NEONATOLOGY Care of the Normal Newborn

Question 1 (20 points)

The first steps in resuscitation of the newborn include all of the following,
except:

a. Placing the infant under a radiant warmer.

b. Drying the infant to prevent evaporation heat loss.
c. Positioning to open the airway.
d. Gently suctioning the mouth followed by suctioning the nares to
prevent gasp aspirations.
e. Weighing the baby to assure accurate drug dosages.

Score: 20 / 20

Question 2 (20 points)

Hyperbilirubinemia occurs frequently in the normal newborn. Each of the

following is a true statement, except:

a. Exaggeration of the enterohepatic shunt may explain both the

early and the late jaundice associated with breast feeding.
b. The aggressive use of phototherapy in healthy full-term infants
with nonhemolytic jaundice does not seem to be indicated when the total
bilirubin is <20 mg/dL.
c. Sick premature infants who have hyperbilirubinemia due to
hemolysis are at the highest risk for developing bilirubin encephalitis.

d. Bacterial sepsis, syphilis, hypothyroidism, and early

galactosemia may cause an elevated direct bilirubin level.
e. The initial workup for neonatal hyperbilirubinemia should include
total and direct bilirubin levels, complete blood count, Coombs test, and
testing of urine for reducing substance.
Score: 20 / 20

Question 3 (20 points)

After the newborn infant is stabilized, which of the following procedures is not
indicated? Student response: Student
Response Answer Choices
a. Ocular Prophylaxis against gonococcal disease and chlamydia.
b. Umbilical cord examination and care and vitamin K injection
 c. Review of the mother's hepatitis status and serology
d. Maturational assessment (Ballard scale), done between 30 and
45 min of age.
e. Facilitation of early parent child interaction
Score: 20 / 20

Question 4 (20 points)

Each of the following statements is false, except:

a. Small-for-gestational age infants have a lower metabolic rate than

those of the same weight who are appropriate for gestational age

b. Premature infants of less than 341/2 weeks gestation are at

increased risk for apnea and bradycardia
c. Preterm ifants are those of less than 37 weeks gestation and a
birthweight of <2500 g
d. The differential diagnosis for the large-for-gestation age infant
includes maternal diabetes, maternal thyroid disease, and maternal obesity
e. Cycles of pauses of 5 to 10 sec, followed by hyperpnea (eg.
periodic breathing), is a precursor to apnea and bradycardia.
Score: 20 / 20

Question 5 (20 points)

Each of the following statements is true, except:

a. Bilious vomiting in the new born sometimes may be normal and

due to an active antiperistaltic reflex
b. Infants with confirmed sepsis or meningitis should have a
brainsterm auditory evoked response examination.
c. Ninety-nine percent of normal, full-term infants will urinate by 24 h
of age
d. All infants of less than 35 weeks' gestation or who weigh <1800 g
at birth and who received oxygen therapy for at least 6 h require an
ophthalmologic examination for retinopathy of prematurity at 4 to 8 wk of
age
e. Hypoglycemia is a blood glucose measurement of <40 to 45 mg/dl,
regardless of gestational age

Score: 20 / 20
Total score: 100 / 100 = 100.0%

Respiratory ALTE and Home Monitors

Question 1 (20 points)

Which of the following statements regarding apparent life-threatening events

(ALTEs) is true?
Student response: Student
Response Answer Choices
a. An apparent cause almost always is discovered during the detailed
history and physical examination.
b. Home event monitors have been shown to reduce the incidence of
ALTEs.
c. Infants who have a history of ALTE are at higher risk of SIDS.
d. Many infants who experience an ALTE have normal physical
examination findings when brought to medical attention.
e. Preterm infants are proven to be at higher risk for ALTEs than are
term infants.

Score: 20 / 20

Question 2 (20 points)

Which of the following is a risk factor for ALTE?

Student response: Student
Response Answer Choices
a. Family history of ALTE.
b. Female sex.
c. Maternal smoking.
d. Pacifier use.
e. Prone sleeping position.
Score: 20 / 20

Question 3 (20 points)

A worried mother brings in her 3-week-old son because he turned blue for 30
seconds and appeared not to be breathing during that time. Your history
reveals that he is a slow eater who often sweats during feedings. Physical
examination reveals mild tachycardia and slightly weakened peripheral
pulses. Of the following, the test that is most likely to reveal the cause of his
ALTE is:
Student response: Student
Response Answer Choices
a. Complete blood count.
b. Computed tomography scan of the head.
c. Echocardiography.
d. Multichannel pneumogram.
e. Urine culture.
Score: 20 / 20

Question 4 (20 points)

A young couple brings their 4-week-old daughter to the emergency

department because she stopped breathing while feeding. They report that
they initiated cardiopulmonary resuscitation but were unable to get a
response from her. The infant is apneic, cyanotic, and limp. You also note on
physical examination that her left arm and left leg are bruised. After you
intubate her and gain intravenous access, you consider the differential
diagnosis of apnea. Of the following, the test that is most important to obtain
to determine the cause of the infant's apneic event is:
Student response: Student
Response Answer Choices
a. Ammonia measurement.
b. Chest radiography.
c. Computed tomography scan of the head.
d. Electrocardiography.
e. Upper gastrointestinal radiographic series.

Score: 20 / 20

Question 5 (20 points)

You are evaluating a 6-week-old boy who was brought to your clinic by his
mother after a choking episode several hours earlier. She reports that shortly
after feeding, he coughed and appeared to be choking and gasping for breath
for 5 seconds. The episode resolved, and he has been breathing normally
since. He is a well-appearing, alert infant who has normal vital signs and no
fever. Except for mild nasal congestion, his physical examination findings are
normal. His mother reports that he spits up occasionally. Of the following, the
most appropriate management of this patient's ALTE is:
 a. Admission to the hospital for a 48-hour observation without
laboratory evaluation.
b. Admission to the short-stay unit for 24 hours of continuous
cardiorespiratory and pulse oximetry monitoring.
c. Discharge from the clinic with an apnea monitor for 2 months.
d. Education of the mother and discharge from the clinic with
gastroesophageal reflux precautions.
e. Full sepsis evaluation, including lumbar puncture, and admission to
the hospital for administration of intravenous antibiotics.

Score: 20 / 20
Total score: 100 / 100 = 100.0%

Cognition: Recognition of Autism Before Age 2 Years

Question 1 (25 points)

Differences in pointing behaviors, as an example of "joint attention," may be

used in descriptions of children believed to have autism. Mature joint
attention is demonstrated best with a point whose purpose is to:

a. Comment.
b. Direct.
c. Distract.
d. Label.
e. Request.
Score: 25 / 25

Question 2 (25 points)

Of the following, the best DSM-IV-TR-based criteria to identify children

younger than 2 years of age who have autism are:
Student response: Student
Response Answer Choices
a. Abnormal conversational skills and stereotypic language.
b. Delay in achieving speech and language milestones.
c. Failure to form age-appropriate peer relationships.
d. Impairment in use of nonverbal behaviors.
e. Ritualistic behaviors and need for routine.
Score: 25 / 25

Question 3 (25 points)

The failure of an 18-month-old child who has autism to respond to his or her
name when called is believed to be the result of deficits in:
Student response: Student
Response Answer Choices
a. Auditory processing.
b. Cognition.
c. Hearing.
d. Receptive language.
e. Social relatedness.
Score: 25 / 25

Question 4 (25 points)

Careful observation of typical children at play has been important in better

understanding children who have autism. Children who have autism rarely
demonstrate evidence of:
Student response: Student
Response Answer Choices
a. Constructive play.
b. Oral motor play.
c. Roughhouse play.
d. Sensory motor play.
e. Symbolic play.
Score: 25 / 25

Total score: 100 / 100 = 100.0%

Respiratory Disorders, Bronchiolitis

Question 1 (20 points)

The most important triad of findings for assessing severity of bronchiolitis are
respiratory rate, work of breathing, and:
Student response: Student
Response Answer Choices
a. Degree of cough.
b. Level of oxygen saturation.
c. Pitch of wheezing.
d. Presence of crackles.
e. Rapidity of heart rate.

Score: 20 / 20

Question 2 (20 points)

Among the following, the best reason to obtain viral studies in those
suspected of having bronchiolitis is to:
Student response: Student
Response Answer Choices
a. Administer specific antiviral therapy.
b. Determine the need for hospitalization.
c. Guide the type of supportive care needed.

d. Identify febrile infants >30 days of age who are at low risk for
serious bacterial infection and may not need empiric antibiotics.
e. Provide the most accurate diagnosis.

Score: 20 / 20

Question 3 (20 points)

Among the following, the febrile patients most likely to have a serious
bacterial infection associated with bronchiolitis:
Student response: Student
Response Answer Choices

a. Are younger than 30 days of age.

b. Are 31 to 60 days old.
c. Are neurologically impaired.
d. Have infiltrates on chest radiography.
e. Have survived neonatal respiratory distress syndrome.
Score: 20 / 20

Question 4 (20 points)

The primary treatment of bronchiolitis includes hydration and:

Student response: Student
Response Answer Choices
a. Bronchodilators.
b. Chest physiotherapy.
c. Corticosteroids.
d. Decongestants.
e. Oxygenation.

Score: 20 / 20

Question 5 (20 points)

The major benefit of palivizumab prophylaxis is:

Student response: Student
Response Answer Choices

a. Decreased hospitalization rate.

b. Improved treatment.
c. Increased cost-effectiveness.
d. Lower mortality rate.
e. Shorter duration of illness.

Score: 20 / 20

Total score: 100 / 100 = 100.0%

Fluid & Electrolytes: Parenteral Fluid Therapy

Question 1 (33 points)

A 6-year-old girl is admitted for elective removal of a mesenteric cyst.
Physical examination reveals a well-hydrated child whose weight is 23 kg and
height is 115 cm. She is afebrile and appears healthy. Which of the following
is the most appropriate parenteral maintenance fluid and electrolytes
regimen for her?

a. 5% Dextrose with 0.20% saline + 20 mEq/L KCI at 65 mL/h.

b. 5% Dextrose with 0.20% saline + 40 mEq/L KCI at 95 mL/h.
c. 5% Dextrose with 0.45% saline + 20 mEq/L KCI at 65 mL/h.
d. 5% Dextrose with 0.45% saline + 40 mEq/L KCI at 95 mL/h.
e. 5% Dextrose with 0.90% saline + 40 mEq/L KCI at 65 mL/h.

Score: 33 / 33

Question 2 (33 points)

A 2-year-old child presents with a 24-hour history of 10 to 12 large, watery

stools and vomiting. Physical examination reveals sunken eyes, weight of
12.5 kg, temperature of 36.8C (98.2F), heart rate of 144 beats/min,
respirations of 26 breaths/min, and blood pressure of 78/40 mm Hg. His
extremities are cool, and the capillary refill time is 3 seconds. Of the
following, the most appropriate initial intravenous bolus to be administered
over the next hour is:
Student response: Student
Response Answer Choices

a. 125 mL Ringer lactate.

b. 250 mL 0.9% saline.
c. 250 mL 5% Dextrose.
d. 125 mL 5% Dextrose with Ringer lactate.
e. 250 Ml 5% Dextrose with 045% saline.

Score: 33 / 33

Question 3 (34 points)

A 6-month-old girl presents with vomiting and loose stools of 3 days'

duration. Physical examination reveals an axillary temperature of 37.2C
(99F), respiratory rate of 32 breaths/min, heart rate of 126 beats/min, and
blood pressure of 98/68 mm Hg. The anterior fontanelle and eyes are sunken,
the lips and oral mucous membranes are dry, and the skin appears doughy.
Results of laboratory studies include: serum sodium, 168 mEq/L (168
mmol/L); potassium, 5.2 mEq/L (5.2 mmol/L); chloride, 136 mEq/Ml (136
mmol/L); and bicarbonate, 10 mEq/L (10 mmol/L). A true statement about this
girl's condition is that:
Student response: Student
Response Answer Choices
a. A 20 mLl/kg bolus of 5% dextrose should be administered over 1 h.
b. Extracellular fluid is depleted more than intracellular fluid.
c. Rehydration should occur over 48 h at a constant rate.
d. Total body potassium is increased.
e. Total body sodium is increased.

Score: 34 / 34

Total score: 100 / 100 = 100.0%

Growth & Development, Toddler Development

Question 1 (25 points)

Which of the following would generally be considered beyond the

developmental level of 18 months?
Student response: Student
Response Answer Choices
a. Has a vocabulary of 20 words.

b. Imitates a horizontal stroke of a crayon.

c. Makes a tower of 4 cubes.
d. Puts 10 cubes into a cup on request.

Score: 25 / 25

Question 2 (25 points)

Which of the following would generally be considered beyond the
developmental level of 24 months?
 a. Builds a tower of 7 cubes.
b. Copies a cross on demonstration.
c. Copies a vertical stroke of a crayon.
d. Makes a circular scribble with a crayon.

Score: 25 / 25

Question 3 (25 points)

Which of the following would generally be considered beyond the

developmental level of 36 months?

a. Draws a stick figure that has eyes, nose, arms, and legs.
b. Puts together sentences of four to five words.
c. Rides a tricycle.
d. Stands momentarily on one foot.

Score: 25 / 25

Question 4 (25 points)

The transition during the toddler period from the sensorimotor to the
preoperational level of development (Piaget) is exemplified best by:

a. The emerging struggle for autonomy.

b. Fine motor development.
c. Language development.
d. The relationship between temperament and social development.

Score: 25 / 25

Total score: 100 / 100 = 100.0%