LATEST NEONATAL-PERINATAL MEDICINE
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 28-week gestation infant is born weighing 950 g.
At 6 hours of life, the infant develops respiratory
distress with grunting, retractions, and hypoxemia.
Chest X-ray shows a granular (ground-glass)
appearance with air bronchograms. What is the most
likely diagnosis?
A) Transient tachypnea of the newborn (TTN)
B) Respiratory distress syndrome (RDS)
C) Meconium aspiration syndrome (MAS)
D) Congenital pneumonia
Correct answer: B
Rationale: RDS (hyaline membrane disease) is
caused by surfactant deficiency, most common in
preterm infants (especially <32 weeks). X-ray
findings: granular (ground-glass) appearance, low
lung volumes, air bronchograms. TTN (A) occurs in
term/LGA infants (transient tachypnea, X-ray: fluid in
fissures, overinflation).
,2. A 41-week gestation infant is born via vacuum
extraction for non-reassuring fetal heart tones. The
infant has Apgars 4 and 7 at 1 and 5 minutes. At 6
hours of life, he has a bulging fontanelle, hypotonia,
and poor feeding. Head ultrasound (HUS) shows a
large subdural hematoma. What is the most
appropriate next step?
A) Emergent burr hole evacuation
B) Intravenous immune globulin (IVIG) and high-dose
corticosteroids
C) Serial head ultrasounds and supportive care
D) Exchange transfusion for hyperbilirubinemia
Correct answer: A
Rationale: Subdural hematoma with mass effect
(bulging fontanelle, hypotonia) in a term infant
requires neurosurgical evacuation. Birth trauma
(vacuum extraction) is a risk factor. Subdural
hematoma from non-accidental trauma (abusive head
trauma) must be ruled out if history is inconsistent.
3. A 30-week gestation infant has respiratory distress
requiring intubation and surfactant. On day 7, the
infant develops apnea and bradycardia. Blood
culture grows coagulase-negative staphylococcus
(CONS). The infant has a peripherally inserted central
,catheter (PICC) line. What is the most appropriate
antibiotic therapy?
A) Vancomycin and gentamicin
B) Vancomycin alone (for CONS)
C) Nafcillin and gentamicin
D) Cefotaxime alone
Correct answer: A
Rationale: Coagulase-negative staphylococcus
(CONS) is the most common cause of late-onset
sepsis (after 72 hours) in NICU infants, associated
with central lines. Vancomycin (MRSA coverage) +
gentamicin (synergy) is standard. Remove the PICC
line if infected.
4. A 34-week gestation infant is born to a mother with
chorioamnionitis (maternal fever, uterine tenderness,
fetal tachycardia). The infant is asymptomatic at birth
but has an elevated white blood cell count (30,000/μL)
and C-reactive protein (CRP) of 5 mg/dL. What is the
most appropriate next step?
A) Discharge home at 48 hours if asymptomatic
B) Obtain blood culture and start empiric antibiotics
(ampicillin + gentamicin)
C) Observe without antibiotics; obtain serial CRP
, D) Obtain a chest X-ray
Correct answer: B
Rationale: Maternal chorioamnionitis is a risk factor
for early-onset sepsis (EOS). Asymptomatic infants
with risk factors (and elevated WBC/CRP) should
have blood culture and empiric antibiotics (ampicillin
(GBS/Listeria) + gentamicin (gram-negatives)). Stop
antibiotics if culture negative at 48 hours.
5. A 28-week gestation infant has a patent ductus
arteriosus (PDA) with a continuous murmur,
bounding pulses, and widened pulse pressure.
Echocardiogram shows a moderate PDA with left-to-
right shunt. What is the most appropriate treatment?
A) Indomethacin or ibuprofen (cyclooxygenase
inhibitor)
B) Surgical ligation (thoracotomy)
C) Fluid restriction and furosemide (diuresis)
D) Observation (PDA often closes spontaneously)
Correct answer: A
Rationale: Indomethacin (or ibuprofen) is first-line
medical treatment for hemodynamically significant
PDA in preterm infants (closes ductus by inhibiting
prostaglandin synthesis). Surgical ligation is
reserved for failure of medical therapy or
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 28-week gestation infant is born weighing 950 g.
At 6 hours of life, the infant develops respiratory
distress with grunting, retractions, and hypoxemia.
Chest X-ray shows a granular (ground-glass)
appearance with air bronchograms. What is the most
likely diagnosis?
A) Transient tachypnea of the newborn (TTN)
B) Respiratory distress syndrome (RDS)
C) Meconium aspiration syndrome (MAS)
D) Congenital pneumonia
Correct answer: B
Rationale: RDS (hyaline membrane disease) is
caused by surfactant deficiency, most common in
preterm infants (especially <32 weeks). X-ray
findings: granular (ground-glass) appearance, low
lung volumes, air bronchograms. TTN (A) occurs in
term/LGA infants (transient tachypnea, X-ray: fluid in
fissures, overinflation).
,2. A 41-week gestation infant is born via vacuum
extraction for non-reassuring fetal heart tones. The
infant has Apgars 4 and 7 at 1 and 5 minutes. At 6
hours of life, he has a bulging fontanelle, hypotonia,
and poor feeding. Head ultrasound (HUS) shows a
large subdural hematoma. What is the most
appropriate next step?
A) Emergent burr hole evacuation
B) Intravenous immune globulin (IVIG) and high-dose
corticosteroids
C) Serial head ultrasounds and supportive care
D) Exchange transfusion for hyperbilirubinemia
Correct answer: A
Rationale: Subdural hematoma with mass effect
(bulging fontanelle, hypotonia) in a term infant
requires neurosurgical evacuation. Birth trauma
(vacuum extraction) is a risk factor. Subdural
hematoma from non-accidental trauma (abusive head
trauma) must be ruled out if history is inconsistent.
3. A 30-week gestation infant has respiratory distress
requiring intubation and surfactant. On day 7, the
infant develops apnea and bradycardia. Blood
culture grows coagulase-negative staphylococcus
(CONS). The infant has a peripherally inserted central
,catheter (PICC) line. What is the most appropriate
antibiotic therapy?
A) Vancomycin and gentamicin
B) Vancomycin alone (for CONS)
C) Nafcillin and gentamicin
D) Cefotaxime alone
Correct answer: A
Rationale: Coagulase-negative staphylococcus
(CONS) is the most common cause of late-onset
sepsis (after 72 hours) in NICU infants, associated
with central lines. Vancomycin (MRSA coverage) +
gentamicin (synergy) is standard. Remove the PICC
line if infected.
4. A 34-week gestation infant is born to a mother with
chorioamnionitis (maternal fever, uterine tenderness,
fetal tachycardia). The infant is asymptomatic at birth
but has an elevated white blood cell count (30,000/μL)
and C-reactive protein (CRP) of 5 mg/dL. What is the
most appropriate next step?
A) Discharge home at 48 hours if asymptomatic
B) Obtain blood culture and start empiric antibiotics
(ampicillin + gentamicin)
C) Observe without antibiotics; obtain serial CRP
, D) Obtain a chest X-ray
Correct answer: B
Rationale: Maternal chorioamnionitis is a risk factor
for early-onset sepsis (EOS). Asymptomatic infants
with risk factors (and elevated WBC/CRP) should
have blood culture and empiric antibiotics (ampicillin
(GBS/Listeria) + gentamicin (gram-negatives)). Stop
antibiotics if culture negative at 48 hours.
5. A 28-week gestation infant has a patent ductus
arteriosus (PDA) with a continuous murmur,
bounding pulses, and widened pulse pressure.
Echocardiogram shows a moderate PDA with left-to-
right shunt. What is the most appropriate treatment?
A) Indomethacin or ibuprofen (cyclooxygenase
inhibitor)
B) Surgical ligation (thoracotomy)
C) Fluid restriction and furosemide (diuresis)
D) Observation (PDA often closes spontaneously)
Correct answer: A
Rationale: Indomethacin (or ibuprofen) is first-line
medical treatment for hemodynamically significant
PDA in preterm infants (closes ductus by inhibiting
prostaglandin synthesis). Surgical ligation is
reserved for failure of medical therapy or
