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| Section | Weight | Objectives |
|---|---|---|
| General Assessment | 15% | - Neonatal assessment
|
| Professional Issues | 3% | - Evidence-based practice
|
| Pharmacology | 9% | - Drugs and breastfeeding
|
| General Management | 19% | - Growth and nutrition
|
| Embryology, Physiology, Pathophysiology and Systems Management | 54% | - Hematopoietic
|
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問題 #33
A neonate has had frequent blood draws to monitor electrolyte and glucose levels. This phlebotomy has caused anemia of prematurity (AOP) although the infant is not acutely hypoxemic. The initial treatment is
答案：A
解題說明：
repo is indicated to stimulate erythropoiesis in phlebotomy-related AOP. Infants with signs of hypoxemia (poor feeding, tachypnea, tachycardia, pallor) may require transfusions. AOP represents a pathologic exaggeration of the normal decrease in hematocrit that occurs in every newborn. Other causes include:
*Decreased RBC production because the premature neonate's response to erythropoietin
*CEPO), the main stimulus for RBC production, has not matured. Lowest Hgb levels are usually at 2-3 months of age.
*Premature RBCs have a shortened lifespan when compared to the full term neonate's
*because of decreased levels of intracellular ATP and enzyme activity.
問題 #34
What method should be used to feed the preterm infant with a weak sucking reflex?
答案：C
解題說明：
Gavage feeding is used to provide nutrition to the infant with a poor sucking reflex, tachypnea, respiratory distress, impaired swallowing, or apneic spells. A nasogastric tube is placed and formula or human milk is slowly fed through the tube with a syringe. Often, the baby will be soothed or gently touched during the feeding to promote positive reinforcement with sucking. The feeding should be stopped if the baby exhibits signs of gasping or choking.
問題 #35
Which condition results in birth defects that are usually fatal before birth or within the first year of life?
答案：C
解題說明：
Edwards syndrome, or trisomy 18, is a condition that occurs when there is an extra 18th chromosome. This is usually diagnosed prenatally with blood screening and ultrasounds. Infants with this condition are smaller than normal and have a small, misshapen head. Over one-third of these infants do not live past the first year of live. Approximately 10% may live up to 10 years of life, though, but with very complex medical problems due to birth defects affecting the organs.
問題 #36
A neonate, 2 days after birth, develops a generalized rash with erythematous papules, vesicles, and some pustules everywhere but on the palms and soles of feet. The most likely diagnosis is
答案：B
解題說明：
Erythema toxicum is a skin eruption of erythematous papules, vesicles, and sometimes pustules. Erythema toxicum is essentially benign and occurs in 250% of newborns. It is a generalized rash everywhere except the palms and soles of the feet, usually occurring 2-3 days after birth. Neonatal pustular melanosis is a benign rash (vesicles and macules) but not associated with erythema. Cutis marmorata is a disorder in which the infant's skin mottles or marbles when exposed to cold, because the superficial blood vessels dilate and contract at the same time.
問題 #37
A mother brings her term infant (and first child) for an exam at 2 weeks after birth. The baby has not regained birth weight, appears listless, face drawn, and skin turgor is poor. The mother is breastfeeding. The most appropriate first action is
答案：A
解題說明：
The mother should be questioned about her nursing technique and frequency and observed while nursing the child. Since this is her first child, she may need further assistance in nursing properly to ensure the infant receives adequate nutrition. While further tests may be indicated, these signs are indicative of dehydration and poor nutrition, so that should be dealt with first. As there are no other indications of neglect, referral to child protective services is not appropriate at this time. Switching from human milk to formula is rarely necessary if mothers receive adequate support and instruction.
問題 #38
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