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Neonatology MCQ's

1- A 2-week-old infant is jaundiced. Findings include weight and length at the 75th percentile for age; icterus; with hepatosplenomegaly; total bilirubin, 6.3 mg/dL; direct bilirubin, 5.5 mg/dL; alanine aminotransferase activity, 130 U/L; aspartate aminotransferase activity, 143 U/L; and gamma-glutamyl transpeptidase activity, 950 U/L.
Of the following, the BEST study to evaluate the excretion of bile from the liver is

A. computed tomography of the liver
B. hepatic ultrasonography
C. hepatobiliary scintigraphy
D. measurement of galactose-1-phosphate uridyltransferase activity
E. measurement of the serum alpha1-antitrypsin level

2- Most authorities encourage the early introduction of human milk in the very-low-birthweight (VLBW) infant. However, mothers must be informed early in the feeding process that supplementation of their milk with protein and other nutrients may be necessary.

The MOST likely explanation for why protein supplementation of human milk often is required in the VLBW infant is that
A. human milk contains less than half the protein of cow milk formula
B. the hepatic ****bolism of protein is ineffective in most preterm infants
C. the protein in preterm human milk is of poor nutritional quality
D. VLBW infants have excessive gastrointestinal losses of ingested protein
E. VLBW infants require an increased protein intake because of their high catabolic rate

3- Which of the following constellations of features BEST describes the fetal alcohol syndrome?
A. Elfin facies, irritability, and supravalvular aortic stenosis
B. Growth deficiency with microcephaly, developmental delay, and short palpebral fissures
C. Intrauterine growth retardation, triangular-shaped face, and clinodactyly of the fifth finger
D. Short stature, ***bed neck, and pulmonic stenosis
E. Weakness, club feet, immobile face, and inadequate respirations

4- Among the following, the condition that is MOST likely to predispose a pediatric patient to the development of systemic candidiasis is
A. history of atopy
B. history of prematurity
C. immunosuppression
D. presence of an indwelling urinary catheter
E. recent tonsillectomy

5- After intubation, arterial blood gas measurements for a 12-hour-old term infant include a PO2 of 18 torr and a PCO2 of 25 torr while receiving ventilation with 100% FIO2. The arterial pH is 7.35, and the umbilical line arterial blood pressure is 75/45 mm Hg. There is no cardiac murmur. Chest radiography shows normal cardiac size and diminished pulmonary vascularity.
The mechanism by which intravenous prostaglandin E1 will benefit this infant is MOST likely due to
A. decreased pulmonary vascular resistance
B. decreased systemic vascular resistance
C. increased mixing of systemic and pulmonary circulations
D. increased pulmonary blood flow
E. increased systemic blood flow

6- A female infant born to a 24-year-old woman has been diagnosed clinically as having Down syndrome. The mother is concerned about her risk of having another child who has a chromosomal abnormality.
The statement that you are MOST likely to include in your discussion is that her risk
A. can be estimated by determination of maternal serum alpha-fetoprotein in all future pregnancies
B. cannot be estimated until her infant's chromosome complement has been determined

C. is increased for Down syndrome, but not for any other chromosomal abnormality
D. is no greater than that of any other woman her age
E. is not increased until she reaches the age of 35





7-During delivery of an infant who has an estimated gestational age of 42 weeks, you note that the amniotic fluid looks like pea soup and contains thick particles of meconium.
Of the following, the MOST important initial step in resuscitation of the infant is to
A. aspirate the gastric *******s
B. determine the Apgar score
C. initiate tracheal intubation
D. provide positive pressure ventilation
E. suction the hypopharynx





9- In addition to irritability, sweating, and difficulty breathing with feeding, the symptom that is MOST indicative of congestive heart failure in a 3-week-old infant is
A. ascites
B. cough
C. cyanosis
D. diminished feeding volume
E. pretibial edema

An infant who was born with myelomeningocele has hydrocephalus, and a ventriculoperitoneal shunt is placed. His parents are concerned about recognizing the signs and symptoms of shunt blockage.
Of the following, the BEST information you can give the parents is that
A. behavioral changes such as decreased spontaneity and mild lethargy may indicate shunt malfunction
B. fewer than 30% of all shunts malfunction
C. most shunt failures occur more than 5 years after the initial surgery
D. seizures are the most common manifestation of shunt malfunction
E. shunt malfunction is usually due to infection






11- You are evaluating a 1-month-old boy who has had inspiratory stridor since birth. The stridor is associated with retractions when the infant becomes agitated. Physical examination reveals a weight of 3.4 kg (10th percentile), no expiratory stridor, and weak cry.
Of the following, the MOST likely cause of the stridor in this infant is
A. bilateral paralysis of the vocal cords
B. laryngeal cleft
C. laryngomalacia
D. subglottic cyst
E. tracheomalacia





12- A male infant is born at an estimated gestational age of 34 weeks. His measurements at birth are: weight, 1,200 g (<10th percentile); crown-heel length, 40 cm (10th percentile); and head circumference, 31.5 cm (50th percentile).
Of the following, the MOST likely explanation for the growth pattern of this infant is
A. chromosomal abnormality
B. congenital viral infection
C. gestational diabetes
D. hereditary constitution
E. pregnancy-induced hypertension






13- You are writing orders for parenteral nutrition for a 24-hour-old infant who weighs 900 g. The infant is on a ventilator, but clinically stable.
Of the following, the MOST appropriate order is to
A. add cysteine
B. add sodium to provide 3.0 mEq/kg per day
C. provide a protein intake of 3.0 g/kg per day
D. provide nonprotein calories of at least 30 kcal/kg per day
E. use casein hydrolysate as a source of protein






14-A male infant is delivered after a pregnancy complicated by breech presentation. Physical examination reveals internally rotated shoulders, decreased muscle mass, extended elbows, contractures of the hands, flexion contractures at the knees, and bilateral equinovarus deformities.
Of the following, the MOST likely outcome for this infant is
A. ambulation after initiation of early physical therapy and surgery
B. death during the first year of life due to respiratory failure
C. death in the first days of life due to renal disease
D. progressive contractures and scoliosis
E. severe psychomotor retardation and failure to attain motor milestones






15- The decreased incidence of enteric infections noted in breastfed infants compared with formula-fed infants is MOST likely due to the
A. more alkaline stool pH in breastfed infants
B. nutritional benefits of human milk on the infant's immune system
C. predominance of Bacteroides and Clostridium in the gut of breastfed infants
D. presence of protective antibodies against enteric infection in human milk
E. sterility of human milk





16- A newborn who weighs 600 g and whose estimated gestational age is 24 weeks at birth is admitted to the neonatal intensive care unit after successful resuscitation in the delivery room. Arterial blood gas measurements on room air are: pH, 7.35; PCO2, 42 mm Hg; PO2, 68 mm Hg; base deficit, 2 mEq/L.
Of the following, the MOST appropriate initial management is to
A. begin intravenous vancomycin
B. begin phototherapy
C. initiate enteral feeding
D. provide bicarbonate infusion
E. provide glucose infusion

A 3-day-old infant presents to the emergency department with vomiting, lethargy, hypotonia, and jaundice. Physical examination reveals hepatomegaly and neurologic depression. A full sepsis evaluation is undertaken, and the Gram stain of the cerebrospinal fluid reveals gram-negative organisms.
Of the following, the BEST additional laboratory test to obtain is
A. erythrocyte galactose-1-phosphate
B. liver glycogen *******
C. plasma insulin level
D. plasma very long-chain fatty acids
E. stool porphyrins





18- You are examining a term newborn in the nursery. His weight is 3.27 kg (50th percentile), and his length is 50.5 cm (50th percentile). The pregnancy, labor, and delivery were unremarkable. There are no significant findings on physical examination.
The MOST likely head circumference in this child, if it is consistent with his other growth parameters, is
A. 31 cm
B. 33 cm
C. 35 cm
D. 37 cm
E. 39 cm





19- previously healthy 5-day-old male who was born at home develops bruising and melena. The pregnancy, delivery, and postnatal course were unremarkable. The infant is breastfeeding vigorously every 2 hours. Findings on physical examination are unremarkable except for several large bruises. Laboratory testing reveals: hemoglobin, 81 g/L (8.1 g/dL); white blood cell count, 9.4 x 109/L (9,400/mm3); prothrombin time, 37 seconds; partial thromboplastin time, 98 seconds; platelet count, 242 x 109/L (242,000/mm3); and fibrinogen, 2.34 g/L (234 mg/dL).
Of the following, the MOST likely cause of the bleeding is
A. disseminated intravascular coagulation
B. factor VIII deficiency hemophilia
C. liver disease
D. vitamin K deficiency
E. von Willebrand disease





20- A newborn whose estimated gestational age is 42 weeks is stained with meconium. Tracheal intubation reveals meconium in the hypopharynx as well as below the vocal cords. The infant has respiratory distress. A chest radiograph is obtained.
Of the following, the MOST likely radiographic finding is
A. coarse infiltrates
B. decreased lung volumes
C. mediastinal shift
D. pleural effusion
E. reticulogranular pattern





21- A 20-year-old primigravida at 30 weeks of gestation has a blood pressure of 160/112 mm Hg, serum total bilirubin level of 44.5 mcmol/L (2.6 mg/dL), serum alanine aminotransferase level of 150 U/L, and platelet count of 75 x 109/L (75,000/mm3). She is hospitalized for observation and electronic fetal heart rate monitoring.
Of the following, the MOST ominous sign of fetal distress during monitoring would be
A. early decelerations
B. increased beat-to-beat variability
C. late decelerations
D. spontaneous accelerations
E. variable decelerations





22- A term newborn presents with bilious vomiting shortly after birth. Her abdomen is distended slightly, and facial features are characteristic of Down syndrome. She has passed a normal meconium stool. The pregnancy was complicated by polyhydramnios.
Of the following, the MOST likely diagnosis is
A. duodenal atresia
B. Hirschsprung disease
C. meconium ileus
D. midgut volvulus
E. pyloric stenosis





23 - An 18-year-old primigravida at 32 weeks' gestation has a blood pressure of 148/96 mm Hg, proteinuria, oliguria, and visual disturbances. Labor is induced, and the infant is delivered. His weight is 850 g (<10th percentile), crown-heel length is 38 cm (10th percentile), and head circumference is 30 cm (50th percentile).
Of the following, the MOST likely complication in this infant is
A. anemia of prematurity
B. hyaline membrane disease
C. hyperglycemia
D. meconium aspiration
E. perinatal asphyxia





24- An infant is born at 27 weeks' gestation following a pregnancy complicated by preterm labor that progressed despite administration of a tocolytic agent.
Of the following, the most appropriate INITIAL management is to
A. measure transcutaneous oxygen saturation
B. perform endotracheal intubation
C. place an umbilical arterial catheter
D. place the infant in an open bed warmer
E. provide nasal continuous positive airway pressure





25- Of the following, the MOST important determinant of neurodevelopmental outcome of VLBW infants is
A. antenatal obstetric management
B .infant gender
C. length of gestation
D. maternal education
E. socioeconomic status

A 10-day-old infant who weighed 1,750 g at birth and whose gestational age was 34 weeks is jaundiced. His total serum bilirubin concentration is 10.0 mg/dL and the direct fraction is 0.8 mg/dL. He is receiving intermittent orogastric feeding of expressed human milk and supplemental parenteral nutrition.
Of the following, the MOST likely explanation for these findings is
A. Crigler-Najjar syndrome
B. jaundice due to parenteral nutrition
C. neonatal hepatitis
D. physiologic jaundice
E. pyloric stenosis






27- Early hospital discharge is defined as the discharge of a newborn earlier than 48 hours following vaginal delivery or 96 hours following cesarean delivery.
Of the following, the MOST common reason for readmission to the hospital within 7 days following an early discharge is
A. bacterial sepsis
B. congenital heart disease
C. gastrointestinal malformation
D. hyperbilirubinemia
E. ****bolic disorders





28--A newborn infant is delivered by emergent cesarean section at 41 weeks' gestation following a pregnancy complicated by a prolapsed umbilical cord and meconium-stained amniotic fluid. At 6 hours of age, the infant has a generalized tonic-clonic seizure.
Of the following, the MOST likely explanation for this seizure is
A. hyponatremia
B. hypoxic-ischemic encephalopathy
C. intracranial hemorrhage
D. meningitis
E. pyridoxine dependency




29- A 4-hour-old newborn has copious oral secretions and episodes of coughing, choking, and cyanosis. The pregnancy was complicated by polyhydramnios. You suspect esophageal atresia with tracheoesophageal fistula.
Of the following, the MOST helpful test to confirm the diagnosis is to
A. inject a contrast medium through an orogastric catheter and obtain a neck radiograph
B. obtain computed tomography of the neck
C. perform flexible bronchoscopy
D. place an endotracheal tube and examine the endotracheal fluid
E. place an orogastric suction catheter and obtain a chest radiograph




30- A newborn is delivered by emergent cesarean section because of fetal distress following acute abruption of the placenta. The infant is resuscitated and transferred to the nursery. On physical examination, she appears pale, and her extremities are cold to touch. The capillary refill is 8 seconds. Results of an arterial blood gas analysis show a Po2 of 48 mm Hg.
Of the following, the MOST likely additional finding is
A. decreased bicarbonate concentration
B. hypercalcemia
C. hyperglycemia
D. hyponatremia
E. normal anion gap




31- Of the following, erythromycin prophylaxis is MOST likely to prevent ocular infection due to
A. Chlamydia trachomatis
B. group B streptococci
C. Neisseria gonorrhoeae
D. Staphylococcus aureus
E. Trichomonas vaginalis





32-A 1,300 g infant who is born at 34 weeks' gestation has a head circumference of 27 cm and crown-heel length of 40 cm. At 48 hours of age, she is irritable, tremulous, and inconsolable. Her systolic blood pressure is 65 mm Hg and heart rate is 180 beats/min. Her face appears normal, and her cry is high-pitched. Cranial ultrasonography reveals bilateral echo densities suggestive of periventricular leukomalacia.
Of the following, the MOST likely explanation for the findings in this infant is maternal exposure to
A. alcohol
B. barbiturates
C. cocaine
D. marijuana
E. opiates




33- A 4.3 kg infant is delivered to a woman whose diabetes mellitus is poorly controlled.
Of the following, the MOST likely neonatal manifestation of maternal diabetes is
A. diabetic ketoacidosis
B.Hirschsprung disease
C.hypercalcemia
D.polycythemia
E.renal vein thrombosis




34 Of the following, the MOST helpful finding to distinguish GBS pneumonia from RDS is
A. a normal C-reactive protein level
B. an elevated erythrocyte sedimentation rate
C. diffuse alveolar infiltrates on chest radiography
D. increased ratio of bands to segmented neutrophils
E. persistent hypoxemia on blood gas analysis





34- An 18-hour-old infant of a diabetic mother develops abdominal distension. Physical examination reveals a protuberant, firm, but nontender abdomen; patent anus; and no grossly visible anomalies. The infant has passed no meconium stool since birth. A supine abdominal radiograph reveals multiple dilated loops of intestine.
Of the following, a contrast enema would MOST likely confirm a diagnosis of
A. atresia of the colon
B. Hirschsprung disease
C. hypoplastic left colon syndrome
D. meconium ileus
E. midgut volvulus with malrotation

You are attending the emergency delivery by cesarean section of a primiparous woman. The gestation was complicated by pregnancy-induced hypertension. Deep variable fetal heart rate decelerations were noted during labor. At delivery, the infant is acrocyanotic with poor tone; spontaneous movement and minimal respiratory effort are present.
Of the following, your INITIAL management is to
A. ascertain the heart rate and assign a 1-minute Apgar score
B. begin tactile stimulation and provide blow-by oxygen supplementation
C. dry all skin surfaces and clear the oropharynx
D. initiate bag-mask ventilation
E. insert an umbilical catheter and administer naloxone





36- A vigorous, normal-appearing term male newborn has not voided by 18 hours after delivery. Perinatal history is negative for maternal illness or medications. Amniotic fluid volume was reportedly normal, and the delivery was uneventful, with Apgar scores of 6 and 9 at 1 and 5 minutes, respectively.
Of the following, the MOST likely reason why this 18-hour-old infant has not voided is
A. bilateral ureteropelvic junction obstruction
B .intravascular volume depletion
C. neurogenic bladder
D. posterior urethral valve
E. un********ed void in the delivery room





37-A 2-week-old neonate who was born at 32 weeks’ gestation has recovered from respiratory distress syndrome. He has been tolerating increasing volumes of enteral feedings via gavage. Over the past several feedings, abdominal distension, gastric residuals, and stools that are positive for blood have been noted.
Of the following, the radiographic finding MOST supportive of the diagnosis of necrotizing enterocolitis is
A .absence of luminal bowel gas
B. generalized bowel distension
C .intraperitoneal fluid
D. pneumatosis intestinalis
E. thickening of the bowel wall





38- A term infant is placed under a radiant warmer, the skin is dried, and the oropharynx and nose are suctioned. After tactile stimulation, there is minimal respiratory effort, dusky color, and a heart rate of 86 beats/min. Bag/mask ventilation is performed for 30 seconds with 100% oxygen at a rate of 40 to 60 breaths/min. The heart rate increases to 100 beats/min.
Of the following, the NEXT best step is to:
A. administer sodium bicarbonate
B. continue bag/mask ventilation at a rate of 20 to 40 breaths/min
C .continue ventilation and begin chest compressions
D. observes for spontaneous respiration and discontinues ventilation
E. perform endotracheal intubation





39- A 900 g male infant is delivered vaginally to a woman who had no prenatal care.
Of the following, the physical finding that is MOST consistent with prematurity rather than intrauterine growth restriction is
A. creases over entire sole of foot
B. descended testes with deep rugae of the scrotum
C. formed and firm pinna with instant recoil
D. gelatinous translucent skin
E. raised areola and 3 mm breast buds\






40 -A 1-day-old infant develops bilious vomiting and gastric distension. She has been afebrile and has been passing meconium-laden stools.
Of the following, the most appropriate INITIAL step in the management of this infant is
A. abdominal radiography to look for the “double-bubble” sign
B .culture of a catheterized urine specimen
C .insertion of a rectal tube for decompression
D .placement of a nasogastric tube and initiation of intravenous fluid therapy
E. upper gastrointestinal radiographic series to look for malrotation of the small bowel





41- While performing ultrasonography on a 31-week fetus, an obstetrician notes that the fetal heart rate ranges from 62 to 66 beats/min. Fetal growth appears normal, and no structural cardiac anomalies are identified. Fetal echocardiography reveals that the fetal atria appear to be contracting at 140 beats/min, with a ventricular rate of 65 beats/min.
Of the following, the NEXT step in the management of this infant is to
A. administer beta-agonist drug therapy to the mother
B. assess the cardiac status of the infant following labor and delivery
C. counsel the parents that intrauterine fetal death is likely
D. perform amniocentesis to confirm lung maturity and if mature, perform immediate cesarean section
E. repeat the fetal echocardiography and fetal ultrasonography in 1 week

term infant is cyanotic and requires intubation. Findings include: heart rate, 175 beats/min; blood pressure, 60/30 mm Hg; increased right ventricular activity; single S2; short systolic murmur; and equal arm and leg pulses; chest radiography, normal heart size and pulmonary congestion. Arterial blood gases (right radial artery on 100% FIO2): pH, 7.31; PO2, 43 torr; PCO2, 48 torr.
Of the following, the MOST likely diagnosis is
A. hyaline membrane disease
B. hypoplastic left heart
C. intrauterine constriction of the ductus arteriosus
D. tetralogy of Fallot
E. total anomalous pulmonary venous connection







44- A 7-day-old infant has copious purulent discharge from both eyes. The 17-year-old mother currently complains of a yellowish vaginal discharge. The only medications received by the infant were vitamin K and topical erythromycin prophylaxis following delivery. Giemsa stain of a conjunctival scraping reveals intracytoplasmic inclusions.
After obtaining appropriate diagnostic studies, the BEST management includes treatment with
A. oral erythromycin
B. oral penicillin
C. topical erythromycin
D. topical gentamicin
E. topical sulfonamide






45- Of the following, the condition that is MOST likely to present with seizures during the first 24 hours of life is
A .fetal alcohol syndrome
B .herpes simplex infection
C. hypoxic-ischemic encephalopathy
D. organic acidemia
E. urea cycle defect

***correct answers***

A 2-week-old infant is jaundiced. Findings include weight and length at the 75th percentile for age; icterus; with hepatosplenomegaly; total bilirubin, 6.3 mg/dL; direct bilirubin, 5.5 mg/dL; alanine aminotransferase activity, 130 U/L; aspartate aminotransferase activity, 143 U/L; and gamma-glutamyl transpeptidase activity, 950 U/L.
Of the following, the BEST study to evaluate the excretion of bile from the liver is

C. hepatobiliary scintigraphy

Most authorities encourage the early introduction of human milk in the very-low-birthweight (VLBW) infant. However, mothers must be informed early in the feeding process that supplementation of their milk with protein and other nutrients may be necessary.

The MOST likely explanation for why protein supplementation of human milk often is required in the VLBW infant is that





A. human milk contains less than half the protein of cow milk formula

- Which of the following constellations of features BEST describes the fetal alcohol syndrome?


B. Growth deficiency with microcephaly, developmental delay, and short palpebral fissures


- Among the following, the condition that is MOST likely to predispose a pediatric patient to the development of systemic candidiasis is

C. immunosuppression

After intubation, arterial blood gas measurements for a 12-hour-old term infant include a PO2 of 18 torr and a PCO2 of 25 torr while receiving ventilation with 100% FIO2. The arterial pH is 7.35, and the umbilical line arterial blood pressure is 75/45 mm Hg. There is no cardiac murmur. Chest radiography shows normal cardiac size and diminished pulmonary vascularity.
The mechanism by which intravenous prostaglandin E1 will benefit this infant is MOST likely due to

D. increased pulmonary blood flow

A female infant born to a 24-year-old woman has been diagnosed clinically as having Down syndrome. The mother is concerned about her risk of having another child who has a chromosomal abnormality.
The statement that you are MOST likely to include in your discussion is that her risk

B. cannot be estimated until her infant's chromosome complement has been determined

During delivery of an infant who has an estimated gestational age of 42 weeks, you note that the amniotic fluid looks like pea soup and contains thick particles of meconium.
Of the following, the MOST important initial step in resuscitation of the infant is to

E. suction the hypopharynx

In addition to irritability, sweating, and difficulty breathing with feeding, the symptom that is MOST indicative of congestive heart failure in a 3-week-old infant is


D. diminished feeding volume



An infant who was born with myelomeningocele has hydrocephalus, and a ventriculoperitoneal shunt is placed. His parents are concerned about recognizing the signs and symptoms of shunt blockage.
Of the following, the BEST information you can give the parents is that



A. behavioral changes such as decreased spontaneity and mild lethargy may indicate shunt malfunction

11- You are evaluating a 1-month-old boy who has had inspiratory stridor since birth. The stridor is associated with retractions when the infant becomes agitated. Physical examination reveals a weight of 3.4 kg (10th percentile), no expiratory stridor, and weak cry.
Of the following, the MOST likely cause of the stridor in this infant is

A. bilateral paralysis of the vocal cords

A male infant is born at an estimated gestational age of 34 weeks. His measurements at birth are: weight, 1,200 g (<10th percentile); crown-heel length, 40 cm (10th percentile); and head circumference, 31.5 cm (50th percentile).
Of the following, the MOST likely explanation for the growth pattern of this infant is

E. pregnancy-induced hypertension



You are writing orders for parenteral nutrition for a 24-hour-old infant who weighs 900 g. The infant is on a ventilator, but clinically stable.
Of the following, the MOST appropriate order is to



D. provide nonprotein calories of at least 30 kcal/kg per day


A male infant is delivered after a pregnancy complicated by breech presentation. Physical examination reveals internally rotated shoulders, decreased muscle mass, extended elbows, contractures of the hands, flexion contractures at the knees, and bilateral equinovarus deformities.
Of the following, the MOST likely outcome for this infant is

A. ambulation after initiation of early physical therapy and surgery

The decreased incidence of enteric infections noted in breastfed infants compared with formula-fed infants is MOST likely due to the

D. presence of protective antibodies against enteric infection in human milk


A newborn who weighs 600 g and whose estimated gestational age is 24 weeks at birth is admitted to the neonatal intensive care unit after successful resuscitation in the delivery room. Arterial blood gas measurements on room air are: pH, 7.35; PCO2, 42 mm Hg; PO2, 68 mm Hg; base deficit, 2 mEq/L.
Of the following, the MOST appropriate initial management is to

E. provide glucose infusion

A 3-day-old infant presents to the emergency department with vomiting, lethargy, hypotonia, and jaundice. Physical examination reveals hepatomegaly and neurologic depression. A full sepsis evaluation is undertaken, and the Gram stain of the cerebrospinal fluid reveals gram-negative organisms.
Of the following, the BEST additional laboratory test to obtain is




. erythrocyte galactose-1-phosphate



You are examining a term newborn in the nursery. His weight is 3.27 kg (50th percentile), and his length is 50.5 cm (50th percentile). The pregnancy, labor, and delivery were unremarkable. There are no significant findings on physical examination.
The MOST likely head circumference in this child, if it is consistent with his other growth parameters, is

D. 37 cm


previously healthy 5-day-old male who was born at home develops bruising and melena. The pregnancy, delivery, and postnatal course were unremarkable. The infant is breastfeeding vigorously every 2 hours. Findings on physical examination are unremarkable except for several large bruises. Laboratory testing reveals: hemoglobin, 81 g/L (8.1 g/dL); white blood cell count, 9.4 x 109/L (9,400/mm3); prothrombin time, 37 seconds; partial thromboplastin time, 98 seconds; platelet count, 242 x 109/L (242,000/mm3); and fibrinogen, 2.34 g/L (234 mg/dL).
Of the following, the MOST likely cause of the bleeding is



D. vitamin K deficiency



A newborn whose estimated gestational age is 42 weeks is stained with meconium. Tracheal intubation reveals meconium in the hypopharynx as well as below the vocal cords. The infant has respiratory distress. A chest radiograph is obtained.
Of the following, the MOST likely radiographic finding is


A. coarse infiltrates


A newborn whose estimated gestational age is 42 weeks is stained with meconium. Tracheal intubation reveals meconium in the hypopharynx as well as below the vocal cords. The infant has respiratory distress. A chest radiograph is obtained.
Of the following, the MOST likely radiographic finding is


A. coarse infiltrates



A term newborn presents with bilious vomiting shortly after birth. Her abdomen is distended slightly, and facial features are characteristic of Down syndrome. She has passed a normal meconium stool. The pregnancy was complicated by polyhydramnios.
Of the following, the MOST likely diagnosis is


A. duodenal atresia


An 18-year-old primigravida at 32 weeks' gestation has a blood pressure of 148/96 mm Hg, proteinuria, oliguria, and visual disturbances. Labor is induced, and the infant is delivered. His weight is 850 g (<10th percentile), crown-heel length is 38 cm (10th percentile), and head circumference is 30 cm (50th percentile).
Of the following, the MOST likely complication in this infant is

E. perinatal asphyxia

An infant is born at 27 weeks' gestation following a pregnancy complicated by preterm labor that progressed despite administration of a tocolytic agent.
Of the following, the most appropriate INITIAL management is to


D. place the infant in an open bed warmer


Of the following, the MOST important determinant of neurodevelopmental outcome of VLBW infants is

C. length of gestation

26- A 10-day-old infant who weighed 1,750 g at birth and whose gestational age was 34 weeks is jaundiced. His total serum bilirubin concentration is 10.0 mg/dL and the direct fraction is 0.8 mg/dL. He is receiving intermittent orogastric feeding of expressed human milk and supplemental parenteral nutrition.
Of the following, the MOST likely explanation for these findings is



D. physiologic jaundice

Early hospital discharge is defined as the discharge of a newborn earlier than 48 hours following vaginal delivery or 96 hours following cesarean delivery.
Of the following, the MOST common reason for readmission to the hospital within 7 days following an early discharge is

D. hyperbilirubinemia






28--A newborn infant is delivered by emergent cesarean section at 41 weeks' gestation following a pregnancy complicated by a prolapsed umbilical cord and meconium-stained amniotic fluid. At 6 hours of age, the infant has a generalized tonic-clonic seizure.
Of the following, the MOST likely explanation for this seizure is

B. hypoxic-ischemic encephalopathy


A 4-hour-old newborn has copious oral secretions and episodes of coughing, choking, and cyanosis. The pregnancy was complicated by polyhydramnios. You suspect esophageal atresia with tracheoesophageal fistula.
Of the following, the MOST helpful test to confirm the diagnosis is to



E. place an orogastric suction catheter and obtain a chest radiograph






30- A newborn is delivered by emergent cesarean section because of fetal distress following acute abruption of the placenta. The infant is resuscitated and transferred to the nursery. On physical examination, she appears pale, and her extremities are cold to touch. The capillary refill is 8 seconds. Results of an arterial blood gas analysis show a Po2 of 48 mm Hg.
Of the following, the MOST likely additional finding is

A. decreased bicarbonate concentration


Of the following, erythromycin prophylaxis is MOST likely to prevent ocular infection due to

C. Neisseria gonorrhoeae






32-A 1,300 g infant who is born at 34 weeks' gestation has a head circumference of 27 cm and crown-heel length of 40 cm. At 48 hours of age, she is irritable, tremulous, and inconsolable. Her systolic blood pressure is 65 mm Hg and heart rate is 180 beats/min. Her face appears normal, and her cry is high-pitched. Cranial ultrasonography reveals bilateral echo densities suggestive of periventricular leukomalacia.
Of the following, the MOST likely explanation for the findings in this infant is maternal exposure to

C. cocaine




33- A 4.3 kg infant is delivered to a woman whose diabetes mellitus is poorly controlled.
Of the following, the MOST likely neonatal manifestation of maternal diabetes is

D.polycythemia


Of the following, the MOST helpful finding to distinguish GBS pneumonia from RDS is

D. increased ratio of bands to segmented neutrophils





34- An 18-hour-old infant of a diabetic mother develops abdominal distension. Physical examination reveals a protuberant, firm, but nontender abdomen; patent anus; and no grossly visible anomalies. The infant has passed no meconium stool since birth. A supine abdominal radiograph reveals multiple dilated loops of intestine.
Of the following, a contrast enema would MOST likely confirm a diagnosis of

C. hypoplastic left colon syndrome






35- You are attending the emergency delivery by cesarean section of a primiparous woman. The gestation was complicated by pregnancy-induced hypertension. Deep variable fetal heart rate decelerations were noted during labor. At delivery, the infant is acrocyanotic with poor tone; spontaneous movement and minimal respiratory effort are present.
Of the following, your INITIAL management is to

C. dry all skin surfaces and clear the oropharynx


A vigorous, normal-appearing term male newborn has not voided by 18 hours after delivery. Perinatal history is negative for maternal illness or medications. Amniotic fluid volume was reportedly normal, and the delivery was uneventful, with Apgar scores of 6 and 9 at 1 and 5 minutes, respectively.
Of the following, the MOST likely reason why this 18-hour-old infant has not voided is


E. un********ed void in the delivery room




37-A 2-week-old neonate who was born at 32 weeks’ gestation has recovered from respiratory distress syndrome. He has been tolerating increasing volumes of enteral feedings via gavage. Over the past several feedings, abdominal distension, gastric residuals, and stools that are positive for blood have been noted.
Of the following, the radiographic finding MOST supportive of the diagnosis of necrotizing enterocolitis is

D. pneumatosis intestinalis





38- A term infant is placed under a radiant warmer, the skin is dried, and the oropharynx and nose are suctioned. After tactile stimulation, there is minimal respiratory effort, dusky color, and a heart rate of 86 beats/min. Bag/mask ventilation is performed for 30 seconds with 100% oxygen at a rate of 40 to 60 breaths/min. The heart rate increases to 100 beats/min.
Of the following, the NEXT best step is to:
D. observes for spontaneous respiration and discontinues ventilation






39- A 900 g male infant is delivered vaginally to a woman who had no prenatal care.
Of the following, the physical finding that is MOST consistent with prematurity rather than intrauterine growth restriction is

D. gelatinous translucent skin

A 1-day-old infant develops bilious vomiting and gastric distension. She has been afebrile and has been passing meconium-laden stools.
Of the following, the most appropriate INITIAL step in the management of this infant is

D .placement of a nasogastric tube and initiation of intravenous fluid therapy




41- While performing ultrasonography on a 31-week fetus, an obstetrician notes that the fetal heart rate ranges from 62 to 66 beats/min. Fetal growth appears normal, and no structural cardiac anomalies are identified. Fetal echocardiography reveals that the fetal atria appear to be contracting at 140 beats/min, with a ventricular rate of 65 beats/min.
Of the following, the NEXT step in the management of this infant is to

E. repeat the fetal echocardiography and fetal ultrasonography in 1 week

A 7-day-old infant has copious purulent discharge from both eyes. The 17-year-old mother currently complains of a yellowish vaginal discharge. The only medications received by the infant were vitamin K and topical erythromycin prophylaxis following delivery. Giemsa stain of a conjunctival scraping reveals intracytoplasmic inclusions.
After obtaining appropriate diagnostic studies, the BEST management includes treatment with
A. oral erythromycin
+




45- Of the following, the condition that is MOST likely to present with seizures during the first 24 hours of life is


C. hypoxic-ischemic encephalopathy

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