MCQs

1. 100 MCQs in Neonatology
By
Ayman Abu Mehrem, MD
Assistant Consultant
Department of Pediatrics
King Abdulaziz Hospital, Al-Ahsa

3. 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:
A. 6
B. 7
C. 8
D. 9
E. 10

4. Question 2
Jaundice is most likely to be physiologic in
a term infant in which of the following
situations:
A. Jaundice at 12 hours of age
B. Serum bilirubin level increasing less than 5
mg/dL/24 hours in the first 2-4 days
C. Direct serum bilirubin greater than 2 mg/dL
D. Jaundice at 13 days of age
E. Serum bilirubin level 15 mg/dL at 7 days of
age

5. 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?
A. Phototherapy
B. Exchange transfusion
C. Phenobarbital
D. Replace breast milk by formula for 48 hours
E. None of the above

6. 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:
A. Choanal atresia
B. Craniofacial malformations
C. Intranasal encephalocele
D. Lacrymal cyst
E. Mucosal inflammation

7. 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:
A. Apert syndrome
B. CHARGE association
C. Crouzon syndrome
D. Pfeiffer syndrome
E. Treacher-Collins syndrome

8. Question 6
The 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

9. 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
A. Alpha-fetoprotein
B. β-hCG
C. Unconjugated pregninolone
D. Inhibin–A
E. Unconjugated esteriol

10. Question 8
Neonatal 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

11. Question 9
The single greatest risk factor for
necrotizing enterocolitis is
A. Prematurity
B. Patent ductus arteriosus
C. Indomethacin therapy
D. Polycythemia
E. Hypoxic-ischemic insult

12. 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
A. Stimulate the infant to breath
B. Administer epinephrine
C. Provide positive-pressure bag-and-mask
ventilation
D. Intubate and provide positive-pressure ventilation
E. Intubate and apply negative-pressure suction

13. 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
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 name
C. Urgent chromosomal analysis
D. Pelvic ultrasound
E. Serum electrolytes with daily monitoring

14. Question 12
Incidence 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

15. Question 13
Normal 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

16. 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
A. Antagonism of prostaglandin activity
B. Blockage of adenosine receptors
C. Enhancement of catecholamine secretion
D. Stimulation of phosphodiesterase
E. Upregulation of gamma-amino-butyric acid
receptors

17. 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
A. Alopecia
B. Diarrhea
C. Failure to thrive
D. Irritability
E. Rash

18. 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
A. Cesarean section
B. Gestational diabetes
C. Maternal pre-eclampsia
D. Multiple gestations
E. Placental abruption

19. 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
A. Albright hereditary osteodystrophy
B. Angelman syndrome
C. Beckwith-Wiedemann syndrome
D. Prader-Willi syndrome
E. Silver-Russell syndrome

20. 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
A. ADAMTS2 gene
B. Collagen 1A1 gene
C. Fibrillin-1 gene
D. Filamin B gene
E. Transforming growth factor receptor 1 gene

21. Question 19
Of the following, the nasal maldevelopment
most likely to be associated with
holoprosencephaly is:
A. Cepocephaly
B. Choanal atresia
C. Nasal agenesis
D. Piriform aperture stenosis
E. Proboscis lateralis

22. Question 20
Regarding 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

23. Question 21
The most prevalent clinical manifestation of
late-onset group B Streptococcus disease is
A. Arthritis
B. Cellulitis
C. Meningitis
D. Osteomyelitis
E. Pneumonia

24. 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
A. Decrease in alveolar septation
B. Diffuse leukocytic infiltration
C. Epithelial squamous metaplasia
D. Hypertrophy of airway smooth muscle
E. Lung parenchymal fibrosis

25. 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
A. Bronchopulmonary dysplasia
B. Necrotizing enterocolitis requiring surgery
C. Parenchymal brain injury
D. Sepsis or meningitis
E. Severe retinopathy of prematurity

26. 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
A. Patent ductus arteriosus
B. Intraventricular hemorrhage
C. Hypoglycemia
D. Pneumothorax
E. Severe respiratory distress syndrome

27. Question 25
A healthy newborn baby boy may
(one incorrect)
A. have erythema of the umbilical skin
extending on to the abdomen
B. produce breast milk
C. have a single palmar crease
D. have an umbilical hernia
E. vomit blood if breast feeding

28. 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
A. Fetal rate of body weight gain
B. Fetal rate of crown-heel length gain
C. Fetal rate of head circumference gain
D. Intrauterine body composition
E. Normal blood urea concentration

29. 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
A. Hyperammonemia
B. Hyperglycemia
C. Hyperkalemia
D. Increase in blood urea nitrogen values
E. Metabolic acidosis

30. 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
A. Crigler-Najjar syndrome
B. Gilbert disease
C. Biliary atresia
D. Hypothyroidism
E. galactosemia

31. Question 29
Fractured 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

32. 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
A. Increases plasma concentrations of
gastrointestinal hormones
B. Is best avoided in infants weighing 500 to 600 g
C. Is contraindicated in the presence of assisted
ventilation
D. Is contraindicated in the presence of indwelling
umbilical catheters
E. Prevents necrotizing enterocolitis

33. Question 31
The only inborn error of metabolism
associated with neonatal hyperammonemia
that is X-linked in inheritance is
A. Hyperinsulinism/hyperammonemia
syndrome
B. Isovaleric acidemia
C. Medium-chain acyl-CoA dehydrogenase
deficiency
D. Ornithine transcarbamylase deficiency
E. Pyruvate carboxylase deficiency

34. 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% O2. The
possible causes of respiratory distress include
(multiple choices)
A. Pneumothorax
B. Respiratory distress syndrome
C. Patent ductus arteriosus
D. Group B streptococcal sepsis
E. Transient tachypnea

35. 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)
A. Preventing bronchopulmonary dysplasia
B. Reducing the incidence of pneumothorax
C. Reducing mortality
D. More rapid improvement of RDS
E. Preventing oligouria

36. 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
A. Aortic arch obstruction
B. Tetralogy of Fallot
C. Total anomalous pulmonary venous return
D. Transposition of the great arteries
E. Ventricular septal defect

37. 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
A. Abdominal compartment syndrome
B. Enterocutaneous fistula
C. Necrotizing enterocolitis
D. Renal ischemia
E. Short bowel syndrome

38. 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
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

39. 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
A. Case-control study
B. Descriptive observational study
C. Prospective cohort study
D. Randomized clinical trial
E. Systematic meta-analysis

40. 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

41. 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
A. Anemia of chronic disease
B. G-6-PD deficiency
C. Hereditary spherocytosis
D. Sicle cell anemia with hemolytic crisis
E. ABO incompatibility with continued hemolysis

42. Question 40
The 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

43. Question 41
The small for gestational age newborn baby
is at increased risk of (multiple choices)
A. Hypoglycemia
B. Polycythemia
C. Hypothermia
D. Hypothyroidism
E. Cardiac abnormalities

44. 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
A. Erythroblastosis fetalis
B. Hereditary spherocytosis
C. Chronic feto-maternal transfusion
D. ABO incompatibility
E. Blackfan-Diamond syndrome

45. Question 43
The twin-twin transfusion is unique to twins
that are
A. Dizygotic, dichorionic
B. Dizygotic, monoamnionic
C. Dizygotic, monochorionic
D. Monozygotic, dichorionic
E. Monozygotic, monochorionic

46. 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
A. Alanine
B. Citrulline
C. Glutamine
D. Leucine
E. Valine

47. Question 45
Respiratory distress syndrome is
exacerbated by the following Except
A. Hypothermia
B. Acidosis
C. Hypoxia
D. Meconium aspiration
E. Withholding enteral feeds

48. Question 46
The most important determinant of
endotracheal tube resistance is
A. Airflow velocity
B. Biofilm coating
C. Gas density
D. Tube curvature
E. Tube diameter

49. 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
A. Beta-glucuronidase
B. Bilirubin hydrogenase
C. Bilirubin oxidase
D. Biliverdin reductase
E. Uridine diphosphoglucuronate
glucuronosyltransferase

50. Question 48
The 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 maneuver
C. Palpation of the uterus for fundal height
D. Ultrasonographic measurement of the amniotic
fluid index
E. Ultrasonographic measurement of the largest
vertical pocket

51. 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
A. Karyotype analysis
B. TORCH titer
C. Renal US
D. Cranial US
E. Skeletal survey

52. 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% 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 aerosol
B. IV ampicillin and gentamicin/cefotaxime
C. IV steroids
D. IV acyclovir
E. HFOV

53. Question 51
The patient described in Question 50 is most
likely suffering from
A. Respiratory distress syndrome
B. Diaphragmatic hernia
C. Congenital pneumonia with sepsis
D. Pneumothorax
E. TORCH infection

54. Question 52
Transient tachypnea of the newborn
(multiple choices)
A. occurs in 15% of full-term babies
B. can be diagnosed if onset occurs up to 48
hours post delivery
C. is caused by delayed absorption of fetal
lung fluid
D. is more common in babies delivered by
cesarean section
E. cannot be clearly differentiated from early
pneumonia

55. 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)
A. Atrial septal defect
B. Fallot’s tetralogy
C. Hypoplastic left heart
D. Coarctation of the aorta
E. Tricuspid atresia

56. Question 54
A 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

57. Question 55
The 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

58. Question 56
Polycythemia 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

59. Question 57
A 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

60. Question 58
The blueberry muffin appearance in infants
with TORCH infections most likely
represents
A. Dermal erythropoiesis
B. Palpable purpura
C. Metastatic hepatic tissue
D. Viral lesions
E. None of the above

61. Question 59
Necrotizing enterocolitis presents with
(multiple choices)
A. A distended abdomen
B. Blood-stained feces
C. Septicemia
D. Bilious vomiting
E. Perforation of small bowel

62. 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
A. Asymmetric dimethylarginine.
B. Endothelin-1
C. Leukotriene
D. Nitric oxide
E. Thromboxane

63. Question 61
The 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

64. Question 62
The clinical and ultrasonographic feature
most consistent with the compensated
phase of fetal hypoxemia is
A. Abnormal biophysical profile
B. Absent fetal weight gain
C. Diminished cardiac ventricular compliance
D. Increased diastolic flow in middle cerebral
artery
E. Lost fetal heart rate variability

65. Question 63
Harlequin color changes is a sign of
A. Congenital ichthyosis
B. TORCH infection
C. Erythroderma
D. Normal physiology
E. Spinal cord trauma

66. Question 64
The risk of developing necrotizing
enterocolitis is increased in
(multiple choices)
A. Breast-fed babies
B. Asphyxiated babies
C. Premature babies
D. Infants who have the umbilical artery
catheterized
E. Infants who have had no milk feeds

67. Question 65
A 2-day-old is noted to have conjunctival
and retinal hemorrhage. The most likely
etiology is
A. Child abuse
B. Maternal alloimmune thrombocytopenia
C. Maternal idiopathic thrombocytopenic
purpura
D. Force of birthing process
E. Forceps delivery

68. 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
A. Bacterial pneumonia
B. Congenital diaphragmatic hernia
C. Idiopathic PPHN
D. Meconium aspiration syndrome
E. Respiratory distress syndrome

69. Question 67
The most common cause of nutritional
intrauterine growth restriction is maternal
A. Chronic disease
B. Drug addiction
C. Hypertension
D. Infection
E. Malnutrition

70. 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
A. Chronic obstructive pulmonary disease
B. Diabetes mellitus
C. Malignancy
D. Osteoporosis
E. Retinal degeneration

71. 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
A. Stage I hypoxic-ischemic encephalopathy
B. Stage II hypoxic-ischemic encephalopathy
C. Stage III hypoxic-ischemic encephalopathy
D. Kernicterus
E. Intraventricular hemorrhage

72. Question 70
The 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

73. Question 71
Maternal 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

74. Question 72
The 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

75. 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
A. 0 cm H2O
B. 3 cm H2O
C. 5 cm H2O
D. 8 cm H2O
E. 10 cm H2O

76. 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
A. Idiopathic preterm labor
B. Multiple gestation pregnancy
C. Placental abruption
D. Prenatal infection
E. Substance abuse

77. Question 75
The most likely syndrome in an infant who has
thrombocytopenia and thumb anomalies is
A. Down syndrome
B. Fanconi syndrome
C. Kasabach-Merritt syndrome
D. Thrombocytopenia with absent radius
syndrome
E. Turner syndrome

78. 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
A. Chromosome 6
B. Chromosome 7
C. Chromosome 11
D. Chromosome 15
E. Chromosome 21

79. Question 77
The 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

80. Question 78
The 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)

81. Question 79
The function that plays a major role in
regulation of the amniotic fluid volume is
A. Fetal lung fluid secretion.
B. Fetal swallowing
C. Fetal urine formation
D. Intramembranous absorption
E. Transmembranous flux

82. Question 80
Direct-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

83. Question 81
The 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

84. Question 82
Nearly 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

85. Question 83
The most accurate statement regarding
gastrointestinal development and enteral
feeding in preterm infants is that
A. Diluted milk empties more slowly from the stomach than
does undiluted milk
B. Feeding intolerance is largely due to immaturity of mucosal
function rather than motor function
C. Gastric emptying is influenced by the temperature of the milk
D. Large feeding volumes induce maturation of motor patterns
of the gut more effectively than small feeding volumes
E. Motor function develops earlier in the stomach/small
intestine than in the rectum/anal canal

86. Question 84
Hemorrhagic disease of the newborn
(multiple choices)
A. is secondary to low prothrombin
B. can present up to 6 months of life
C. is treated with protamine sulphate
D. is prevented by administering vitamin E to
all newborn babies
E. can result in intracerebral hemorrhge

87. Question 85
The most critical determinant
of ventilator-induced lung injury in preterm
neonates is excessive
A. Airway pressure
B. Gas flow
C. Oxygen concentration
D. Tidal volume
E. Time constant

88. 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
A. 28 weeks
B. 30 weeks
C. 32 weeks
D. 34 weeks
E. 36 weeks

89. Question 87
All 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

90. Question 88
The most critical factor in the development
of respiratory distress syndrome in the
preterm neonate is
A. Immature composition and biophysical function
of surfactant
B. Leaking epithelium/endothelium barrier from
lung injury
C. Low lung gas volume with susceptibility to
overdistention
D. Low surfactant lipid pool size
E. Saccular versus alveolar stage of lung
development

91. Question 89
A 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

92. Question 90
The 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

93. Question 91
A 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

94. Question 92
You 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

95. Question 93
The 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

96. Question 94
Infants at risk of hyperinsulinemic
hypoglycemia include all of the following
Except
A. Infants with nesidioblastosis
B. Infants of diabetic mothers
C. Infants with galactosemia
D. Infants with leucine sensitivity with
hyperammonemia
E. Infants with Beckwith-Wiedemann
syndrome

97. Question 95
Neural tube defects
A. Occurs with frequency of 2 per 10,000 births
B. Have a genetic predisposition
C. Result from abnormal development of the
neural tube at 3-4 months’ gestation
D. Can be detected antenatally by low maternal
serum alpha-fetoprotein levels
E. Are treated with folic acid

98. Question 96
Metabolic 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

99. Question 97
The 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

100. Question 98
The aromatic amino acid most likely to be
detected by tandem mass spectrometry is
A. Citrulline
B. Leucine
C. Methionine
D. Phenylalanine
E. Valine

101. Question 99
Hydrops 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

102. Question 100
The blood constituents most implicated in
the pathogenesis of transfusion-associated
graft versus host disease are
A. Anti-neutrophil antibodies
B. Anti-T agglutinins
C. Donor-derived lymphocytes
D. Erythrocytic RhD antigens
E. Inflammatory interleukins