Neonatology ACTUAL Questions and
CORRECT Answers
A woman who has chronic hypertension presents for a prenatal pediatric visit at 32 weeks'
gestation. She is coming in early because her obstetrician has said she is likely to deliver
prematurely. She has a previous history of an intrauterine demise at 34 weeks gestation that
was attributed to "a small placenta." During your discussion she asks how her baby can be
monitored prenatally.
A. Amniotic fluid volume assessment can be used to predict perinatal outcome
B. Biophysical profile testing can be used to assess fetal growth
C. Contraction stress testing can be used to look for evidence of uteroplacental insufficiency
D. Home uterine activity monitoring can be used to decreased preterm delivery and neonatal
complications
E. Nonstress testing can be used to document flow through the umbilical vessels - CORRECT
ANSWER✔✔- C. Contraction stress testing can be used to look for evidence of
uteroplacental insufficiency
Know that the non-stress test monitors fetal heart rate reactivity in response to fetal activity
During a routine health supervision visit, a mother relates that her sister recently gave birth to
an infant who had hypoplastic left heart syndrome. She has just found out she is 6 weeks
pregnant with her second child and is very worried because she has learned that other
members of her family have had children with heart problems over the past three generations.
She would like to know how her baby can be assessed prenatally for heart problems.
Of the following, you are MOST likely to advise her that a fetal heart defect can best be
diagnosed by
A. amniocentesis
B. chorionic villus sampling
C. fetal magnetic resonance imaging
D. maternal serum alpha-fetoprotein concentrations
E. prenatal level 2 ultrasonography - CORRECT ANSWER✔✔- E. prenatal level 2
ultrasonography
Recognize that prenatal ultrasonography can detect major fetal anomalies
,(eg, hydro- or anencephalus, myelomeningocele, congenital heart defects, gastrointestinal or
genitourinary abnormalities) as early as 16 weeks' gestation
Prenatal ultrasonography remains the primary method for fetal anatomic imaging because it
permits good visualization of structures that are filled with fluid, allowing identification of
genitourinary, gastrointestinal, central nervous system, and cardiac abnormalities in the
developing fetus.
You are attending a delivery at term for a woman who received limited prenatal care. Upon
reviewing the chart while awaiting the delivery, you find that she first presented for prenatal
care at the beginning of the second trimester. Limited screening was done, but you note that
the maternal serum alpha-fetoprotein concentration measured at 16 weeks' gestation was
described as "low." Ultrasonography was scheduled, but the mother did not show up for the
appointment. She was lost to follow-up after that time, and no further was performed.
Of the following, the MOST likely potential diagnosis for the infant is
A. anencephaly
B. omphalocele
C. spina bifida
D. tracheoesophageal fistula
E. trisomy 21 - CORRECT ANSWER✔✔- E. trisomy 21
Know the significance of abnormal maternal serum alpha-feto protein concentrations
Low msAFP levels, as reported for the woman in the vignette, may be associated with fetuses
affected by trisomy 18 and 21 and are felt to be related to decreased hepatic production.
The mother of a 4-year-old patient tells you that she is contemplating another pregnancy. She
is taking a number of medications and asks if any of them would pose a risk to a future
pregnancy.
Of the following, the oral medication you would be MOST concerned about her taking during
her first trimester is
A. isotretinoin
B. montelukast
C. phenobarbital
,D. prednisone
E. sertraline hydrochloride - CORRECT ANSWER✔✔- A. isotretinoin
The most concerning medication listed would be isotretinoin because of its recognized severe
teratogenicity during early fetal development. Isotretinoin is prescribed most often for cystic
acne, and because it closely resembles retinoic acid, which directs normal embryonic
development, isotretinoin use is contraindicated in pregnancy
B. montelukast
C. phenobarbital
D. prednisone
E. sertraline hydrochloride
You are examining an infant in the newborn nursery. The infant's mother had rheumatic fever
as a child and underwent artificial valve replacement for severe mitral regurgitation 5 years
before delivery. The pregnancy was unplanned and the mother was not aware that she was
pregnant until the 10th week of gestation. She had been taking warfarin for anticoagulation
until she discovered she was pregnant, at which time she was switched to a low-molecular-
weight heparin. She declined ultrasound screening for fetal anomalies.
Of the following, the MOST likely craniofacial feature this newborn may have that is related
to in utero warfarin exposure is
A. bilateral microtia
B. flattening of the philtrum
C. infraorbital creases
D. nasal hypoplasia
E. short palpebral fissures - CORRECT ANSWER✔✔- D. nasal hypoplasia
Maternal use of warfarin during the first trimester is associated with an embryopathy that
includes nasal hypoplasia. Fetal warfarin syndrome has been described in the infants of
mothers who took warfarin during first trimester, especially between 6 and 9 weeks of
gestation. Warfarin is a low-molecular-weight compound and easily crosses the placenta. In
more than 6% of exposed infants, nasal hypoplasia, stippled epiphyses, and growth restriction
are seen.
, You are seeing a 2-year-old girl for a routine health supervision visit. Her mother tells you
that she is thinking about becoming pregnant, but she was diagnosed last year with bipolar
disorder and is currently maintained on lithium. Her psychiatrist feels that lithium is her best
option for medical management and has discouraged her from stopping this medication. She
asks your advice about another pregnancy.
A. the decision whether to discontinue lithium requires a risk-benefit assessment since the
risk of fetal anomaly is relatively low
B. lithium is a potent teratogen and she should not consider a pregnancy while on this
medication
C. lithium use is primarily associated with cardiac and limb defects, which can be detected on
second trimester ultrasonography
D. she can resume lithium after delivery and may breastfeed without concern because little is
excreted into breast milk
E. she should discontinue lithium throu - CORRECT ANSWER✔✔- A. the decision whether
to discontinue lithium requires a risk-benefit assessment since the risk of fetal anomaly is
relatively low
Although the risks for birth defects associated with lithium use in pregnancy are well-
documented, the actual risk for birth defects, including Ebstein anomaly, are relatively low.
The estimated risk for cardiac defects in fetuses with prenatal exposure to lithium is between
1% and 5%, compared to 0.5% to 1% for the general population. Therefore, the decision
whether to discontinue this medication in pregnancy requires a risk-benefit decision in
consultation with the woman's psychiatrist and obstetrician.
A young mother brings in her 7-day-old newborn, accompanied by bot grandmothers, for the
infant's first health supervision visit. The baby has a reddish-orange area of what appears to
be mercurochrome applied to the umbilicus, which had been treated with triple dye in the
nursery. The infant also has a "belly band," a soft cotton wrap, applied around her abdomen.
During your discussions with the family, you sense some conflict about the best care for the
umbilical cord stump.
A. Alternate applying mercurochrome with alcohol
B. Apply moist compress three times daily to lead to faster separation
C. Apply povidone-iodine to the stump
D. Dry the stump after washing the baby with mild soap and water
E. Remove the "belly band" because it is likely to cause harm - CORRECT ANSWER✔✔-
D. Dry the stump after washing the baby with mild soap and water
