1
,Q1. A 30-week gestation infant receiving CPAP of 6 cm H₂O
with FiO₂ 0.35 develops worsening tachypnea, retractions,
and an FiO₂ requirement of 0.6 over 2 hours. What is the most
appropriate next step?
A) Increase CPAP to 8 cm H₂O
B) Transition to nasal cannula
C) Intubate and initiate surfactant
D) Administer a diuretic
Correct Answer: C
Rationale: This infant shows signs of respiratory distress
syndrome (RDS) with escalating oxygen need. CPAP failure with
FiO₂ >0.4-0.5 in a preterm infant warrants intubation and
surfactant administration per evidence-based guidelines.
2
,Q2. Which finding on cranial ultrasound in a preterm infant is
most strongly associated with later development of cerebral
palsy?
A) Grade I germinal matrix hemorrhage
B) Periventricular leukomalacia
C) Subependymal cyst
D) Transient periventricular echodensity
Correct Answer: B
Rationale: Periventricular leukomalacia (PVL) is cystic necrosis of
white matter adjacent to the lateral ventricles. It is the strongest
ultrasound predictor of cerebral palsy, particularly spastic
diplegia, in preterm infants.
Q3. A term infant presents with jaundice at 18 hours of life.
Total bilirubin is 12 mg/dL, direct bilirubin is 1.2 mg/dL.
Maternal blood type is O negative. What is the most
appropriate next step?
A) Phototherapy
B) Exchange transfusion
C) Direct Coombs test
D) Observation with repeat bilirubin in 12 hours
3
, Correct Answer: C
Rationale: Early jaundice (<24 hours) is pathologic. Maternal
blood type O negative raises concern for ABO or Rh
incompatibility. Direct Coombs test identifies antibody-coated
infant RBCs and guides further management.
Q4. A 32-week preterm infant on high-flow nasal cannula (2
L/kg/min, FiO₂ 0.3) develops abdominal distension, bilious
gastric residuals, and bloody stools. Which finding on
abdominal X-ray confirms necrotizing enterocolitis (NEC)?
A) Distended bowel loops
B) Pneumatosis intestinalis
C) Ascites
D) Hepatomegaly
Correct Answer: B
Rationale: Pneumatosis intestinalis (gas within the bowel wall) is
pathognomonic for NEC. Distended loops and ascites may be
seen but are not diagnostic.
4
,Q1. A 30-week gestation infant receiving CPAP of 6 cm H₂O
with FiO₂ 0.35 develops worsening tachypnea, retractions,
and an FiO₂ requirement of 0.6 over 2 hours. What is the most
appropriate next step?
A) Increase CPAP to 8 cm H₂O
B) Transition to nasal cannula
C) Intubate and initiate surfactant
D) Administer a diuretic
Correct Answer: C
Rationale: This infant shows signs of respiratory distress
syndrome (RDS) with escalating oxygen need. CPAP failure with
FiO₂ >0.4-0.5 in a preterm infant warrants intubation and
surfactant administration per evidence-based guidelines.
2
,Q2. Which finding on cranial ultrasound in a preterm infant is
most strongly associated with later development of cerebral
palsy?
A) Grade I germinal matrix hemorrhage
B) Periventricular leukomalacia
C) Subependymal cyst
D) Transient periventricular echodensity
Correct Answer: B
Rationale: Periventricular leukomalacia (PVL) is cystic necrosis of
white matter adjacent to the lateral ventricles. It is the strongest
ultrasound predictor of cerebral palsy, particularly spastic
diplegia, in preterm infants.
Q3. A term infant presents with jaundice at 18 hours of life.
Total bilirubin is 12 mg/dL, direct bilirubin is 1.2 mg/dL.
Maternal blood type is O negative. What is the most
appropriate next step?
A) Phototherapy
B) Exchange transfusion
C) Direct Coombs test
D) Observation with repeat bilirubin in 12 hours
3
, Correct Answer: C
Rationale: Early jaundice (<24 hours) is pathologic. Maternal
blood type O negative raises concern for ABO or Rh
incompatibility. Direct Coombs test identifies antibody-coated
infant RBCs and guides further management.
Q4. A 32-week preterm infant on high-flow nasal cannula (2
L/kg/min, FiO₂ 0.3) develops abdominal distension, bilious
gastric residuals, and bloody stools. Which finding on
abdominal X-ray confirms necrotizing enterocolitis (NEC)?
A) Distended bowel loops
B) Pneumatosis intestinalis
C) Ascites
D) Hepatomegaly
Correct Answer: B
Rationale: Pneumatosis intestinalis (gas within the bowel wall) is
pathognomonic for NEC. Distended loops and ascites may be
seen but are not diagnostic.
4
