Test Bank For Avery's Neonatology Board Review, 2nd Edition
Certification and Clinical Refresher
Author: Patricia R. Batchelor Chess
,Chapter 1 Theme: Maximizing Test Performance
Clinical/Application MCQs
Question 1
A 27-week infant is delivered because of severe maternal preeclampsia. Shortly after birth
the infant develops respiratory distress requiring CPAP. Blood pressure, oxygen saturation,
and glucose are normal. A chest radiograph demonstrates diffuse reticulogranular
infiltrates.
During a board examination, which approach is most likely to identify the correct
diagnosis?
A. Select the diagnosis associated with the rarest pulmonary disorder
B. Focus on the gestational age and most likely disease before considering uncommon
disorders
C. Base the diagnosis solely on the radiographic appearance
D. Assume congenital pneumonia because respiratory distress began immediately after
birth
Correct Answer: B
Explanation
Board-style neonatal questions generally reward identification of the most likely diagnosis
using clinical context. Extreme prematurity, immediate respiratory distress, and classic
radiographic findings strongly support respiratory distress syndrome (RDS). Beginning with
the highest-probability diagnosis improves diagnostic accuracy.
Why the Other Answers Are Incorrect
A. Rare diseases are less likely than common neonatal conditions when the presentation
is classic.
C. Imaging supports but does not replace clinical reasoning.
D. Congenital pneumonia remains possible but lacks supporting maternal or neonatal
infectious findings.
Question 2
,A term infant is cyanotic despite receiving 100% oxygen. Breath sounds are equal, blood
pressure is stable, and preductal oxygen saturation remains 72%.
What is the best next diagnostic step?
A. Delay evaluation until blood culture results return
B. Obtain echocardiography to evaluate for critical congenital heart disease
C. Begin broad-spectrum antifungal therapy
D. Repeat pulse oximetry every hour before intervention
Correct Answer: B
Explanation
Persistent hypoxemia despite oxygen therapy strongly suggests cyanotic congenital heart
disease or persistent pulmonary hypertension. Echocardiography rapidly distinguishes
these life-threatening conditions.
Incorrect Options
A. Sepsis evaluation is important but should not delay diagnosis of critical cardiac disease.
C. No evidence supports fungal infection.
D. Delaying evaluation risks cardiovascular collapse.
Question 3
A 30-week infant develops hypotension at 8 hours of life. Capillary refill is prolonged, urine
output decreases, and serum lactate is elevated.
Which principle best guides management?
A. Treat laboratory abnormalities before assessing perfusion
B. Clinical assessment of perfusion should direct initial stabilization
C. Blood pressure alone determines circulatory status
D. Lactate elevation confirms septic shock
Correct Answer: B
Explanation
, Effective neonatal stabilization integrates blood pressure, capillary refill, urine output,
heart rate, lactate, and overall clinical appearance. No single parameter determines
perfusion.
Incorrect Options
A. Clinical stabilization precedes correction of isolated laboratory abnormalities.
C. Normal blood pressure may coexist with poor perfusion.
D. Elevated lactate has multiple causes.
Question 4
A newborn presents with hypoglycemia, seizures, and apnea.
Which management priority is most appropriate?
A. MRI before treatment
B. Immediate correction of hypoglycemia
C. Lumbar puncture before glucose administration
D. Observe for spontaneous recovery
Correct Answer: B
Explanation
Life-threatening metabolic abnormalities require immediate correction before extensive
diagnostic evaluation.
Incorrect Options
A. Imaging can wait.
C. Lumbar puncture delays treatment.
D. Untreated hypoglycemia causes neurologic injury.
Question 5
A neonate has severe metabolic acidosis shortly after birth.
Which additional information is most valuable in narrowing the differential diagnosis?
Certification and Clinical Refresher
Author: Patricia R. Batchelor Chess
,Chapter 1 Theme: Maximizing Test Performance
Clinical/Application MCQs
Question 1
A 27-week infant is delivered because of severe maternal preeclampsia. Shortly after birth
the infant develops respiratory distress requiring CPAP. Blood pressure, oxygen saturation,
and glucose are normal. A chest radiograph demonstrates diffuse reticulogranular
infiltrates.
During a board examination, which approach is most likely to identify the correct
diagnosis?
A. Select the diagnosis associated with the rarest pulmonary disorder
B. Focus on the gestational age and most likely disease before considering uncommon
disorders
C. Base the diagnosis solely on the radiographic appearance
D. Assume congenital pneumonia because respiratory distress began immediately after
birth
Correct Answer: B
Explanation
Board-style neonatal questions generally reward identification of the most likely diagnosis
using clinical context. Extreme prematurity, immediate respiratory distress, and classic
radiographic findings strongly support respiratory distress syndrome (RDS). Beginning with
the highest-probability diagnosis improves diagnostic accuracy.
Why the Other Answers Are Incorrect
A. Rare diseases are less likely than common neonatal conditions when the presentation
is classic.
C. Imaging supports but does not replace clinical reasoning.
D. Congenital pneumonia remains possible but lacks supporting maternal or neonatal
infectious findings.
Question 2
,A term infant is cyanotic despite receiving 100% oxygen. Breath sounds are equal, blood
pressure is stable, and preductal oxygen saturation remains 72%.
What is the best next diagnostic step?
A. Delay evaluation until blood culture results return
B. Obtain echocardiography to evaluate for critical congenital heart disease
C. Begin broad-spectrum antifungal therapy
D. Repeat pulse oximetry every hour before intervention
Correct Answer: B
Explanation
Persistent hypoxemia despite oxygen therapy strongly suggests cyanotic congenital heart
disease or persistent pulmonary hypertension. Echocardiography rapidly distinguishes
these life-threatening conditions.
Incorrect Options
A. Sepsis evaluation is important but should not delay diagnosis of critical cardiac disease.
C. No evidence supports fungal infection.
D. Delaying evaluation risks cardiovascular collapse.
Question 3
A 30-week infant develops hypotension at 8 hours of life. Capillary refill is prolonged, urine
output decreases, and serum lactate is elevated.
Which principle best guides management?
A. Treat laboratory abnormalities before assessing perfusion
B. Clinical assessment of perfusion should direct initial stabilization
C. Blood pressure alone determines circulatory status
D. Lactate elevation confirms septic shock
Correct Answer: B
Explanation
, Effective neonatal stabilization integrates blood pressure, capillary refill, urine output,
heart rate, lactate, and overall clinical appearance. No single parameter determines
perfusion.
Incorrect Options
A. Clinical stabilization precedes correction of isolated laboratory abnormalities.
C. Normal blood pressure may coexist with poor perfusion.
D. Elevated lactate has multiple causes.
Question 4
A newborn presents with hypoglycemia, seizures, and apnea.
Which management priority is most appropriate?
A. MRI before treatment
B. Immediate correction of hypoglycemia
C. Lumbar puncture before glucose administration
D. Observe for spontaneous recovery
Correct Answer: B
Explanation
Life-threatening metabolic abnormalities require immediate correction before extensive
diagnostic evaluation.
Incorrect Options
A. Imaging can wait.
C. Lumbar puncture delays treatment.
D. Untreated hypoglycemia causes neurologic injury.
Question 5
A neonate has severe metabolic acidosis shortly after birth.
Which additional information is most valuable in narrowing the differential diagnosis?
