Neonatal infections — MCQs

A 1-month-old girl is brought to the physician for evaluation of a rash on her face that first appeared 3 days ago. She was delivered at term after an uncomplicated pregnancy. She is at the 25th percentile for length and 40th percentile for weight. Examination shows small perioral vesicles surrounded by erythema and honey-colored crusts. Laboratory studies show: At birth Day 30 Hemoglobin 18.0 g/dL 15.1 g/dL Leukocyte count 7,600/mm³ 6,830/mm³ Segmented neutrophils 2% 3% Eosinophils 13% 10% Lymphocytes 60% 63% Monocytes 25% 24% Platelet count 220,000/mm³ 223,000/mm³ Which of the following underlying conditions is most likely responsible for this patient's predisposition to skin infections?

A newborn is evaluated by the on-call pediatrician. She was born at 33 weeks gestation via spontaneous vaginal delivery to a 34-year-old G1P1. The pregnancy was complicated by poorly controlled diabetes mellitus type 2. Her birth weight was 3,700 g and the appearance, pulse, grimace, activity, and respiration (APGAR) scores were 7 and 8 at 1 and 5 minutes, respectively. The umbilical cord had 3 vessels and the placenta was tan-red with all cotyledons intact. Fetal membranes were tan-white and semi-translucent. The normal-appearing placenta and cord were sent to pathology for further evaluation. On physical exam, the newborn’s vital signs include: temperature 36.8°C (98.2°F), blood pressure 60/44 mm Hg, pulse 185/min, and respiratory rate 74/min. She presents with nasal flaring, subcostal retractions, and mild cyanosis. Breath sounds are decreased at the bases of both lungs. Arterial blood gas results include a pH of 6.91, partial pressure of carbon dioxide (PaCO2) 97 mm Hg, partial pressure of oxygen (PaO2) 25 mm Hg, and base excess of 15.5 mmol/L (reference range: ± 3 mmol/L). What is the most likely diagnosis?

Five weeks after delivery, a 1350-g (3-lb 0-oz) male newborn has respiratory distress. He was born at 26 weeks' gestation. He required intubation and mechanical ventilation for a month following delivery and has been on noninvasive pressure ventilation for 5 days. His temperature is 36.8°C (98.2°F), pulse is 148/min, respirations are 63/min, and blood pressure is 60/32 mm Hg. Pulse oximetry on 40% oxygen shows an oxygen saturation of 91%. Examination shows moderate intercostal and subcostal retractions. Scattered crackles are heard in the thorax. An x-ray of the chest shows diffuse granular densities and basal atelectasis. Which of the following is the most likely diagnosis?

A 4-day-old girl presents with jaundice for the last 2 days. Although the patient’s parents were initially told that it was neonatal jaundice and would resolve quickly, they think that the yellow color of the patient’s skin appears to be more obvious today. The patient’s mother reports that the girl eats well, has normal stool and urine color. It’s her first child from the first healthy pregnancy. The patient was born at term via a spontaneous transvaginal delivery without any complications. Family history is significant for a paternal aunt who had 2 babies who died as infants from unknown causes and for a maternal uncle who has unexplained jaundice. On physical examination, the patient is awake, calm, and appears healthy except for the yellow tone of the skin and scleral icterus. Laboratory findings are significant for an elevated level of unconjugated bilirubin. A complete blood count and other routine biochemical blood tests are within expected parameters. The patient is treated with phototherapy, but her hyperbilirubinemia becomes more severe. Which of the following is the most appropriate course of treatment in this patient?

Thirty minutes after delivery, a 1780-g (3-lb 15-oz) male newborn develops respiratory distress. He was born at 30 weeks' gestation via vaginal delivery. His temperature is 36.8C (98.2F), pulse is 140/min, respirations are 64/min, and blood pressure is 61/32 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 90%. Examination shows pale extremities. Grunting and moderate subcostal retractions are present. Pulmonary examination shows decreased breath sounds bilaterally. Supplemental oxygen is administered. Ten minutes later, his pulse is 148/min and respirations are 66/min. Pulse oximetry on 60% oxygen shows an oxygen saturation of 90%. Which of the following is the most likely diagnosis?

A newborn infant is born at 40 weeks gestation to a G1P1 mother. The pregnancy was uncomplicated and was followed by the patient's primary care physician. The mother has no past medical history and is currently taking a multi-vitamin, folate, B12, and iron. The infant is moving its limbs spontaneously and is crying. His temperature is 98.7°F (37.1°C), blood pressure is 60/38 mmHg, pulse is 150/min, respirations are 33/min, and oxygen saturation is 99% on room air. Which of the following is the best next step in management?

A 3-month-old infant is brought to the E.R. by his parents. They state that the child has not had a bowel movement in several days and they are having trouble feeding the child. The physician examines the child and notices that the child appears less active and slightly hypotonic. Which of the following is most likely to be discovered during the patient history?

A newborn whose mother had uncontrolled diabetes mellitus during pregnancy is likely to have which of the following findings?

A 6-hour-old newborn male is noted to have a “lump on his head” by his mother. She denies that the lump was present at birth and is concerned about an infection. The child was born at 39 weeks gestation to a 34-year-old gravida 2 by vacuum-assisted vaginal delivery after a prolonged labor. The child’s birth weight was 3.8 kg (8.4 lb), and his length and head circumference are at the 40th and 60th percentiles, respectively. The mother was diagnosed during this pregnancy with gestational diabetes mellitus and received prenatal care throughout. All prenatal screening was normal, and the 20-week anatomy ultrasound was unremarkable. On physical exam, the child is in no acute distress. He has a 3x3 cm fluctuant swelling over the right parietal bone that does not cross the midline. There is no discoloration of the overlying scalp. Laboratory testing is performed and reveals the following: Total bilirubin: 5.5 mg/dL Direct bilirubin: 0.7 mg/dL Which of the following is the best next step in management?

A 3-week-old male infant is brought to the physician for follow-up. He was delivered at 30 weeks' gestation via Cesarean section and was cyanotic at birth, requiring resuscitation and a neonatal intensive care unit hospitalization. His mother received no prenatal care; she has diabetes mellitus type II and hypertension. She was not tested for sexually transmitted infections during the pregnancy. The infant appears well. Ophthalmologic examination shows tortuous retinal vessels. There are well-demarcated areas of non-vascularized retina in the periphery. This patient's retinal findings are most likely a result of which of the following?