NEONATAL NP (NNP) WITH CORRECT ACTUAL
QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
Gestational Age Assessment & Physical Exam (1–15)
1. A newborn is born at 28 weeks gestation. Which physical characteristic would
be expected on the Ballard exam?
A) Well-developed areola with 3–4 mm stippling
B) Heel creases covering the entire foot
C) Pinna of the ear is flat and folded with minimal recoil
D) Full-term genitalia (rugae on scrotum, labia majora covering labia minora)
Answer: C
Rationale: At 28 weeks, the ear cartilage is still soft, the pinna is flat and stays
folded (minimal recoil). Areola develops after 32 weeks. Heel creases appear after
34 weeks. Rugae on scrotum appear after 36 weeks.
2. A newborn is being assessed for gestational age using the New Ballard Score
(NBS). The infant has a square window angle of 90°, arm recoil of 180°, popliteal
angle of 180°, scarf sign that the elbow reaches across the chest, and heel to ear
that reaches the chest. What is the approximate gestational age?
A) 28 weeks
B) 30 weeks
C) 32 weeks
D) 34 weeks
,Answer: A
Rationale: These physical maturity findings (square window 90°, arm recoil 180°,
popliteal angle 180°, scarf sign across chest, heel to ear to chest) correspond to an
extremely preterm infant at approximately 26–28 weeks gestation.
3. A newborn has a gestational age of 35 weeks by Ballard exam. Which of the
following findings would be consistent with this gestational age?
A) Lanugo present over entire back
B) Sole creases covering anterior two-thirds of foot
C) Breast bud with 5–10 mm areola
D) Testes in the inguinal canal with few rugae
Answer: B
*Rationale: At 35 weeks, sole creases cover the anterior two-thirds of the foot.
Lanugo is mostly gone by 34–36 weeks. Breast bud with 5–10 mm areola is seen
at term (38–40 weeks). Testes in the scrotum with rugae is term.*
4. A 38-week gestation newborn has a scaphoid abdomen, bilateral
cryptorchidism, and a flat nasal bridge. What congenital anomaly should be
suspected?
A) Trisomy 21 (Down syndrome)
B) Congenital diaphragmatic hernia (CDH)
C) Patau syndrome (Trisomy 13)
D) Prune belly syndrome
Answer: B
Rationale: Scaphoid abdomen (sunken abdomen) and cryptorchidism are
associated with congenital diaphragmatic hernia (herniation of abdominal
contents into the chest, leaving a scaphoid abdomen). CDH also presents with
respiratory distress.
,5. A newborn has a single umbilical artery (SUA). This finding is associated with an
increased risk of which anomaly?
A) Cardiac and renal anomalies
B) Neural tube defects
C) Cleft lip and palate
D) Tracheoesophageal fistula
Answer: A
Rationale: Single umbilical artery occurs in 0.5–1% of pregnancies and is
associated with a 20–30% risk of congenital anomalies, especially cardiac and
renal. Renal ultrasound and echocardiogram are recommended.
6. A term newborn has a red reflex examination that shows a white reflex
(leukocoria) in the left eye. What is the most concerning diagnosis?
A) Retinopathy of prematurity (ROP)
B) Congenital cataract
C) Retinoblastoma
D) Corneal abrasion
Answer: C
Rationale: Leukocoria (white reflex) is an emergency. Retinoblastoma (malignant
eye tumor) must be ruled out immediately. Other causes: congenital cataract,
Coats disease, ROP (but ROP is in preterm infants).
7. A newborn has a sacral dimple located 2 cm above the anus with a visible tuft
of hair. What is the most appropriate next step?
A) Reassure parents that this is a normal finding
B) Order a spinal ultrasound (if <3 months) or MRI spine
C) Perform a rectal exam
D) Observe and discharge
Answer: B
Rationale: A sacral dimple >2.5 cm from the anus, with associated hair tuft,
, hemangioma, or subcutaneous mass, raises concern for occult spinal dysraphism
(tethered cord). Spinal ultrasound is indicated in infants <3 months.
8. A newborn has a palpable olive-shaped mass in the right upper quadrant and
projectile non-bilious vomiting at 6 weeks of age. What is the most likely
diagnosis?
A) Malrotation with volvulus
B) Pyloric stenosis
C) Gastroesophageal reflux
D) Duodenal atresia
Answer: B
*Rationale: Pyloric stenosis presents at 3–6 weeks with progressive projectile non-
bilious vomiting, palpable olive sign, and hypochloremic metabolic alkalosis.
Ultrasound confirms. Malrotation presents with bilious vomiting.*
9. A term newborn has a symmetric, firm, non-erythematous swelling over the
right parietal bone that does not cross suture lines. What is the most likely
diagnosis?
A) Caput succedaneum
B) Cephalohematoma
C) Subgaleal hemorrhage
D) Skull fracture
Answer: B
Rationale: Cephalohematoma: subperiosteal hemorrhage, does not cross suture
lines, appears within 24 hours, firm, may take weeks to resolve. Associated with
vacuum or forceps delivery. Caput succedaneum crosses suture lines, resolves in
days.
QUESTIONS AND CORRECTLY WELL DEFINED
ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
Gestational Age Assessment & Physical Exam (1–15)
1. A newborn is born at 28 weeks gestation. Which physical characteristic would
be expected on the Ballard exam?
A) Well-developed areola with 3–4 mm stippling
B) Heel creases covering the entire foot
C) Pinna of the ear is flat and folded with minimal recoil
D) Full-term genitalia (rugae on scrotum, labia majora covering labia minora)
Answer: C
Rationale: At 28 weeks, the ear cartilage is still soft, the pinna is flat and stays
folded (minimal recoil). Areola develops after 32 weeks. Heel creases appear after
34 weeks. Rugae on scrotum appear after 36 weeks.
2. A newborn is being assessed for gestational age using the New Ballard Score
(NBS). The infant has a square window angle of 90°, arm recoil of 180°, popliteal
angle of 180°, scarf sign that the elbow reaches across the chest, and heel to ear
that reaches the chest. What is the approximate gestational age?
A) 28 weeks
B) 30 weeks
C) 32 weeks
D) 34 weeks
,Answer: A
Rationale: These physical maturity findings (square window 90°, arm recoil 180°,
popliteal angle 180°, scarf sign across chest, heel to ear to chest) correspond to an
extremely preterm infant at approximately 26–28 weeks gestation.
3. A newborn has a gestational age of 35 weeks by Ballard exam. Which of the
following findings would be consistent with this gestational age?
A) Lanugo present over entire back
B) Sole creases covering anterior two-thirds of foot
C) Breast bud with 5–10 mm areola
D) Testes in the inguinal canal with few rugae
Answer: B
*Rationale: At 35 weeks, sole creases cover the anterior two-thirds of the foot.
Lanugo is mostly gone by 34–36 weeks. Breast bud with 5–10 mm areola is seen
at term (38–40 weeks). Testes in the scrotum with rugae is term.*
4. A 38-week gestation newborn has a scaphoid abdomen, bilateral
cryptorchidism, and a flat nasal bridge. What congenital anomaly should be
suspected?
A) Trisomy 21 (Down syndrome)
B) Congenital diaphragmatic hernia (CDH)
C) Patau syndrome (Trisomy 13)
D) Prune belly syndrome
Answer: B
Rationale: Scaphoid abdomen (sunken abdomen) and cryptorchidism are
associated with congenital diaphragmatic hernia (herniation of abdominal
contents into the chest, leaving a scaphoid abdomen). CDH also presents with
respiratory distress.
,5. A newborn has a single umbilical artery (SUA). This finding is associated with an
increased risk of which anomaly?
A) Cardiac and renal anomalies
B) Neural tube defects
C) Cleft lip and palate
D) Tracheoesophageal fistula
Answer: A
Rationale: Single umbilical artery occurs in 0.5–1% of pregnancies and is
associated with a 20–30% risk of congenital anomalies, especially cardiac and
renal. Renal ultrasound and echocardiogram are recommended.
6. A term newborn has a red reflex examination that shows a white reflex
(leukocoria) in the left eye. What is the most concerning diagnosis?
A) Retinopathy of prematurity (ROP)
B) Congenital cataract
C) Retinoblastoma
D) Corneal abrasion
Answer: C
Rationale: Leukocoria (white reflex) is an emergency. Retinoblastoma (malignant
eye tumor) must be ruled out immediately. Other causes: congenital cataract,
Coats disease, ROP (but ROP is in preterm infants).
7. A newborn has a sacral dimple located 2 cm above the anus with a visible tuft
of hair. What is the most appropriate next step?
A) Reassure parents that this is a normal finding
B) Order a spinal ultrasound (if <3 months) or MRI spine
C) Perform a rectal exam
D) Observe and discharge
Answer: B
Rationale: A sacral dimple >2.5 cm from the anus, with associated hair tuft,
, hemangioma, or subcutaneous mass, raises concern for occult spinal dysraphism
(tethered cord). Spinal ultrasound is indicated in infants <3 months.
8. A newborn has a palpable olive-shaped mass in the right upper quadrant and
projectile non-bilious vomiting at 6 weeks of age. What is the most likely
diagnosis?
A) Malrotation with volvulus
B) Pyloric stenosis
C) Gastroesophageal reflux
D) Duodenal atresia
Answer: B
*Rationale: Pyloric stenosis presents at 3–6 weeks with progressive projectile non-
bilious vomiting, palpable olive sign, and hypochloremic metabolic alkalosis.
Ultrasound confirms. Malrotation presents with bilious vomiting.*
9. A term newborn has a symmetric, firm, non-erythematous swelling over the
right parietal bone that does not cross suture lines. What is the most likely
diagnosis?
A) Caput succedaneum
B) Cephalohematoma
C) Subgaleal hemorrhage
D) Skull fracture
Answer: B
Rationale: Cephalohematoma: subperiosteal hemorrhage, does not cross suture
lines, appears within 24 hours, firm, may take weeks to resolve. Associated with
vacuum or forceps delivery. Caput succedaneum crosses suture lines, resolves in
days.
