1.

A 5 days old female baby, who was born in a hospital by normal

vaginal delivery, brought with complaint of profuse pussy discharge,
lids swelling, extensive redness and conjunctival chemosis of 2 days
duration. The family reported that an eye drop was put into the
baby's eye immediately after delivery. On examination the cornea
looks normal. What is the best treatment for this baby? ---- DX=
Ophthalmic neonatorum

A) Tetracycline eye ointment BID for 7 days

B) Ciprofloxacin eye drop 2 hourly for 2 days then QID for 10 days

C) Ceftriaxone 50 mg/Kg IM single dose

D) Chloramphenicol eye drop QID for 14 days

2. A 6 weeks old infant who was born to an RVI positive mother came
for routine follow up to the PMTCT clinic. His mother was on HAART
for the past two years with viral load of 500copies.He is on exclusive
breast feeding, growing normally with normal vital sign and systemic
evaluation. What is the most appropriate next step?

A) Start vaccination but don't give the live attenuated vaccines.

B) Start HAART and cotrimoxazole preventive therapy.

C) Do DNA PCR regardless of his clinical condition.

D) Determine rapid antibody test and stop breast feeding if negative

3. A 1-hour old neonate was born at gestational age of 43 weeks

present with respiratory distress. On physical examination he has
intercostal and subcostal retraction. There was added sound on the
left chest. He has increased chest wall diameter and scaphoid
abdomen.

What is the most likely diagnosis of this patient?

A) Meconium aspiration syndrome

B) Congenital pneumonia

C) Pneumothorax

D) Diaphragmatic hernia

4. A 1.5kg male neonate born at a gestational age of 32 weeks

presented at the age of 30 minutes with tachypnea, grunting,
intercostal and subcostal retractions and cyanosis. Breath sounds
were diminished bilaterally. Chest x-ray taken 12 hours later showed
a fine reticular granularity of the lung and air bronchograms. What is
the best initial management for this patient? DX= RDS

A) Oxygen with Continuous Positive Airway Pressure

B) Ampicillin and Gentamicin

C) Prostaglandin

D) Chest tube

5. A mother who brought her 45 days old infant is counseled to

continue exclusive breast feeding until 6 months. What deficiency is
likely unless additional care is provided to this infant?

A) Vitamin D

B) Vitamin A

C) Fluorine

D) There wouldn't be any deficiency as breast milk is a perfect food

6. A 3-day old neonate with persistent bilious vomiting and refusal to

breast feed is brought to clinic by his parent. Associated with these he
has progressive abdominal distention. After preparation he was taken
to OR and intra-operation finding is displayed. What is the likely cause
of neonate’s condition?

A) Abnormal Rotation

B) Cell migration failure

C) Vascular Occlusion

D) Recanalization failure
7. An 8 days old preterm neonate was on treatment in NICU for the
diagnosis of preterm (30weeks), LBW (1450gm) and HMD. Currently
the baby is off of oxygen, on NGT expressed breast feeding and her
weight is 1400gm with temperature of 36.0 degree Celsius but no
other remarkable finding. What is your next management plan?

A) Discharging her with close follow up

B) Continue the incubator care with strict monitoring

C) Start the baby on kangaroo mother care

D) Put her on preterm formula

8. A 10 days old neonate who was in a good state of health came with
chief complaint of yellowish discoloration of the eyes of 1 day. His
blood group is O-Negative. Direct bilirubin was 5.5mg/dl and indirect
was 0.9mg/dl. What diagnosis best explain his condition?

A) Hemolytic disease of the new born

B) Type II Crigler-Najjar disease

C) Neonatal hepatitis

D) Breast milk jaundice

9. A 12 hours old term macrocosmic neonate was sent to NICU for

evaluation. The labor and delivery were uneventful with outcome of
4200gm male neonate with APGAR of 8 and 9 at first and fifth
minutes. On examination- he has RR of 50 bpm, red-purple face and
trunk with sustained sucking reflex. On laboratory investigation- WBC-
20,000cells/mm3 (56percent neutrophil), Hgb - 25mg/dl, Plt-
340,000cells/mm3 and RBS - 56mg/dl. What is the most next
appropriate step? ----- DX- Polycythmia

A) Double exchange transfusion

B) Hydration with normal saline

C) Volume to volume exchange transfusion.

D) Partial exchange transfusion

11. A 4 weeks old neonate presented with 1 week history of non-

bilious vomiting that occurs immediately after feeding. After vomiting
he is eager and wants to feed again. He looks emaciated. What is the
most likely diagnosis of this neonate?

A) Infantile hypertrophic pyloric stenosis

B) Late onset neonatal sepsis

C) Acute gastroenteritis

D) Inborn error of metabolism

11. A child with severe combined primary immunodeficiency is
brought to your clinic for routine childhood immunization. What
vaccine is contraindicated to this child? ---- MMR and BCG

A) Diphtheria, Tetanus, Pertussis (DTaP) vaccine

B) Measles Vaccine

C) PCV (pneumococcal) vaccine

D) Hepatitis virus vaccine

12. A 50 hours old male neonate presented with yellowish

discoloration of a body of one day duration but no irritability. The
mother's blood group is O positive. On evaluation the baby has icteric
sclerae with jaundice up to the level of the sole. Otherwise, there was
no other remarkable finding. Total and direct serum bilirubin were
23mg/dl 3mg/dl, respectively. Hct was 25mg/dl. What is the most
appropriate management?

A) Start intensive phototherapy with strict monitoring.

B) Refer to higher centers for exchange transfusion.

C) Start him on phenobarbital till the serum bilirubin is < 10mg/dl.

D) Investigate the baby for direct hyperbilirubinemia

14. A 5 hours male neonate presented with drooling of saliva since
birth. Additionally, he has cough after each swallowing of breast
milk. NG Tube insertion was tried it failed go down to stomach. On
CXR with NGT insertion shows coiled NG Tube on the upper chest.
What is the major determinate of poor outcome of this neonate?

A) Presence of other severe anomalies

B) Aspiration pneumonia

C) Hypothermia

D) Hypovolemia

It is esophageal atresia TEF

15. A 5-week-old infant came to high-risk infant clinic for non-

projectile non-bilious vomiting soon after breast feeding since 3weeks
of life. Examination revealed a swelling over epigastric area. Contrast
ultrasonography showed "string sign" and "double tract sign".

What is the most likely diagnosis?

A) Pyloric duplication

B) Pyloric stenosis

C) Duodenal stenosis

D) Pyloric web
16. Routine physical examination of a female new-born revealed
epicanthal folds, high arched palate, low set ears and systolic murmur
at the left sternal border. What is the most likely diagnosis?

A) Turner Syndrome

B) Patau syndrome

C) Down syndrome

D) Edward's syndrome

17. A mother brought her 2 days old neonate after noticing

abnormality on the hand and arm. She had a forceps delivery at
health center. On examination, the neonate had internally rotated
adducted left shoulder, extended elbow and flexed hands at the wrist.
Moro reflex was absent on left side.

What is the most likely diagnosis?

A) Klumpke's paralysis

B) Left shoulder dislocation

C) Left humeral fracture

D) Erb's palsy

18. A 48-hour old male neonate delivered via assisted vaginal delivery
is admitted to NICU for a compliant of swelling over his head of a day
duration. On examination: RR =70bpm, PR =166bpm, firm localized
swelling over right parieto-occipital area and warm extremities. Lab
results showed a Hgb of 9mg/dL. You gave oxygen via nasal prong.

What is the next step in the management of this neonate?

A) Transfuse with 10ml/kg of PRBC over 3hours

B) Give 10ml/kg of normal saline as fast as possible

C) Supplement with iron

D) Administer IV antibiotics

19. An intern from neonatal ward came to you for consultation about
a neonate being managed for neurosyphilis. What measure could
have prevented such condition?

A) Prevent acquisition of syphilis in a woman of child bearing age

B) Prompt diagnosis and treatment of both parents

C) Prompt diagnosis and treatment of the mother

D) Prompt diagnosis and follow with treponemal tests

20. A newborn weighing 3500gm is admitted for treatment of sepsis is

on nasogastric tube feeding. You want to provide 120Kcal/Kg/Day to
be fed every 3 hours. How much breast milk is required per feed?

A) 80 mL
B) 60 mL

C) 50 mL

D) 70 mL

82. A mother bought her 1-month-old infant to the OPD after she
noticed bilateral feet deformity since birth. She had ANC follow up
and had vaginal delivery with breech presentation. On examination,
the infant's feet were in varus, equinus and supinated position. Infant
had no back problem. What is the next appropriate step?

A) Hip examination for DDH

B) Knee examination for congenital knee dislocation

C) Hip US for DDH

D) Knee US for congenital knee dislocation