Neonatology MCQs

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

بسم الله الرحمن الرحيم

Question 1 An 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: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 2 Jaundice is most likely to be physiologic in a term infant in which of the following situations: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 3 Which 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? ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 5 A 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: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 6 The following are accepted definitions Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 8 Neonatal hypercalcemia is associated with all of the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 9 The single greatest risk factor for necrotizing enterocolitis is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 10 You 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 12 Incidence of respiratory distress syndrome increases with all of the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 13 Normal findings in a newborn baby includes all of the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 14 The 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 by ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 15 When clinical zinc deficiency occurs in term and preterm infants, almost all affected infants are exclusively 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 16 Assisted 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 17 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 18 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 20 Regarding the head of a newborn infant (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 21 The most prevalent clinical manifestation of late-onset group B Streptococcus disease is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 22 In 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 23 Several 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 24 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 25 A healthy newborn baby boy may (one incorrect) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 26 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 27 The interruption in the transfer of nutrients from the mother to the fetus that occurs following birth can be 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 28 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 29 Fractured clavicle (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 30 Minimal 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 31 The only inborn error of metabolism associated with neonatal hyperammonemia that is X-linked in inheritance is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 32 A 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% O 2 . The possible causes of respiratory distress include (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

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

Question 35 Contemporary 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 36 Amniotic 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 37 You 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 38 The most common fetal cause of polyhydramnios is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 39 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 40 The following predispose a baby to be small for gestational age (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 41 The small for gestational age newborn baby is at increased risk of (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 42 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 43 The twin-twin transfusion is unique to twins that are ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 44 The amino acids derived from swallowed amniotic fluid are important for fetal gastrointestinal development. The amino acid considered conditionally essential for normal growth and maturation of the fetal gastrointestinal tract is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 45 Respiratory distress syndrome is exacerbated by the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 46 The most important determinant of endotracheal tube resistance is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 47 Bilirubin 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 48 The most widely used and accurate method for estimating amniotic fluid volume is by ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 50 A 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% O 2 . Vital signs are T: 35.7 ˚ C, HR 195 bpm, mean BP 22 mm Hg. WBC 1500/ μ L, platelets 59,000/ μ L. The next most appropriate treatment for this baby is to administer ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 51 The patient described in Question 50 is most likely suffering from ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 52 Transient tachypnea of the newborn (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 54 A well baby has difficulty sucking. Causes for this could be (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 56 Polycythemia in the neonatal period is associated with the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 58 The blueberry muffin appearance in infants with TORCH infections most likely represents ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 59 Necrotizing enterocolitis presents with (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 60 When 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 61 The triggering mechanism that has become the standard of care in neonatal synchronized ventilation involves ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 62 The clinical and ultrasonographic feature most consistent with the compensated phase of fetal hypoxemia is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 63 Harlequin color changes is a sign of ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 64 The risk of developing necrotizing enterocolitis is increased in (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 66 Inhaled 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 67 The most common cause of nutritional intrauterine growth restriction is maternal ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 68 Fetal 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 69 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 70 The most typical inspiratory-to-expiratory time used with high-frequency oscillatory ventilation is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 71 Maternal chorioamnionitis is most likely to prevent the occurrence or severity of ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 72 The clinical manifestation most predictive of intestinal necrosis in necrotizing enterocolitis is: ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 73 A 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

Question 75 The most likely syndrome in an infant who has thrombocytopenia and thumb anomalies is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 76 Transient 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 77 The plasma constituents most commonly implicated in the pathogenesis of transfusion-related acute lung injury are ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 78 The first time the human fetus demonstrates swallowing ability is by the gestational age of ,[object Object],[object Object],[object Object],[object Object],[object Object],(Sucking at 18-20 weeks)

Question 79 The function that plays a major role in regulation of the amniotic fluid volume is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 80 Direct-reacting hyperbilirubinemia on the 10 th day of life suggests all of the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 81 The ventilator variable most influential in avoiding atelectasis in mechanically ventilated neonates is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 82 Nearly all preterm neonates are most likely to have passed meconium by the postnatal age of ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 83 The most accurate statement regarding gastrointestinal development and enteral feeding in preterm infants is that ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 84 Hemorrhagic disease of the newborn (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 85 The most critical determinant of ventilator-induced lung injury in preterm neonates is excessive ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 86 The 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 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 87 All of the following are problems of an infant of a recently diagnosed diabetic mother Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 88 The most critical factor in the development of respiratory distress syndrome in the preterm neonate is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 89 A newborn baby has profound thrombocytopenia. The causes include all of the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 90 The high-frequency ventilator variable most likely to influence oxygenation is ,[object Object],[object Object],[object Object],[object Object],[object Object]

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

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

Question 93 The distribution of surfactant in the lungs is most efficient when surfactant is administered ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 94 Infants at risk of hyperinsulinemic hypoglycemia include all of the following Except ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 95 Neural tube defects ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 96 Metabolic bone disease of prematurity (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 97 The most common limb defect associated with amniotic bands is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 98 The aromatic amino acid most likely to be detected by tandem mass spectrometry is ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 99 Hydrops fetalis is associated with (multiple choices) ,[object Object],[object Object],[object Object],[object Object],[object Object]

Question 100 The blood constituents most implicated in the pathogenesis of transfusion-associated graft versus host disease are ,[object Object],[object Object],[object Object],[object Object],[object Object]

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