sickle cell disease and common across the Gulf. It is treated aggressively with antibiotics, oxygen, incentive spirometry and transfusion when indicated.

Child protection

Question 15

A 7-month-old who is not yet mobile presents with a spiral femoral fracture. The history is of rolling off a sofa. The appropriate action is:

1. Accept the history and discharge after casting
2. Treat the fracture, perform a skeletal survey and safeguarding assessment, and report according to local child protection law
3. Confront the parents and call the police directly
4. Ignore the inconsistency

Answer: B. A fracture in a non-mobile infant with an inconsistent mechanism is a sentinel injury for abuse. Every Gulf country has mandatory reporting for suspected child abuse, and the child's safety takes precedence.

How to use these questions

• Learn age-specific values: vital signs, fluid volumes, drug doses by weight, developmental milestones, vaccine schedules.
• Know the red flags that mandate admission or investigation, especially in the under-3-month infant.
• Cover neonatology even if you work in general paediatrics; it is a large share of the paper.
• Practise under time in the Paediatrics bank, with the error-log method.

Other specialty banks are listed in specialty question banks for doctors. Pay for paediatricians by country is in doctor salary in the UAE. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the paediatrics specialist Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 60 to 70% depending on the title and authority; the consultant paper sits at the higher end.

Does the paper include neonatology?

Yes, substantially: resuscitation, jaundice, prematurity, sepsis and feeding.

Can an MD or DCH holder sit the specialist paper?

An MD or equivalent postgraduate degree usually supports a specialist title; a diploma alone may not. Check the recognition guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.