Newborn MCQ

5/20/2018 Newborn MCQ

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MCQ OF NEWBORN

Abdulrahman Bashire


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ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI

1) Newborn infants commonly have:-A. Capillary hemangioma on the forehead.

B. Posterior cranial fontenalle.

C. Metopic sutures.

D. Impalpable coronal sutures.E. Skin tag in front of the ear.

Ans:- ABC

2) The following should be investigated in five day old baby:-

A. Erythema Toxicum

B. Cloudy corneaC. Divarication of rectiiD. Subconjunctival hemorrhage

E. Preauricular skin tags

Ans:-BE

3) During morning rounds in the newborn nursery, you examine a healthy infant who has

blotchy erythematous macules that are 2 to 3 cm in diameter. The macules are scattered

over the trunk, face, and proximal extremities; the palms and soles are spared. Each

macule has a 1- to 3-mm central vesicle or pustule.Of the following, the MOST likely

additional finding in this patient is

A. pigmented macules located at sites of resolving pustules

B. presence of lesions at birth

C. pustules coalescing into bullae D. Wright stain of a smear of the vesicopustular contents revealing a predominance of

eosinophils

E. Wright stain of a smear of the vesicopustular contents revealing a predominance of

polymorphonuclear neutrophils

Preferred Response: D

The infant described in the vignette exhibits the classic presentation oferythema toxicumneonatorum. Tiny vesicles or pustules arise from blotchy erythematous macules, with

lesions characteristically appearing at 24 to 48 hours after birth. The pustules do not coalesce into

bullae. Wright staining of the pustular contents reveals a predominance of eosinophils, not

neutrophils. Because the lesions are seen in healthy infants, it has been suggested that this benign

condition be renamed; suggested names include benign neonatal rash or benign erythemaneonatorum.

Transient neonatal pustular melanosis (TNPM)is another well-recognized benign dermal

eruption of infancy in which pustular lesions spontaneously resolve into transient pigmented

macules . TNPM may be present at birth, and examination of pustular contents reveals apredominance of neutrophils.

Infantile acropustulosisis a chronic or recurring benign condition manifested by intensely

pruritic pustules on hands and feet. Characteristic papules and pustules may coalesce into bullae.


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Infantile acropustulosis frequently is confused with scabies infestation. The lesions resolvespontaneously at 1 to 2 years of age.

4) You are examining a newborn who is the product of an uneventful pregnancy, labor, and

delivery. Apgar scores were 9 at both 1 and 5 minutes. Findings on the initial physical

examination are unremarkable except for the presence of vesicopustules and frecklelikemacules (Item Q33A), some of which have a collarette of surrounding scale. Wright stain

of a smear of the vesicopustular contents reveals a predominance of polymorphonuclear

neutrophils.Of the following, the MOST likely diagnosis is

A. congenital candidiasis

B. erythema toxicum neonatorum

C. infantile acropustulosis D. miliaria rubra

E. transient neonatal pustular melanosis

Preferred Response: ECharacteristic lesions oftransient neonatal pustular melanosis (TNPM)may be present at birth as

vesicles, pustules, or ruptured vesicles or pustules that have a collarette of surrounding scale.

Pigmented macules (Item C33A) often develop at the sites of resolving pustules or vesicles.Primary lesions usually disappear by 5 days of age; the secondary pigmented lesions may remain

up to 3 months. TNPM occurs more commonly in African-American infants.

Lesions can occur on palms and soles. Pustular contents reveal a predominance of neutrophils on

Wright stain examination, as reported for the newborn in the vignette.

Infants who have congenital cutaneous candidiasismay present with scaling, erythematous

papules and pustules (Item C33B) at birth. Candida albicans can penetrate through the amnion andchorion to cause congenital infections. Scrapings from lesions prepared with potassium hydroxide

document pseudohyphae (Item C33C) or budding yeast.

Term infants who have erythema toxicum neonatorumexhibit vesicopustular lesions (Item

C33D) that usually overlie erythematous macules. Lesions of erythema toxicum rarely are present

at birth, and Wright stain of smears of pustular contents reveals a predominance of eosinophils.Infantile acropustulosispresents as pustules or vesicles (Item C33E) localized to the hands

and feet. It may be present at birth but more commonly develops in the first weeks and months

after birth, possibly continuing or recurring throughout infancy and early childhood. Lesions are

very similar to those of infantile scabies infestation. Pustular contents may reveal prominentneutrophils and occasional eosinophils without evidence of the mites, ova, or feces seen in

scabies. An absence of hyperpigmentation in resolving lesions and a prolonged or recurringcourse distinguishes infantile acropustulosis from TNPM.

Miliaria rubra(prickly heat or heat rash) is caused by intraepidermal obstruction of the sweat

ducts. A secondary local inflammatory response is responsible for the erythema (Item C33F)

associated with the papules and vesicles. Miliaria rubra occurs later than miliaria crystallina,

usually beyond thefirst postnatal week. Hyperpigmented, frecklelike lesions are not expected in

miliaria rubra.

5) The following is true regarding changes in the fetal cardiovascular system after birth:

A. There is normally immediate closure of the ductus arteriosus


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B. Hypoxia-induced vasoconstriction is the mechanism of closure of the ductusarteriosus

C. The ligamentum teres is the remnant of the umbilical vein

D. Regression of right ventricular hypertrophy occurs postnatally

E. Inferior vena caval pressure falls after birth

Ans:-CDEOcclusion of the umbilical cord removes this low resistance capillary bed from the circulation;

breathing results in a marked decrease in pulmonary vascular resistance, hence there is increased

pulmonary blood flow returning to the left atrium raising the pressure in the left atrium causing

the foramen ovale to close. As pressure in the systemic circulation rises, shunt through the ductus

arteriosus reverses. As the pO2 rises, synthesis of bradykinin and prostacyclins is inhibited, thus

causing closure of the ductus arteriosus. The ductus arteriosus can take up to 3 months to close innormal neonates.

6) Neonatal RDS:-A. Seen in most babies of birth weight < 2.5 kg.

B. More common in infants of diabetic mothers.

C. Associated with prolonged rupture of membrane.D. Less sever in babies of Afro-Caribiean origin than Caucasians.

E. Exacerbated by hypothermia.

Ans:-BDE

7) The following are causes of generalized hypotonia in 2 days old infants:-

A. Prematurity

B. HypothyroidismC. Myotonic dystrophy

D. Spinal dysraphyism

E. Anterior horn cell disease

Ans:-ACE

8) Regarding surfactant:-

A. Production begins at 30 weeksB. It is produced by Type II pneumocytes in the walls of the bronchi

C. Testosterone stimulates surfactant production

D. Production is increased during a stressful event like hypothermiaE. Betamathasone given to the mother improves surfactant production in the

premature baby Ans:- E

Surfactant production begins at 20-22 weeks. It is produced by Type II pneumocytes which are in

the walls of the alveoli. The hormones testosterone and insulin inhibit surfactant production;

hence hyaline membrane disease is more common in males than females and more common in

infants of diabetic mothers. Surfactant production is suppressed if the baby is hypothermic,

hypoxic, acidotic or hypoglycemic.Although dexamethasone is more commonly used, betamethasone has an identical effect on lung

maturation

9) Concerning fetal lung development:-


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A. Type pneumocytes are present at 24 week gestationB. Cuboidal cells are capable of gas transfer in utero

C. There is virtually no smooth muscle in the terminal & respiratory bronchioles at

6 month of age

D. The large airways are formed at 16 week gestation

E. Alveoli are completely formed at birth Ans:-AD

10) Congenital CMV infection:-

A. Only 10% of affected pregnancies have resulting long term sequel at birth

B. Diagnosis is by viral isolation from the urine

C. Hearing loss can develop gradually over the first 5 years

D. The affected newborn should be treated with ganciclovirE. Intracranial calcifications are seen in a periventricular distribution

Ans:- ABCE

Congenital CMV occurs in approximately 1% of all live births and only 10% of these infectionsresult in clinical symptoms. Severe clinical disease is associated with primary maternal infection

in pregnancy. Infection in early gestation carries a far greater risk of severe fetal disease. In CMV

intra-cranial calcifications are in a periventricular distribution. Ganciclovir is only used if there isCNS involvement, chorioretinitis or pneumonitis.

11) The following conditions will present with cyanosis in the first week of life:

A. Aortic stenosis

B. Transposition of the great vessels

C. Hypoplastic left heart syndromeD. Fallot's tetralogy

E. Fallot's pentalogy

Ans:- B

Any cardiac lesion which allows a mixing of blood along with a right to left flow or any cardiac

lesion wherein pulmonary perfusion is impaired results in cyanosis. Left heart problems or

outflow tract obstructions present as cardiac failure. Fallot's pentalogy includes an ASD alongwith the tetrad of infundibular pulmonary stenosis, RVH, over-riding of the aorta and a VSD.

Babies with tetralogy of Fallot usually have a patent ductus arteriosus at birth that provides

additional pulmonary blood flow, so severe cyanosis is rare early after birth.As the ductus arteriosus closes, as it typically will in the first days of life, cyanosis can develop or

become more severe.The degree of cyanosis is proportional to lung blood flow and thus depends upon the degree of

narrowing of the outflow tract to the pulmonary arteries.

12) Pulmonary surfactant

A. Is partly recycled by endocytosis into the synthesizing cell

B. Is produced by type alveolar cells

C. Reduction in pulmonary flow can cause a decrease in surfactant productionD. Synthesis is inhibited by thyroxine

E. Synthesis is stimulated by glucocorticoids

Ans:- ACE


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Dipalmityl- phosphotidyl choline is the main component of surfactant and is produced by Type-

alveolar cells (granular pneumocytes). Its half-life is 14 hours and its main function is to reduce

the surface tension of the alveoli.

13) Lung surfactant

A. Decreases the surface tension within an alveolusB. Causes an increase in chest wall compliance

C. Is a glycoprotein

D. Maintains the same surface tension for different sized alveoli

E. Appears only after the 1st week of life

Ans:- A

Surfactant is a dipalmitoyl-phosphatidyl choline and is a phospholipid, which prevents alveolarcollapse by reducing alveoli surface tension. It is produced by type-II pneumocytes and is seen at

about 24 weeks gestation. It causes an increase in lung compliance only (not chest wall

compliance).

14) The following organisms cause conjunctivitis:-

A. Epstein Barr virusB. Chlamydia trachomatis

C. Adenovirus

D. Haemophilus influenzae

E. Neisseria gonorrhoeae

Ans:- BCDE

Chlamydia trachomatis causes conjunctivitis in 30-50% of neonates born to mothers withcervicitis. It is a purulent conjunctivitis, which develops 5-14 days after birth and is

indistinguishable from gonococcal infection. It is diagnosed on a swab scraped over the lower

eyelid (to allow cells to be collected dont forget it is an intracellular organism) by direct

fluorescent antibody, ELISA or PCR. Tetracycline ointment topically is combined with oral

erythromycin the oral antibiotic is to prevent relapse after ointment is discontinued and to

prevent progression to pneumonia. Gonococcal conjunctivitis presents earlier than chlamydialdisease (usually within 2 days), is diagnosed on gram stain and culture and should be treated with

IV penicillin and chloramphenicol eye drops. Dont forget sexual health screening for the mother

and informing public health of ophthalmia neonatorum. Adenovirus causes conjunctivitis insummer outbreaks; enterovirus, coxsackie and herpes simplex are other viral causes.

15) Concerning blood flow in the fetus:-

A. Blood flow from right to left through the foramen ovale

B. Blood in the ascending aorta has higher oxygen content than in the descending

aorta

C. The ductus arteriosus is closed

D. Pulmonary pressure equal systemic pressureE. Hemoglobin may be 20 gm/dl

Ans:-ABE

16) -In a healthy baby the transition from fetal to neonatal circulation involves:-

A. Functional closure of the foramen ovale in the first 24 hours


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B. Blood flow in the ductus arteriosus continues from right to left until its closureC. Decrease in pulmonary artery resistance following closure of the ductus arteriosus

D. The ductus arteriosus closes in response to decreased oxygen concentrations

E. The umbilical artery is a branch of the common iliac artery

Ans:- A

Functional closure of the ductus arteriosus occurs soon after birth but anatomical closure can takeupto one week. As pulmonary pressures fall after birth, blood flow in the ductus is reversed ie

from left to right. The umbilical artery is a branch of the internal iliac artery.

Factors influencing closure of the ductus include:-

1.Increased oxygen concentrations

2.Decreased prostaglandin levels 3.Drop in pulmonary artery pressuresN.B.Prostaglandin E2 keeps the ductus open.

17) A 10-day old male presents with bilious emesis. What is the most likely diagnosis?A. Appendicitis

B. Pyloric stenosis

C. Malrotation with midgut volvulusD. Feeding intolerance

Ans:- C

18) A term newborn is delivered by emergent cesarean section because of intrauterine

growth restriction, oligohydramnios, and nonreassuring fetal heart rate monitoring in

labor. Delivery room resuscitation includes endotracheal intubation and assisted

ventilation with 100% oxygen, chest compressions, intravenous epinephrine, and volumeexpansion. Apgar scores are 1, 2, and 3 at 1, 5, and 10 minutes, respectively. An umbilical

cord arterial blood gas measurement documents a pH of 6.9 and a base deficit of 20

mmol/L. At 12 hours of age, the infant demonstrates tonic-clonic convulsive activity of

the arms and legs with a concomitant decrease in heart rate and bedside pulse oximetry

saturation. Of the following, the MOST likely cause for this infant's seizure is:-

A.Hypercalcemia.B.Hypercarbia.

C.Hyperglycemia.

D.Hypomagnesemia.E. Hypoxia.

Preferred Response: ESeizures are the most frequent sign of central nervous system injury in the newborn. When

seizures occur in a newborn who has depressed neuromotor tone, reflexes, and

cardiopulmonary function at birth that requires assisted ventilation, perinatal asphyxia is likely. In

this event, Apgar scores typically are depressed to less than 3 at 5 or more minutes after birth,

and there is a severely acidotic umbilical cord arterial pH (


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and accounts for up to 67% of early neonatal seizures. Other causes of neonatal seizureinclude intracranial hemorrhage, cerebrovascular accidents (stroke), or hemorrhagic infarction

(10% to 15%); intracranial malformation (


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their oxygen saturation when oxygen is administered. Indomethacin is used to close a patentductus.

22) How should a neonate with lethargy and a blood sugar of 20mg/dl be treated?

A. Oral feeds with apple juice

B. 25% dextrose solutionC. 10% dextrose solution

D. 50% dextrose solution

Ans:- C

Newborns with hypoglycemia should be treated with D10W solution with a range of 2-

10cc/kg. Higher concentrations should not be used as they can cause vein sclerosis and

intracranial hemorrhage. Infants and young children should be treated with D25 2-4cc/kg.

23) Neonatal convulsion can be caused by:-

A. Maternal hyperparathyroidismB. Subdural hematoma

C. Birth asphyxia

D. HyponatremiaE. Wilson's disease

Ans:-ABCD

24) A 2-day-old female presents with abdominal distension and vomiting. She has not yet

passed a meconium stool. What is the most likely diagnosis?

A. Hirschsprung Disease

B. Malrotation with midgut volvulusC. Necrotizing enterocolitis

D. Constipation

Ans:-A

Suspect Hirschsprung Disease in a newborn who has not yet passed a meconium stool. Other

possibilities include an imperforate anus or meconium plugging. Older children present with a

history of chronic constipation. Hirschsprung disease is the absence of intramural ganglion cells inthe rectum which extends to the sigmoid colon in 77% of patients and involves the entire colon in

15% of patients. The incidence is 1/5,000 live-births, with a male to female ratio of 4:1. The

diagnosis should be suspected if the patient presents with lack of meconium stool within the first24 to 48 hours of life. Vomiting and abdominal distension may also be present.

25) A 3-week-old female presents with persistent seizures despite aggressive management

with benzodiazepines and phenobarbital. The mother reports giving her daughter some

water to "stop her from getting dehydrated." What is the most likely cause of her status

epilepticus?

A. Hypoglycemia

B. Diabetes insipidus

C. HyponatremiaD. Hypokalemi

Ans:-C


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Excessive free water intake can result in hyponatremic seizures. Infants less than 6 months of ageare particularly susceptible to these types of seizures and commonly have intractable seizures

requiring intubation and hypothermia. Immediate treatment includes the administration of 3%

saline 4cc/kg.

26) A 1-week-old male presents with some mild erythema around his umbilicus extendingonto the abdominal wall. Which of the following is the correct management for this

patient?

A. Reassurance and continue with alcohol wipes of umbilicus

B. Topical antibiotic ointment and recheck the patient the next day

C. Discharge on cephalexin and recheck the next day

D. Perform a full septic workup and admit the patient Ans:- D

This patient has Omphalitis and should undergo a full septic evaluation, administration of

antibiotics and hospital admission. Surgical debridement may be required for severe cases.Omphalitis is inflammation and infection surrounding the umbilicus that can spread to the liver or

peritoneum. Patients can present with symptoms ranging from mild erythema to necrosing lesions

surrounding the umbilicus on the abdominal wall. Fever may be present

27) A 5-day old, well-appearing male is brought to the ED by his mother today because she

noted that he has a cluster of vesicles on his scalp. Which of the following should be the

management approach?

A. Skin biopsy

B. IV acyclovir and a full septic workupC. Oral acyclovir

D. Discharge, with next day follow up

Ans:-B

This patient is at risk for herpes encephalitis and should undergo a complete septic workup and IV

acyclovir should be initiated in the ED. Begin acyclovir (20mg/kg every 8 hours IV) if there is a

positive maternal history of herpes, a vesicular rash, focal neurologic findings, CSF pleocytosis orelevated CSF protein without organisms on gram stain.

28) The following maternal condition can cause disease in the fetus/newborn:-A. Hyperparathyroidism

B. ITPC. Myasthenia gravis

D. Diabetus mellitus

E. Thyrotoxicosis

Ans:-ABCDE

29) Which of the following heart rates is most suggestive of supraventricular tachycardia in

a newborn?

A. 180 BPMB. 230 BPM

C. 150 BPM

D. 210 BPM


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Ans:-BPALS defines SVT in infants as a heart rate of greater than 220 BPM. In older children the

heart rate for SVT is greater than 180 BPM. The ECG demonstrates a narrow complex

tachycardia without discernible p waves or beat-to-beat variability. In the stable patient, vagal

maneuvers are the first treatment of choice (ice to the face, or blowing through an occluded

straw in older children). Adenosine given as centrally as possible is the first drug of choice (0.1mg/kg up to 6mg for the first dose and then 0.2mg/kg for the second dose up to 12 mg) If

this is not successful, then amiodarone 5mg/kg given over 20-60 minutes or procainamide

15mg/kg given over 30-60 minutes are the next drugs of choice. Unstable patients should

undergo cardioversion with 0.5-1J/kg followed by 2J/kg. If an IV is accessible, a dose of

adenosine can be given while setting up for the cardioversion.

30) Vaginal bleeding in a 3-day-old female is:

A. Is always indicative of child abuse

B. May be due to withdrawal of maternal hormonesC. Is suspicious for gonorrhea

D. Is most commonly due to a vaginal foreign body-such as baby wipes

Ans:- B

31) Cyanosis in the first week of life can be caused by:-

A. Tetralogy of Fallot

B. Pulmonary stenosis

C. Eisenmenger syndrome

D. TAPVD

E. Ebistein's anomaly Ans:-ABDE

32) A 3-week old male presenting to the emergency department with vomiting and altered

mental status and acidosis. What additional laboratory test should be included in your

evaluation?

A. Ammonia level

B. Cortisol levelC. Serum acetone

D. Thyroid function test

Ans:- ASuspect an inborn error of metabolism in patients who have an altered level of consciousness.

These patients may or may not be acidotic depending on the type of inborn error that is present.Patients with a urea cycle defect typically have a normal blood gas but an elevated ammonia

level. Patients with organic acidemias will be acidotic but may or may not have an elevated

ammonia level. Patients with galactosemiawill have a normal blood gas and ammonia level but

will have reducing substances in the urine.

33) Which of the following are causes of shock in the newborn?

A. InfectionB. Inborn errors of metabolism

C. Child abuse

D. Thyrotoxicosis


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E. All of the above Ans:- E

34) In neonatal RDS (respiratory distress syndrome):

A. Surfactant is useful in the treatment.

B. It is rare in infants below 28 weeks gestation.

C. Antenatal steroids are beneficial.D. Maternal opiate abuse increases the risk.

E. Maternal diabetes increases the risk.

Ans:- ACE

35) The risk of neonatal jaundice is increase by:

A. Prematurity.

B. Trisomy 21.C. Elective caesarean section.

D. Congenital hypothyroidism.

E. Cephalahaematoma. Ans:-ABDE

36) At birth the blood volume is approximately:-

A. 65 ml/kg body weightB. 85 ml/kg body weight

C. 110 ml/kg body weight

D. 125 ml/kg body weight

E. 150 ml/kg body weight

Ans:- B

37) Newborn infants commonly have:-A. Papulovesicles over the trunk.

B. Posterior fusion of the labia minora.

C. An adherent foreskin

D. Breast enlargement

E. Shallow sacral dimple

Ans:-ACDE

38) The following conditions signify disease in the newborn;-

A. Peeling of the skin of the hands and feet

B. Blanched on one side of the body and pink on the opposite sideC. Pinhead lesion on the nose ( milia)

D. Peripheral cyanosisE. Oedema of one arm

Ans:- ALL FALS

39) Apreviously healthy full term infant have several episode of duskiness and feeding

difficulties during the second day of life . She is noted to have increasing jaundice, which

of the following tests will be the least helpful in making diagnosis:-

A. CSF

B. Urine C/ SC. Total bilirubin

D. Endotracheal aspirate C/S

E. Venous blood


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Ans:- D

40) Difference between infant born to heroin-abusing mothers and infant born to

phenobarbitone-abusing mothers is that infant in the later group:-

A. Don't have withdrawal symptoms

B. Have withdrawal symptoms appearing earlier than heroin withdrawal

C. Don't develop tremorD. Have high incidence of jaundice

E. Are usually term and full size

Ans:- E

41) Which of the following organisms is the most frequent causes of neonatal meningitis:-

A. GBS

B. E . coliC. L . monocytogenes

D. H .influenza

E. S. pneumoniae Ans:- A

42) One should be concerned about term infant who has not passed meconium stool:-

A. During the process of birthB. Within few min of birth

C. By 1-2 hour of life

D. By 6-12 hour of life

E. By 24 hour of life

Ans:- E

43) The initial lesion of incontinentia pigmenti are:-A. Deeply pigmented

B. Scaly

C. Waxy papules

D. Inflammatory bullae

E. Small vesicles

Ans:- D

44) Factor that appear to lower threshold for neurologic damage and kernicterus from

unconjugated hyperbilirubinemia include all of the following except:-

A. AcidosisB. Asphyxia

C. SepsisD. Postmaturity

E. Hypothermia

Ans:- D

45) Infant born to diabetic mothers are at risk of all of the following except:-

A. Polycythemia

B. Hyperglycemic dehydration

C. HypocalcemiaD. Congenital malformation

E. Cardiomyopathy

Ans:- B


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46) The Apt test is used for what purpose:-

A. Crude test for carbon monoxide poisoning

B. Semiquantitative test for lead poisoning

C. Qualitative test for fetal hemoglobin

D. Screening test for S hemoglobin

E. Test for blood viscosity Ans:- C

47) Birth injury account for the majority of the following conditions detected in early

infancy:-

A. Intraventricular hemorrhage

B. Cephalohematoma

C. HydrocephalusD. Facial nerve palsy

E. Pneumothorax

Ans:-BD48) In birth trauma:-

A. Erb's palsy involve C6,C7 & C8

B. Klumpke's palsy involve C7,C8 &T1C. Facial nerve palsy lead to persistently closed eye

D. Sciatic nerve involvement is common

E. Cephalohematoma is characteristically present at birth

Ans:- B

In Erb-Duchenne paralysis, the injury is limited to the 5th and 6th cervical nerves. The infant

loses the power to abduct the arm from the shoulder, rotate the arm externally, and supinate theforearm. The characteristic position consists of adduction and internal rotation of the arm with

pronation of the forearm. Klumpke paralysisis a rare form of brachial palsy; injury to the 7th

and 8th cervical nerves and the 1st thoracic nerve produces a paralyzed hand and ipsilateral ptosis,

anhidrosis and miosis (Horner syndrome)if the sympathetic fibers of the 1st thoracic root are

also injured (which reflects damage to the stellate ganglion adjacent to T1.)

49) Birth injury:-

A. Paralysis of the upper arm has better prognosis than paralysis of the lower

B. In nerve injury, neuroplasty is advised at the end of first year of lifeC. In phrenic nerve paralysis, spontaneous recovery is expected

D. Facial nerve paralysis will result from the nuclear agenesis of the facial nerve Ans:-AC

If the paralysis persists without improvement for 36 mo, neuroplasty, neurolysis, end-to-end

anastomosis, and nerve grafting offer hope for partial recovery. function usually returns in a few

months. Total disruption of nerves (neurotmesis) or root avulsion is the most severe, especially if

it involves C5T1; microsurgical repair may be indicated. Fortunately, most (75%) injuries are at

the root level C5C6, involve neurapraxia and axonotmesis, and should heal spontaneously.Botulism toxin may be used to treat biceps-triceps co-contractions.

50) The following are useful in the assessment of gestational age in preterm:-

A. Presence of palmar creases


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B. Breast sizeC. Sacral edema

D. The scarf sign

E. Muscle ton

Ans:-BDE

51) Cephalohematoma:-A. Must be differentiated from subperiosteal hemorrhage

B. Is usually visible at birth

C. May calcify

D. May be associated with underling fracture of the skull

E. Should be managed surgically

Ans:-CD

52) Caput succedaneum is characterized by all of the following except:-

A. Diffuse edematous swelling of the soft tissues of the scalp involving the

portion presenting during vertex deliveryB. It may extend across the midline

C. It may extend across the suture lines

D. Edema usually disappear within 2-3 monthsE. The scalp overlying the area may show mild bruising

Ans:- D

53) In newborn with oral moniliasis the most common primary source of infection

A. Maternal source ( vaginal )

B. Contaminated fomites

C. Following use of AgNO2D. Contact by hospital carriers

E. Systemic antibiotic therapy

Ans:- A

54) Meconium impaction is associated with:-

A. Cretinism

B. Cystic fibrosisC. Thrush

D. HMD

E. Trisomy 21 syndromes Ans;- B

55) Premature infant is delivered precipitiously and appear asphyxiated . The infant is

cyanotic, there are no respiratory efforts,and the heart rate is 80 / min .The infant is

meconium stained and thick particulate meconium is noted in the amniotic fluid and in

infant mouth. At this point you should:-

A. Pass an umbilical artery catheter to measure the PH & PO2

B. Start bag-mask ventilation with 100% oxygen

C. Suction the oropharynx & trachea with ETT to remove the meconiumD. Intubate the trachea & begin the ventilation with 100 % oxygen

E. Establish monitoring with ECG & pulse oximeter

Ans:- C

56) Hypoglycemia has been observed in all of the following except;-


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A. With LBW and RDSB. With anoxic injury

C. With hypothermia

D. Who are SGA

E. With high PO2

Ans:- E57) All of the following are usually associated with cretinism except:-

A. Constipation

B. Prolonged jaundice

C. Lethargy

D. Tetany

E. Hypotonia Ans:- D

58) All of the following are characteristic of single umbilical artery except:-

A. Presence in about 5 of 1000 birthB. About 1/3 of such infants have congenital abnormalities

C. 21 trisomy is frequently found

D. Among twin ,the rate of occurrence is 35 / 1000E. The associated congenital abnormalities may involve the genitourinary tract

Ans:- C

59) Two minutes after normal term delivary:-

A. The ductus venosus will be closed

B. The pulmonary arterial pressure will have fallen

C. The pressure in the left atrium will have fallenD. The arterial oxygen tension will have risen

E. Regular breathing will have begun

Ans :-ABDE

60) Established neonatal resuscitation procedures include:-

A. Directing cold stream of oxygen at the nose

B. Administration of drugs with respiratory stimulant propertiesC. Oropharyngeal suction

D. Bag and face mask ventilation

E. Prompt cooling Ans:-ACD

61) The Apgar score :-

A. At 1 min is reliable measure of asphyxia

B. At 1 min is reliable measure of respiratory failure

C. At 10 min is strongly correlated with later neurological deficit

D. Includes the infant response to pharyngeal suction catheter

E. Isn't application after 10 min of age

Ans:- BCD

62) Criteria used in the Apgar score include :-

A. Core temperature

B. Heart rate

C. Respiratory rate


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D. Skin thicknessE. Muscle tone

Ans :-BE

63) Pink newborn with HR of 88/min is actively gasping , he has good muscle tone and

respond to nasal catheter stimulation with facial grimace, the apgar score is:-

A. 5B. 6

C. 7

D. 8

E. 9

Ans:- D

64) Mongolian spots are characterized by all of the following except:-

A. They are permanent

B. They are usually of a slate blue pigmentation

C. They are generally observed over the buttocksD. The area of pigmentation is well demarcated

E. They aren't associated with trisomy syndromes

Ans:-A

65) All of the following physical signs may be useful in estimating the gestational age at birth

except:-

A. There are only one or two transverse skin creases on the sole of the foot until

36 week of gestation

B. The breast nodule is usually not palpable at 33 or 34 weeks

C. The breast nodule is usually 4-10 mm in term infantD. The testes are descending and rugae cover the entire scrotal surface by 34

weeks

E. The texture of scalp hair

Ans:- D

The testes are usually not completely descended until after 36 weeks & scrotal rugae are few and

limited the anterior and inferior aspect of relatively small scrotum . By 34 weeks the areolabecome raised and between 36-37 weeks the breast bud is 1 2 mm reaching size of 4-10 mm at

term. The transversr foot creases develop at 31 32 weeks .By 36 weeks creases cover the

anterior two-third of the sole .

66) Newborn infant who remain centrally cyanosed after intubation and IPPV may have:-

A. Diaphragmatic hernia

B. Choanal atresia

C. Tension pneumothorax

D. Drug induced respiratory center impairment

E. Profound anaemia

Ans:-AC

67) The following statement about pulmonary hypertension are true :-

A. It recognized complication of group B streptococcal sepsis

B. Hyperventilation is an effective treatment

C. Tolazoline is potent pulmonary vasoconstriction


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D. Radial arterial PaO2 is lower than umbilical artery PaO2E. Birth asphyxia is a risk factor

Ans:-ABE

68) Concerning air leak syndromes in the newborn:-

A. Underwater seal drain is only required if the pneumothorax is under tensionB. In term baby with small pneumothorax giving oxygen at high concentration

can worsen it

C. Increasing the I; E ratio in ventilated baby decrease the risk of pneumothorax

D. Pneumomediastenum is usually fatal

E. They can be asymptomatic

Ans;- E

69) Recognized problem of infants born at term SGA include:-

A. Hypothermia

B. SepsisC. Polycythemia

D. Hypoglycemia

E. Retinopathy of prematurity Ans:-ABCD

70) Complication of steroid therapy in the newborn include:-

A. Leucopenia

B. Hypoglycemia

C. Cataract

D. SepsisE. Gastric perforation

Ans:-CDE

71) Concerning NEC :-

A. Exchange transfusion is predisposing factor

B. Clostridium welchii is implicated in the pathogenesis

C. It is most common in infants born less than 1500 gmD. Oral antibiotics are useful

E. Complications include short bowel syndrome

Ans:-ACE72) The following congenital condition require immediate ( within first week) treatment

after birth:-

A. TEF

B. Cleft lip

C. Spina bifida

D. Exomphalos

E. Hydrcephalus

Ans:-ACD

73) Preterm infant at increased risk from :-

A. Conjugated hyperbilirubinemia

B. Meconium aspiration

C. Periventricular leucomalacia


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D. Necrotizing enterocloitisE. Child abuse

Ans:- CDE

74) Peri- or intraventricular cerebral hemorrhage

A. Occur in less than 10% of VLBW infant

B. Arise most commonly in the first 72 hour after delivaryC. Is direct result of impaired vitamin K supply

D. Is the single most common cause of congenital cerebral palsy

E. May result in rapidly evolving hydrocephalus

Ans:-BE

75) Feature typical of physiological jaundice include:-

A. Recognizable jaundice in the first 48 hoursB. Peak plasma bilirubin at 4-5 days

C. Persistent beyond first week

D. IrritabilityE. Pale stool

Ans:- B

76) Jaundice on day 1 is often caused by ;-

A. Metabolic disorder

B. TORCH infection

C. Gastrointestinal obstruction

D. Hemolysis

E. Physiological factor

Ans:-BD77) Persistant, conjugated hyperbilirubinaemia may be caused by:

A. Alpha-1-antitrypsin deficiency.

B. Hypothyroidism.

C. Haemolytic disease.

D. Cytomegalovirus infection.

E. Cystic fibrosis. Ans:-ABDE

Explanation:- all cases need further investigation.

Causes of conjugated hyperbilirubinaemia in a neonte are:1)-Intrahepatic cholestasis

-Infections. -Congenital infections (STORCH-syphlis, toxoplasma, rubella,

cytomegalovirus, hepatitis, herpes virus infection)

-Acquired infections- septicaemia, UTI.

-Metabolic disorders cystic fibrosis, alpha-1- antitrypsin deficiency, galactosaemia,

fructosaemia, lysosomal storage disorders, peroxisomal disorders.

-Endocrine disorders hypothyroidism, hypopituitarism, hypoadrenalism. -Anatomical disorders intrahepatic:bile duct hypoplasia.

-Miscellaneous idiopathic neonatal hepatitis, chromosomal abnormalities, trisomy 21, 18

and 13.

2)-Extrahepatic cholestasis:-biliary atresia, choledochal cyst, spontaneous bile duct


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perforation, inspissated bile syndrome.Unconjugated neonatal jaundice is normally physiological and resolves spontaneously.

78) All of the following are characteristic of jaundice associated with breast feeding except :-

A. Significant elevation of unconjugated bilirubin

B. Rapid fall in serum bilirubin after discontinuation of nursingC. Nursing can be resumed after several days without return of hyperbilirbinemia

D. Significant elevation of conjugated bilirubin

E. Kernicterus has never been reported to occur as result of breast milk jaundice alone

Ans :- D

79) Persistent jaundice during the first month of life may associated with all of the following

except:-

A. Cytomegalic inclusion disease

B. Congenital atresia of the bile duct

C. GalactosemiaD. Rh incompatibility

E. Penicillin treatment

Ans:- E

80) A 26-week gestation preterm infant is now 6 weeks old and weighs 1,250 g. He is

receiving full-volume enteral nutrition. The only significant finding on physical

examination is pallor. He has anemia (hematocrit of 28% [0.28]; reticulocyte count of 8%

[0.08]) and receives iron supplementation. He is receiving a formula that is high in

polyunsaturated fatty acids.Of the following, the MOST correct statement about his need

for vitamin E is that it A. does not need to be supplemented in infancy

B. has no effect on anemia

C. needs to be supplemented now

D. will be needed when the infant is 3 months old

E. will prevent anemia

Preferred Response: CHistorically, inadequate vitamin E, a high level of polyunsaturated fatty acids (PUFAs) in infant

formula, and exposure to the oxidizing effects of iron supplementation contributed to a hemolytic

anemia seen in preterm infants. In the United States and many developed countries, infantformulas now provide an adequate vitamin E:PUFA ratio to eliminate this risk. However, preterm

infants continue to have low vitamin E levels due to limited stores, especially when the birth isextremely premature, and limited enteral feedings early in their postnatal neonatal intensive care

unit course.

The neonate who has anemia and is receiving iron supplementation, such as the infant described

in the vignette, requires the antioxidant effect of vitamin E to reduce red blood cell hemolysis. A

total daily requirement of 10 to 25 IU of vitamin E meets the infants needs, only 50% of which is

provided by dietary formula. Of note, human milk also is an incomplete source of vitamin E.

81) Amniocentesis is useful in establishing the prenatal diagnosis of:-

A. Down syndrome

B. Meningomyelocele


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C. Erythroblastosis fetalisD. Achondroplasia

Ans:-ABC

82) USS can be used during pregnancy to:-

A. Determine crown rump length

B. Determine fetal sexC. Determine biparietal diameter

D. Accurately determine fetal weight

Ans ;-AC

83) Gestation that produce multiple births:-

A. Are classified as high risk

B. Are always delivered by cesarean sectionC. Can produce infant with discordance in body size at birth

D. Aren't associated with the premature onset of labour

Ans:-AC84) For newborn infant, the least important factor to consider in assessing the risk of

kernicterus is:-

A. Breast feedingB. Acidosis

C. Sepsis

D. Albumin level

E. Moxalactam, cephalosporin type antibiotic

Ans:- A

85) The following maternal conditions are known to cause adverse effects on the neonate:

A. Diabetes insipidus.

B. Toxoplasmosis.

C. Chronic myeloid leukaemia.

D. SLE.

E. Hyperthyroidism. Ans:-BCDE

Explanation:- Maternal SLE is a risk factor for neonatal lupus syndrome. The neonate presents

with clinical features of SLE due to transplacental passage of maternal Ab. The skin is frequentlyinvolved with malar rashes and there can be haematological and cardiac abnormalities. The most

frequent heart abnormality is congenital heart block 90% of mothers whose infants havecongenital heart block are anti-Ro(SSA)Ab positive.

Toxoplasmosis leads to congenital infection by transplacental transmission. The rate of

transmission is +/- 60% of third trimester infections and 20%-30% during the first two trimesters.

The ewborn presents with the classic triad of hydrocephalus, chorioretinitis, and cerebral

calcification.

Maternal chronic myeloid leukaemia can have adverse effect on pregnancy fetal/neonatalmortality is 16-38%. Pathology can be secondary to placental leukaemic infiltrates, anaemia and

infectious complications. Splenomegaly can restrict intrauterine growth and lead to premature

delivery.


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If hyperthyroidism is due to Graves disease or Hashimoto thyroiditis, the neonate may presentwith thyrotoxicosis due to the transplacental passage of TSI. These symptoms are frequentely

short-lived i.e as long as the circulating antibodies persist in the babys circulation.

86) Each of the following statement about GBS infection in the newborn is true except:-

A. Incidence is correlates inversely with the presence of maternal antibodiesB. The exotoxin has powerful pulmonary vasoconstrictive effects

C. The disease has two distinct pattern; early & late onset

D. Both the incidence & severity of the disease can be lessened by pretreatment of the

mother who is colonized

E. The risk of invasive disease isn't related to the amount of inoculum received by the

infant Ans:- E

87) Newborn infant may present with bile stained vomiting and abdominal distension as the

result ofA. Oesophageal atresia

B. Duodenal atresia

C. Birth asphyxiaD. Electrolyte disturbance

E. Cystic fibrosis

Ans:-BCDE

88) The following feature are consistent with newborn infant having oesophageal atresia and

tracheo-oesophageal fistula:-

A. Maternal polyhydramnioseB. Passage of wide bore orogastric catheter into the stomach

C. Plain x-ray evidence of air in the stomach and small bowel

D. Plain x-ray evidence of hemivertebra

E. Excessive mucus in the nostrils or mouth.

Ans:-ACDE

89) Vitamin K

A. Is an essential cofactor for the synthesis of coagulation factorII, VII,IC,C

B. Is readily transported across the placenta

C. Is present in the breast milk at higher concentration than in cow milk.D. Given in single oral dose after delivary effectively prevent s hemorrhagic disease

E. Related hemorrhage in the newborn is commoner when mother have taken

anticonvulsant during pregnancy

Ans:-AE

90) The following are recognizable causes of neonatal convulsion:-

A. Birth asphyxia

B. Hypoglycemia

C. Hypothermia

D. Opiate withdrawalE. Hypernatremia

Ans:-ABDE

91) With regard to Apgar score:-


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A. 2 points given to pulse of 88/minB. 1 point is given for irregular gasps

C. An initial satisfactory score gurarantees an eventual perinatal period

D. Score of 2 at 10 min carries worse prognosis than score of 2 at 5 min

E. The lowest possible score is 1

Ans:-BD92) Intrauterine posture is commonly responsible for:-

A. Congenital dislocation of the hip

B. Plagiocephaly

C. Sternomastoid shortening

D. Syndactyly

E. Mandibular asymmetry Ans:-ABCE

93) Established neonatal screening tests include:-

A. Umbilical cord blood analysis to detect phenylketonuriaB. Umbilical cord blood analysis to detect galactose

C. Umbilical cord blood analysis to detect sickle cell disease

D. Capillary blood analysis at 6-8 days to detect elevated TSHE. Capillary blood analysis at 6-8 days to detect elevated immunoreactive trypsin

Ans:-CDE

94) Maternal condition that may have effect in the neonatal period include:-

A. ITPB. Multiple sclerosis

C. DM

D. Varicella zoster

E. Bornholm disease

Ans:-ACDE

95) Neonatal polycythemia :-

A. Occur in small for date infant as response to placental insufficiency

B. Has an increased incidence if maternal diabetes is poorly controlled

C. Carry an increased risk of cerebral venous sinus thrombosisD. Is recognizable feature of congenital hypothyroidism

E. May occur as result of feto-maternal transfusion Ans:-ABCD

96) Polycythemia on the newborn is characterized by all of the following except:-

A. Increased the incidence in IDM

B. Placental transfusion decreased by late clamping of the umbilical cord

C. Clinical presentation that includes jitteriness & poor feeding

D. Complication including heart failure & NECE. Elevated viscosity of whole blood

Ans;- B

97) Causes of neonatal polycythemia include:-

A. Congenital rubella infection


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B. Pre-eclampsiaC. Maternal diabtus mellitus

D. Delayed clamping of umbilical cord

E. Congenital adrenal hyperplasia

Ans:- BCDE

98) Meconium aspiration pneumonia:-A. Occur with equal frequency in term and preterm infant

B. In infant required ventilation for this condition, combination of high PEEP and

rapid rate is advisable

C. Has high risk of developing even if liquor is only thinly stained

D. High dose steroid are the mainstay of treatment

E. Antibiotic treatment is an important part of treatment Ans :- all False

99) The following statement are true regarding hemolytic disease of newborn ( HDN ):_

A. Hemolytic disease should be suspected if jaundice is noted in the first 24 hour oflife

B. HDN may occur if mother is group A+ve and the baby is group O+ve

C. If due to Rh incompatibility the severity of the hemolysis typically increase with

each affected pregnancyD. HDN due to ABO incompatibility can be detected at 36 week gestation by

amniocentesis

E. As long as the level of unconjugated bilirubin never rises above20 mg/dl there is no

dangerous of kernicterus

Ans:-AC100) Full term infant has tachypnea with grunting , chest X ray show well expanded lung

with streaky shadows radiating from the bilateral hilar region , the most likely diagnosis

is :-

A. TTN

B. Congenital pneumonia

C. BPD

D. Meconium aspirationE. Aspiration pneumonia

Ans:- A101) Condition associated with polyhydramniose include:-

A. Oesophageal atresia

B. Down's syndrome

C. Renal agenesisD. Cord around the neck

E. CNS malformation

Ans:- ABE

102) The following are causes of polyhydramnios:

A. Maternal diabetes mellitus.B. Potter syndrome.

C. Anencephaly.

D. Oesophageal atresia.


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E. Polycystic kidneys. Ans:-ACD

103) The following are causes of polyhydramniose:-

A. Pottrer syndrome

B. TEF and oesophageal atresia

C. Rh incompatibilityD. Anencephaly

E. Maternal diabetus

Ans:-BDE

104) For necrotizing enterocloitis:-

A. Term baby are particularly at risk

B. Perinatal asphyxia is risk factorC. Expressed breast milk from milk bank confer no protection

D. Failure of temperature control is late sign

E. High platelet count is frequently seen Ans:- B

105) You diagnose necrotizing enterocolitis in a preterm neonate who has abdominal

distention and blood in the stool. You decide that this infant should be placed on a 14-day

regimen of parenteral nutrition.Of the following, the micronutrient for which weekly

monitoring is MOST recommended during this infants parenteral nutrition therapy is

A. copper

B. iron

C. phosphorus

D. selenium E. zinc

Preferred Response: C

Parenteral nutrition (PN), the intravenous administration of carbohydrates, lipids, amino acids,

and micronutrients, is an important component in the management of a variety of chronic

disorders, including surgical conditions (eg, omphalocele, gastroschisis, diaphragmatic hernia,

short bowel syndrome), inflammatory conditions (eg, Crohn disease, ulcerative colitis,pseudomembranous colitis, pancreatitis, graft versus host disease), hypermetabolic states (eg,

burns, trauma), and intestinal motility disorders (eg, pseudo-obstruction). PN is especially

important in the support of very low-birthweight infants, who frequently have increased caloricrequirements, decreased oral intake, and immature intestinal motility.

In addition to glucose, amino acids, sodium, potassium, and chloride, PN provides additionalmineral supplements, including calcium, phosphorus, magnesium, zinc, copper, selenium,

chromium, manganese, molybdenum, and iodide. In preterm infants, the administration of both

calcium and phosphorus is important to prevent metabolic bone disease.

However, the amount of calcium and phosphorus that can be administered in PN must be limited

because of the risk of precipitation in the PN and formation of calcium-phosphorus complexes

that could embolize. It generally is thought that the chance of precipitation is high if the productof the concentrations (in mmol/L) of the calcium and phosphorus in PN is greater than 40.

Because hypophosphatemia can have significant consequences (including impaired cardiac

function, muscle weakness, and hemolysis), it is recommended that serum phosphorus

concentrations be assessed at least once weekly for patients receiving PN. The serum


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concentrations of copper, iron, selenium, and zinc, which are trace elements, require only periodicassessment (eg, once a month or less).

106) An 1,800-g preterm infant is recovering from surgery for gastroschisis. Of the

following, the MOST correct statement regarding this infants immediate dailynutritional requirements is that he

A. can meet energy needs from fat through enteral feeding

B. can meet protein needs for growth through enteral feeding

C. requires lysine supplementation to promote protein synthesis

D. requires more protein per kilogram than a term infant

E. requires 2.5 g/kg per day of protein Preferred Response: D

Milk remains the principal source of nutrition for infants, who consume 120 to 150 mL/kg per day

in the newborn period.Human milk has 67 kcal/100 mL, and most term infant formulas have a similar composition. The

energy derived from ingesting milk comes primarily from fat calories (3.8 g/100 mL = 34kcal/100

mL), followed by carbohydrates (lactose, 7 g/100 mL = 28 kcal/100 mL) and minimally fromprotein (1.3 g/100 mL = 5 kcal/100 mL). Conditions such as prematurity, lung disease, or surgery

may increase both caloric and specific nutrient requirements for newborns.

The newborn described in the vignette can only take limited enteral nutrition and has an

increased need for both protein and calories to facilitate healing and growth. The normal 2 to 3

g/kg per day of protein ingested by the term infant who is either formula- or breastfed is

inadequate for this low-birthweight, preterm newborn. He will grow and heal best receiving 3.5 to4.0 g/kg per day of protein. The potential benefits of single amino-acid supplementation, such

as lysine, remain unknown.

107) Hypoxic-ischemic encephalopathy all are correct except:-

A. Result from excessive use of oxytocin

B. IUGR is be first indication of fetal hyoxiaC. Associated with increased beat to beat variability

D. Prognosis depend on gestational age

E. Persistent of abnormal neurological sign at two week indicate poor prognosis Ans:- C

108) polyhydramniose:-

A. Is defined as an amniotic fluid volume of more than 500 ml

B. Occur with increased frequency in diabetic pregnancy

C. Is associated with renal agenesis

D. Is associated with tracheo-oesophageal fistula

E. Is associated with increased risk of premature labor Ans :-BDE

109) Polyhydramnios is associated with all of the following condition except:-

A. Amniotic fluid volume between 500-2000 ml

B. Maternal diabetes


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C. TwinsD. Erythroblastosis fetalis

E. Down syndrome

Ans:- A

110) Condition associated with oligohydramnios include:-

A. Infantile polycystic kidneyB. Congenital heart disease

C. IUGR

D. High intestinal obstruction

E. Posterior urethral valve

Ans:- ACE

111) Regarding hyaline membrane disease ( HMD)

A. Can occur in infants of diabetic mother of 37-40 week gestation

B. Infant born to mothers who are heroin addicts are at increased risk of HMD

C. Light-for date infant of 33 weeks gestation has greater risk of developingHMD than 33 week infant of appropriate weight

D. Administration of artificial surfactant is curative

E. Chest x-ray finding are markedly different between cases of HMD and GroupB streptococcal pneumonia

Ans:- A

112) Hyaline membrane disease:-

A. Is more common in babies of diabetic mother

B. Is due to surfactant deficiency

C. Is not seen in term babiesD. Occur most commonly at 12 hour post-delivary

E. Always require ventilation

Ans:- AB

113) The following symptoms in an infants in the first month of life should alert one to

possibility of hypothyroidism:

A. Prolonged jaundiceB. Vomiting

C. Diarrhea

D. Hoarse cryE. Voracious appetite

Ans:- AD

114) The following malformation can occur in children born to mother who have IDDM:

A. Cleft lip/ palate

B. Caudal regression syndrome

C. Femoral hypoplasia

D. HolopresencaphalyE. Polydactyly

Ans:- BCDE

115) With regard to RDS of the newborn


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A. Meconium aspiration pneumonia is especially likely to be the cause if the infant ispreterm

B. HMD is unlikely to be the cause if the prepartum lecithin sphingomylin (L/S) ratio

in amniotic fluid is > 2;1

C. Patchy opacities on chest X-ray are evidence in favour of diagnosis HMD

D. In the artificial ventilation of infant with HMD , inflation pressure must neverexceed 30 cm of water

E. CPAP is an effective in treatment for Pneumothorax

Ans : B

116) In RDS due to meconium aspiration

A. Antibiotic therapy is of crucial importance

B. Steroid therapy improve the prognosisC. There is high risk of Pneumothorax

D. Chest X-ray typically shows ground glass opacity

E. The infant may also suffer from cerebral oedema Ans:-C

117) Recognized association of small-for-date babies include

A. Maternal smoking in pregnancyB. Hemolytic disease due to ABO incompatibility

C. Pre-eclamptic toxaemia

D. Congenital rubella infection

E. Fetal alcohol syndrome

Ans:- ACDE

118) Prolonged neonatal jaundice is recognized feature in infants withA. CMV infection

B. Congenital hypothyroidism

C. Untreated urinary tract infection

D. Tracheo-oesophageal fistula

E. Galactosemia

Ans:- ABCE

119) In baby of 32 week gestation who has tachypnea and sternal recession at 4 hour of age:

A. The ductus arteriosus is likely to be patent

B. Meconium aspiration pneumonia is likely to be diagnosisC. The L/S ratio is likely to be low

D. Fluid level on chest X-ray suggest pneumonia due to Group B streptococcusE. The presence of bowel shadows on the left side of the chest on X-ray is

diagnostic of Tracheo-oesophageal fistula

Ans :-AC

120) The following condition characteristically cause jaundice within the first 24 hour of life:-

A. G6PD deficiency

B. Congenital hypothyroidism

C. Sever congenital CMV infectionD. Choledochal cyst

E. Primary tyrosinaemia

Ans:- AC


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121) Hypothermia can cause the following in LBW infant:-

A. Decrease synthesis of surfactant

B. Hypernatremia

C. Hypoglycemia

D. Increased oxygen consumption

E. Hypercalcemia Ans :- ACD

122) The following substance are freely transmitted across the placenta:-

A. Carbimazole

B. Diazepam

C. Warfarin

D. PethidineE. IgM antibodies

Ans:-ABCD

123) In congenital diaphragmatic hernia:-A. Hernia most commonly occur on the left

B. Pulmonary hypoplasia is the major cause of death

C. Persistent fetal circulation occurs uncommonlyD. Associated congenital anomalies are common

E. Most present between 12-24 hours of life

Ans:- AB

The incidence of CDH is between 1/2,000 and 1/5,000 live births, with females affected twice as

often as males. Defects are more common on the left (85%) and are occasionally (


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E. Apnoeic attacke Ans:- D

126) Recurrent apnoea of prematurity:-

A. Characteristically develop within the first 24 hour of life

B. Is more likely to occur in infant of < 32 week gestation

C. Usually respond to naloxoneD. Should be treated with 100% oxygen during attack

E. May be accentuated by the presence of nasogastric tube

Ans:- BE

127) In the management of HMD:

A. Tolazoline may lead to systemic hypertension

B. Early use of CPAP may reduce the need for subsequent ventilatory supportC. Antibiotic improve ventilation- perfusion ratio

D. The illness may be expected to increase in the severity for the first 5 days

E. Corticosteroid used postnatally have beneficial effect on the course of thedisease

Ans:- B

128) Characteristic finding in preterm baby include:-

A. Chin reaching only to the tip of shoulder

B. Full wrist flexion

C. Flat on couch when lying prone

D. Incomplete ankle dorsiflexion

E. Incomplete knee extension with hip fully flexed

Ans:- C129) Drug effects on the fetus:-

A. Isotretinion can lead to CNS defects mainly if given in the third trimester

B. Phenytoin can lead to cleft lip, finger and toe abnormalities mainly if given in

the second trimester

C. Carbimazole cause goiter, mainly if given in the third trimester

D. Warfarine can lead to neonatal hemorrhage mainly if given in the firsttrimester

E. Valproate can lead to neural tube defects mainly if given in the third trimester

Ans:- C130) The external criteria for the Dubowitz score for gestational age include:-A. Breast sizeB. Skin texture

C. External genitalia

D. Langue hair

E. Nose firmness

Ans:-ABCD

131) Problem of babies born to mothers with poorly controlled diabetus mellitus:

A. HypermagnesemiaB. Polycythemia

C. Hypocalcemia

D. Sacral agenesis


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E. Respiratory distress Ans:-BCDE

132) The following are recognised associations of maternal diabetes:

A. Sacral agenesis

B. Intrauterine growth retardation

C. MacrosomiaD. Hyaline membrane disease

E. Hypertrophic cardiomyopathy

Ans:-ABCDE

Comments:

Overall, malformations occur in 6%, with an increased incidence of cardiac malformations, sacral

agenesis, hyperplastic left colon. Intrauterine growth retardation is 3 times as common due tosmall vessel disease in the mother. More common is macrosomia, and this is related to the degree

of maternal hyperglycaemia. The glucose crosses the placenta while the insulin does not, so the

fetus increases its production of insulin. This results in increased cell number andsize. 25% of IDM are greater than 4kg compared with only 8% of non-diabetics. This gives

problems with delivery such as CPD, shoulder dystosia resulting in an increased incidence of birth

asphyxia and trauma.In the neonatal period, hypoglycaemia, respiratory distress and reversible hypotrophic

cardiomyopathy and polychthaemia are all more common. Gestational diabetes is when

carbohydrate intolerance occurs only during pregnancy. It is commonest in obese women and

those from Afro-Caribbean and Asian ethnic groups. In these women there is no increase in

congenital malformations, thoug macrosomia and other complications remain similar in

frequency.

133) Characteristic finding in full term baby are:-

A. Full knee extension with hips fully flexed

B. Momentary neck extension when held sitting

C. Chin reach beyond tip of shoulder

D. Hip abducts and legs flat on couch when lying supineE. Full ankle dorsiflexion

Ans:- BE

134) The external criteria for the Dubowitz score for gestational age include:-A. Nipple formation

B. Ear form & firmnessC. Skin colour & opacity

D. Protruding tongue

E. Planter creases

Ans:- ABCE

135) In fetal circulation:-

A. 30% of the fetal cardiac output goes through the placentaB. Oxygenated blood from the placenta passes through the ductus arteriosus toward

the right atrium

C. The oxygen saturation of blood in umbilical arteries is approximately 60%


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D. Blood entering the heart from the inferior vena cava is diverted directly to the leftatrium via patent foramen ovale

E. There is one umbilical vein

Ans:- CDE

136) The following disease can now be diagnosed prenatally:-

A. PhenylketonuriaB. Homocystinuria

C. Sever combined immunodeficiency

D. Fanconi's anaemia

E. Lesh-Nyhan syndrome

Ans:- ABCDE

137) Resuscitation of neonate with coarctation of aorta may require the use of :-

A. Frusemide

B. Bicarbonate

C. IndomethacinD. Dopamine

E. Prostaglandin E

Ans:- ABDE

138) Recognized causes of the floppy baby include:-

A. Trisomy 21

B. Zellweger syndrome

C. Becker muscular dystrophy

D. Spinal muscular atrophy

E. Hypothyroidism Ans:- ABDE

139) Which of the following may cause apnoea in preterm infant

A. Hypocalcemia

B. Hypoglycemia

C. RSV infection

D. CaffeineE. Intraventricular hemorrahage

Ans:- ABCE

140) Failure of resuscitation of newborn may be due to :-A. PDA

B. VSDC. Congenital diaphragmatic hernia

D. Pulmonary hypoplasia

E. HMD

Ans:-CD

141) Feature of IUGR include:-

A. Neutropenia

B. HypoglycemiaC. Necrotizing Enterocolitis

D. Weight loss > 10% of birth weight in first week

E. Thermal instability


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Ans:- ABCE

142) Newborn infant has breathing difficulty with central cyanosis .Nitrogen washout test

raised the PO2 to 15 kPa possible diagnosis include:-

A. Fallot's tetralogy

B. VSD

C. PneumoniaD. Tricuspid atresia

E. HMD

Ans:- CE

143) Newborn infant has central cyanosis and fit with slow & shallow breathing , Nitogen

washout test produce slight raise in the PO2 , the most likely cause of cyanosis is:-

A. MethemoglobinemiaB. Cerebral disorder

C. Persistent fetal circulation

D. Congenital cyanotic heart diseaseE. Lung disease

Ans:- B


A. Hypercholesterolemia

B. Polycystic kidney disease

C. Cystinosis

D. Gaucher's disease

E. Beta thalassaemia

Ans:-ABCDE145) Common causes of seizure in the neonatal period include:-

A. Intracranial hemorrhage

B. Electrolyte disturbance

C. Infection

D. Drug withdrawal

E. Febrile convulsion Ans:- ABCD

146) Neonatal convulsion may be caused by :-

A. HypomagnesaemiaB. Hyperkalamia

C. Pyridoxine dependencyD. Cephalohematoma

E. HSV infection

Ans:- ACE


A. Sickle cell disease

B. Maple syrup urine diseaseC. Retinoblastoma

D. Hypophosphaturia

E. Von-Willebrand disease


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Ans:- ABCDE

148) Which of the following statement regarding surfactant therapy is correct :-

A. The incidence of Pneumothorax is reduced

B. The incidence of intraventricular hemorrhage is reduced

C. Early therapy ( within 4 hour) is more beneficial than later administration ( after

12 hour)D. Prolonged courses of surfactant therapy confer advantages

E. The incidence of chronic lung disease is increased

Ans:- ABC

149) Which of the following statement regarding periventricular hemorrhage are correct:

A. Most hemorrhage occur after the fourth day of life

B. Over 80% of hemorrhage progress to ventricular dilatationC. Most cases of posthemorrhagic hydrocephalous are communicating

D. Early ventricular tapping improve the neurological outcome

E. Hemorrhage is usually caused by hypoglycemia Ans:- C

150) Complication of phototherapy include:-

A. DiarrheaB. Erythematosus rash

C. Hyponatremia

D. Skin discoloration

E. Peripheral desqumation

Ans:- ABD

151) Which of the following are characteristic haemodynamic changes encountered at birth:-A. Increase the pulmonary vascular pressure

B. Right to left flow through the ductus arteriosus

C. Closure of the ductus arteriosus

D. Increased right ventricular end diastolic pressure

E. Reversal of flow across the foramen ovale

Ans:- C

152) Feature suggestive of TEF with oesophageal atresia include:-

A. FTT

B. Recurrent pneumoniaC. Oligohydramniose

D. Large amount of mucus in the pharynx at delivaryE. Slow to establish feed

Ans:- D

153) The development of Pneumothorax is associated with :-

A. Surfactant therapy

B. Artificial paralysis

C. Patient triggered ventilationD. Meconium aspiration

E. Pulmonary interstitial emphysema

Ans:- DE


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154) Cyanotic congenital heart disease in the newborn include:-

A. TGA

B. Pulmonary stenosis

C. Fallot's tetrallogy

D. VSD

E. Tricuspid atresia Ans:- AE

155) The following congenital disorder require immediate ( within first week) treatment after

birth:-

A. Hemangioma

B. Imperforate anus

C. Choanal atresiaD. Hypospadius

E. Congenital diaphragmatic hernia

Ans:-BCE156) Causes of neonatal hypoglycemia include;-

A. Erythroblastosis fetalis

B. Glycogen storage disease typeI

C. Maternal treatment with sodium valproateD. Galactosemia

E. Congenital adrenal hypoplasia

Ans:- ABDE

Plasma glucose level of


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Micropenis:Congenital gonadotropin deficiency and possible pituitary abnormalities causethis condition.

Hepatomegaly:This is associated with glycogen storage diseases and fatty acid oxidation

disorders.

157) Healthy term neonate differ from adult in the following way:-

A. Less complementB. Decrease IgG level

C. Fewer B lymphocytes

D. Lower level of secretory IgA

E. Higher level of C reactive protein

Ans:- AD

158) Necrotizing enterocloitis is recognized complication of:-

A. Polycythemia

B. Umbilical arterial catheterization

C. Parenteral feedingD. Maternal Crohn's disease

E. Birth asphyxia in term neonate

Ans:- ABE

159) NEC is associated with:-

A. Epidemic

B. Thrombocytopenia

C. Malabsorption

D. Bile stained aspirate

E. Air in the portal tree on abdominal X ray Ans:- ABCDE

160) The presenting feature of NEC include:-

A. Apnoea

B. Bradycardia

C. Abdominal distension

D. Intramural gas on abdominal X rayE. Bloody stool

Ans:- ABCDE

161) A 3-week-old breastfed infant presents to the emergency department with irritability,

fever, jaundice, and hepatomegaly. A laboratory evaluation shows a normal complete blood

count and a bilirubin concentration of 6.5 mg/dL (111.2 mcmol/L). A urinalysis is positive for

reducing substances. A blood culture is positive for Escherichia coli. You initiate antibiotic

therapy Of the following, the MOST appropriate dietary management of this patient is to

A. continue breastfeeding

B. switch to a cow milk-based formula

C. switch to a soy-based formula D. switch to a whey hydrolysate formula

E. switch to an elemental formula

Preferred Response: C


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The clinical features of jaundice, hepatomegaly, and invasive Escherichia coli infection describedfor the neonate in the vignette suggest the possible diagnosis of galactosemia.

Galactosemia is an autosomal recessive disorder most commonly caused by a deficiency of the

enzyme galactose-1-phosphate uridyltransferase. The reducing substances in the urine represent

the accumulation of galactose. In addition to recognizing and treating the gram-negative infection

in the infant, it is important to remove lactose, which is comprised of glucose and galactose,from the diet as soon as the diagnosis is suspected.

Soy protein formulas are the first choice of nutrition for infants who have suspected or proven

galactosemia because the carbohydrate source in these formulas is sucrose or corn syrup rather

than lactose. Protein hydrolysate and elemental formulas also contain other carbohydrates than

lactose, but they can be more expensive and less readily available than soy formulas. Lactose is

the primary carbohydrate in human milk, cow milk-based formulas, and most whey hydrolysateformulas.

162) Hydrops fetalis may be associated with :-A. Rhesus isoimmunization

B. Paroxysmal supraventricular tachycardia

C. CMV infectionD. Achondroplasia

E. Renal vein thrombosis

Ans:- ABCDE

163) The following drugs are correctly paired with their potential teratogenic effect:-

A. Alcohol & macrocephaly with congenital heart diseaseB. Phenytoin & meningomyelocele

C. Isotretinoic acid & cutis laxis syndrome

D. Penicillamine & facial abnormalities with pinna defects

E. Lithium & Ebtein's anomaly

Ans:-BCDE

Warfarine Hypoplastic nasal bridge ,chrondroplasi puncta

Isotretinoic acid facial , ear , cardiovascular abnormality

Phenytoin Hypoplastic nail, IUGR, typical facies & may be associated withneural tube defect

Tetracyclin Enamel hypoplasia Sodium Valproate Neural tube defect

164) The neonate of mother with SLE may demonstrate:-

A. Polythycemia

B. Rash

C. NeutropeniaD. Atrial fibrillation

E. Anti-Ro antibodies

Ans:- BCE

165) Pulmonary hypoplasia is consequence of :-


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A. Congenital varicella zosterB. Anencephaly

C. Posterior urethral valve

D. Congenital diaphragmatic hernia

E. Exomphalos

Ans:- BCDE166) The following conditions may present with bile-stained vomiting in the first week of life:-

A. Duodenal atresia

B. Cystic fibrosis

C. Inguinal hernia

D. GER

E. NEC Ans:- ABCE

167) Renal immaturity in normal neonate born at term is manifested as:-

A. Reduced number of nephronsB. Decreased glucose reabsorption

C. Increased glomerular filteration rate

D. Decreased renal bicarbonate reabsorptionE. Decreased urea excretion

Ans:- BDE

168) The following maternal factors increase the incidence of surfactant deficient RDS:-

A. Steroid therapyB. Opiate

C. Placental insufficiency leading to IUGR

D. Diabetus

E. Alcoholism

Ans:- D

169) Bacteria commonly isolated in case of neonatal meningitis include:-

A. Escherichia coli

B. Haemophilus infuenzae

C. Group B streptococcusD. Staphylococcu epidermidis

E. Neisseria meningitis Ans:- AC

170) In the infant of diabetic mother :-

A. The infants brain size is increased beyond normal

B. The infant's liver size is increased beyond normal

C. He can be small for gestational age

D. There is an increased incidence of polycythemiaE. He has an increased incidence of hypertrophic Cardiomyopathy

Ans:- BCDE

171) Galactosaemia:-

A. Is caused by deficiency of the enzyme galactokinase


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B. Causes jaundice in the newbornC. May present with cataract at birth

D. Is associated with Escherichia coli septicemia

E. Is diagnosed as result of screening in the majority of cases.

Ans:- BCD

172) SVT in neonate:-A. Is the most common abnormal tachycardia

B. Reflect underlying congenital heart disease in the majority of cases

C. Show regular rate of 160-220 beats /min on the ECG

D. Recurrent episodes usually persist into adulthood

E. May be stopped with rapid I/V bolus of adenosine

Ans:- A E

173) Neonates suffering withdrawal from in utero exposure to narcotics may show sign of

A. Irritability

B. VomitingC. Photophobia

D. Hypotonia

E. Diarrhea Ans:- ABCE

174) Clinical feature of congenital hypothyroidism diagnosed in the newborn period include:-

A. Large tongue

B. Presence of third fontenalle

C. Umbilical hernia

D. Loose stoolsE. High incidence of mental retardation

Ans:- A C

175) Causes of persistent neonatal unconjugated hyperbilirubinemia after 2 weeks include:-

A. Rhesus incompatibility

B. HypothyroidismC. Breast milk jaundice

D. Rotor syndrome

E. Sepsis Ans:- ABCE

176) Growth retardation babies are at increased risk of:-

A. Polycythemia

B. HMD

C. Hypoglycemia

D. Group B streptococcal infection

E. Sudden intrapartum death

Ans:- ACE

177) Oesophageal atresia is associated with:-

A. Maternal polyhydramniose

B. Vertebral anomalies

C. Diaphragmatic hernia


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D. Low birthweightE. Duplex collecting system

Ans:- ABDE

178) Congenital Rubella:-

A. Is associated with cerebral calcification

B. Frequently lead to cataractC. Is associated with VSD

D. Rarely occur following maternal infection in the third trimester

E. Should be prevented by vaccinating women found to be seronegative during the

first trimester

Ans:- B D

179) Human breast milk contain:-

A. Secretory IgA

B. Macrophages

C. LysozymeD. Vitamin c

E. Zinc

Ans:- ABCDE

180) The following are recommended daily requirement for 1 month old child /hg of B wt:-

A. Fluids 150-180 ml orally

B. Calories 90-115 kcal

C. Sodium 1.25-2.5 mmol

D. Protein 2.2-3.5 gm

E. Potassium 2.0-3.5 mmol Ans:- ABCDE

181) Compared with cow's milk, human breast milk contains:

A. Less sodium.

B. Less calcium.

C. Less protein.D. Less fat.

E. Less carbohydrate.

Ans:-A B C

182) UK infants are routinely immunised against:

A. Meningococcus type B.

B. Diphtheria.

C. Cholera.

D. Polio.Pertussis.

Ans:-B D E

183) Mature breast milk contain per 100 ml;-

A. 60-75 kcalB. 8-10 gm of protein

C. 0.1-0.5 gm of fat

D. 0.1-0.5 gm of carbohydrate


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E. 5.2mg of folic acid

Ans:- AE

MATURE BREAST

MILK

COWS

MILK

carbohydrate 7.4 gm 4.6 gmFat 4.2 gm 3.9 gm

protein 1.1 gm 3.4 gm

Calories 70 67

folic acid 5.2 mg 3.7mg

184) Treatment of PDA with Indomethacin:-

A. Should be first line therapy

B. Is safe in renal failureC. Should not be given if there is thrombocythenia

D. Should be avoided in jaundiced babies

E. Should not be given in the presence of IVH Ans:- D E

185) Retinopathy of prematurity ;-

A. Develop in the first week of life

B. Is more likely to occur in VLBW infants

C. Is recognized complication of hypoglycemia

D. Rarely resolve spontaneouslyE. May be treated effectively with Laser therapy

Ans:- B E

186) Alpha fetoprotein level from maternal serum may be helpful in diagnosing:-

A. Congenital cardiac malformation

B. Prune-belly syndromeC. Cleft lip & palate

D. Down syndrome

E. Fetal alcohol syndrome

Ans:- D187) 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 activityE. measurement of the serum alpha1-antitrypsin level

Ans:- C


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188) 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 thefifth finger

D. Short stature, webbed neck, and pulmonic stenosis

E. Weakness, club feet, immobile face, and inadequate respirations

Ans:- B

189) 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 abnormalityThe 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 allfuture pregnancies

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

determinedC. 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

Ans:- B

190) 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 contents

B. determine the Apgar score initiate tracheal intubation

C. provide positive pressure ventilation

D. suction the hypopharynx

Ans:- D

191) 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 isA. ascites

B. coughC. cyanosis

D. diminished feeding volume

E. pretibial edema

Ans:- D

192) 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 infantsB. 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


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E. sterility of human milk Ans:- D

193) 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 initialmanagement is to

A. begin intravenous vancomycin

B. begin phototherapy

C. initiate enteral feeding

D. provide bicarbonate infusion

E. provide glucose infusion Ans:- E

194) A 3-day-old infant presents to the emergency department with vomiting, lethargy,

hypotonia, and jaundice. Physical examination reveals hepatomegaly and neurologicdepression. 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 content

C. plasma insulin level

D. plasma very long-chain fatty acids.

E. stool porphyrins

Ans:- A195) 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 cmC. 35 cm

D. 37 cm

E. 39 cm Ans:- D

196) 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 coagulationB. factor VIII deficiency hemophilia

C. liver disease

D. vitamin K deficiency


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E. von Willebrand disease Ans:- D

197) 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 isA. coarse infiltrates

B. decreased lung volumes

C. mediastinal shift

D. pleural effusion

E. reticulogranular pattern

Ans:- A

198) 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 ishospitalized for observation and electronic fetal heart rate monitoring. Of the following, the

MOST ominous sign of fetal distress during monitoring would be

A. early decelerationsB. increased beat-to-beat variability

C. late decelerations

D. spontaneous accelerations

E. variable decelerations

Ans:- C

199) A term newborn presents with bilious vomiting shortly after birth. Her abdomen isdistended slightly, and facial features are characteristic of Dow

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Newborn MCQ

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