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100 MCQs in Neonatology By Ayman Abu Mehrem, MD Assistant Consultant Department of Pediatrics King Abdulaziz Hospital, Al- Ahsa

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Page 1: Neonatology MCQs

100 MCQs in Neonatology

By

Ayman Abu Mehrem, MDAssistant Consultant

Department of PediatricsKing Abdulaziz Hospital, Al-Ahsa

Page 2: Neonatology MCQs
Page 3: Neonatology MCQs

Question 1An infant has the following findings at 5 minutes of life: pulse 130 bpm, cyanotic hands and feet, good muscle tone, and a strong cry and grimace. This infant Apgar score is:A. 6B. 7C. 8D. 9E. 10

Page 4: Neonatology MCQs

Question 2Jaundice is most likely to be physiologic in a term infant in which of the following situations:A. Jaundice at 12 hours of ageB. Serum bilirubin level increasing less than 5

mg/dL/24 hours in the first 2-4 daysC. Direct serum bilirubin greater than 2 mg/dLD. Jaundice at 13 days of ageE. Serum bilirubin level 15 mg/dL at 7 days of

age

Page 5: Neonatology MCQs

Question 3Which of the following is most appropriate for treating hyperbilirubinemia (11.2 mg/dL) in a 3-week-old, breast-fed infant with normal growth and development?

A. PhototherapyB. Exchange transfusionC. PhenobarbitalD. Replace breast milk by formula for 48 hoursE. None of the above

Page 6: Neonatology MCQs

Question 4Newborns are obligate nasal breathers for the first few months after birth. Of the following, the most common cause of neonatal nasal obstruction is:

A. Choanal atresiaB. Craniofacial malformationsC. Intranasal encephaloceleD. Lacrymal cystE. Mucosal inflammation

Page 7: Neonatology MCQs

Question 5A term newborn appears dusky at rest, but becomes pink with crying. Attempts to pass a catheter through each nostril have failed. Physical examination of the infant reveals other congenital anomalies. Of the following, the most likely clinical syndrome in this infant is:

A. Apert syndromeB. CHARGE associationC. Crouzon syndromeD. Pfeiffer syndromeE. Treacher-Collins syndrome

Page 8: Neonatology MCQs

Question 6The following are accepted definitions Except

A. The neonatal period is the first 28 days of life of a newborn of any gestational age

B. Small for gestation infants have a birth weight less than 10th centile

C. Infancy refers to the 1st year of life

D. The fetal period is from the 12th week of gestation to delivery

E. The perinatal mortality rate is the number of stillbirths and neonatal deaths per 1000 total births

Page 9: Neonatology MCQs

Question 7The maternal serum screening test or “quadruple test” is done between 14 and 22 weeks gestation. It includes all of the following Except

A. Alpha-fetoproteinB. β-hCGC. Unconjugated pregninoloneD. Inhibin–AE. Unconjugated esteriol

Page 10: Neonatology MCQs

Question 8Neonatal hypercalcemia is associated with all of the following Except

A. Williams syndrome

B. Subcutaneous fat necrosis

C. Blue diaper syndrome

D. Familial hypercalciuric hypercalcemia

E. Primary hyperparathyroidism

Page 11: Neonatology MCQs

Question 9The single greatest risk factor for necrotizing enterocolitis is

A. Prematurity

B. Patent ductus arteriosus

C. Indomethacin therapy

D. Polycythemia

E. Hypoxic-ischemic insult

Page 12: Neonatology MCQs

Question 10You are called to the delivery of a boy at 42 weeks’ GA with thick meconium-stained fluid and type II decelerations. The obstetrician rapidly delivers the baby and hands him to you. The boy hypotonic, cyanotic, apneic, and bradycardic. The most appropriate action is to

A. Stimulate the infant to breathB. Administer epinephrineC. Provide positive-pressure bag-and-mask

ventilationD. Intubate and provide positive-pressure ventilationE. Intubate and apply negative-pressure suction

Page 13: Neonatology MCQs

Question 11You are called to see one-hour-old term baby in normal newborn nursery with ambiguous genitalia. Your plan includes all the following Except

A. Inform the parents that their baby’s genitalia are incompletely developed, and you need to do some investigation to identify their baby’s gender

B. Advise the parents to use unigender nameC. Urgent chromosomal analysisD. Pelvic ultrasoundE. Serum electrolytes with daily monitoring

Page 14: Neonatology MCQs

Question 12Incidence of respiratory distress syndrome increases with all of the following Except

A. Prematurity

B. Maternal diabetes

C. Black race

D. Male gender

E. Cesarean section delivery

Page 15: Neonatology MCQs

Question 13Normal findings in a newborn baby includes all of the following Except

A. A mongolian blue spot

B. A strawberry nevus

C. Vaginal blood loss

D. Lanugo hair

E. Erythema toxicum

Page 16: Neonatology MCQs

Question 14The pharmacologic effects of caffeine in the treatment of apnea of prematurity include stimulation of the medullary respiratory center, increased sensitivity to carbon dioxide, and enhanced diaphragmatic contractility. Of the following, caffeine exerts most of its effects byA. Antagonism of prostaglandin activityB. Blockage of adenosine receptorsC. Enhancement of catecholamine secretionD. Stimulation of phosphodiesteraseE. Upregulation of gamma-amino-butyric acid

receptors

Page 17: Neonatology MCQs

Question 15When clinical zinc deficiency occurs in term and preterm infants, almost all affected infants areexclusively breastfed and receiving breast milk that has substantially lower-than-average zinc content. Of the following, the most common clinical manifestation of zinc deficiency in infants is

A. Alopecia

B. Diarrhea

C. Failure to thrive

D. Irritability

E. Rash

Page 18: Neonatology MCQs

Question 16Assisted reproductive technology is associated with significant risks to the fetus and the mother. Of the following, the greatest risk to the fetus is related to

A. Cesarean sectionB. Gestational diabetesC. Maternal pre-eclampsiaD. Multiple gestationsE. Placental abruption

Page 19: Neonatology MCQs

Question 17A term male newborn has severe intrauterine growth restriction, triangular face with broad forehead and pointed chin, leg length asymmetry, fifth finger clinodactyly, and cryptorchidism. Of the following, the most likely genomic imprinting disorder in this infant is

A. Albright hereditary osteodystrophy

B. Angelman syndrome

C. Beckwith-Wiedemann syndrome

D. Prader-Willi syndrome

E. Silver-Russell syndrome

Page 20: Neonatology MCQs

Question 18A preterm newborn has multiple fractures of long bones, wormian skull, dark blue sclera, and beaked nose. Osteogenesis imperfecta type II is suspected. Genetic molecular tests are ordered for confirmation of the diagnosis. Of the following, the genetic mutation in this infant is most likely to involve the

A. ADAMTS2 gene

B. Collagen 1A1 gene

C. Fibrillin-1 gene

D. Filamin B gene

E. Transforming growth factor receptor 1 gene

Page 21: Neonatology MCQs

Question 19Of the following, the nasal maldevelopment most likely to be associated with holoprosencephaly is:

A. CepocephalyB. Choanal atresiaC. Nasal agenesisD. Piriform aperture stenosisE. Proboscis lateralis

Page 22: Neonatology MCQs

Question 20Regarding the head of a newborn infant(multiple choices)

A. A cephalohematoma will resolve within the first 24 hours of life

B. Caput is due to edema of the presenting part of the head

C. A cephalohematoma is due to bleeding into the skin

D. Overlapping of the skull bones is a normal finding

E. A cephalohematoma should be drained

Page 23: Neonatology MCQs

Question 21The most prevalent clinical manifestation of late-onset group B Streptococcus disease is

A. Arthritis

B. Cellulitis

C. Meningitis

D. Osteomyelitis

E. Pneumonia

Page 24: Neonatology MCQs

Question 22In contrast to “classic” bronchopulmonary dysplasia (BPD), the “new” BPD in the more contemporary clinical setting is characterized by different histopathologic findings on examination of the lung tissue. The most striking abnormality in the lungs of infants who have new BPD is

A. Decrease in alveolar septation

B. Diffuse leukocytic infiltration

C. Epithelial squamous metaplasia

D. Hypertrophy of airway smooth muscle

E. Lung parenchymal fibrosis

Page 25: Neonatology MCQs

Question 23Several risk factors during prenatal, perinatal, and postnatal development have been proposed as predictors of cerebral palsy in preterm infants. Of the following, the highest rate of cerebral palsy among preterm infants is associated with

A. Bronchopulmonary dysplasia

B. Necrotizing enterocolitis requiring surgery

C. Parenchymal brain injury

D. Sepsis or meningitis

E. Severe retinopathy of prematurity

Page 26: Neonatology MCQs

Question 24A 1700-g infant is born at 36 weeks’ gestation complicated by severe oligohydramnios. The Apgar scores are 3 and 5 at 1 and 5 min respectively. The baby required intubation as part of the resuscitation and continued MV to improve the ABGs. At 1 hour of age, the baby showed acute deterioration with cyanosis, bradycardia, and hypotension. The most likely diagnosis of this acute change is

A. Patent ductus arteriosusB. Intraventricular hemorrhageC. HypoglycemiaD. PneumothoraxE. Severe respiratory distress syndrome

Page 27: Neonatology MCQs

Question 25A healthy newborn baby boy may(one incorrect)

A. have erythema of the umbilical skin extending on to the abdomen

B. produce breast milkC. have a single palmar creaseD. have an umbilical herniaE. vomit blood if breast feeding

Page 28: Neonatology MCQs

Question 26A 14-day-old preterm infant, whose birthweight was 980 g at an estimated gestational age of 27 weeks, is receiving full enteral feedings of fortified human milk. The infant is breathing spontaneously in room air and has no evidence of cardiac, renal, or intracranial abnormalities. Of the following, the most desirable goal of enteral nutrition in this infant is to achieve

A. Fetal rate of body weight gainB. Fetal rate of crown-heel length gainC. Fetal rate of head circumference gainD. Intrauterine body compositionE. Normal blood urea concentration

Page 29: Neonatology MCQs

Question 27The interruption in the transfer of nutrients from the mother to the fetus that occurs following birth canbe minimized by early administration of parenteral nutrition in VLBW neonates within the first 24 hours after birth. Of the following, the most common metabolic consequence of early parenteral nutrition with amino acids is

A. Hyperammonemia

B. Hyperglycemia

C. Hyperkalemia

D. Increase in blood urea nitrogen values

E. Metabolic acidosis

Page 30: Neonatology MCQs

Question 28A 3600-g, breast-fed female, 42 weeks’ GA, is noted to have persistent hyperbilirubinemia at 2 weeks of age. On examination, the infant has not gained weight since birth and has decreased tone, an umbilical hernia, and an anterior fontanel measuring 4 x 6 cm. The most likely diagnosis is

A. Crigler-Najjar syndromeB. Gilbert diseaseC. Biliary atresiaD. HypothyroidismE. galactosemia

Page 31: Neonatology MCQs

Question 29Fractured clavicle (multiple choices)

A. occurs more frequently in infants of diabetic mothers

B. requires treatment with a sling

C. is associated with Erb’s palsy

D. causes an asymmetric Moro reflex

E. is not painful

Page 32: Neonatology MCQs

Question 30Minimal enteral feeding, also called gut priming or trophic feeding, is designed to improve gastrointestinal function and is used frequently in the nutritional management of VLBW neonates. The most accurate statement regarding minimal enteral feeding is that it

A. Increases plasma concentrations of gastrointestinal hormones

B. Is best avoided in infants weighing 500 to 600 gC. Is contraindicated in the presence of assisted

ventilationD. Is contraindicated in the presence of indwelling

umbilical cathetersE. Prevents necrotizing enterocolitis

Page 33: Neonatology MCQs

Question 31The only inborn error of metabolism associated with neonatal hyperammonemia that is X-linked in inheritance is

A. Hyperinsulinism/hyperammonemia syndrome

B. Isovaleric acidemiaC. Medium-chain acyl-CoA dehydrogenase

deficiencyD. Ornithine transcarbamylase deficiencyE. Pyruvate carboxylase deficiency

Page 34: Neonatology MCQs

Question 32A 750-g black female experienced respiratory distress after a preterm delivery at 27 wks’ gestation. Pregnancy was uncomplicated, but labor was abrupt and therefore the mother did not receive steroid or penicillin therapy. The baby required intubation and MV with 100% O2. The possible causes of respiratory distress include (multiple choices)

A. PneumothoraxB. Respiratory distress syndromeC. Patent ductus arteriosusD. Group B streptococcal sepsisE. Transient tachypnea

Page 35: Neonatology MCQs

Question 33The patient in Question 32 was also treated with endotracheal instillation of exogenous surfactant. This is likely to be beneficial by (multiple choices)

A. Preventing bronchopulmonary dysplasiaB. Reducing the incidence of pneumothoraxC. Reducing mortalityD. More rapid improvement of RDSE. Preventing oligouria

Page 36: Neonatology MCQs

Question 34Approximately 10% of infants born with congenital diaphragmatic hernia (CDH) have significant heart defects. The most common congenital heart defect associated with CDH is

A. Aortic arch obstruction

B. Tetralogy of Fallot

C. Total anomalous pulmonary venous return

D. Transposition of the great arteries

E. Ventricular septal defect

Page 37: Neonatology MCQs

Question 35Contemporary management of gastroschisis is associated with a 10% to 25% incidence of postoperative intestinal and related complications. The most common postoperative complication of surgical repair of gastroschisis is

A. Abdominal compartment syndromeB. Enterocutaneous fistulaC. Necrotizing enterocolitisD. Renal ischemiaE. Short bowel syndrome

Page 38: Neonatology MCQs

Question 36Amniotic fluid volume varies substantially at each week of human gestation, as reflected in the wide range of normal values. The largest variation in amniotic fluid volume occurs at the gestational age of

A. 26 to 27 weeks

B. 29 to 30 weeks

C. 32 to 33 weeks

D. 35 to 36 weeks

E. 38 to 39 weeks

Page 39: Neonatology MCQs

Question 37You wish to determine the incidence and natural course of necrotizing enterocolitis in preterm neonates. Of the following, the best study design to address this question is a

A. Case-control study

B. Descriptive observational study

C. Prospective cohort study

D. Randomized clinical trial

E. Systematic meta-analysis

Page 40: Neonatology MCQs

Question 38 The most common fetal cause of polyhydramnios is

A. Decreased absorption of amniotic fluid due to gastrointestinal atresia

B. Decreased fetal swallowing from neuromuscular disorder

C. Excessive transudation of fluid from an abdominal wall defect

D. Increased fetal lung fluid secretion associated with gestational diabetes

E. Increased fetal urine output from hydrops associated with anemia

Page 41: Neonatology MCQs

Question 39A 4-week-old, A-positive, African-American former 40-week’s-gestational age infant was born to an O-positive mother and experienced hyperbilirubinemia requiring 2 days of phototherapy in the NB nursery after birth. The infant appears apathetic and demonstrates pallor, a grade 2/6 ESM, and a HR 175 bpm. The most likely diagnosis is

A. Anemia of chronic diseaseB. G-6-PD deficiencyC. Hereditary spherocytosisD. Sicle cell anemia with hemolytic crisisE. ABO incompatibility with continued hemolysis

Page 42: Neonatology MCQs

Question 40The following predispose a baby to be small for gestational age (multiple choices)

A. Placental insufficiency

B. Twin pregnancy

C. Congenital infection

D. Maternal diabetes

E. Alcohol consumption

Page 43: Neonatology MCQs

Question 41The small for gestational age newborn baby is at increased risk of (multiple choices)

A. Hypoglycemia

B. Polycythemia

C. Hypothermia

D. Hypothyroidism

E. Cardiac abnormalities

Page 44: Neonatology MCQs

Question 42A term infant is born with Apgar score 5 and 7 at 1 and 5 min respectively. The infant has a HR 170 bpm and demonstrates pallor with hepatosplenomegaly. A Kleihauer-Betke test was positive. The most likely diagnosis is

A. Erythroblastosis fetalisB. Hereditary spherocytosisC. Chronic feto-maternal transfusionD. ABO incompatibilityE. Blackfan-Diamond syndrome

Page 45: Neonatology MCQs

Question 43The twin-twin transfusion is unique to twins that are

A. Dizygotic, dichorionic

B. Dizygotic, monoamnionic

C. Dizygotic, monochorionic

D. Monozygotic, dichorionic

E. Monozygotic, monochorionic

Page 46: Neonatology MCQs

Question 44The amino acids derived from swallowedamniotic fluid are important for fetal gastrointestinal development. The amino acid considered conditionally essential for normal growth and maturation of the fetal gastrointestinal tract isA. AlanineB. CitrullineC. GlutamineD. LeucineE. Valine

Page 47: Neonatology MCQs

Question 45Respiratory distress syndrome is exacerbated by the following Except

A. Hypothermia

B. Acidosis

C. Hypoxia

D. Meconium aspiration

E. Withholding enteral feeds

Page 48: Neonatology MCQs

Question 46The most important determinant of endotracheal tube resistance is

A. Airflow velocity

B. Biofilm coating

C. Gas density

D. Tube curvature

E. Tube diameter

Page 49: Neonatology MCQs

Question 47Bilirubin conjugated in the liver and secreted into bile can be deconjugated in the gut, then reabsorbed into the bloodstream, resulting in enterohepatic bilirubin circulation. The enzyme most responsible for contributing to enterohepatic bilirubin circulation is

A. Beta-glucuronidaseB. Bilirubin hydrogenaseC. Bilirubin oxidaseD. Biliverdin reductaseE. Uridine diphosphoglucuronate

glucuronosyltransferase

Page 50: Neonatology MCQs

Question 48The most widely used and accurate method for estimating amniotic fluid volume is by

A. Determination of dye dilution by timed amniocentesis

B. Palpation of the fetus by the Leopold maneuverC. Palpation of the uterus for fundal heightD. Ultrasonographic measurement of the amniotic

fluid indexE. Ultrasonographic measurement of the largest

vertical pocket

Page 51: Neonatology MCQs

Question 49A NB female has a ventricular septal defect, cleft lip and palate, imperforate anus. All of the following tests would be appropriate Except

A. Karyotype analysisB. TORCH titerC. Renal USD. Cranial USE. Skeletal survey

Page 52: Neonatology MCQs

Question 50A 2700-g, 36-wk’s-GA white male is born after 22 hrs of premature rupture of the amniotic membranes. The Apgar scores are 3 and 5. He immediately experienced respiratory distress and cyanosis requiring ET intubation and MV with 100% O2. Vital signs are T: 35.7˚C, HR 195 bpm, mean BP 22 mm Hg. WBC 1500/ μL, platelets 59,000/ μL. The next most appropriate treatment for this baby is to administer

A. Surfactant by aerosolB. IV ampicillin and gentamicin/cefotaximeC. IV steroidsD. IV acyclovirE. HFOV

Page 53: Neonatology MCQs

Question 51The patient described in Question 50 is most likely suffering from

A. Respiratory distress syndromeB. Diaphragmatic herniaC. Congenital pneumonia with sepsisD. PneumothoraxE. TORCH infection

Page 54: Neonatology MCQs

Question 52Transient tachypnea of the newborn(multiple choices)

A. occurs in 15% of full-term babiesB. can be diagnosed if onset occurs up to 48

hours post deliveryC. is caused by delayed absorption of fetal

lung fluidD. is more common in babies delivered by

cesarean sectionE. cannot be clearly differentiated from early

pneumonia

Page 55: Neonatology MCQs

Question 53A baby presents in heart failure at 5 days of age. The baby is not centrally cyanosed. The differential diagnosis includes(multiple choices)

A. Atrial septal defect

B. Fallot’s tetralogy

C. Hypoplastic left heart

D. Coarctation of the aorta

E. Tricuspid atresia

Page 56: Neonatology MCQs

Question 54A well baby has difficulty sucking. Causes for this could be (multiple choices)

A. Micrognathia

B. Dystrophia myotonica

C. Cleft palate

D. Prader-Willi syndrome

E. Bulbar palsy

Page 57: Neonatology MCQs

Question 55The causes for failure to pass meconium in the first 24 hours of life include(multiple choices)

A. Cystic fibrosis

B. Hyperthyroidism

C. Hirschsprung’s disease

D. Hiatus hernia

E. Galactosemia

Page 58: Neonatology MCQs

Question 56Polycythemia in the neonatal period is associated with the following Except

A. Trisomy 21

B. The donor twin in a twin-twin transfusion

C. Maternal diabetes

D. Intrauterine growth restriction

E. Respiratory distress

Page 59: Neonatology MCQs

Question 57A preterm baby of 30 week’s gestation is intubated and ventilated. On the 2nd day of life he suddenly deteriorates. The differential diagnosis includes (multiple choices)

A. An intraventricular hemorrhage

B. A blocked endotracheal tube

C. A pulmonary hemorrhage

D. Pneumonia

E. Self-extubation

Page 60: Neonatology MCQs

Question 58The blueberry muffin appearance in infants with TORCH infections most likely represents

A. Dermal erythropoiesisB. Palpable purpuraC. Metastatic hepatic tissueD. Viral lesionsE. None of the above

Page 61: Neonatology MCQs

Question 59Necrotizing enterocolitis presents with(multiple choices)

A. A distended abdomen

B. Blood-stained feces

C. Septicemia

D. Bilious vomiting

E. Perforation of small bowel

Page 62: Neonatology MCQs

Question 60When a newborn fails to achieve or sustain the normal decrease in pulmonary vascular resistance at birth, the result is hypoxemic respiratory failure or persistent pulmonary hypertension of the newborn (PPHN). Of the following, the mediator most responsible for normal pulmonary vascular transition at birth is

A. Asymmetric dimethylarginine.

B. Endothelin-1

C. Leukotriene

D. Nitric oxide

E. Thromboxane

Page 63: Neonatology MCQs

Question 61The triggering mechanism that has become the standard of care in neonatal synchronized ventilation involves

A. Airflow trigger

B. Esophageal probe

C. Pressure trigger

D. Surface capsule

E. Thoracic impedance

Page 64: Neonatology MCQs

Question 62The clinical and ultrasonographic feature most consistent with the compensated phase of fetal hypoxemia is

A. Abnormal biophysical profileB. Absent fetal weight gainC. Diminished cardiac ventricular complianceD. Increased diastolic flow in middle cerebral

arteryE. Lost fetal heart rate variability

Page 65: Neonatology MCQs

Question 63Harlequin color changes is a sign of

A. Congenital ichthyosisB. TORCH infectionC. ErythrodermaD. Normal physiologyE. Spinal cord trauma

Page 66: Neonatology MCQs

Question 64The risk of developing necrotizing enterocolitis is increased in(multiple choices)

A. Breast-fed babiesB. Asphyxiated babiesC. Premature babiesD. Infants who have the umbilical artery

catheterizedE. Infants who have had no milk feeds

Page 67: Neonatology MCQs

Question 65A 2-day-old is noted to have conjunctival and retinal hemorrhage. The most likely etiology is

A. Child abuseB. Maternal alloimmune thrombocytopeniaC. Maternal idiopathic thrombocytopenic

purpuraD. Force of birthing processE. Forceps delivery

Page 68: Neonatology MCQs

Question 66Inhaled nitric oxide (iNO) has many of the characteristics of an ideal selective pulmonary vasodilator and, therefore, is used widely in the treatment of PPHN. Of the following, the lung disease most resistant to iNO is

A. Bacterial pneumonia

B. Congenital diaphragmatic hernia

C. Idiopathic PPHN

D. Meconium aspiration syndrome

E. Respiratory distress syndrome

Page 69: Neonatology MCQs

Question 67The most common cause of nutritional intrauterine growth restriction is maternal

A. Chronic disease

B. Drug addiction

C. Hypertension

D. Infection

E. Malnutrition

Page 70: Neonatology MCQs

Question 68Fetal undernutrition can have long-term effects on the occurrence of chronic adult diseases, a phenomenon described as fetal programming. Of the following, in addition to coronary heart disease and hypertension, the most common chronic adult disease attributed to fetal programming is

A. Chronic obstructive pulmonary diseaseB. Diabetes mellitusC. MalignancyD. OsteoporosisE. Retinal degeneration

Page 71: Neonatology MCQs

Question 69A baby with Apgar scores of 1 and 2 at 1 and 5 minutes, respectively, appears hyperalert and has hyperactive deep tendon reflexes and mydriasis. The most likely diagnosis is

A. Stage I hypoxic-ischemic encephalopathyB. Stage II hypoxic-ischemic encephalopathyC. Stage III hypoxic-ischemic encephalopathyD. KernicterusE. Intraventricular hemorrhage

Page 72: Neonatology MCQs

Question 70The most typical inspiratory-to-expiratory time used with high-frequency oscillatory ventilation is

A. 1:2

B. 1:3

C. 1:4

D. 1:5

E. 1:6

Page 73: Neonatology MCQs

Question 71Maternal chorioamnionitis is most likely to prevent the occurrence or severity of

A. Bronchopulmonary dysplasia

B. Cerebral palsy

C. Cystic periventricular leukomalacia

D. Intraventricular hemorrhage

E. Respiratory distress syndrome

Page 74: Neonatology MCQs

Question 72The clinical manifestation most predictive of intestinal necrosis in necrotizing enterocolitis is:

A. Abdominal tenderness

B. Bloody stools

C. Erythema of the abdominal wall

D. Gastric residuals

E. Hemodynamic instability

Page 75: Neonatology MCQs

Question 73A 2-week old preterm neonate (30 weeks) is experiencing recurrent episodes of apnea. The infant is well-oxygenated in room air between episodes and has no clinical or radiographic evidence of lung disease. Mechanical ventilation using the strategy of volume guarantee is started. The most appropriate positive end-expiratory pressure in this infant is

A. 0 cm H2OB. 3 cm H2OC. 5 cm H2OD. 8 cm H2OE. 10 cm H2O

Page 76: Neonatology MCQs

Question 74Many identifiable factors contribute to human preterm birth. Of the following, the largest single category of causes associated with human preterm birth is

A. Idiopathic preterm labor

B. Multiple gestation pregnancy

C. Placental abruption

D. Prenatal infection

E. Substance abuse

Page 77: Neonatology MCQs

Question 75The most likely syndrome in an infant who has thrombocytopenia and thumb anomalies is

A. Down syndromeB. Fanconi syndromeC. Kasabach-Merritt syndromeD. Thrombocytopenia with absent radius

syndromeE. Turner syndrome

Page 78: Neonatology MCQs

Question 76Transient neonatal diabetes mellitus is a rare disorder of genomic imprinting. Its clinical presentation includes intrauterine growth restriction, failure to thrive, hyperglycemia, and dehydration. Of the following, the imprinting defect in transient neonatal diabetes mellitus is most likely to involve

A. Chromosome 6

B. Chromosome 7

C. Chromosome 11

D. Chromosome 15

E. Chromosome 21

Page 79: Neonatology MCQs

Question 77The plasma constituents most commonly implicated in the pathogenesis of transfusion-related acute lung injury are

A. ABO alloantibodies

B. Anti-IgA antibodies

C. Anti-neutrophil and anti-HLA antibodies

D. Anti-T agglutinins

E. Inflammatory interleukins

Page 80: Neonatology MCQs

Question 78The first time the human fetus demonstrates swallowing ability is by the gestational age of

A. 11 weeks

B. 13 weeks

C. 15 weeks

D. 17 weeks

E. 19 weeks

(Sucking at 18-20 weeks)

Page 81: Neonatology MCQs

Question 79The function that plays a major role inregulation of the amniotic fluid volume is

A. Fetal lung fluid secretion.

B. Fetal swallowing

C. Fetal urine formation

D. Intramembranous absorption

E. Transmembranous flux

Page 82: Neonatology MCQs

Question 80Direct-reacting hyperbilirubinemia on the 10th day of life suggests all of the following Except

A. Cystic fibrosis

B. Galactosemia

C. Neonatal hepatitis

D. Byler syndrome

E. Gilbert disease

Page 83: Neonatology MCQs

Question 81The ventilator variable most influential in avoiding atelectasis in mechanically ventilated neonates is

A. Inspiratory time

B. Peak inspiratory pressure

C. Positive end-expiratory pressure

D. Tidal volume

E. Ventilator rate

Page 84: Neonatology MCQs

Question 82Nearly all preterm neonates are most likely to have passed meconium by the postnatal age of

A. 48 hours

B. 96 hours

C. 144 hours

D. 192 hours

E. 240 hours

Page 85: Neonatology MCQs

Question 83The most accurate statement regarding gastrointestinal development and enteral feeding in preterm infants is thatA. Diluted milk empties more slowly from the stomach than does

undiluted milkB. Feeding intolerance is largely due to immaturity of mucosal

function rather than motor functionC. Gastric emptying is influenced by the temperature of the milkD. Large feeding volumes induce maturation of motor patterns

of the gut more effectively than small feeding volumesE. Motor function develops earlier in the stomach/small intestine

than in the rectum/anal canal

Page 86: Neonatology MCQs

Question 84Hemorrhagic disease of the newborn(multiple choices)

A. is secondary to low prothrombinB. can present up to 6 months of lifeC. is treated with protamine sulphateD. is prevented by administering vitamin E to

all newborn babiesE. can result in intracerebral hemorrhge

Page 87: Neonatology MCQs

Question 85The most critical determinantof ventilator-induced lung injury in preterm neonates is excessive

A. Airway pressure

B. Gas flow

C. Oxygen concentration

D. Tidal volume

E. Time constant

Page 88: Neonatology MCQs

Question 86The postmenstrual age at which preterm infants who have stable cardiopulmonary status and no neurologic abnormalities are likely to be introduced to oral feeding is closest to

A. 28 weeksB. 30 weeksC. 32 weeksD. 34 weeksE. 36 weeks

Page 89: Neonatology MCQs

Question 87All of the following are problems of an infant of a recently diagnosed diabetic mother Except

A. Hypoglycemia

B. Hypocalcemia

C. Intrauterine growth restriction

D. Hypomagnesemia

E. hyperbilirubinemia

Page 90: Neonatology MCQs

Question 88The most critical factor in the development of respiratory distress syndrome in the preterm neonate isA. Immature composition and biophysical function

of surfactantB. Leaking epithelium/endothelium barrier from

lung injuryC. Low lung gas volume with susceptibility to

overdistentionD. Low surfactant lipid pool sizeE. Saccular versus alveolar stage of lung

development

Page 91: Neonatology MCQs

Question 89A newborn baby has profound thrombocytopenia. The causes include all of the following Except

A. Cytomegalovirus infection

B. Autoimmune neonatal thrombocytopenia

C. Maternal ingestion of warfarin

D. Alloimmune neonatal thrombocytopenia

E. Gram-negative septicemia

Page 92: Neonatology MCQs

Question 90The high-frequency ventilator variable most likely to influence oxygenation is

A. Amplitude

B. Frequency

C. Inspiratory-to-expiratory time ratio

D. Mean airway pressure

E. Tidal volume

Page 93: Neonatology MCQs

Question 91A severely hydropic infant is about to be delivered. Complications to be prepared for include all of the following Except

A. Pulmonary hypoplasia

B. Abdominal ascites

C. Polycythemia

D. Heart failure

E. Laryngeal edema

Page 94: Neonatology MCQs

Question 92You are called to see a tow-day-old jittery baby. The causes to consider are(multiple choices)

A. Maternal diabetes

B. Fetal alcohol syndrome

C. Maternal hyperparathyroidism

D. Maternal thyrotoxicosis

E. Congenital adrenal hyperplasia

Page 95: Neonatology MCQs

Question 93The distribution of surfactant in the lungs is most efficient when surfactant is administered

A. After a period of mechanical ventilation

B. As an aerosolized preparation

C. At a slow rate of infusion

D. At birth in the presence of fetal lung fluid

E. Using a smaller volume of the drug

Page 96: Neonatology MCQs

Question 94Infants at risk of hyperinsulinemic hypoglycemia include all of the following Except

A. Infants with nesidioblastosisB. Infants of diabetic mothersC. Infants with galactosemiaD. Infants with leucine sensitivity with

hyperammonemiaE. Infants with Beckwith-Wiedemann

syndrome

Page 97: Neonatology MCQs

Question 95Neural tube defects

A. Occurs with frequency of 2 per 10,000 birthsB. Have a genetic predispositionC. Result from abnormal development of the

neural tube at 3-4 months’ gestationD. Can be detected antenatally by low maternal

serum alpha-fetoprotein levelsE. Are treated with folic acid

Page 98: Neonatology MCQs

Question 96Metabolic bone disease of prematurity(multiple choices)A. Is associated with chronic respiratory distress

B. Is prevented by administration of vitamin D

C. Is less severe in infants fed with breast milk compared to formula-fed infants

D. Can result in spontaneous fractures

E. Is caused by a substrate deficiency

Page 99: Neonatology MCQs

Question 97The most common limb defect associated with amniotic bands is

A. Amputation of digits

B. Congenital arthrogryposis

C. Preaxial polydactyly

D. Proximal syndactyly

E. Single bones in extremities

Page 100: Neonatology MCQs

Question 98The aromatic amino acid most likely to be detected by tandem mass spectrometry is

A. Citrulline

B. Leucine

C. Methionine

D. Phenylalanine

E. Valine

Page 101: Neonatology MCQs

Question 99Hydrops fetalis is associated with(multiple choices)

A. Beta-thalassemia

B. Diaphragmatic hernia

C. Paroxysmal supraventricular tachycardia

D. OA materno-fetal blood group incompatibility

E. Turner syndrome

Page 102: Neonatology MCQs

Question 100The blood constituents most implicated in the pathogenesis of transfusion-associated graft versus host disease are

A. Anti-neutrophil antibodiesB. Anti-T agglutininsC. Donor-derived lymphocytesD. Erythrocytic RhD antigensE. Inflammatory interleukins

Page 103: Neonatology MCQs