Aquifer Peds ACTUAL EXAM 2025/2026
EXPERT VERIFIED QUESTIONS WITH
DETAILED ANSWERS| GUARANTEED PASS
A 2-hour-old infant is evaluated in the nursery for progressively
worsening tachypnea. He was born at 32 weeks gestational age
via spontaneous vaginal delivery to a mother with diabetes and
negative group B streptococcus status. His Apgar scores were 8
at one minute and 9 at five minutes. On physical examination he
is large for gestational age. His vital signs are respiratory rate 75
breaths/minute, temperature 36.5 C (97.7 F), and pulse is 130
beats per minute. His lung exam is remarkable for i - ,,,,correct
answer,,,,,..RDS
A 3-hour-old infant, born by C-section at 36 weeks to a 30-year-
old G1P1 with Apgars of 8 and 9 at 1 and 5 minutes, respectively,
is found to be tachypneic in the newborn nursery. His mother has
a history of type II diabetes that was poorly controlled during her
pregnancy. She took prenatal vitamins and no other medications
during her pregnancy. Prenatal labs, including GBS, were
negative. The mother's membranes ruptured 9 hours prior to
delivery, she was afebrile, and the amniotic fluid had no -
,,,,correct answer,,,,,..Hypoglycemia
A male infant weighing 3200 grams is born to a G1P1 female at
39 weeks' gestational age via planned C-section. Maternal PMH
is unremarkable, and GBS status is negative. Apgars are 7 and 8
at 1 and 5 minutes of life, respectively. The delivery was
uncomplicated, and the infant initially appeared in good condition.
However, one hour following delivery the infant develops
increasing respiratory distress. Respiratory rate is assessed as 90
,breaths/min. All other vital signs are within normal limits. -
,,,,correct answer,,,,,..TTN
A one-hour-old newborn male is evaluated in the nursery. He was
born to a G2P1 mother at 36 weeks gestation via spontaneous
vaginal delivery. The mother did not receive prenatal care
because she did not have insurance. She thinks that her water
broke about two days ago, but she did not have any contractions
after that, so she decided not to come to the hospital. She did not
start having contractions until 19 hours before she delivered. No
meconium was noted at delivery. The infant did not cry vi -
,,,,correct answer,,,,,..Sepsis secondary to prolonged rupture of
membranes
A 30-minute-old infant is evaluated in the nursery for tachypnea.
He was born at 30 5/7 weeks gestation by vaginal delivery. Labor
was induced due to severe maternal pre-eclampsia. Mother
received no prenatal care. Apgars were 6 and 7 at 1 and 5
minutes, respectively. One dose of betamethasone was given
prior to delivery. A chest x-ray reveals decreased lung expansion.
Which of the following diagnoses is most consistent with this
patient's presentation? - ,,,,correct answer,,,,,..RDS
Which of Olivia's growth parameters and vital signs are
concerning? - ,,,,correct answer,,,,,..Temp and weight
Does the history suggest that Olivia is getting enough breast
milk? - ,,,,correct answer,,,,,..No
Olivia's mom is concerned that her baby is sleepy. Which of the
following best describes Olivia at this point? - ,,,,correct
answer,,,,,..None of the above
,With the key findings from Olivia's history in mind, what diagnoses
would you include in your differential at this point? - ,,,,correct
answer,,,,,..Abusive head trauma
Congenital adrenal hyperplasia (CAH)
Congenital hypothyroidism
Genetic conditions such as Down Syndrome
Inborn error of metabolism
Based on what you know about the patient so far, write a one- to
three-sentence summary statement to communicate your
understanding of the patient to other providers. - ,,,,correct
answer,,,,,..Olivia is a non-dysmorphic 2-week-old female
presenting with decreased activity and poor feeding. Physical
exam is notable for weight still below birthweight, a slightly low
temperature, otherwise normal vital signs, enlarged fontanelles,
mild hypotonia, jaundice, and an umbilical hernia. She was born
post-term AGA at home and had no newborn screen.
Based on your summary statement, select the most likely
diagnoses remaining on your differential at this point. - ,,,,correct
answer,,,,,..Congenital adrenal hyperplasia
Congenital hypothyroidism
Inborn error of metabolism
In addition to sending a newborn screen, which of the following
lab tests are now indicated? - ,,,,correct answer,,,,,..Serum
ammonia
, Serum glucose
Serum potassium
Serum sodium
T4
Total and direct bilirubin
TSH
Which one of the following disorders meets the ideal criteria for
universal newborn screening? - ,,,,correct answer,,,,,..Galactosemia
A two-month-old infant is brought to clinic by her mother for a
well-baby checkup. Mom says that her daughter is easy to care
for because "she rarely cries and sleeps most of the time." On
exam, the patient has a yellow tint to the skin, decreased muscle
tone, and a large anterior fontanel. What is the most likely
diagnosis in this patient? - ,,,,correct answer,,,,,..Congenital
hypothyroidism
A 2-week-old infant is brought by her mother to the clinic because
of concerns for jaundice, constipation, sleepiness, and poor
feeding. She has not had any vomiting. The patient was born at
home and received no medications or lab studies. Physical exam
reveals enlarged anterior fontanelle, jaundice, hypotonia, and an
umbilical hernia. The remainder of the examination is normal.
While obtaining confirmation of the diagnosis, which of the
following is the most appropriate pharmacotherapy in this -
,,,,correct answer,,,,,..Consult with pediatric endocrinologist and
start treatment with 10 to 15 mcg/kg/day of crushed levothyroxine
in liquid, and follow up labs in 2 weeks
EXPERT VERIFIED QUESTIONS WITH
DETAILED ANSWERS| GUARANTEED PASS
A 2-hour-old infant is evaluated in the nursery for progressively
worsening tachypnea. He was born at 32 weeks gestational age
via spontaneous vaginal delivery to a mother with diabetes and
negative group B streptococcus status. His Apgar scores were 8
at one minute and 9 at five minutes. On physical examination he
is large for gestational age. His vital signs are respiratory rate 75
breaths/minute, temperature 36.5 C (97.7 F), and pulse is 130
beats per minute. His lung exam is remarkable for i - ,,,,correct
answer,,,,,..RDS
A 3-hour-old infant, born by C-section at 36 weeks to a 30-year-
old G1P1 with Apgars of 8 and 9 at 1 and 5 minutes, respectively,
is found to be tachypneic in the newborn nursery. His mother has
a history of type II diabetes that was poorly controlled during her
pregnancy. She took prenatal vitamins and no other medications
during her pregnancy. Prenatal labs, including GBS, were
negative. The mother's membranes ruptured 9 hours prior to
delivery, she was afebrile, and the amniotic fluid had no -
,,,,correct answer,,,,,..Hypoglycemia
A male infant weighing 3200 grams is born to a G1P1 female at
39 weeks' gestational age via planned C-section. Maternal PMH
is unremarkable, and GBS status is negative. Apgars are 7 and 8
at 1 and 5 minutes of life, respectively. The delivery was
uncomplicated, and the infant initially appeared in good condition.
However, one hour following delivery the infant develops
increasing respiratory distress. Respiratory rate is assessed as 90
,breaths/min. All other vital signs are within normal limits. -
,,,,correct answer,,,,,..TTN
A one-hour-old newborn male is evaluated in the nursery. He was
born to a G2P1 mother at 36 weeks gestation via spontaneous
vaginal delivery. The mother did not receive prenatal care
because she did not have insurance. She thinks that her water
broke about two days ago, but she did not have any contractions
after that, so she decided not to come to the hospital. She did not
start having contractions until 19 hours before she delivered. No
meconium was noted at delivery. The infant did not cry vi -
,,,,correct answer,,,,,..Sepsis secondary to prolonged rupture of
membranes
A 30-minute-old infant is evaluated in the nursery for tachypnea.
He was born at 30 5/7 weeks gestation by vaginal delivery. Labor
was induced due to severe maternal pre-eclampsia. Mother
received no prenatal care. Apgars were 6 and 7 at 1 and 5
minutes, respectively. One dose of betamethasone was given
prior to delivery. A chest x-ray reveals decreased lung expansion.
Which of the following diagnoses is most consistent with this
patient's presentation? - ,,,,correct answer,,,,,..RDS
Which of Olivia's growth parameters and vital signs are
concerning? - ,,,,correct answer,,,,,..Temp and weight
Does the history suggest that Olivia is getting enough breast
milk? - ,,,,correct answer,,,,,..No
Olivia's mom is concerned that her baby is sleepy. Which of the
following best describes Olivia at this point? - ,,,,correct
answer,,,,,..None of the above
,With the key findings from Olivia's history in mind, what diagnoses
would you include in your differential at this point? - ,,,,correct
answer,,,,,..Abusive head trauma
Congenital adrenal hyperplasia (CAH)
Congenital hypothyroidism
Genetic conditions such as Down Syndrome
Inborn error of metabolism
Based on what you know about the patient so far, write a one- to
three-sentence summary statement to communicate your
understanding of the patient to other providers. - ,,,,correct
answer,,,,,..Olivia is a non-dysmorphic 2-week-old female
presenting with decreased activity and poor feeding. Physical
exam is notable for weight still below birthweight, a slightly low
temperature, otherwise normal vital signs, enlarged fontanelles,
mild hypotonia, jaundice, and an umbilical hernia. She was born
post-term AGA at home and had no newborn screen.
Based on your summary statement, select the most likely
diagnoses remaining on your differential at this point. - ,,,,correct
answer,,,,,..Congenital adrenal hyperplasia
Congenital hypothyroidism
Inborn error of metabolism
In addition to sending a newborn screen, which of the following
lab tests are now indicated? - ,,,,correct answer,,,,,..Serum
ammonia
, Serum glucose
Serum potassium
Serum sodium
T4
Total and direct bilirubin
TSH
Which one of the following disorders meets the ideal criteria for
universal newborn screening? - ,,,,correct answer,,,,,..Galactosemia
A two-month-old infant is brought to clinic by her mother for a
well-baby checkup. Mom says that her daughter is easy to care
for because "she rarely cries and sleeps most of the time." On
exam, the patient has a yellow tint to the skin, decreased muscle
tone, and a large anterior fontanel. What is the most likely
diagnosis in this patient? - ,,,,correct answer,,,,,..Congenital
hypothyroidism
A 2-week-old infant is brought by her mother to the clinic because
of concerns for jaundice, constipation, sleepiness, and poor
feeding. She has not had any vomiting. The patient was born at
home and received no medications or lab studies. Physical exam
reveals enlarged anterior fontanelle, jaundice, hypotonia, and an
umbilical hernia. The remainder of the examination is normal.
While obtaining confirmation of the diagnosis, which of the
following is the most appropriate pharmacotherapy in this -
,,,,correct answer,,,,,..Consult with pediatric endocrinologist and
start treatment with 10 to 15 mcg/kg/day of crushed levothyroxine
in liquid, and follow up labs in 2 weeks
