Pediatric Boards Free Sample Questions

 

1.        Babies who are well enough to take milk feeds, however, are nearly always well enough to take medication by mouth, and many drugs are just as effective when given this way. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

 

 

A.    rectify ambiguous

B.     methicillin resistant strains

C.     filtration and tubular secretion

  1. co-trimoxazole,

 

Answer: D

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include amoxicillin, ampicillin, cephalexin, chloramphenicol, ciprofloxacin and  co-trimoxazole,

 

2.        Medication by mouth is clearly unsuitable for babies who are shocked, acidotic, or otherwise obviously unwell because there is a real risk of paralytic ileus and delayed absorption. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

 

A.    controlled trial evaluation

B.     prophylactic use of vancomycin

  1. metronidazole,

D.    240 mg of phospholipid

 

Answer: C

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include erythromycin, flucloxacillin, fluconazole, flucytosine, isoniazid, metronidazole, pyrimethamine, rifampicin, sodium fusidate, and trimethoprim.

 

3.        Babies who are well enough to take milk feeds, however, are nearly always well enough to take medication by mouth, and many drugs are just as effective when given this way. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

  1. ciprofloxacin,

B.     synthetic surfactant

C.     tyloxapol per vial

D.    Head-to-head trials of a natural surfactant

 

 

Answer:A

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include amoxicillin, ampicillin, cephalexin, chloramphenicol, ciprofloxacin and  co-trimoxazole,

 

4.        Medication by mouth is clearly unsuitable for babies who are shocked, acidotic, or otherwise obviously unwell because there is a real risk of paralytic ileus and delayed absorption. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

 

A.    synthetic surfactant

B.     tyloxapol per vial

C.     Head-to-head trials of a natural surfactant

  1. isoniazid,

 

Answer:D

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include erythromycin, flucloxacillin, fluconazole, flucytosine, isoniazid, metronidazole, pyrimethamine, rifampicin, sodium fusidate, and trimethoprim.

 

5.      Oral medication is clearly unsuitable for babies who are shocked, acidotic, or otherwise obviously unwell because there is a real risk of paralytic ileus and delayed absorption. As compare to IV administration, Oral administration is:

  1. treatment continued by the parents after discharge

B.     ml and 8 ml vials containing 100 mg and 200 mg of phospholipid

C.     lucinactant Surfaxin

D.    artificial surfactant

 

 

Answer:  A                                                                                                                                 Explanation:  Oral administration is often quicker, cheaper, and safer than IV administration. Oral administration is also much more easily managed on the postnatal wards, and treatment can then be continued by the parents after discharge where appropriate.

6.      It is important to remember that if only half the proffered feed is taken, only half the medicine is administered. Where possible all of a day’s supplements should be added to the first feed of the day. Additives to milk: Vitamins are often added to milk. chose the one option that can also be given as dietary supplements in the same way.

 

A.    artificial surfactant

B.     colfosceril

C.     methicillin resistant strains

  1. Phosphate and bicarbonate

 

Answer:D

Explanation: Additives to milk: Vitamins are often added to milk. Sodium, phosphate, and bicarbonate can also be given as dietary supplements in the same way.

 

7.      Rectal administration: This can be a useful way of giving a drug that is normally given by mouth to a baby who is not being fed. Absorption is usually slower, often less complete, and sometimes less reliable than with oral administration. Check out the best choice that is one of the medicine sometimes given by mouth to a baby who is not being fed.

 

 

  1. Factors influencing
  2. Potential areas in neonatal care
  3. A neonate with a cystic hygroma
  4. anticonvulsants

 

Answer:D

Explanation: Chloral hydrate, cisapride, codeine phosphate, and paracetamol are sometimes given by mouth to a baby who is not being fed. Suppositories have usually been used in the past (merely because that is how rectal drugs are normally given to adults) but liquid formulations are more appropriate in the neonatal period.

 

8.      Suppositories have usually been used in the past (merely because that is how rectal drugs are normally given to adults) but liquid formulations are more appropriate in the neonatal period. When a liquid formulation is used absorption is always:

 

  1. Anaesthetic facemasks
  2. more rapid
  3. Causes of renal failure in infants
  4. Indices of renal failure in infants

 

Answer: B

Explanation: Absorption is always more rapid and often more complete when a liquid formulation is used. It is also much easier to administer a precise, weight related dose.

 

9.      Do not flush the drug through by changing the basic infusion rate; several deaths have resulted from a failure to handle this manoeuvre correctly. Giving a routine chaser by hand ties up valuable senior nursing time, tends to result in overrapid administration when staff time is at a premium, and can, if repeated frequently, result in the baby getting a lot of undocumented:

 

  1. Size and length of tracheal

B.     Alopecia and Water

C.     mild blanching

  1. Water

 

Answer:D

Explanation: To result in overrapid administration when staff time is at a premium, and can, if repeated frequently, result in the baby getting a lot of undocumented water, sodium, or glucose.

 

10.  IV drugs should be given slowly and, where possible, through a secure established IV line containing dextrose and/or sodium chloride. Particular care must be taken not to mix potentially incompatible fluids. Staff must also remain alert to the very real risks of:

 

A.    Gram positive anaerobes

  1. tissue extravasation
  2. Sleep-wake states
  3. The NICU environment

 

Answer:B

Explanation: Staff must also remain alert to the very real risks of air embolism, infection, inflammation, thrombosis, and tissue extravasation (as set out in the earlier parts of that monograph). They should also be familiar with the management of anaphylaxis.

 

11.  Drugs should never be injected or connected into a line containing blood or a blood product. Since the volume of drug to be given seldom exceeds 2 ml in neonatal practice. The standard procedure for using a three way tap to give a slow IV “stat” dose is as follows.

 

  1. Postural support
  2. Supine position

C.     death in the preterm baby

  1. Turn the tap and flush fluid through

 

Answer:D

Explanation: Connect the preloaded syringe to the free tap inlet. Turn the tap so the syringe is connected to the patient and give the injection and turn the tap so the syringe is connected to the giving set, draw up about 0·2 ml of infusion fluid, turn the tap back so the syringe is reconnected to the patient, and flush this fluid through so that it just enters the giving set.

 

12.  Drugs that need to be given by slow intermittent IV infusion can, if necessary, be given by hand through a three way tap as a series of 2 ml bolus doses every few minutes, but some are best injected into an existing IV line through a three way tap using a programmable syringe pump:

 

 

A.    exacerbate any existing renal impairment

  1. Side-lying position
  2. Resuscitation of the newborn
  3. co-trimoxazole and erythromycin

 

Answer:D

Explanation: Drugs that need to be given by slow intermittent IV infusion can be given by hand through a three way tap as a series of 2 ml bolus doses every few minutes, but aciclovir, amphotericin B, ciprofloxacin, co-trimoxazole, erythromycin, fluconazole, flucytosine, are best injected into an existing IV line through a three way tap using a programmable syringe pump.

 

13.  The unquestioning acceptance of any time consuming policy of type without a critical review of its justification limits the time staff can give to other tasks. Drugs that need to be given by slow intermittent IV infusion can be given by hand some are best injected into an existing IV line through a three way tap using a programmable syringe pump:

 

A.    Hold total intake from milk

B.     toxicity of systemic tetracaine

  1. Phenytoin and vancomycin,
  2. Asphyxia  vancomycin,

 

Answer: C

Explanation: Slow infusion has been recommended for a range of other antibiotics without the support of any justificatory evidence. Phenytoin, rifampicin, sodium fusidate, vancomycin, and zidovudine are best injected into an existing IV line through a three way tap using a programmable syringe pump.

 

 

14.  Continuous IV infusions: Drugs for continuous infusion should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

These drugs for continuous infusion contain:

 

 

  1. Blood clotting factors
  2. atracurium, isoprenaline
  3. Infants at risk of hyperglycaemia

D.    Causes of intestinal obstruction

 

Answer: B

Explanation: The volume of drug to be given seldom exceeds 2 ml in neonatal practice, abrupt administration can be avoided by siting a three way tap.Drugs for continuous infusion such as adrenaline, atracurium, diamorphine, dobutamine, dopamine, doxapram, enoximone, epoprostenol, should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

 

 

15.  Great care is needed to ensure that patients never receive accidentally even a brief surge of one of the vasoactive drugs, and the same is true of many inotropes. Never load the syringe or burette with more of the drug than is likely to be needed in 12–24 hours. Continuous IV infusions indludes the drugs for continuous infusion:

 

  1. transport bag
  2. Sleep-wake assessment scales
  3. Stress and stability signals
  4. lidocaine and magnesium sulphate

 

Answer:D

Explanation: Drug infusion should be followed by a 2 ml “chaser” of 0·9% sodium chloride from a second syringe in order to flush the active drug through the IV line as rapidly as possible. Drugs for continuous infusion such as glyceryl trinitrate, hydrocortisone, insulin, isoprenaline, Intralipid, labetalol, lidocaine, magnesium sulphate, should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

 

 

16.  Never load the syringe or burette with more of the drug than is likely to be needed.The guidelines relating to the administration of intermittent IV injections also apply when a continuous infusion is first set up. Administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line are drugs for continuous infusion and remember to readjust the total fluid intake.

 

A.    Grading scale

B.     periventricular haemorrhage

C.     Causes of jaundice

  1. thiopental and tolazoline

 

Answer:D

Explanation: Drugs for continuous infusion such as midazolam, milrinone, morphine, noradrenaline, nitroprusside, prostaglandin E, streptokinase, thiopental, and tolazoline should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

 

 

17.  safe site is the only site that should be used routinely in the first year of life. Try to alternate between the two legs if multiple injections are required. Superficial injections may result in the drug entering subcutaneous fat rather than:

 

  1. postnatal ages
  2. The regression
  3. muscular tissue,

D.    Anticipation

 

Answer:C

Explanation: Superficial injections may result in the drug entering subcutaneous fat rather than muscular tissue, causing induration, fat necrosis, delayed drug release, and a palpable subcutaneous lump that may persist for many weeks. Intradermal injections can also leave a permanent scar.

 

18.  Intraosseous administration: This can be a valuable way of providing fluid in an emergency. using a slight screwing action, until marrow is entered. Point the needle obliquely and away from the knee joint. The resultant fat embolisation is almost always silent; osteomyelitis is the only common complication.

 

A.    ABC(D and E) of resuscitation

B.     Meconium stained liquor

  1. the structures needed
  2. 18 gauge

Answer: D

Explanation: An 18 gauge bone marrow needle is best, but success can be achieved with a 21 gauge lumbar puncture needle and stylet. The resultant fat embolisation is almost always silent; osteomyelitis is the only common complication.

 

19.  Connect the preloaded syringe to the free tap inlet is one of the standard procedure for using a three way tap to give a slow IV “stat” dose. Surfactant is the only drug regularly given down an endotracheal tube, but other drugs occasionally given this way.Thesedrugs are included:

 

  1. nociception to occur
  2. Infants at risk of hypoglycaemia

C.     hepatic impairment

  1. midazolam,

 

Answer: D

Explanation: Surfactant is the only drug regularly given down an endotracheal tube, but other drugs occasionally given this way include adrenaline, atropine, diazepam, lidocaine, midazolam, naloxone, propranolol, and tolazoline. Tolazoline and adrenaline are the only drugs for which a sound case has been made for such an approach.

 

20.  Drugs occasionally regularly given down an endotracheal tube include adrenaline and atropine. Tolazoline and adrenaline are the only drugs for which a sound case has been made for such an approach. A range of drugs have sometimes been administered as a fine nebulised mist and one of the following is also lies in this patterns.

 

A.    anaesthetic but no anticonvulsant

B.     irritability

  1. ipratropium,
  2. ipratropium Management of thermal

 

 

Answer: C

Explanation: A range of drugs, including adrenaline, betamethasone, epoprostenol, furosemide, ipratropium, nitroprusside, salbutamol, and ribavirin have sometimes been administered as a fine nebulised mist.

 

21.  IV benzyl alcohol can cause collapse and neonatal death (“gasping” syndrome), and the daily intake should never exceed 30 mg/kg. Some Products which the UK formulation now contains benzyl alcohol, several other US products still contain this excipient:

 

  1. Evaluation of resuscitation
  2. Immature skin
  3. Transepidermal water loss (TEWL)
  4. clonazepam,

 

Answer: D

Explanation: Amiodarone, diazepam, clindamycin, clonazepam, and lorazepam are the only products  which the UK formulation now contains benzyl alcohol, several other US products still contain this excipient.

 

22.  While the UK laws that control the prescribing and the supply of medicines may seem complex, they actually impose few constraints on staff working in a hospital setting.The Medicines Act of 1968, passed in the wake of the thalidomide disaster,IT comprises:

 

A.    metabolised to a range of inactive oligopeptides

  1. marketing authorisation

C.     tissue necrosis

D.    Clostridium species

 

Answer: B

Explanation: The Medicines Act of 1968, passed in the wake of the thalidomide disaster, regulates the activity of the pharmaceutical industry, making it illegal for any medicine to be marketed for human use in the UK without a product licence (marketing authorisation).

 

23.  Marketing authorisation are issued by the Licencing Authority on the advice of the Medicines and Healthcare products Regulatory Agency. Chose the option that indicate that what the MHRA also oversees and:

 

  1. advises the Agency on their efficacy,
  2. Thermal instability
  3. Respiratory water loss
  4. Hypothermia

 

 

Answer: A

Explanation: Medicines and Healthcare products Regulatory Agency The MHRA also oversees the manufacture, promotion, and distribution of medicines, while the Committee on Safety of Medicines advises the Agency on their efficacy, quality, and safety.

 

24.  Licencing Authority (the Ministers of Health) on the advice of the Medicines and Healthcare products Regulatory Agency (MHRA).The Committee on Safety of Medicines advises the Agency on their efficacy, quality, and safety. Find the best statement about licences:

 

  1. Cold stress dose ranges,
  2. Neonatal cold injury
  3. Effects of neonatal diseases
  4. recommended dose ranges,

 

Answer:D

Explanation: Licences are not published, the relevant provisions, including indications for use, recommended precautions, and dose ranges, are summarised in the manufacturer’s summary of product characteristics (SPC).

 

25.  According to group protocols, was recognised as having much merit by the Crown Report in 1998, and legislation was subsequently passed making it legal for nurses to supply and administer medicines to specific groups of patients under a formal agreement with a prescribing doctor. Other groups are covered under thisare:

 

  1. Pharmacists and Nurses
  2. specific nutrient requirements
  3. bacterial infections and Nurses
  4. Re-warming in severe

 

Answer: B

Explanation: Pharmacists, physiotherapists, and other “paramedic” groups can be covered in a similar way that An “ad hoc” system of “group protocols” was recognised as having much merit by the Crown Report in 1998.

 

26.  PGDs need to conform to the guidance They need to be prepared by a multidisciplinary group involving a senior doctor, pharmacist in consultation with the therapeutics committee, and then approved by the:

 

  1. The heart tubes fuse
  2. pressures are equal
  3. haemofiltration
  4. hospital

 

 

Answer:D

Explanation: It need to conform to the guidance given in Health Service Circular.They need to be prepared in consultation with the local drug and therapeutics committee, and then approved by the hospital or primary care trust.

 

27.  A specific Act classifies medicines into those available for general sale and those only available for retail sale through a pharmacy. PGDs need to conform to the guidance They need to be prepared by a multidisciplinary group involving a :

 

  1. Hyperthermia
  2. pharmacist and nurse

C.     anorexia,

D.    haemorrhage, pneumothorax

 

Answer: B

Explanation: Patient group directions need to conform to the guidance given in Health Service Circular.They need to be prepared by a multidisciplinary group involving a senior doctor, pharmacist, and nurse or midwife.

 

28.  Intravascular lines serve a number of vital functions. Very real advantages have to be balanced against a  range of very real disadvantages. Of these, infection due to localised vasculitis or insidious low grade septicaemia is perhaps the most common, and advantages like make possible to give fluids and :

 

A.    rapidly taken up by the liver

  1. to give drugs painlessly.
  2. hypothermia
  3. Delivery by cesarean section

 

Answer: B

Explanation: Intravascular lines make it possible to give fluids, including glucose and a range of other nutrients, when oral nutrition is impossible or inappropriate, monitor both arterial and central venous pressure directly and continuously, to collect blood specimens without causing pain or disturbance, and to give drugs reliably and painlessly.

 

29.  Very real advantages have to be balanced in intravascular lines against a  range of very real disadvantages. Of these, infection due to localised vasculitis or insidious low grade septicaemia is perhaps the most common, Intravascular lines serve a number of vital functions having some advantage:

 

  1. Monitor  venous pressure when oral nutrition is inappropriate
  2. The asphyxiated infant
  3. the NICU
  4. Radiant warmers

 

 

Answer:A

Explanation: Glucose and a range of other nutrients, when oral nutrition is impossible or inappropriate, monitor both arterial and central venous pressure directly and continuously are some of the advantages.

 

30.  Vascular thrombosis is a hazard, and thrombi can also shed emboli. Even reactive arterial vasospasm can cause significant ischaemia. Bleeding from an arterial line can cause serious blood loss, and fluid extravasation can cause severe ischaemia or?

 

A.    damage  and diarrhoea,

B.     Down’s syndrome or a cardiac anomaly

C.     sedation and analgesia

  1. chemical tissue damage

 

Answer:D

Explanation: Intravascular lines serve a number of vital functions. Bleeding from an arterial line can cause serious blood loss, life threatening air embolism can occur into any central venous line.

 

31.  Routine use of a lateral x-ray film to identify where any central catheter has lodged can help to ensure that the tip is optimally sited and there is now good controlled trial evidence that there are fewer recognisable complications associated with high placement. It is standard practice to site any aortic catheter either above the:

 

A.     Radiant warmers                                                                                                                                                    C.Humidity                                                                                                                                                                        D. Heated water-filled

  1.  (T6)

 

Answer:D

Explanation: It is standard practice to site any aortic catheter either above the diaphragm (T6) or below the two renal arteries (L4) to minimise the risk of a silent renal or mesenteric artery thrombosis.

 

32.  Central venous thrombosis is also underdiagnosed, but can cause a chylous ascites by occluding the exit of the thoracic duct. Occlusion of a small vein is seldom a problem because of the nature of the anastomotic venous plexus, but occlusion of even a small artery can cause:

 

A.    growth failure.

B.     intake can usually be increased rapidly

  1. severe ischaemia or end artery

D.    Lidocaine

 

Answer:C

Explanation: Occlusion of a small vein is seldom a problem because of the nature of the anastomotic venous plexus, but occlusion of even a small artery can cause severe ischaemia  if it is an “end artery”, the only vessel supplying a particular area of the body.

 

 

33.  Every baby with an intravascular line in place should be examined regularly by the nursing staff for evidence of any of the complications. There are some causes and outputs as even occlusion of the radial artery can sometimes cause vascular compromise in absence of:

 

A.    Continuous monitoring

  1. Venous cannulation
  2. Suprapubic aspiration
  3. anastomosis and ulnar arteries

 

Answer: D

Explanation: The only vessel supplying a particular area of the body. Even occlusion of the radial artery can sometimes cause vascular compromise if there is no significant terminal anastomosis between the radial and ulnar arteries.

 

34.  Never give a drug into a drip that has started to “tissue”. Delivery cannot be guaranteed once this has happened. Fluids containing calcium cause particularly severe scarring. Serious damage can also be caused by the fluids used in providing parenteral nutrition. Some drugs can also cause severe can damage:

 

A.    Intermittent temperature

B.     Localised hypothermia

  1. tissue
  2. birth asphyxia tissue

 

Answer:C

Explanation: some drugs can also cause severe tissue damage. Fluids containing calcium cause particularly severe scarring.

 

35.  Never give a drug into a drip that has started to “tissue”. Delivery cannot be guaranteed once this has happened, and some drugs as noted in the individual drug monographs, it can also cause severe tissue damage. Problems will be noticed promptly only if every drip is so strapped  and the damages can included and caused by fluids:

 

A.    Respiration in the neonate

B.     rare and potentially lethal condition

C.     inactive oligopeptides                                                                                                                                          d. parenteral nutrition

 

Answer:D

Explanation: Fluids containing calcium cause particularly severe scarring. Serious damage can also be caused by the fluids used in providing parenteral nutrition.

 

36.  Serious damage can also be caused by the fluids used in providing parenteral nutrition. Such problems will be noticed promptly only if every drip is so strapped that the tissue around the cannula tip can be inspected at any time. The best line of management if extravasation is starting  where:

 

A.    benzylpenicillin (penicillin G),                                                                                                      

  1. Pneumonia and cold compresses
  2. Meconium aspiration syndrome
  3. Hot or cold compresses are not countable

 

Answer:D

Explanation: Never give a drug into a drip that has started to “tissue”. The best line of management, if extravasation is starting to cause tissue damage, involves early tissue irrigation. Hot or cold compresses are of no measurable value. Neither is limb elevation.

 

37.  Localised or generalised infection is probably the commonest complication of the use of intravascular lines. Infection can be devastating in the small baby, and it is a clear indictment of unit policy if the way in which a baby is cared for puts it unnecessarily at increased risk of infection. Usually infections or symptoms reported in babies:

 

  1. Pulmonary haemorrhage
  2. septicaemia
  3. Acid base balance
  4. pressure (CPAP)

 

Answer:B

Explanation: Localised or generalised infection is probably the commonest complication of the use of intravascular lines. Indolent, usually low grade, but occasionally life threatening, blood borne infection (septicaemia) has been reported in more than 20% of all babies with “long lines” in some units.

 

38.  An impregnated chlorhexidine disc  may help to prevent the multiplication of skin bacteria. Infection most frequently enters where the catheter pierces the skin. This is also involved the factors for most infusion related infections broviac lines “tunnelled” surgically under:

 

  1. a left-sided diaphragmatic hernia
  2. shortly after birth
  3. Chest radiograph
  4. skin less often become infected.

 

Answer: D

Explanation: Most infusion related infections are caused by coagulase negative staphylococci, and why Broviac lines “tunnelled” surgically under the skin less often become infected.

 

39.  Bacterial colonisation of the catheter hub (where the catheter connects to the giving set) can also be the precursor of overt septicaemia Stopcocks often become contaminated, but there is no evidence that such contamination causes catheter related infection. The risk of generalized infection is increased by the use:

 

  1. Intralipid certainly does,

B.     destroyed by acid

C.     toxoplasmosis

  1. Positive-pressure ventilation

 

Answer:A

Explanation: The risk of generalized infection is increased by the use of a long line rather than a short line. Independently of this, parenteral nutrition may, and Intralipid certainly does, further increase the risk of systemic infection.

 

40.  The infusion is going in through a long line or a short line, not only because of the high risk of iatrogenic infection but also because :

 

A.    negative staphylococcal infection

  1. Insertion of a chest drain
  2. Radiograph showing

D.    risk of drug incompatibility.

 

 

Answer:D

Explanation: Limited vascular access, it does become necessary to use a single line both to give drugs and to give total parenteral nutrition, steps must be taken to separate the two infusion fluids with a separating bolus of 0·9% sodium chloride.

 

41.  The infusion is going in through a long line or a short line, not only because of the high risk of iatrogenic infection but also because of the risk of drug incompatibility. Limited vascular access, it does become necessary to use a single line:

 

A.    kernicteric brain damage 

  1. to give drugs and to give total parenteral nutrition
  2. High frequency jet ventilation

D.    gentamicin and ceftazidime and total parenteral nutrition

 

Answer:B

Explanation: Limited vascular access, it does become necessary to use a single line both to give drugs and to give total parenteral nutrition, steps must be taken to separate the two infusion fluids with a separating bolus of 0·9% sodium chloride.

 

42.  False positive evidence of infection can also result if blood is drawn for blood culture from an already established intravascular line. When septicaemia is suspected it is always best to collect blood direct into a culture medium from a fresh venous that is:

 

  1. disorders
  2. a classic ‘double bubble

C.     cardiovascular effects

  1. needle stab

 

Answer:D

Explanation: When septicaemia is suspected it is always best to collect blood direct into a culture medium from a fresh venous “needle stab”. The catheter dead space is first cleared by temporarily withdrawing 5 ml of blood before collecting the sample for analysis.

 

43.  There is no good evidence that these benefit from heparinisation and, in any strict interpretation of the regulations. When there is no need to give a continuous infusion a cannula can be inserted and left “stopped off” with:

 

  1.  (HFJV)
  2. a rubber injection

C.     infiltrate deep tissues

D.    metabolised to a range                                                                                                                                

 

Answer:B

Explanation: When there is no need to give a continuous infusion, a cannula can be inserted and left “stopped off” with a rubber injection “bung”. Humiliating Peripheral veins used for collecting blood samples and for giving almost any drug, although care should be taken when infusing a number of vasoactive drugs

 

44.  Solution would need to be prescribed, and each administration signed for separately each time. There is no good evidence that these benefit from heparinisation and, in any strict interpretation of the regulations, solution need to be prescribed:

 

  1. Negative extrathoracic pressure
  2. Extracorporeal drug
  3. oxygenation (ECMO)
  4. the drug

 

Answer:D

Explanation: There is no good evidence that these benefit from heparinisation and, in any strict interpretation of the regulations, both the drug and the heparinised flush solution would need to be prescribed, and each administration signed for separately each time.

 

45.  Drugs can be given safely into any central venous line once ultrasound, or an x ray film, has shown where the catheter tip has lodged; this is the best route for giving any drug or infusion that tends to damage the vascular endothelium:

 

A.    blood tobramycin as blood gentamicin

  1. Liquid ventilation
  2. Nitric oxide (NO)
  3. solutions containing 10% glucose

Answer:D

Explanation: Drugs can be given safely into any central venous line once ultrasound, or an x ray film, has shown where the catheter tip has lodged; this is the best route for giving any drug or infusion that tends to damage the vascular endothelium.

 

46.  Aztreonam is a narrow spectrum monocyclic  lactam (“monobactam”) antibiotic, first introduced in 1985, which is only active against Gram negative aerobic bacteria. It is bactericidal, acting, like penicillin, to inhibit bacterial cell wall synthesis, and does not, like most other, treatment of infection with Pseudomonas,

 

A.    Bordetella pertussis organisms

  1. a property with ceftazidime (q.v.),

C.     anaesthetise the urethra   

  1. Formation of the aortic

 

Answer: B

Explanation:  Aztreonam is a narrow spectrum monocyclic lactam (“monobactam”) antibiotic, first introduced in 1985, which is only active against Gram negative aerobic bacteria lactam antibiotics, seem to induce lactamase activity. It is particularly useful in the treatment of infection with Pseudomonas, a property it shares with ceftazidime (q.v.), and has sometimes been used in conjunction.

 

47.  Aztreonam is a narrow spectrum monocyclic. It is bactericidal, acting, like penicillin, to inhibit bacterial cell wall synthesis.Lactamase activity. It is particularly useful in the treatment of infection with Pseudomonas, and has sometimes been used in conjunction with an aminoglycoside in the management of infection with Pseudomonas because of synergy in vitro. It can also be of value in some  management:

 

 

 

A.    a suspension of killed

  1. pulmonarytrunks
  2. The fetal circulation
  3. Klebsiella,

 

Answer:D

Explanation: It can also be of value in the management of Haemophilus influenzae (including ampicillin resistant and other penicillinase producing strains), Enterobacter, Klebsiella, Neisseria, and Proteus species.

 

48.  A narrow spectrum monocyclic is aztreonam. There is no evidence of teratogenicity, but the manufacturer is not yet prepared to recommend its use during pregnancy (or its use in babies less than 1 week old). It is particularly useful in the treatment of infection with Pseudomonas and also be of value in some  management and It is widely distributed in most body fluids:

 

A.    anaesthesia after less than 1 min

  1. diffuses into the cerebrospinal fluid

C.     nasal intubation                                                                                               

  1. Blood pressure

 

Answer:B

Explanation:It is widely distributed in most body fluids, including bile, urine, and bronchial secretions, and diffuses into the cerebrospinal fluid relatively well when the meninges are inflamed. Aztreonam is excreted partially metabolised to an inactive metabolite, SQ-26992, which has a long half life, but is mostly excreted in the urine by a combination of glomerular filtration and tubular secretion.

 

49.  Biochemistry:Biotin is one of the water soluble group B vitamins. Holocarboxylase synthetase catalyses the covalent attachment of biotin to these proteins. When carboxylases are degraded, biotin is liberated by the action of biotinidase and recycled. Biotin is found :

 

  1. theophylline levels in infants,
  2. Plasma elimination half-lives
  3. Congestive heart failure
  4. some vegetables.

 

Answer: D

Explanation: Nutritional deficiency is extremely rare. Biotin is one of the water soluble group B vitamins. Biotin is found foods, including eggs, liver, kidneys, and some vegetables.

 

50.  Biotin is one of the water soluble group B vitamins.When carboxylases are degraded, biotin is liberated by the action of biotinidase and recycled. Deficiency of either holocarboxylase synthetase or biotinidase leads to “multiple carboxylase deficiency”.Nutritional deficiency is extremely rare.  Biotin is a cofactor for four carboxylases: the covalent attachment of biotin to these proteins catalyses:

 

A.    ototoxicity and nephrotoxicity

  1. Holocarboxylase synthetase
  2. perfusion and blood pressure
  3. Palpation of the chest wall

 

Answer:A

Explanation: Biotin is a cofactor for four carboxylases: propionyl-CoA carboxylase, pyruvate carboxylase, 3-methyl-crotonyl-CoA carboxylase, and acetyl-CoA carboxylase. Holocarboxylase synthetase catalyses the covalent attachment of biotin to these proteins.

 

51.  Lymphocytes and fibroblasts can be used to confirm the enzyme deficiency. Mothers of patients are sometimes given 10 mg of biotin a day during any subsequent pregnancy, although it is not clear whether such prenatal treatment is actually necessary. Patients with holocarboxylase synthetase deficiency present as neonates or infants with feeding problems, that compatible with:

 

A.    damaging cerebral discharges

  1. Palpation liver

C.     vasoconstriction

  1. four carboxylase deficiencies.

 

Answer:D

Explanation: Patients with holocarboxylase synthetase deficiency present as neonates or infants with feeding problems, encephalopathy, metabolic acidosis, and urinary organic acids compatible with the four carboxylase deficiencies.

 

52.  Allergic reactions with urticaria are rare in the neonatal period. Symptomatic treatment with 1 mg of chlorphenamine maleate IM  may be appropriate. Intravascular haemolysis due to ABO incompatibility is rare but potentially fatal. Immediate signs include:

 

 

  1. Auscultation and oliguria,
  2. the aortic and pulmonary
  3. Brain injury in the premature
  4. hypotension, and oliguria,

 

 

Answer:

Explanation: Intravascular haemolysis due to ABO incompatibility is rare but potentially fatal. Immediate signs include flushing, dyspnoea, fever, hypotension, and oliguria, with haemoglobinaemia and haemoglobinuria.

 

 

53.  Intravascular haemolysis due to ABO incompatibility is rare but potentially fatal. Immediate signs include flushing, dyspnoea with haemoglobinaemia and haemoglobinuria. With jaundice and anaemia  chose the best option that may cause late reticuloendothelial haemolysis:

 

  1. Rhesus

B.     diagnostically and therapeutically

  1. bupivacaine and  Rhesus
  2. right atrium exceeds

 

Answer:B

Explanation: Stop the transfusion at once, take specimens for laboratory analysis, and watch for renal failure, hyperkalaemia, and a coagulopathy. Rhesus, Kell, Kidd  , and Duffy  antibodies may cause late reticuloendothelial haemolysis with jaundice and anaemia.

 

54.  Caffeine is well absorbed by mouth and IV treatment is seldom necessary. It is mostly excreted, unchanged, in the urine in the first month of life. Clearance rises as a result of increased liver metabolism and, in infants more than 4 months old, approaches the rate found in adults. The outcomes of tenfold overdose :

 

  1. premature infant brain
  2. Periventricular vascular
  3. birth asphyxia
  4. severe hyperglycaemia,

 

Answer: D

Explanation: Tachycardia and agitation are the first signs of toxicity, while a tenfold overdose causes sweating, hypertonia, severe hyperglycaemia, and heart failure. The international CAP trial continues to look into the safety of long term neonatal use.

 

55.  Some degree of hypocalcaemia is common in the first 2 days of life, with apathy and hypotonia, especially if there is intrapartum asphyxia or respiratory distress. Late hypocalcaemia on the other hand is usually associated with multifocal seizures :

 

A.    arrhythmia

  1. Hypomagnesaemia present

C.     haemorrhage

  1. Pneumonia

 

Answer:B

Explanation: Seizures are usually associated with a serum calcium of less than 1·7 mmol/l and more specifically an ionised calcium of less than 0·64 mmol/l. Hypomagnesaemia is also often present.

 

56.  The neonatal response to treatment with an ACE inhibitor is very variable, it is essential to give a first small test dose and then increase the dose cautiously. Chose the one of the adverse effects that  have been unacceptably common when these drugs were used to control hypertension in the first month of life.

 

  1. Factors influencing the development of the neonatal
  2. nurse role
  3. The developmental history
  4. Apnoea and seizures,

 

Answer:D

Explanation: Adverse effects including apnoea, seizures, and renal failure, as well as severe unpredictable hypotension have been unacceptably common when these drugs were used to control hypertension in the first month of life.

 

57.  Antibiotic prophylaxis can never be a substitute for good surgical technique and meticulous asepsis. Despite this, controlled trials have shown, quite unequivocally, that a policy of routine antibiotic prophylaxis is associated with:

 

  1. atrium, blood passes
  2. risk of postoperative fever,

C.     Oral zinc sulphate

  1. the vulnerability

 

 

Answer:B

Explanation: A policy of routine antibiotic prophylaxis is associated with a threefold reduction in the risk of serious postoperative infection, localised wound infection, and endometritis, as well as the much commoner risk of postoperative fever, in women undergoing caesarean delivery.

 

58.  Ceftazidime is reasonably active against group A and group B streptococci and against Streptococcus pneumoniae, but only has limited efficacy with most other Gram positive organisms. Ceftazidime, the widespread regular use of this cephalosporin can result:

 

  1. sustained pain relief and enterococci
  2. Meconium aspiration syndrome
  3. Pulmonary haemorrhage
  4. enterococci

 

Answer:D

Explanation: Ceftazidime is not effective against Enterococci, Listeria, Helicobacter or Bacteroides fragilis, and the widespread regular use of this cephalosporin can result in an increasing proportion of babies becoming colonised with enterococci and with other potentially dangerous organisms.

 

59.  Generalised fungal infection is also a potential hazard. Ceftazidime should not, therefore, be used on its own in the management of neonatal infection due to an unidentified organism. Ceftazidime is widely distributed in most body tissues that include:

 

  1. Positive-pressure ventilation
  2. (CSF),
  3. High frequency jet ventilation and  (CSF),
  4. High frequency flow interrpution

 

 

Answer:B

Explanation: Ceftazidime is widely distributed in most body tissues including respiratory secretions, ascitic fluid and cerebrospinal fluid (CSF), although CSF penetration is rather variable unless the meninges are inflamed. There is no clear evidence that aminoglycosides are synergistic.

 

60.  The half life is 4–10 hours at birth, but half this in babies more than a week old. Adverse effects are not common with any of the cephalosporin antibiotics in the neonatal period, but hypersensitivity reactions are occasionally seen in older patients sometimes overlapping with hypersensitivity to penicillin.

 

  1. pneumothorax (HFV)
  2. High frequency oscillation (HFO)
  3. Negative extrathoracic pressure

D.    heavy or intermenstrual bleeding

Answer:D

Explanation: Rashes, phlebitis, and leucopenia have all been reported. Diarrhoea can progress to pseudomembranous colitis, due to an overgrowth of antibiotic resistant bowel organisms, such as Clostridium difficile

61.  Cefuroxime is a lactamase resistant second generation cephalosporin first patented in 1973, which is active against most Gram positive organisms (including group B streptococci and penicillin resistant staphylococci) and a wide range of Gram negative organisms. It is reasonably inactive against :

 

  1. enterococci
  2.  enterococci (pertussis) vaccine

C.     sugar-free suspension

  1. Extracorporeal membrane

 

 

Answer:A

Explanation: It is reasonably active against Haemophilus influenzae and Neisseria gonorrhoeae, but inactive against Listeria, enterococci and Bacteroides, and Pseudomonas species. It penetrates cerebrospinal fluid poorly, but has sometimes been used prophylactically.

 

62.  Symptomatic treatment with 1 mg of chlorphenamine maleate IM  may be appropriate. Coagulase negative staphylococci are increasingly resistant to this antibiotic. It was advocated for some years for use at birth in asymptomatic babies who were thought to be at risk as a result of:

 

  1. Liquid ventilation

B.     pneumothorax

C.     3-desacetyl-vecuronium

  1. low potential toxicity. 

 

Answer:D

Explanation: It was advocated for some years for use (on its own) at birth in asymptomatic babies who were thought to be at risk as a result of prolonged rupture o  membranes, maternal pyrexia, or meconium aspiration, because of its broad spectrum and low potential toxicity. 

63.  Hypotension and respiratory depression have been described. Long term use has also, on occasion, been thought to cause jaundice and an increased metabolic acidosis in the neonate. The main adverse effects of oral administration:

 

A.    Whooping cough (pertussis) vaccine

B.     Diphtheria

  1. An overdose can be dangerous.
  2. Cardiac embryology  cause to overdose

Answer:C

Explanation: Nausea, vomiting, and gastric irritation are the main adverse effects of oral administration , and these can be minimised by giving the drug with a small amount of milk or fruit juice.

 

64.  Malaria, caused by four closely related parasites spread by the bite of the night feeding female Anopheles mosquito, currently kills 2 million people in the tropics each year, most of them children. Residents develop considerable immunity over time, but pregnancy makes women more vulnerable infection could be:

 

  1. Respiration in the neonate
  2. the risk of stillbirth, and prematurity.
  3. Acid base balance
  4. pressure (CPAP)

 

Answer:B

Explanation: Pregnancy makes women more vulnerable, and infection during pregnancy increases the risk of anaemia, miscarriage, stillbirth, and prematurity.

 

65.  Transplacental spread is uncommon but infection sometimes occurs during delivery, although florid symptoms. Diagnosis of infection, however acquired, depends on recognising the intracellular parasite in a thick smear of stained blood on a  microscope slide. Parasite numbers rise every 2–3 days as the fever peaks, infection being considered severe if there is:

 

  1. The atria red cells are involved.
  2. The ventricles
  3. Radiograph showing
  4. shock, and more than5% of red cells are involved.

 

Answer:D

Explanation: Infection being considered severe if there is shock, acidosis, hypoglycaemia, or cerebral symptoms, or if more than 5% of red cells are involved.Treatment with chloroquine can leave organisms dormant in the liver unless primaquine is then given.

 

66.  Excess chloroquine is toxic to the heart and is a central nervous system depressant. Prompt high dose diazepam (2 mg/kg daily) and ventilation seem beneficial. The steps or output for gastric lavage may be appropriate once:

 

  1. a left-sided diaphragmatic hernia
  2. Acidosis must be corrected.
  3. shortly after birth with Acidosis
  4. Chest radiograph

 

Answer:B

Explanation: The airway has been protected, and activated charcoal may reduce gut absorption. IV adrenaline helps to control hypotension. Acidosis must be corrected. Phenytoin or a blocker is the only safe treatment for arrhythmia.

 

67.  Many different drugs provoke similar withdrawal symptoms in the baby after birth. Restlessness, irritability, and excessive wakefulness are the commonest problems seen. Feeding can prove difficult. Symptoms can be very unpleasant and occasionally, if particularly severe, dangerous. Autonomic dysfunction can include :

 

A.    Vasodilatation instability.

  1. diaphragmatic hernia
  2. sweating, and temperature instability.
  3. Formation of the aortic

 

Answer:C

Explanation: Autonomic dysfunction can include sneezing, yawning, sweating, and temperature instability. Feeding can prove difficult. Symptomatic treatment with 1 mg of chlorphenamine maleate IM may be appropriate.

 

68.  Cimetidine is a safe and widely used drug, a low dose formulation of which is now available “over the counter” without prescription for the short term management of indigestion and heartburn in adults. Type of  dose are uses for some different purposes like :

 

A.    chlamydial

  1. Congenital heart defects
  2. Patent ductus arteriosus
  3. low dose maintenance treatment

 

Answer:D

Explanation: High dose treatment has been shown to speed the healing of peptic ulcers in the oesophagus, stomach, and duodenum, and low dose maintenance treatment can be used to prevent a recurrence in vulnerable patients.

 

69.  A single 125 mg IM dose of ceftriaxone is widely used to treat maternal infection. If it is not possible to test for possible co-infection with Chlamydia, it may be appropriate to give a single 1 g dose of azithromycin by mouth as well. Cimetidine (unlike ranitidine) binds very strongly to cytochrome P450, drug amongst most notably affected:

 

  1. suxamethonium and theophylline

B.     rickettsial

C.     hydrocortisone

  1. Coarctation of the aorta

 

Answer:A

Explanation: The drugs amongst most notably affected are erythromycin, lidocaine, midazolam, nifedipine, phenytoin, suxamethonium, theophylline or aminophylline, and warfarin.

 

70.  Cisapride is readily absorbed when taken by mouth, and undergoes rapid first pass metabolism in the liver and gut wall. The metabolites are then excreted in the urine and faeces (the adult plasma elimination half life being 7–10 hours). Bioavailability is approximately halved when the drug is given rectally. The reported commonest sign of an overdose, for an adult:

 

  1. Congestive heart failure
  2. perfusion and blood pressure

C.     symptoms protozoal infections,

  1. Dizziness and tachycardia,

 

Answer:D

Explanation: The commonest sign of an overdose I  adults is abdominal cramp and intestinal hurry, although headache, dizziness, tachycardia, and convulsions have been reported. Drug accumulation can cause a serious arrhythmia. Avoid in hypokalaemia or hypomagnesaemia.

 

71.  Some particular drugs interfere with the metabolic inactivation of cisapride and can prolong the QT interval, causing ventricular arrhythmia. Chose the drug that for a patients if taking,should never be given cisapride;

 

A.    strongly as sulfafurazole

  1. spiramycin,
  2. the vulnerability
  3. premature infant brain

 

Answer:B

Explanation: Patients taking amiodarone, doxapram, erythromycin, spiramycin, or any of the systemic imidazole or triazole antifungal agents (such as fluconazole) should never be given cisapride.

 

72.  The manufacturers do not recommend IV use in babies less than 4 weeks old. The risk of diarrhoea, and of occasionally fatal antibiotic related pseudomembranous colitis  has limited the neonatal use of this antibiotic Oral vancomycin  and parenteral nutrition are often used to treat colitis. Other adverse effects include skin rashes and the drug is still sometimes used :

 

A.    A rapid IV bolus

B.     limits of neonatal homeostasis

  1. premature infant
  2. alternative to sodium fusidate (q.v.)

 

Answer:D

Explanation: The drug is still sometimes used as an alternative to sodium fusidate in the management of resistant staphylococcal osteomyelitis, and to control the anaerobic sepsis associated with necrotising enterocolitis.

 

73.  Clonazepam has often been given as a slow, continuous, IV infusion in the neonatal period. its onset of action will be seriously delayed if an initial loading dose is not given. Drug tolerance becomes a problem if treatment is continued for any extended period, and increasing seizure activity may occur if the serum level exceeds 125 g/l. Major adverse effects for this:

 

  1. haemorrhage

B.     infarctio

  1. neurological dysfunction

D.    Hypersensitivity reactions

 

Answer:C

Explanation: Major adverse effects are drowsiness, ataxia, and behavioural changes. Bronchial hypersecretion and salivation are said to be a problem in infancy, particularly if there is neurological dysfunction with impaired swallowing.

 

 

74.  Clonazepam has often been given as a slow, continuous, IV infusion in the neonatal period, but this approach is of no particular benefit since it is only slowly cleared from the brain . Drug tolerance becomes a problem if treatment is continued for any extended period. Major adverse effects :

 

  1. neurological dysfunction with impaired swallowing.
  2. Circulation
  3. Drugs
  4. Meconium stained liquor

 

Answer:A

Explanation: Major adverse effects are drowsiness, ataxia, and behavioural changes. Bronchial hypersecretion and salivation are said to be a problem in infancy, particularly if there is neurological dysfunction with impaired swallowing.

 

75.  There are no good controlled trial data on the use of clonazepam in the control of neonatal seizures. Drug tolerance becomes a problem if treatment is continued for any extended period. certainly the cause seem for clonazepam could be nausea as dose of morphin:

 

  1. Drugs
  2. Meconium stained liquor
  3. similar analgesic potency.
  4. Evaluation

 

Answer:C

Explanation: Clonazepam  certainly seems to cause as much nausea, vomiting, constipation, and ileus as a dose of morphine of similar analgesic potency. It also causes as much respiratory depression and hypotension. Much is finally excreted after conjugation with glucuronic acid in the urine, making repeated, or high dose, administration.

 

76.  There is no good evidence that blood levels of up to 15 mmol/l are dangerous, or that urinary loss can cause an osmotic diuresis (as is often feared) until the urine contains at least 1% glucose. Sudden hyperglycaemia in a previously stable baby caused:

 

  1. stability
  2. PAULINE FELLOWS
  3. Introduction
  4. infection and necrotizing enterocolitis,

 

Answer:D

Explanation: Sudden hyperglycaemia in a previously stable baby may be caused by pain, infection, necrotizing enterocolitis, or an intracranial bleed. Very high plasma levels raise serum osmolality.

 

77.  Dextrose given IV prevents and corrects hypoglycaemia, and provides calories for babies who are too ill to be fully fed by mouth. It is a key component of parenteral nutrition (q.v.).Half litre bags containing  how much % of components are available as stock?

 

  1. PAULINE FELLOWS
  2. Introduction
  3. Embryology
  4. 0·18% sodium chloride

 

Answer:D

Explanation: Half litre bags containing 5%, 10%, and 15% dextrose, 4% dextrose in 0·18% sodium chloride and 10% dextrose in 0·18% sodium chloride are available as stock, and cost 48p to £1·60 each. 25 ml

 

78.  Diamorphine hydrochloride is a potent semisynthetic opioid analgesic. It is well absorbed by mouth, but bioavailability is reduced by rapid first pass liver metabolism. Diamorphine hydrochloride it is all converted, within minutes, to morphine and 6-monoacetylmorphine in the body that may have adverse affect and some characteristics :

 

  1. makes the drug so addictive.
  2. Embryology
  3. Mechanisms of heat gain
  4. Vasoconstriction

 

Answer:A

Explanation:Diamorphine hydrochloride is all converted to morphine and 6-monoacetylmorphine in the body, almost all the drug’s properties and adverse effects, including reduced peristalsis, urinary retention, and respiratory depression, are essentially the same as for morphine.

 

79.  Diazepam may control seizures where phenobarbital (q.v.) fails, but a more sustained   anticonvulsant effect is obtained by using the newer benzodiazepines lorazepam or clonazepam (q.v.). Diazepam is primarily an anxiolytic chose the option that is related to diazepam’s functions of shows its drawback:

 

 

  1. Mechanisms of heat gain
  2. Vasoconstriction
  3. Thermal receptors
  4. treatment of pre-eclampsia,

 

Answer:D

Explanation:  Diazepam is often used to control status epilepticus drug accumulation, toxicity, and increasing tolerance make the drug of limited value for long term use. the treatment of pre-eclampsia, although evidence for its efficacy was always limited, and its sedative effect did nothing to control maternal blood pressure.

 

80.  Diazepam may control seizures where phenobarbital (q.v.) fails, but a more sustained anticonvulsant effect is obtained by using the newer benzodiazepines lorazepam or clonazepam The drug has a long half life in adults and a longer half life in late pregnancy, while the drug and its pharmacologically active contains some adverse affects:

 

  1. Non-shivering thermogenesis
  2. Thermoneutrality
  3. (VD ~ 1·3 l/kg).
  4. Mechanisms of heat loss

 

Answer:C

Explanation: The drug has a long half life (20–60 hours) in adults and a longer half life in late pregnancy, while the drug and its pharmacologically active metabolite, N-desmethyl diazepam, accumulate in both maternal and fetal tissues (VD ~ 1·3 l/kg).

 

81.  The half life in the neonatal period is even longer than in adults. Chronic low dose maternal medication may possibly have effect because the drug seems to accumulate in the fetus. As a result, a maternal dose of 30 mg or more in the 15 hours before delivery can cause:

 

  1. Mechanisms of heat loss
  2. Conduction
  3. Convection
  4. symptoms with jitteriness

 

Answer:D

Explanation: As a result, a maternal dose of 30 mg or more in the 15 hours before delivery can cause severe hypotonia, respiratory depression, and feeding difficulties, as well as temperature instability, particularly in babies of short gestation.

 

82.  Dobutamine hydrochloride is a synthetic inotropic catecholamine developed in 1973 by the systemic alteration of isoprenaline with a view to reducing some of the latter’s unwanted adrenergic effects. Dobutamine:

 

 

  1. Radiation
  2. effects can decrease rather than increase peripheral resistance.
  3. Evaporation
  4. Heat exchanged through the

 

Answer:B

Explanation: Dobutamine hydrochloride is a synthetic inotropic catecholamine developed in 1973 by the systemic alteration of isoprenaline with a view to reducing some of the latter’s unwanted adrenergic effects chronotropism, arrhythmias, vascular constriction.

 

83.  Dopamine hydrochloride has been widely used to control neonatal hypotension, but it has a variable, unpredictable, and dose dependent impact on vascular tone. Its use too often fails to recognise that adequate tissue perfusion, rather than supply pressure per se must be the primary aim of treatment. if low cardiac output is the primary problem.

 

  1. respiratory tract
  2. Surface area
  3. Immature skin
  4. adrenaline (q.v.) infusion used

 

Answer:D

Explanation: . Studies suggest that hydrocortisone (q.v.) is sometimes better at raising neonatal blood pressure. A dobutamine or adrenaline (q.v.) infusion should be used if low cardiac output is the primary problem.

 

84.  Dopamine hydrochloride has been widely used to control neonatal hypotension, but it has a variable, unpredictable, and dose dependent impact on vascular tone. Dopamine is a naturally occurring catecholamine precursor of noradrenaline (q.v.) Low dose infusion (2 micrograms/kg per minute:

 

  1. Immature skin
  2. Transepidermal water loss (TEWL)
  3. Respiratory water loss
  4. does not protect renal function

 

Answer:D

Explanation: Low dose infusion (2 micrograms/kg per minute) normally causes dopaminergic coronary, renal, and mesenteric vasodilatation, but there is little evidence that this is clinically beneficial, and good controlled trial evidence that such treatment does not protect renal function in adults with septic shock.

 

85.  Dopamine hydrochloride use too often fails to recognise that adequate tissue perfusion, rather than supply pressure per se must be the primary aim of treatment. Dopamine is inactivated by alkali but can be added to a line containing:

 

  1. milrinone,
  2. Immature skin
  3. Transepidermal water loss (TEWL)
  4. Respiratory water loss

 

 

Answer:A

Explanation: Dopamine is inactivated by alkali but can be added (terminally) to a line containing standard total parenteral nutrition when absolutely necessary, and to a line containing fentanyl, lidocaine, midazolam, milrinone, or morphine.

 

86.  Doxapram stimulates all levels of the cerebrospinal axis, and respiration appears to be stimulated at doses that cause little general excitation. A plasma concentration of 2 mg/l doubles the minute volume in healthy adults, but there is no evidence of any additive benefit from raising the plasma level above 1 mg/l in babies. High doses cause convulsions, and subconvulsive doses can still cause:

 

  1. Respiratory water loss
  2. Thermal instability
  3. Hypothermia
  4. hypertension and hyperpyrexia,

 

Answer:D

Explanation: High doses cause convulsions, and subconvulsive doses can still cause tachycardia, hypertension, hyperpyrexia, jitteriness, laryngospasm, and vomiting. Oral caffeine is usually considered the drug of choice in the management of idiopathic neonatal apnoea but adding doxapram can sometimes bring additional benefit.

87.  Continuous IV infusions: Drugs for continuous infusion should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

These drugs for continuous infusion contain:

 

 

  1. Anaesthetic facemasks
  2. epoprostenol,renal failure in infants

C.     Alopecia

  1. Adrenaline and epoprostenol,

 

Answer:D

Explanation: The volume of drug to be given seldom exceeds 2 ml in neonatal practice, abrupt administration can be avoided by siting a three way tap.Drugs for continuous infusion such as adrenaline, atracurium, diamorphine, dobutamine, dopamine, doxapram, enoximone, epoprostenol, should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

 

 

88.  Great care is needed to ensure that patients never receive accidentally even a brief surge of one of the vasoactive drugs, and the same is true of many inotropes. Never load the syringe or burette with more of the drug than is likely to be needed in 12–24 hours. Continuous IV infusions indludes the drugs for continuous infusion:

 

  1. glyceryl trinitrate and magnesium sulphate
  2. Size and length of tracheal

C.     Alopecia

D.    mild blanching

 

Answer:A

Explanation: Drug infusion should be followed by a 2 ml “chaser” of 0·9% sodium chloride from a second syringe in order to flush the active drug through the IV line as rapidly as possible. Drugs for continuous infusion such as glyceryl trinitrate, hydrocortisone, insulin, isoprenaline, Intralipid, labetalol, lidocaine, magnesium sulphate, should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

 

 

89.  Never load the syringe or burette with more of the drug than is likely to be needed. Administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line are drugs for continuous infusion and remember to readjust the total fluid intake.

 

  1. Postural support
  2. Midazolam and tolazoline
  3. Supine position

D.    death in the preterm baby

 

Answer:B

Explanation: Drugs for continuous infusion such as midazolam, milrinone, morphine, noradrenaline, nitroprusside, prostaglandin E, streptokinase, thiopental, and tolazoline should be administered from a second carefully labelled infusion pump connected by a three way tap into the main infusion line.

 

 

90.  Drugs should never be injected or connected into a line containing blood or a blood product. Since the volume of drug to be given seldom exceeds 2 ml in neonatal practice. The standard procedure for using a three way tap to give a slow IV “stat” dose is as follows.

 

A.    exacerbate any existing renal impairment

  1. Side-lying position
  2. Resuscitation of the newborn
  3. turn the tap back so the syringe is reconnected to the patient,

 

Answer:D

Explanation: Connect the preloaded syringe to the free tap inlet. Turn the tap so the syringe is connected to the patient and give the injection and turn the tap so the syringe is connected to the giving set, draw up about 0·2 ml of infusion fluid, turn the tap back so the syringe is reconnected to the patient, and flush this fluid through so that it just enters the giving set.

 

91.  Babies who are well enough to take milk feeds, however, are nearly always well enough to take medication by mouth, and many drugs are just as effective when given this way. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

 

A.    Hold total intake from milk

  1. Amoxicillin and ampicillin,

C.     toxicity of systemic tetracaine

  1. Asphyxia

 

 

Answer:B

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include amoxicillin, ampicillin, cephalexin, chloramphenicol, ciprofloxacin and  co-trimoxazole,

 

92.  Medication by mouth is clearly unsuitable for babies who are shocked, acidotic, or otherwise obviously unwell because there is a real risk of paralytic ileus and delayed absorption. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

 

  1. Blood clotting factors
  2. Infants at risk of hyperglycaemia

C.     Causes of intestinal obstruction

  1. pyrimethamine,

 

Answer:D

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include erythromycin, flucloxacillin, fluconazole, flucytosine, isoniazid, metronidazole, pyrimethamine, rifampicin, sodium fusidate, and trimethoprim.

 

93.  Babies who are well enough to take milk feeds, however, are nearly always well enough to take medication by mouth, and many drugs are just as effective when given this way. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

 

  1. transport bag
  2. ampicillin, and co-trimoxazole,
  3. Sleep-wake assessment scales
  4. Stress and stability signals

 

Answer:B

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include amoxicillin, ampicillin, cephalexin, chloramphenicol, ciprofloxacin and  co-trimoxazole,

 

94.  Medication by mouth is clearly unsuitable for babies who are shocked, acidotic, or otherwise obviously unwell because there is a real risk of paralytic ileus and delayed absorption. Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include:

 

A.    Grading scale

B.     periventricular haemorrhage

C.     Causes of jaundice

  1. rifampicin,

 

Answer:D

Explanation: Antibiotics that can be given by mouth to any baby who is well enough to take milk feeds without detriment to the blood levels that are achieved include erythromycin, flucloxacillin, fluconazole, flucytosine, isoniazid, metronidazole, pyrimethamine, rifampicin, sodium fusidate, and trimethoprim.

 

95.  Oral medication is clearly unsuitable for babies who are shocked, acidotic, or otherwise obviously unwell because there is a real risk of paralytic ileus and delayed absorption. As compare to IV administration, Oral administration is:

  1. cheaper and easily managed on the postnatal wards
  2. postnatal ages
  3. The regression

D.    Anticipation

 

Answer:  A                                                                                                                                 Explanation:  Oral administration is often quicker, cheaper, and safer than IV administration. Oral administration is also much more easily managed on the postnatal wards, and treatment can then be continued by the parents after discharge where appropriate.

96.   Dilution with a syrup containing glucose threatened to increase the risk of caries in recently erupted teeth in later infancy. Small quantities are best given from a dropper bottle dropped on to the back of the tongue from the nozzle of a syringe. Dilution often reduced

 

A.    ABC(D and E) of resuscitation

B.     Meconium stained liquor

  1. the structures needed
  2. shortened the drug’s “shelf life”.

 

Answer:D

Explanation: Dilution often reduced stability and shortened the drug’s “shelf life”. Dilution with a syrup containing glucose threatened to increase the risk of caries in recently erupted teeth in later infancy.

 

 

97.  It is important to remember that if only half the proffered feed is taken, only half the medicine is administered. Where possible all of a day’s supplements should be added to the first feed of the day. Additives to milk: Vitamins are often added to milk. chose the one option that can also be given as dietary supplements in the same way.

 

  1. nociception to occur
  2. Infants at risk of hypoglycaemia

C.     hepatic impairment

  1. Sodium and bicarbonate

 

Answer:D

Explanation: Additives to milk: Vitamins are often added to milk. Sodium, phosphate, and bicarbonate can also be given as dietary supplements in the same way.

 

98.  Rectal administration: This can be a useful way of giving a drug that is normally given by mouth to a baby who is not being fed. Absorption is usually slower, often less complete, and sometimes less reliable than with oral administration. Check out the best choice that is one of the medicine sometimes given by mouth to a baby who is not being fed.

 

 

A.    anesthetic but no anticonvulsant

  1. carbamazepine,

C.     irritability

  1. Management of thermal

 

 

Answer:B

Explanation: Chloral hydrate, cisapride, codeine phosphate, and paracetamol are sometimes given by mouth to a baby who is not being fed. Suppositories have usually been used in the past (merely because that is how rectal drugs are normally given to adults) but liquid formulations are more appropriate in the neonatal period.

 

99.  Suppositories have usually been used in the past (merely because that is how rectal drugs are normally given to adults) but liquid formulations are more appropriate in the neonatal period. When a liquid formulation is used absorption is always:

 

  1. Evaluation of resuscitation
  2. Immature skin
  3. Transepidermal water loss (TEWL)
  4. weight related dose.

 

Answer:D

Explanation: Absorption is always more rapid and often more complete when a liquid formulation is used. It is also much easier to administer a precise, weight related dose.

 

100. IV drugs should be given slowly and, where possible, through a secure established IV line containing dextrose and/or sodium chloride. Particular care must be taken not to mix potentially incompatible fluids. Staff must also remain alert to the very real risks of air embolism and familiar with:

 

  1. Thermal instability
  2. management of anaphylaxis.

C.     metabolized to a range of inactive oligopeptides

D.    tissue necrosis

 

Answer:B

Explanation: Staff must also remain alert to the very real risks of air embolism, infection, inflammation, thrombosis, and tissue extravasation (as set out in the earlier parts of that monograph). They should also be familiar with the management of anaphylaxis.