28.

What is the initial priority in treatment of hypoxic-ischemic

encephalopathy?
A. Starting therapeutic hypothermia
B. Correction of acid base status
C. Hemodynamic stabilization
D. Control of seizures
E. Starting parentral nutrition

29. What is the MOST common acquired neuronal injury in newborns?

A. Phrenic nerve
B. Brachial plexus
C. Facial nerve
D. Spinal cord transection
E. Horner syndrome

30. You are resuscitating a full term neonate who is depressed at birth, you
need to stat bag and mask resuscitation. The fraction of inspired O2 that is
needed should be
A. 21%
B. 40%
C. 60%
D. 80%
E. 100%

31. An ex-28-week-preterm baby, at 3 weeks of life is recovering from RDS,

extubated since 2 wks, he is developing frequent apneic attacks with
bradycardia and desaturation. The baby general condition is good with good
capillary refill; he is not pale and appears alert. He is on increasing feeding
protocol, TPN had stopped since 4 days, increasing weight, his acid-base balance
is normal with euglycemia.
Of the following, the MOST appropriate action is to
A. do septic screen and start empirical antibiotics
B. reintubate the baby and put on low ventilatory settings
C. start nasal continuous positive airway pressure (nasal CPAP, 3-5 cm H2O)
D. start heated humidified high-flow nasal cannula (HFNC, 1-4 l/min)
E. start caffeine

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32. A well preterm baby recovered from RDS of prematurity, develops
gastroesophageal reflux (GER). You are anticipating possible apneic episodes.
Of the following, the MOST appropriate option for management is to start
A. omeprazole
B. ranitidine
C. combination of omeprazole and ranitidine
D. domperidone
E. monitoring

33. A near-term baby boy delivered to diabetic mother with no risk factors apart
from mother was being poor attendant to antenatal care; the baby birth weight
is 2.8 kg. He develops tachypnea and desaturation few hours after birth with no
respiratory distress, his heart rate 170 bpm, respiratory rate 72/min, blood
pressure 55/35 mmHg. He has hepatomegaly and no cardiac murmur. Chest X-
ray shows complete white-out. Blood gas analysis shows mixed respiratory and
metabolic acidosis with hypoxia. The baby admitted to NICU, received INSURE
therapy with minimal response, he is euglycemic now.
Of the following, the MOST appropriate action is to
A. give 2nd dose of survanta
B. intubate and start mechanical ventilation
C. collect septic screen and start empirical antibiotics
D. order an Echocardiography
E. consult metabolic/endocrine team

34. What is the BEST type of steroid that should be used antenatally to decrease
incidence of RDS of prematurity?
A. Dexamethasone
B. Betamethasone
C. Methylprednisolone
D. Hydrocortisone
E. Clobetasone

35. A 2-day-old full-term baby boy with difficult labor has unilateral scalp
swelling which is firm, tense with palpable rims that does not extend to
contralateral side, and it has central depression. The baby is hemodynamically
stable and neurologically normal; he has jaundice over the face and upper
trunk.
Of the following, the MOST appropriate action is to
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 A. closely follow the results of PCV and TSB
B. reassure the family and give appointment follow up within 1 week
C. reassure the family about the benign nature which may disappear after
2weeks-3months
D. order radiological assessment
E. refer to pediatric neurologist

36. A full-term baby girl delivered by vacuum-assisted delivery, attention was

coming from accompanied attendant that noticed an increasing scalp swelling
overtime, you found a fluctuant mass that straddles cranial sutures involving
the scalp and some of subcutaneous tissues of the neck. The baby looks pale.
Of the following, the MOST appropriate action is to
A. order serial PCV tests and treat the baby accordingly
B. keep the baby beside the mother and informed staff nurse to monitor
vitals and the lesion size
C. admit the baby to NICU
D. reassure the parents about benign nature of lesion
E. anticipate the expected hyperbilirubinemia and anemia by starting single
phototherapy and serial PCV

37. You are counseling a mother of large for date baby with difficult labor who
was admitted to NICU for complication of meconium aspiration syndrome; now
he is improved and the team is willing to discharge the baby; mother is raising a
point about the result of head MRI which shows a small subdural hemorrhage in
posterior fossa; she asks about the prognosis.
Which one of the following represents the MOST appropriate answer?
A. We will arrange an appointment in pediatric neurology clinic for follow-
up
B. We will assess neurological status of the baby in next visit and we will
order radiological assessment accordingly
C. Serial of MRI will decide the need for evacuation of the lesion
D. Such lesions will calcify leaving asymptomatic cyst which needs no
intervention
E. These lesions causes no residual neurological problem

38. All preterm babies should be subjected to cranial ultrasound for detection of
intraventricular hemorrhage during the first 3-7 days of life if delivered below
A. 24 weeks of gestation
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 B. 26 weeks of gestation
C. 28 weeks of gestation
D. 30 weeks of gestation
E. 32 weeks of gestation

39. A 28-week-gestational age preterm baby with a birth weight of 1000 gram
received prophylactic surfactant at birth, eventually he needs to be intubated
and ventilated on SIMV mode with moderate settings, TPN started on day 1. On
day 2 his PCV shows drop from 40 to 28, and he developed hypotension and
metabolic acidosis. He received fluid resuscitation and packed RBCs transfusion.
Repeated blood gas shows persistence of metabolic acidosis.
Of the following, the MOST likely explanation is
A. development of early onset sepsis
B. underlying inborn error of metabolism
C. development of anemia of prematurity
D. development of intracranial hemorrhage
E. TPN related complication

40. A 32-week-preterm baby with 1200 grams birth weight, developed

respiratory distress and received rescue INSURE therapy since 4 hours. Now he
is on nCPAP with pressure of 6 cm of water and FiO2 of 60, his saturation
ranging between 85-88%; other hemodynamic parameters are accepted.
Of the following, the MOST appropriate next step in the management is to
A. keep the nCPAP parameters the same to avoid O2 toxicity
B. increase nCPAP parameters
C. consider the second dose of surfactant
D. start mechanical ventilation
E. use inhaled nitric oxide

41. Assisted reproductive technology (in vitro fertilization) can increase the risk
of
A. Beckwith-Wiedemann syndrome
B. neural tube defect
C. Cornela de-lange syndrome
D. major chromosomal disorders
E. Peirr-robin sequence

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42. The MOST effective way to increase the O2 saturation in ventilated infant or
neonate is by increasing the
A. inspiratory time
B. ventilator rate
C. positive end-expiratory pressure (PEEP)
D. peak inspiratory pressure (PIP)
E. FiO2

43. The currently recommended oxygen saturation targets in ventilated

neonates is
A. 81-85%
B. 86-90%
C. 91–95%
D. constantly above 95%
E. 100%

44. You are preparing to extubate a preterm baby.

Which premedication can enhance the success of extubation?
A. Methylxanthine
B. Dexamethasone
C. Betamethasone
D. IV atropine
E. Endotracheal atropine

45. Which of the following medications proved to have a role in decreasing the
risk of development of bronchopulmonary dysplasia in preterm babies?
A. Inhaled corticosteroids therapy
B. Diuretics
C. Vitamin A
D. Low dose systemic dexamethasone
E. Caffeine

46. In delivery room, you received a 28 weeks gestational age preterm baby
with a birth weight of 1.28 kg. His APGAR score is good, he needs only routine
measures of resuscitation; he develops mild grunting, and his saturation is
maintained with minimal nasal O2.
Of the following, the MOST appropriate step in management is to
A. give prophylactic surfactant therapy
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 B. wait for the signs of severe respiratory distress then give rescue dose of
surfactant
C. start nasal CPAP
D. continue on low flow nasal O2 cannula as much as O2 saturation is
maintained
E. transfer to neonatal care unit by transport incubator and decision should
be made by senior colleague

47. An 18-day-old, ex-preterm baby (30 wks of gestation), his current weight
1.44 kg, had weaned from nasal CPAP, and on increasing feeding protocol. The
staff nurse reported an increase need for nasal O2, increase work of breathing,
and decrease urine output < 1ml/kg/hr. By examination, you have noticed
bounding pulse and hepatomegaly.
Of the following, the MOST appropriate action is to
A. order an echocardiography
B. order renal function and monitor urine output
C. administer diuretics
D. administer ibuprofen
E. refer to pediatric cardiology department

48. You are explaining the effectiveness of supportive measures in spontaneous

closure of PDA in extremely preterm infants to a junior colleague.
Which of the followings represent the MOST appropriate answer?
A. Most of the infants eventually will needs cyclooxygenase inhibitors
B. About half of them will be cured
C. Most of them will be cured
D. Surgical intervention is high in those who treated by this way
E. It is no longer considered as an option for treatment

49. What is the MOST common etiology of tachypnea in newborns?

A. Transient tachypnea of the newborn
B. Hyaline membrane disease
C. Meconium aspiration syndrome
D. Amniotic fluid aspiration
E. Early onset sepsis

50. What is the MOST important effective step in prevention of meconium

aspiration syndrome?
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 A. Amnioinfusion
B. Intrapartum nasopharyngeal suction
C. Intubation and suctioning of depressed meconium stained baby
D. Monitoring of fetal distress
E. Liberal rules for cesarean sections

51. A full-term baby boy delivered by cesarean section because of meconium

stained amniotic fluid, developed respiratory distress and required mechanical
ventilation ultimately. On day 4 discovered to have systolic murmur, his O2
saturation is ranging between 82% and 96%. He had frequent weaning failure
from ventilation.
Of the following, the MOST likely etiology of cardiac murmur is
A. associated cyanotic congenital heart disease
B. patent ductus arteriosus
C. pulmonary hypertension
D. asphyxiated cardiomyopathy
E. functional mitral regurgitation

52. A full-term baby boy delivered by uneventful simple vaginal delivery, had
good APGAR score and discharge home. At the age of 20 hours developed
refusal to feed, rapid breathing, and bluish discoloration of the face. He had no
dysmorphic features, HR 185 beat/min, RR 70 breath/min, O2 saturation 68%
which sometimes increases to 90%, blood gas analysis shows hypoxemia with
CO2 retention. Mother was G4 P3, attending antenatal care regularly but had
used ibuprofen frequently for headache without medical consultation.
Investigations shows RBS 55mg/dl; Hb 20 gm/dl; WBC 24,000 mm3 mainly
neutrophils; echocardiography shows no congenital heart disease; blood culture
and metabolic screen is pending.
Of the following, the MOST likely diagnosis is
A. bacterial sepsis
B. concealed congenital heart disease (distal aortic arch anomaly)
C. inborn error of metabolism
D. persistent pulmonary hypertension
E. pulmonary hypoplasia

53. A post-term baby girl ventilated for persistent pulmonary hypertension is

suffering from hypotension which is persistent even after adjustment of basic
metabolic needs, volume replacement and vasopressor agents.
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Of the following, the MOST appropriate step in management is to
A. use another bolus of volume replacement therapy
B. use of hydrocortisone
C. use of desmopressin
D. send for serum cortisone
E. order urgent brain ultrasound

54. You are receiving a newborn in delivery room with prenatal diagnosis of
diaphragmatic hernia. He delivered with good APGAR score, vitals are normal
with normal O2 saturation.
Of the following, the MOST appropriate action is to
A. administer O2 through face mask
B. pass a wide bore nasogastric tube to deflate the stomach
C. intubate and gently ventilate the baby with standards of permissive
hypercapnia
D. contact with pediatric surgeon
E. transfer to neonatal care unit

55. What is the best time for operation in ventilated infant with congenital
diaphragmatic hernia?
A. As early as possible
B. First 48 hours
C. After 48 hours
D. After neonatal period
E. After total weaning from ventilation

56. An 18-month-old toddler, his weight 12.5kg, with normal development

admitted for recurrent lobar infiltration of right lower lobe, chest X-ray shows
elevated right dome of diaphragm and paradoxical movement during
fluoroscopy.
Of the following, the MOST likely cause of recurrent lobar infiltration is
A. eventration of right dome of diaphragm
B. lobar sequestration
C. lung hypoplasia
D. phrenic nerve palsy
E. spinal muscular atrophy

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57. A 48-hour-old full-term baby boy, his weight 1.8kg, didn’t pass motion yet.
He develops an increasing abdominal distension and occasional vomiting, his
erect abdominal X-ray shows dilated large bowl, and PR examination is
unremarkable. Mother is G3P3, had severe preeclapmsia and received
magnesium sulphate, other siblings had no chronic medical problem.
Of the following, the MOST likely diagnosis is
A. meconium plug
B. meconium ileus
C. necrotizing enterocolitis
D. hirschsprung disease
E. cystic fibrosis

58. What is the characteristic X-ray finding in abdominal contrast study done for
a neonate with meconium ileus?
A. Coil spring sign
B. Dilated distal bowl
C. Microcolon
D. Whirl sign
E. Double bubble sign

59. The usual onset of necrotizing enterocolitis in VLBW preterm babies is at

A. first few hours of life
B. first 48 hours of life
C. first week of life
D. 2nd and 3rd weeks of life
E. 4th week of life

60. What is the MOST effective preventive strategy for necrotizing

enterocolitis?
A. Human milk
B. Probiotics
C. Synbiotics
D. Pretreatment with H2 receptors antagonist
E. Good antibiotic coverage for bacteria that colonize intensive care unit

61. A well active full-term baby boy, his blood group is B+ve; delivered to 23-
year-primigravida mother, her blood group is O+ve with good antenatal care
and had no perinatal problems. His complete blood count shows, HB 13 g/dl,
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MCV 92 fL, MCHC 36. The blood film, Coomb's test, and serum bilirubin are
pending.
From the available data, what is the MOST probable diagnosis?
A. ABO incompatibility
B. α-thalassemia trait
C. Maternal iron deficiency
D. Hereditary spherocytosis
E. Normal values for age

62. A primimother, 36 wks gestations who was well throughout pregnancy,

reported decreased fetal movements to her obstetrician, for which emergency
cesarean section had been done. Her baby was pale and limp and required full
resuscitation including volume replacement.
What laboratory test should be done for precise diagnosis?
A. Urgent baby complete blood count and peripheral blood smear
B. Kleihauer-Betke test using maternal blood
C. Reticulocyte count, MCV and MCHC of baby sample
D. Baby and mother Coomb's test
E. Flow cytometry using maternal blood

63. A 3-day-old full-term baby girl presents with history of increasing neonatal
jaundice. Examination shows active, pale baby, with splenomegaly. Her
investigations show HB 11 gm/dl, MCV 102, MCHC 37, direct antiglobuline test -
ve, indirect bilirubin 18 mg/dl, direct bilirubin 0.4mg/dl, blood group B +ve;
hematologist reported increased reticulocyte count and bizarre RBCs
morphology featuring acanthocytes. The baby developed a stormy course,
treated aggressively with phototherapy and frequent blood transfusions
throughout neonatal period. Parents are consanguineous and are free from
chronic medical problems; mother blood group is O+ve.
Of the following, the MOST likely diagnosis is
A. hereditary spherocytosis with incomplete penetrance
B. pyruvate kinase deficiency
C. G6PD deficiency
D. ABO blood groups incompatibility
E. congenital abetalipoproteinmia

64. What is the suggested PCV transfusion threshold for a 5-day-old VLBW baby
who has no respiratory support?
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 A. 40
B. 35
C. 30
D. 25
E. 20

65. Which of the following factors reduce mother sensitization in hemolytic

disease of fetus and newborn HDFN resulting from Rh incompatibility?
A. ABO incompatibility
B. Increasing order of pregnancies
C. Type E Rh antigen
D. IgG type maternal antibody response
E. Larger volume of fetomaternal blood transfusion

66. Which of the following is a recognized complication of hemolytic disease of

fetus and newborn HDFN?
A. Hypocalcemia
B. Hypoglycemia
C. Hyperkalemia
D. Sepsis
E. Hyperthermia

67. A G5P4 mother who had previous 2 affected babies with hemolytic disease
of fetus and newborn (due to Rh incompatility) is asking about how to know
whether her coming baby is going to be sffected or not.
Which of the following tests you would use inresponse to her question?
A. Amniocentesis
B. Umbilical blood sampling
C. Fetal DNA from maternal serum
D. Chorionic villous sampling
E. Rising RhD antibody titers

68. A sensitized Rh-negative mother during second trimester is found to have

RhD antibody titers of ≥1:16 (15 IU/mL).
What is the MOST appropriate next step in management?
A. Give follow up visit after 2 weeks with repeat RhD antibody titer
B. Order umbilical blood sampling
C. Order fetal blood transfusion
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 D. Administration of Rh-immunoglobulin
E. Order Doppler study of the middle cerebral artery

69. What is the MOST appropriate statement that describes the trigger point of
pathophysiology of hydrops fetalis?
A. Severe anaemia that causes hypoalbuminemia
B. Extramedullary hematopoiesis that ultimately leads to hepatocellular
dysfunction
C. Anaemia that leads to right sided heart failure
D. Renal failure secondary to fetal renal vein thrombosis because of severe
hemolysis
E. Generalized tissue hypoxia

70. You are a team leader expecting delivery of a baby with hydrops due to
HDFN. The baby is delivered and initial steps of resuscitation were done
successfully. He has pallor, upper and lower limbs edema, mild ascites,
tachypnea and tachycardia. You started O2 and other supportive therapy.
Which of the following is the MOST appropriate step in the management?
A. Whole fresh compatible blood transfusion
B. Small packed RBCs transfusion
C. Small dose of diuretics
D. 20% albumin transfusion
E. Assisted ventilation

71. You are treating a 6- hour-old full term neonate with hemolytic disease of
fetus and newborn HDFN due to Rh incompatibility; he received small packed
RBCs transfusion, and he is stable right now. His serum bilirubin 8mg/dl
(136mmol/l) and hemoglobin 12g/dl.
Of the following, the MOST appropriate next step in the management is to
A. proceed for immediate exchange transfusion
B. plot the serial results of total bilirubin on exchange transfusion standard
graph and manage accordingly
C. start intensive phototherapy
D. administer IV immunoglobulin
E. administer 20% albumin

72. In which of the following scenarios an immediate exchange transfusion is an

indication? (1mg of bilirubin=17mmol/l of bilirubin)
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 A. A 5 days full-term baby with jaundice, fever, lethargy and hypertonia
B. A 24 hours full-term with Rh negative mother, bilirubin 13 mg/dl, HB
12gm/dl
C. A 48 hours 35 wks high risk baby with bilirubin of 15 mg/dl
D. A 48 hours asphyxiated baby with bilirubin of 15 mg/dl
E. A 72 hours standard risk full-term baby with bilirubin 20 mg/dl

73. Which of the following is the MOST common cause for neonatal
polycythemia in term infant?
A. Twin-twin transfusion for the recipient
B. Maternal-fetal transfusions
C. Post-maturity
D. Small-for-gestational age
E. Delayed clamping of the umbilical cord

74. A 3-day-old low birth weight neonate brought to emergency room with
feeding disturbance and lethargy. Examination shows alert baby with mild
tachypnea, cyanosis, and jaundice affecting the face and trunk. His RBS is low,
and capillary hematocrit is 68%. No risk factors in the history suggest sepsis.
Of the following, the MOST appropriate step in management is to
A. measure central hematocrit
B. start partial exchange transfusion
C. start empirical antibiotics
D. start hydration with normal saline
E. order echocardiography

75. At which age vitamin K–dependent coagulation factors reach adult ranges?
A. End of first week of life
B. End of neonatal period
C. At 4 months of life
D. At 6 months of life
E. At end of first year of life

76. A well and active 3-day-old full term breast fed baby delivered at home,
presents to OP clinic with fresh blood in stool, and some nasal bleed.
Of the following, the MOST likely diagnosis is
A. early form of hemorrhagic disease of the newborn
B. classic form of hemorrhagic disease of the newborn
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 C. factor VIII deficiency
D. factor IX deficiency
E. neonatal thrombocytopenia

77. A pregnant mother with familial hypercholesterolemia on cholesterol

lowering medication consults you about any possible risk of taking such
medications.
What is your BEST advice for her?
A. Such medications are safe and causes no possible harm to coming baby
B. We should stop such medications right now
C. A plan is needed for you and your baby to control hypercholesterolemia
D. A plan is needed for you and your baby to control possible bleeding
disorder
E. A lipid profile is needed for baby after birth

78. What is the MOST common presentation for late onset hemorrhagic disease
of the newborn?
A. Cutaneous bleeding
B. Bleeding from injection site
C. Ear-nose-throat and mucosal bleeding
D. Gastrointestinal bleeding
E. Intracranial bleeding

79. Which of the following causes of non-immune hydrops can be treated

prenatally?
A. Supraventricular tachycardia
B. Gaucher disease
C. Acardiac twin
D. Fetal akinesia syndromes
E. α-thalassemia

80. What is the MOST common remnant of the omphalo-mesenteric duct OMD?
A. Umbilical polyp
B. Umbilical granuloma
C. Umbilical sinus
D. Umbilical fistula
E. Meckel diverticulum

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81. What is the BEST treatment of umbilical granuloma?
A. Topical use of silver nitrite
B. Topical use of alcohol pads
C. Topical use of povidone-iodine
D. Ligation of the base and excision
E. Frequent soap and water toilet

82. A 5-day-old newborn presents with lethargy, mild umbilical discharge and
redness of peri-umbilical tissue.
Of the following, the MOST appropriate antimicrobial treatment is
A. Oral amoxcillin
B. Vancomycin pulse amikacin
C. Ampicillin plus gentamicin
D. Vancomycin
E. Cefuroxime

83. A young parents counseled you about the possible risk of antidepressant
medication (fluoxetine) during pregnancy.
What is the MOST appropriate answer?
A. It's safe to use such medication
B. It's acceptable to be used as so far has no recorded risk registered
C. We can use it with caution, if its benefits outweigh its risk
D. We can use it only in life threatening emergencies
E. We should not use it

84. You are taking first on-call duty in postnatal ward when staff nurse called
you for an 8-hour-old baby who has fever, weak suckling, irritability, tremor,
and weak cry. Mother is giving history of taking fluoxetine started in third
trimester for major depression.
Of the following, the MOST appropriate action/advice is to
A. advice the mother about proper positionimg and attachment on breast
B. explain this is not related to side effects of medication
C. order RBS and advice for small frequent breast feedings
D. stop breast feeding and start bottle feeding
E. admit the baby to NICU

85. Which of the following is differentiating primordial dwarfism from pituitary

dwarfism?
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 A. It had in utero growth failure
B. It has hyperbilirubinemia
C. It has hypoglycemia
D. It has micropenis at birth
E. It has associated birth defects

86. A colleague is asking about the maximum time limit to start treatment in
congenital hypothyroidism and by which we can still achieve normal
development. Your answer would be
A. first 7 days of life
B. first 14 days of life
C. first 21 days of life
D. first 30 days of life
E. first 2 months of life

87. A 7-day-old baby with history of traumatic delivery develops irritability,

vomiting, increased tone, and constipation. A firm purple nodule can be
appreciated on the trunk. All laboratory work up shows normal results apart
from hypercalcemia.
Of the following, the MOST likely diagnosis is
A. parathyroid hyperplasia
B. subcutaneous fat necrosis
C. idiopathic hypercalcemia
D. maternal hypoparathyroidism
E. transient hyperparathyroidism

88. What is the confirmative diagnostic test for salt wasting congenital adrenal
hyperplasia?
A. Decreased serum glucose
B. Elevated serum potassium
C. Reduced serum cortisone
D. Elevated 17-hydroxyprogesterone
E. Reduced serum aldosterone

89. A female infant with webbing of the neck, lymphedema, hypoplasia of the
nipples, cutis laxa, and low hairline at the nape of the neck, low-set ears, high-
arched palate, and cubitus valgus should be suspected of having
A. Noonan syndrome
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 B. Turner syndrome
C. William syndrome
D. Edward syndrome
E. Patau syndrome

90. What is the recommended goal for periconceptual HbA1c in pregestational

diabetic mothers to achieve the best outcomes for the mother and the baby?
A. <5%
B. <5.5%
C. <6%
D. <6.5%
E. <7%

91. A full-term macrosomic baby, a product of normal vaginal delivery to a

mother with gestational diabetes develops tachypnea, tachycardia, and
decreased O2 saturation. Chest X-ray shows cardiomegaly with pulmonary
congestion, and echocardiography shows severe asymmetrical septal
hypertrophy with systolic anterior motion (SAM) of anterior mitral leaflet. Baby
is on O2, supportive measures and low dose diuretics, but he is still
symptomatic.
Of the following, the MOST appropriate action is to start
A. digitalization
B. dopamin
C. propranolol
D. captopril
E. amlodipine

92. A fullterm macrosomic baby boy delivered by difficult and assisted normal
vaginal delivery. History reveals, mother had pregestational diabetes with fair
control and the baby had passed motion only once since birth. On 36 hours of
life, he develops decreased activity and feeding, and red color urine.
Examination shows fair hydration, HR 140 b/min, BP 100/75 mmHg, and left
sided flank mass. Investigations; RBS 44 mg/dl, TSB 12.9 mg/dl, blood gases
normal, HB 20 gm/dl, WBCs 22000/mm3, and platelets 55000/mm3.
Of the following, the MOST likely diagnosis is
A. small left colon syndrome
B. Hirschsprung disease
C. congenital infantile polycystic kidney disease
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 D. unilateral dysplastic kidney
E. renal vein thrombosis

93. In mothers who are elected for cesarean section, the BEST solution to solve
postoperative breast feeding delay problem is to
A. use prenatally expressed breast milk
B. arrange for spinal anesthesia
C. use oral dextrose gel
D. use formula milk with spoon
E. use breast milk bank

94. What is the pre-feeding target plasma glucose concentration in first 48 hrs
of life in infants of diabetic mothers?
A. ≥30 mg/dl
B. ≥35 mg/dl
C. ≥40 mg/dL
D. ≥45 mg/dL
E. ≥50 mg/dL

95. What is the plasma glucose level at which IV glucose is indicated in neonatal
hypoglycemia in first 4 hours of life?
A. <20mg/dL
B. <25mg/dL
C. <30mg/dL
D. <35mg/dL
E. <40mg/dL

96. Screening for asymptomatic hypoglycemia during first day of life among at-
risk infants is indicated for
A. post-term infants
B. infants with congenital infection
C. infants of obese mothers
D. infants with birth asphyxia
E. infant with mothers on beta blockers

97. Which of the following markers have ability to identify neonates with
serious bacterial infection?
A. Erythrocyte sedimentation rate
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 B. Immature-to-total neutrophil count
C. Serum C-reactive protein
D. Procalcitonin
E. Thrombocytopenia

98. What is the empirical antibiotic therapy for early onset neonatal sepsis?
A. Ampicillin
B. Ampicillin + Aminoglycoside
C. Vancomycin + Aminoglycoside
D. Cefotaxime + Aminoglycoside
E. Cefotaxime

99. You are explaining the non- antimicrobial treatment strategies and the role
of recombinant GM-CSF and IVIG in treatment of neonatal sepsis to a junior
colleague.
Which of the following is the MOST appropriate sentence?
A. Recent studies shows encouraging results of their use
B. Recent studies has established their role
C. Studies shows a lot of adverse effects during their use
D. There is insufficient evidence to support their clinical use
E. There is no role in treatment of neonatal sepsis

100. Which of the following is true regarding the dose of empiric antibiotic
regime in early onset sepsis?
A. Ampicillin 50 mg/kg/dose BID, gentamicin 5mg/kg/dose BID
B. Ampicillin 50 mg/kg/dose BID, gentamicin 5mg/kg/dose OD
C. Ampicillin 100 mg/kg/dose BID, gentamicin 4mg/kg/dose OD
D. Ampicillin 150 mg/kg/dose BID, gentamicin 4mg/kg/dose OD
E. Ampicillin 50 mg/kg/dose BID, gentamicin 10mg/kg/dose OD

101. You are reviewing the clinical data for a G2 P1 mother who has elected for
induction of labor tomorrow. Past obstetrical history reveals GBS infection of
her previous baby during early neonatal period.
Of the following, the MOST appropriate plan is to
A. order for GBS screening vaginal culture
B. give GBS vaccine to the mother
C. start combination of broad spectrum antibiotics to the mother
D. give intrapartum penicillin chemoprophylaxis
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 E. collect blood culture for the neonate after birth and treat him
accordingly

102. A 36-week-gestation, G1P0 mother presents with labor, she had poor
antenatal care visits and her GBS status is unknown. She has neither fever nor
rupture of membrane.
Of the following, the MOST appropriate action is to
A. order rapid intrapartum nucleic acid amplification test NAAT for GBS
B. start combination of broad spectrum antibiotics to the mother
C. give intrapartum penicillin chemoprophylaxis
D. collect blood culture for the neonate after delivery and treat him
accordingly
E. start empiric antibiotic therapy to the neonate

103. Which of the following congenital viral infections causes persistent

postnatal infection?
A. Mumps
B. Coxsackievirus B
C. Rubeola
D. Smallpox
E. Hepatitis B virus

104. Which of the following congenital viral infections can cause congenital
glaucoma?
A. Cytomegalovirus
B. Rubella virus
C. Treponema pallidum
D. Toxoplasma gondii
E. Human parvovirus B19

105. What is the viral infection if acquired during pregnancy causes mild
infection to mother but causes microcephaly, lissencephaly and cerebellar
hypoplasia to the baby?
A. Rubella
B. VZV
C. Coxsackievirus B
D. HIV
E. Zika
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106. What is the MOST common health care acquired infection (nosocomial) in
the neonatal intensive care unit?
A. Central line–associated bloodstream infection
B. Ventilator-associated pneumonia
C. Surgical site infection
D. Catheter-associated urinary tract infection
E. Peritoneal dialysis catheter infection

107. What is the predominant microorganism causing the largest fraction of

health care acquired infection in the NICU?
A. Coagulase-negative staphylococcus
B. Staphylococcus aureus
C. Enterococcus
D. Escherichia coli
E. Klebsiella pneumonia

108. What is the MOST common reported microorganism in ventilation-

associated pneumonia?
A. Enterococcus
B. Gram-negative rod
C. Coagulase-negative staphylococcus
D. Staphylococcus aureus
E. Escherichia coli

109. What is the MOST effective measure in reducing fungal colonization and
invasive infection in NICU for babies < 1000 gm birth weight?
A. Limit the use of broad-spectrum antimicrobials
B. Limitation of postnatal corticosteroid use in VLBW
C. Early enteral feeding with human milk feeding
D. Prophylactic administration of fluconazole
E. Early extubation

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Chapter 11
The Fetus and the Neonatal Infant
Answers
AHMED TAWFIQ
1.(E) Benign neonatal myoclonic seizure is a self-limiting disorder characterize
by neonatal onset myoclonic jerks during non- rapid eye movement sleep and
consistent cessation with arousal with absent concomitant EEG findings. Such
history in a well-baby requires no investigations.
2.(A) While prematurity is the main cause in early neonatal period (first 7 days
of life); the sepsis takes the lead in late neonatal life.
3.(C)
4.(E) Other distracters cause white reflex which is always pathological.
5.(A) Thin ribs and clubfoot are also recognized features.
6.(B) Full-term, vigorous infants may initially be placed on the mother's
abdomen after delivery, during which time delayed clamping of the umbilical
cord (30-60 sec) is recommended to improve transitional circulation and
increase neonatal red blood cell (RBC) volume.
7.(C) Clearing the mouth of secretions with gentle suction with a bulb syringe or
soft catheter is indicated if there is an excessive (copious) amount of fluid in the
mouth or nares. In resource-poor countries, gentle wiping of the face, nose, and
mouth with a soft cloth may be equally effective as a bulb syringe.
Spontaneously breathing neonates without distress require no assisted method
to clear their airway.
8.(A) Famous drugs that is contraindicated in a nursing mothers are
amphetamines, antineoplastic agents, bromocriptine, and chloramphenicol
while other distracters can be used with caution.
9.(C) For TB, treatment for 14 days is usually suffice; for all types of hepatitis
breast feeding is not contraindicated, while in varicella covering of the lesion is
enough.
10.(E)
11.(C) The ultrasound criteria for these diagnoses are based on either the
amniotic fluid index (AFI) or a deepest vertical pocket (DVP). The AFI is
determined by measuring the vertical dimension of amniotic fluid pockets in 4
quadrants and reporting the sum of these values. An index >24 cm suggests
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