Neonatal infections Practice Questions

Question 1

A 2-day-old boy, born at 38-weeks gestation, presents with jaundice and microcephaly. Social history reveals his mother is an animal caretaker. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 75/40 mm Hg, pulse 150/min, respiratory rate 40/min, and oxygen saturation 99% on room air. Physical examination reveals hepatosplenomegaly. A CT and MRI of the head are significant for the following findings (see picture). Which of the following diseases contracted during pregnancy is the most likely cause of this patient's condition?

Accepted Answer

CMV

Answer

Toxoplasmosis

Answer

Syphilis

Answer

Varicella

Answer

Rubella

Question 2

A neonate born at 33 weeks is transferred to the NICU after a complicated pregnancy and C-section. A week after being admitted, he developed a fever and became lethargic and minimally responsive to stimuli. A lumbar puncture is performed that reveals the following:
Appearance  Cloudy
Protein 64 mg/dL
Glucose 22 mg/dL
Pressure 330 mm H20
Cells 295 cells/mm³ (> 90% PMN)
A specimen is sent to microbiology and reveals gram-negative rods. Which of the following is the next appropriate step in management?

Accepted Answer

Start the patient on IV cefotaxime

Answer

MRI scan of the head

Answer

Start the patient on IV ceftriaxone

Answer

Provide supportive measures only

Answer

Start the patient on oral rifampin

Question 3

A 2-day-old newborn male delivered at 38 weeks' gestation is evaluated for poor feeding and irritability. His temperature is 35°C (95°F), pulse is 168/min, respirations are 80/min, and blood pressure is 60/30 mm Hg. Blood culture on sheep agar grows motile, gram-positive bacteria surrounded by a narrow clear zone. Further testing confirms the presence of a pore-forming toxin. Which of the following is the most important factor in successful clearance of the causal pathogen?

Accepted Answer

Interferon-γ-induced macrophage activation

Answer

Secretion of interferon-α from infected cells

Answer

Secretion of interleukin 10 by regulatory T cells

Answer

Secretion of immunoglobulin G from plasma cells

Answer

Formation of the membrane attack complex

Question 4

A 6-day-old newborn is brought to the emergency department by his mother due to a high fever that started last night. His mother says that he was born via an uneventful vaginal delivery at home at 38 weeks gestation and was doing fine up until yesterday when he became disinterested in breastfeeding and spit up several times. His temperature is 39.5°C (103.1°F), pulse is 155/min, respirations are 45/min, and O2 sats are 92% on room air. He is lethargic and minimally responsive to stimuli. While on his back, his head is quickly lifted towards his chest which causes his legs to flex. The mother had only a few prenatal care visits and none at the end of the pregnancy. What is the most likely source of this patients infection?

Accepted Answer

During birth

Answer

Tick bite

Answer

Infection from surgery

Answer

Contaminated food

Answer

Mother’s roommate

Question 5

A 5-day-old male newborn is brought to the emergency department 1 hour after having a seizure. It lasted approximately 1 minute, and involved blinking and lip-smacking movements as well as left-sided jerking of the hand and foot. His mother says she measured a temperature of 38.2°C (100.7°F) at that time. He has had increasing difficulty feeding since yesterday. He was born at 39 weeks' gestation and weighed 3189 g (7 lb, 1 oz); he currently weighs 2980 g (6 lb, 9 oz). The mother's prenatal course was significant for gonorrhea infection diagnosed early in pregnancy and treated with ceftriaxone and azithromycin combination therapy. The boy appears irritable and lethargic. His temperature is 36.0°C (96.8°F). Examination shows clusters of vesicular lesions with an erythematous base on the patient's face and trunk. There is profuse lacrimation. Laboratory studies show:
Leukocyte count 16,200/mm3
Segmented neutrophils 25%
Bands 5%
Lymphocytes 65%
Monocytes 3%
Eosinophils 2%
Serum
Glucose 80 mg/dL
A lumbar puncture is performed. Cerebrospinal fluid analysis shows a leukocyte count of 117/μL, a protein concentration of 52 mg/dL, and a glucose concentration of 58 mg/dL. Results of blood cultures are pending. Which of the following is the most appropriate pharmacotherapy?

Accepted Answer

IV acyclovir

Answer

IV ceftriaxone

Answer

Pyrimethamine

Answer

IV ganciclovir

Answer

IV vancomycin

Question 6

The occupational health department at a hospital implements new safety precautions to prevent laboratory-acquired infections. One of the new precautions includes disinfecting the microbiology laboratory benches with 70% ethanol before and after use. This measure is most likely to be effective in preventing the transmission of which of the following viruses?

Accepted Answer

Herpes simplex virus

Answer

Hepatitis A virus

Answer

Poliovirus

Answer

Parvovirus

Answer

Polyomavirus

Question 7

You are a resident in the surgical ICU. One of the patients you are covering is a 35-year-old pregnant G1P0 in her first trimester admitted for complicated appendicitis and awaiting appendectomy. Your attending surgeon would like you to start the patient on moxifloxacin IV preoperatively. You remember from your obstetrics clerkship, however, that moxifloxacin is Pregnancy Category C, and animal studies have shown that immature animals exposed to fluoroquinolones like moxifloxacin may experience cartilage damage. You know that there are potentially safer antibiotics, such as piperacillin/tazobactam, which is in Pregnancy Category B. What should you do?

Accepted Answer

Wait to administer any antibiotics until you discuss your safety concerns with your attending.

Answer

Administer moxifloxacin since it is only Pregnancy Category C and, although studies may have revealed adverse effects in animals, there is no definite evidence that it causes risk in humans.

Answer

Administer piperacillin/tazobactam instead of moxifloxacin without discussing with the attending since your obligation is to "first, do no harm" and both are acceptable antibiotics for complicated appendicitis.

Answer

Discuss the adverse effects of each antibiotic with the patient, and then let the patient decide which antibiotic she would prefer.

Answer

Administer moxifloxacin since the attending is the executive decision maker and had to know the patient was pregnant when deciding on an antibiotic.

Question 8

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?

Accepted Answer

Bronchopulmonary dysplasia

Answer

Tracheomalacia

Answer

Bronchiolitis obliterans

Answer

Interstitial emphysema

Answer

Pneumonia

Question 9

Three days after delivery, a 1100-g (2-lb 7-oz) newborn has a tonic seizure that lasts for 25 seconds. She has become increasingly lethargic over the past 18 hours. She was born at 31 weeks' gestation. Antenatal period was complicated by chorioamnionitis. Apgar scores were 3 and 6 at 1 and 5 minutes, respectively. She appears ill. Her pulse is 123/min, respirations are 50/min and irregular, and blood pressure is 60/30 mm Hg. Examination shows a tense anterior fontanelle. The pupils are equal and react sluggishly to light. Examination shows slow, conjugate back and forth movements of the eyes. Muscle tone is decreased in all extremities. The lungs are clear to auscultation. Which of the following is the most likely diagnosis?

Accepted Answer

Intraventricular hemorrhage

Answer

Spinal muscular atrophy

Answer

Galactosemia

Answer

Congenital hydrocephalus

Answer

Phenylketonuria

Question 10

A 7-year-old boy is brought to the emergency department because of a 3-day history of generalized fatigue, myalgia, and fever. He has sickle cell disease. His current medications include hydroxyurea and folic acid. He appears ill. His temperature is 39.2°C (102.6°F), pulse is 103/min, and respirations are 28/min. Examination shows pale conjunctivae. The lungs are clear to auscultation. The abdomen is soft and nontender. Neurologic examination shows no focal findings, His hemoglobin concentration is 10.3 g/dL and leukocyte count is 14,100/mm3. Intravenous fluid is administered and blood cultures are obtained. Which of the following is the most appropriate next step in treatment?

Accepted Answer

Ceftriaxone

Answer

Clindamycin

Answer

Prednisone

Answer

Vancomycin

Answer

Levofloxacin

Neonatal infections

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Early-onset sepsis

Late-onset sepsis

Group B streptococcal disease

Neonatal meningitis

Congenital TORCH infections

Neonatal HSV

Neonatal candidiasis

Necrotizing enterocolitis

Omphalitis

Nursery outbreaks

Antibiotic stewardship in NICU

Diagnostic approach to neonatal sepsis

Maternal factors and neonatal infection risk

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