1 The child was born from the third pregnancy, the second birth. Pregnancy proceeded against anemia,
gestosis of the second half. The gestation period is 35 weeks, with a mass of 2200.0; length - 45 cm.
Evaluation on the Apgar score 6/7 points. After 6 hours appeared respiratory disorders: paradoxical
breathing, acute retractions of intercostal spaces and sternium, manifest perioral cyanosis, extended
expiration auscultatory. How many points on the Silverman score is needed to evaluate the condition of
the child?
A 8 points
B 4 points
C 5 points
D 6 points
E 7 points
2 A newborn at the 1 st minute after birth has respiratory rate-26 / min., heart rate - 90 / min. Muscle
tone is low. During the suction of mucus by a catheter from the nose and mouth - the child reacts with a
grimace. The skin is cyanotic. Auscultatory: weakened vesicular breathing over the lungs. Heart sounds
are sonorous. After 5 minutes: respiratory rate - 40 / min., rhythmic heart rate - 120 / min. Acrocyanosis,
muscle tone decreased. What is the most likely diagnosis?
A Asphyxia of the newborn
B Birth trauma of the newborn
C Hemolytic disease of the newborn
D Hemorrhagic disease of the newborn
E Sepsis of the newborn
3
The newborn child is diagnosed with intranatal asphyxia. During mucus sucking from the upper
respiratory tract, the meconium contaminants were revieled. There is no independent breathing. The
further action of the neonatologist should provide:
A Intubation of the trachea, sanitation of the respiratory tract
B External heart massage
C Application of 100% oxygen
D Introduction of epinephrine
E Tactile stimulation of respiration
4
The child has stopped breathing suddenly. His skin became cyanotic. There is disappearing of pulse on
the main vessels and narrowing of the pupils. What are the best first-priority measures?
A Artificial ventilation of the lungs, closed heart massage
B Intravenous administration of euphyllin
C Gastric lavage
D Oxygenotherapy
E Intracardiac injection of epinephrine
5
The baby was born with an Apgar score of 8-9 points. When should it be put on the mother’s chest?
A After treatment of the umbilical cord and prevention of gonorrhea
B Immediately after birth
C After the treatment of the umbilical cord
D 30 minutes after birth
E 2 hours after birth
6
A newborn weighs 4000 g. During delivery the delay in the removal of the shoulders was observed.
According to Apgar score the condition was 6-8 points. Erba-Duchenne's paralysis on the left side was
diagnosed on examination. Specify the level of damage to the spinal cord:
A CV-CVI
B C I-C III
C C III - CIV
D CVII-Th I
E Th I - Th II
7
After pathological delivery, a newborn of life has no active movements in the right hand from the first
day. There is dislocation of the child’s position. Moro reflex is not called to the right. The tendonperiosteal reflexes on the affected arm are sharply reduced. What is the most likely diagnosis?
A Traumatic plexitis, total type
B Traumatic plexitis, distal type
C Osteomyelitis of right humerus
D Traumatic fracture of right humerus
E Intracranial birth injury
8
A premature boy of the first day of life was born on the 29th week of gestation from pregnancy with
chronic fetoplacental insufficiency, the threat of interruption. Body weight at birth 1200 g, height 38 cm,
grade Apgar score 3/4 points. Self-breathing is not present, artificial ventilation of lunds is performed.
Respiratory distress syndrome, disseminated lung atelectasis are diagnosed. Which drug should be
prescribed firstly?
A Alveofakt endotraсheal
B Dexamethasone intravenously
C Eufillin endotraheal
D Etymisol intravenously
E Ambroxol intravenously
9
A 2-day-old baby who was born on the 34th week of pregnancy with a weight of 2200 g and an Apgar
score of 6 points has respiratory distress in the form of retraction of the xiphoid process and intercostal
spaces, the participation of the nose wings in breathing. There are no percussion changes, with
auscultation - moist various rales at both sides. Congenital reflexes are called. There is acrocyanosis of
the skin. Indicate the most likely cause of respiratory distress:
A Aspiration syndrome
B Primary atelectasis of the lungs
C Congenital pneumonia
D Disease of hyaline membranes
E Birth injury
10
A newborn child has the gestation age of 42 weeks. Amniotic waters are with meconium impurities. At
the third minute after birth, the child had marked signs of a syndrome of respiratory disorders, with
auscultation in the lungs - an abundance of moist rales. Radiographically, there are confluent foci of
compaction of lung tissue. What is the probable diagnosis?
A Aspiration pneumonia
B Congenital sepsis
C Scattered atelectasis of the lungs
D Craniocerebral trauma
E Congenital diaphragmatic hernia
11
Since 4 hours after birth, a premature baby born with the gestational age of 34 weeks has tachypnea,
breathing by the type of swings, sternal sinking, expiratory noises. Respiratory rate - 80 / min.
Weakened breathing is observed above the lungs with incontant, different-sized rales. On the radiogram
of the lungs – air-full bronchogram and nodose-reticular net. What is the most likely diagnosis?
A Hyaline membranes disease
B Atelectasis of the lungs
C Syndrome of massive meconial aspiration
D Birth trauma
E Pneumonia of newborns
12
The child was born at the gestational age of 30 weeks, with a weight of 1100.0. Since 3 hours after birth,
there were frequent apneas, breathing by the type of "gasps", heart rate of 98 per min. Score on the
Silverman scale 9 points. Additional oxygenation did not lead to an improvement in the condition. What
needs to be done?
A Start ventilation under positive pressure
B Start a tactile stimulation
C Start intubating the trachea
D Initiate artificial ventilation
E Start an external massage of the heart
13
A newborn at the age of 32 weeks gestation since 2 hours after birth has progressive cyanosis, shortness
of breath, swelling of the wings of the nose, retraction of intercostal spaces, weakened breathing. Score
on the Silverman scale - 4 points. X-ray examination of the chest revealed a nodose-reticular pattern of
the lungs, reduced pneumatization. What is the most likely diagnosis?
A Respiratory distress syndrome
B Intratinal asphyxia
C Congenital pneumonia
D Pneumothorax
E Congenital heart disease
14
A newborn has jaundice at the age of one day. Total serum bilirubin is 144 μmol / l, indirect bilirubin130 μmol / l. The Coombs test is positive. A child from the first pregnancy. The mother's blood group is 0
(I) Rh (-). What is the probable cause of jaundice?
A ABO-incompatibility
B Atresia of the biliary tract
C Rh-incompatibility
D Physiological jaundice
E Fetal hepatitis
15
A child was born from physiological delivery on time. On the second day, the child has an icteric skin and
mucous membranes. Indirect bilirubin is 136 μmol / l. The mother's blood group is 0 (I) Rh-, in the child A (II) Rh +. What is the mechanism of jaundice?
A Hemolysis of erythrocytes
B Cholestasis
C Hepatitis
D Disturbance of outflow of bile
E Disturbance of bilirubin metabolism
16
From the first days of life, a newborn had jaundice. Level of indirect bilirubin was 328 mmol / l. The
child is from the second pregnancy, delivery on time. Mother’s blood group is I (0), Rh (+). On the 3rd
days tarted regurgitation, poor sucking. The liver and spleen are enlarged. Hb - 140 g / l, er. 4 х1012/ / l.
What is the most likely diagnosis?
A Hemolytic disease of newborns
B Physiological icterus
C Fetal hepatitis
D Conjugation jaundice
E Atresia of the biliary tract
17
The child with the age of 3 days of lifeis remaining on treat mentatthespecializeddepartmentwith a
diagnosis: Birth trauma, CNS damage, subarachnoid hemorrhage. There is cefalogematoma of the
occipital bone. In the general blood test analysis: Er - 3.4 x 10¹² l, Hb - 118 g / l, CI- 1.0. What is the main
cause of the change?
A Posthemorrhagic anemia
B Hemolytic anemia
C Deficiency of erythropoietin
D Disturbance of hemopoiesis
E Iron deficiency
18
A newborn child with blood group A (II) Rh +, which was born from a mother with a group 0 (I), Rh +, had
jaundice on the second day of life. The total bilirubin level was 310 μmol / l, due to the predominance
of the indirect fraction. Transaminases in the blood serum are equal to the normal value. What is
the presumptive diagnosis of the child?
A Hemolytic disease of newborns associated with ABO conflict, icteric form
B Hemolytic disease of newborns associated with Rh-conflict , icteric form
C Fetal hepatitis
D Atresia of the bile ducts
E Gilbert's Syndrome
19
A baby was born from a second full term pregnancy, the second urgent delivery from a mother who has
the blood group A (II) Rh-. The baby's blood group is 0 (I) Rh +. The level of indirect bilirubin in the blood
from the umbilical cord was 45 μmol / l. After 3 hours, the indicator of the content of indirect bilirubin in
the blood serum of the child was 170 μmol / l. At this point, the child should be assigned:
A Replacement blood transfusion
B Phototherapy
C Phenobarbital
D Enterosorbents
E Infusion therapy
20
A newborn with hemolytic disease associated with the Rh factor has the blood group O (I) Rh (+), the
mother’s blood group is A (II) Rh (-). What kind of blood is needed to be transfused during a transfusion
operation?
A O (I) Rh (-)
B A (II) Rh (-)
C O (I) Rh (+)
D A (II) Rh (+)
E B (III) Rh (-)
21
A child was born on time from Rh - negative mother. It was the second pregnancy (the 1st one ended by
childbirth of healthy full-term child). What are tactics of postnatal diagnosis?
A Determine Rh-accessory and bilirubin of cord blood
B Determine group and Rh-blood accessory
C Determine bilirubin of umbilical cord blood, general blood test
D Determine ALT and AST, Coombs test
E Determine group and Rh-blood accessory, total blood test
22
On the third day of life, a full-term baby has hemorrhages on the skin, bloody vomiting, melena.
Hemorrhagic disease of the newborn was diagnosed. What drug is needed for the child as an emergency
aid?
A Fresh-frozen plasma
B Erythrocyte mass
C Platelet mass
D Etamsylate
E Calcium chloride
23
The child was born with a mass of 3700 with and an Apgar score of 8-10 points. On the 5th day of life,
the child was discharged home. On the 8th day of life a vesicle-pustular eruption appeared on the skin
of the child in the places of natural folds. The general condition of the child is not violated. The general
or common analysis of a blood without abnormalities. Formulate the diagnosis:
A Vesiculopustulosis
B Epidermal pemphigus of newborns, benign form
C Ritter's exfoliative dermatitis
D Intranatal rubella
E Congenital syphilis
24
A one-year-old baby has symptoms of chorioretinitis, hydrocephalus. The child was born premature,
with signs of intrauterine infection. Indicate the most likely cause of the disease:
A Toxoplasmosis
B HIV infection
C Viral hepatitis B
D Mycoplasmosis
E Chlamydia
25
The child (was born at the 8th month of pregnancy) has: microcephaly, cataract, heart disease. The
mother of the baby was sick at the 2nd month of pregnancy: there was a short-term of rising in
temperature to 37.5oC, an increasing in lymph nodes and a small-spot rash on the trunk and extremities
that disappeared without residual effects. What condition was the mother suffering during pregnancy?
A Congenital rubella
B Cytomegalovirus infection
C Herpetic infection
D Chlamydial infection
E Toxoplasmosis
26
A newborn child with gestational age of 36 weeks (after birth the weight was 2400g, the length- 51 cm)
is highly excitable. There are tremor of extremities, poor sucking, expressed dyspnea,
hepatosplenomegaly. At the end of the first day, jaundice of the skin and mucous membranes appeared,
on the second day there was a rash on the skin (vesicles in the thorax). What is your diagnosis?
A Intrauterine infection
B Hemolytic disease of the newborn
C Newborn physiological jaundice
D Hypoxic - ischemic encephalopathy
E Atresia of the biliary tract
27
A newborn child from the first pregnancy has the gestational age of 36 weeks. Birth weight of 2200g,
and length of 41 cm. The mother lives in the village, has a cat, a dog. Pregnancy was complicated by
toxicosis, subfebrile temperature was noted. The condition of the child after birth is severe: there are
clinical manifestations of perinatal damage of the central nervous system, hypertensive - hydrocephalic
syndrome. Radiographically: calcifications of the brain. Signs of chorioretinitis. What is the possible
diagnosis:
A Toxoplasmosis
B Listeriosis
C Syphilis
D Mycoplasma infection
E Cytomegalovirus infection
28
A newborn girl of the 4- day-old has swelling of the mammary glands with secretion, swelling of the
vulva, spotting from the genital tract. What is the most likely cause of this condition?
A Transition of the mother's estrogen to the fetus
B Adopting mother hormones during pregnancy
C Increased thyroid stimulating hormone in a newborn
D Granulosocular tumor
E Testicular feminization
29
A newborn baby has swollen eyelids, hyperemic conjunctiva and a small amount of clear eye discharge
since 6 hours after birth. What is the most likely diagnosis?
A. Chemical conjunctivitis
B. Dacriocystitis
C. Pneumococcal conjunctivitis
D. Gonococcal conjunctivitis
E. Chlamydial conjunctivitis
30
A child was born with anemic-jaundiced hemolytic disease. The baby is from the second delivery of 30years-old mother. Woman’s blood group is A (II) Rh negative; blood group of the newborn is B (ІІІ) Rh
positive, blood group of newborn's father is B (ІІІ) Rh positive also. What is the most likely cause of an
immune conflict?
A. Rhesus-conflict
B.
C.
D.
E.
Conflict with Antigen B
Conflict with AB0
Conflict with Antigen A
Conflict with antigen AB
31
In a newborn with a gestational age of 31 weeks, lethargy, muscular hypotension and oppression of
consciousness are increasing. Liquor analysis: elevated levels of erythrocytes, protein, and high glucose
content. What is the most likely diagnosis?
A. Intracranial hemorrhage
B. Anemia
C. Fetal infection
D. Meningitis
E. Sepsis
32
In a 3-day-old infant newborn, the level of indirect bilirubin is - 345 μmol / l, hourly increase - 6.8 μm / l.
The condition of the child is heavy: reflexes are reduced; there is hypotension of muscles, tremor of
blood vessels. The blood of the child and the mother is incompatible with the Rh factor. Which method
of treatment is most effective?
A. Replacement transfusion of single-group and Rh-compatible blood
B. Phototherapy
C. Reception of a phenobarbital
D. Hemosorbtion
E. Replacement transfusion of Rh-compatible blood
33
In a full-term newborn of the 8-days-age, body temperature increased up to 37, 5oC. Breast sucking
became sluggish. The child was attached to the mother's breast on the 3rd day due to the postpartum
endometritis of the mother. Objectively: the child is active. There are surface flaccid blisters with a
diameter of 10, 5-10 mm and cloudy contents, located on the skin of the chest, abdomen, thighs. Some
of them collapsed, with a bright pink surface. On the part of the internal organs there is no change.
Indicate the most probable diagnosis:
A.
B.
C.
D.
E.
Newborn pemphigus
Vesiculopustulosis
Ritter Exfoliative Dermatitis
Lyell's syndrome
Infected inpetigo
34
The newborn has been suffering from asphyxia during childbirth. On the 3rd day of life, bleeding from
the umbilical wound appeared. The results of the laboratory tests revealed gipocoagulation,
thrombocytopenia, gipotrombinemia. What are the causes of the clinical laboratory changes?
A.
B.
C.
D.
E.
DIC-syndrome
Hemorrhagic disease of newborns
Congenital angiopathy
Thrombocytopenic purpura
Trauma of the umbilical vessel
35
The child was born from an HIV-infected mother. The general condition is satisfactory. Evaluation by the
Apgar score is 8 points. Body weight is 3200g, length - 50 cm. During pregnancy, childbirth and
postpartum period, chemoprophylaxis of AIDS has not been performed. When can the presence of HIV
infection be determined by ELISA?
A.
B.
C.
D.
E.
After 18 months
After 6 months
After 3 months
In 1 month
On the first days after birth
36
A newborn was born from Rh-negative mother. The childbirth was urgent. The baby is from the second
pregnancy (the first one has ended by the delivery of a healthy child). What should the tactics of the
post-natal diagnostic be?
A.
B.
C.
D.
E.
Determine the Rh factor and bilirubin of the umbilical cord blood
Determine the blood group and the Rh factor
Determine the bilirubin of the umbilical cord blood and general blood test
Determine ALT and AST, Coombs test
---
37
A child was born from the first pregnancy, proceeding on the background of the threat of breakdown.
On the seventh day, there was icteric colouration of the skin with a grey tinge, hemorrhagic discharge
from the umbilical wound, dark color of urine, acholic stool. The results of the blood analysis: bilirubin
total is 160 μmol / l, direct is 90 μmol / l, AST - 1,9 mmol / l, ALT - 2,2 mmol / l, prothrombin - 47%,
general protein is 40 g / l. Ultrasound of the liver reveals bile ducts, formed correctly. The mother has
blood group B (III) Rh "-", child A (II) Rh "-". What kind of jaundice does this disease belongs to?
A.
B.
C.
D.
E.
Parenchymal
Hemolytic
Conjugation
Mechanical
Mixed
38
The child was born with the gestational age of 40 weeks. A birth weight was 3000 g. The evaluation by
the Apgar score was 7-8 units. Mother’s blood group is AB (IY) Rh (-) negative, the child’s one is B (III) Rh
(+) positive. Jaundice appeared on the first day. Total bilirubin is 200 μmol / l, indirect fraction -190 μmol
/ l, direct fraction - 10 μmol / l, Hb-160 g / l, reticulocytes - 4,4%. The liver is +4 cm, the spleen is + 1.5
cm. The urine is light, while the stool is colored. The Coombs test is positive. Your diagnosis will be:
A.
B.
C.
D.
E.
Hemolytic disease of newborns
Hemorrhagic disease of newborns
Fetal hepatitis
Physiologicaljaundice
TheKriegler-Nayarsyndrome
39
The right arm of a newborn child is adducted to the trunk, extended in all joints, rotated inward in the
shoulder, penetrated in the forearm; the hand is in condition of palmar flexion. There are no
spontaneous movements in the shoulder and elbow joints. Passive movements are painless. What is the
most likely diagnosis?
A.
B.
C.
D.
E.
Upper proximal obstetric paresis, Dushenne-Erb type
Lower distal obstetric paresis, Dezherin-Klumpke type
Total type of obstetric paresis
Osteomyelitis of right humerus
Poliomyelitis
40
A premature newborn with a nasopharyngeal tube had vomiting with scarlet blood on the first day of
life. The Apt test is positive. Blood coagulation test according to Lee-White - 6 min. What is the most
likely cause of bleeding?
A.
B.
C.
D.
E.
Maternal blood swallowing
Injury with insertion of a probe
Hemorrhagic disease of newborns
DIC-Syndrome
Coagulopathy
41
A newborn child with the weight of 3100 g was born from the third pregnancy. The first pregnancy
ended by artificial abortion, the second one – by spontaneous miscarriage in 12-13 weeks. Evaluation by
the Apgar score on is 9 points. The placenta is large, weighing 800 g. On the first day, the yellow color of
the skin appeared. The child has become sluggish. The mother has B (III), Rh a negative blood group, the
child is A (II) Rh-positive. There is an increase of liver and spleen. Results of the umbilical cord blood
analysis- bilirubin - 80 μmol / l; Hb - 116 g / l, erythrocytes - 2,0х10¹² / l; there is presence of young forms
of erythrocytes. What is the most appropriate treatment tactic in this case?
A.
B.
C.
D.
E.
Replacement blood transfusion
Phototherapy
Desintoxication
Improving of liver conjugative function
Using of enterosorbents
42
On a day after birth, the condition of a newborn has gotten worse. It is known from the anamnesis that
his mother has 0 (1) Rh [-] blood group, father - A (II) Rh [+]. The first pregnancy ended with a
spontaneous miscarriage. The baby is pale. There is vascular convulsive trembling of the limbs. Liver is
enlarged. Icteric coloration of the skin and mucous membranes is observed. What is the most likely
diagnosis?
A.
B.
C.
D.
E.
Hemolytic neonatal disease
Intrauterine infection
Infectious hepatitis
Intracranial injury
Transient hyperbilirubinemia
43
A child was born with the gestational age of 32-weeks. Since four hours after birth, symptoms of
respiratory distress syndrome have developed. Objectively: there is bloody-foamy discharge from the
mouth. Auscultatory: weakened breathing, diffuse crepitation and mild fine moist rales are determined
in the lungs. Radiographically: there is a decrease in the size of pulmonary fields, a "blurred"
radiographic picture. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Edematous-hemorrhagic syndrome
Primary atelectasis
Hyaline membranes disease
Transient tachypnea
Intrauterine pneumonia
44
The child has B (III) Rh-negative blood group, the mother- A (II) Rh-positive. On the 12th day of life, the
level of total bilirubin is 150 μmol / l, direct fraction 7.8 μmol / l, indirect fraction 142.2 μmol / l. The
condition is not violated. What is the most likely diagnosis in a child?
A.
B.
C.
D.
E.
Conjunctive jaundice
Hemolytic disease of newborns, icteric form, Rh-conflict
Hemolytic disease of newborns, icteric form, group incompatibility
Mechanicaljaundice
Physiologicaljaundice
45
The baby was born from the fifth pregnancy (previous pregnancies were interrupted in the first
trimester), proceeding against the background of gestosis, anemia and chronic salpingoforeitis of the
mother. An abnormal eye development (congenital cataract of the left eye), anagenesis of the external
auditory passage and congenital heart defect have been observed in the child. What is the most
probable reason of these abnormalities?
A.
B.
C.
D.
E.
Intrauterine infection
Genetic anomalies
Chromosomal abnormalities
Influence of professional harm
Influence of contaminated environment
46
The boy of the age of 1 month has been admitted to the hospital because of hydrocephalus, moderate
jaundice. The child is from the third pregnancy, proceeded with the threat of interruption. The labor has
been flowing normally. The mother works on a farm. Results of the examination: there is chorioretinitis,
intracranial calcifications, and liver+ 3 cm. Changes of liquor are determined: xanthrochromy, protein 4.2 g / l, cytosis- 60 cells, lymphocytes -70%. The results of the blood tests: Hb-105 g / L, erythrocytes3.5 T / L, CI-0.85, leukocytes- 11 g / l, lymph.-55%, segmented neutroph.-25%, eosinophils-12%,
monocytes-8 % What is the most likely reason for this child's condition?
A.
B.
C.
D.
E.
Congenital toxoplasmosis
Intracranial labor injury
Cytomegalovirus infection
Herpetic infection
Congenital syphilis
47
The newborn girl was born from the second pregnancy, proceeded against the background of
pyelonephritis, colpitis. From the 3rd day of life, the appearance and growth of skin yellowness were
observed with the background of sluggishness, loss of appetite. There is weakened breathing in the
lungs. Heart tones are muffled. Moderate abdominal bloating is noted . Liver is +3 cm. Spleen is +0.5 cm
Urine has a color of "beer", stool has the usual color. Total bilirubin -168 μmol / l, direct fraction -138
μmol / l. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Intrauterine hepatitis
Hemolytic neonatal disease
Physiological jaundice of newborns
Jaundice of mother's milk
Atresia of biliary tract
48
The child is 3 months old. Head circumference was 35cm at birth; one is 45cm during examination.
Symptoms of excitability, bulging of fontanelsare revealed. Size of the anterior fontanel is 4x4cm;
sagittal seam is open to 1cm. The child has regurgitation and vomiting separately from eating. There is
psychomotor development delay. Muscle tone is elevated. Eye fundus is with the signs of stagnation.
Which pathology is most probable?
A Hydrocephaly
B Meningitis
C Rachitis
D Microcephaly
E Craniostenosis
49
Vomiting with blood impurities and melena have been observed in a healthy 2-days-old girl. What is the
most likely diagnosis?
A Hemorrhagic disease of the newborn
B Birth injury
C Thrombocytopathy
D DIC-syndrome
E Disorders of the gastrointestinal tract
50
Newborn baby with the gestation period of 38 weeks has a weight of 3400 g, length of 54 cm.
The general condition at birth is moderate due to asphyxia of medium severity. After primary intensive
care, there was an independent breath, the heart rate - 110 beats per minute. Acrocyanosis is noted.
What is the next action of a neonatologist in this situation?
A Additional oxygenation.
B Intubation of the trachea.
C Artificial heart massage.
D Mucus suction from the upper respiratory tract.
E Auxiliary ventilation of the lungs.
51
A child with the age of 2 days was born on the 32nd week of pregnancy with a weight of 1700 g.
Changes of the respiratory system have been increasing since 8 hours after birth. The child is from the
III pregnancy, II delivery. There were no abortions. Previous born baby died from respiratory distress
syndrome. Objectively: score by the Silverman scale is 6 points, breathing is with violated rhythm.
Apnea, sound exhalation, nodding of his head during breathing are determined. There is reducing of
muscle tone. Auscultatively: breathing is moderately weakened; there are many wheezing on both sides.
Rentgenologically: presence nodose-reticulum mesh is detected. What is the reason of respiratory
distress syndrome in a child?
A Hyaline membrane syndrom
B Diaphragmatic hernia
C Atellectasis of the lungs
D Fetal pneumonia
E Fetal hemorrhagic syndrome
52
Pregnant woman R., 26 years old, has been admitted to the maternity hospital in a labor period. This is
the second pregnancy. The first one ended with premature delivery of dead fetus. Since 30 minutes
after the beginning of the labor, alive girl with a weight of 3600 g was born. Childs crying appeared
immediately. The skin is pale. There is slight jaundice. An increase of the liver and spleen is determined.
The afterbirth tissues have detached and separated after 15 minutes; the mass of the placenta is 800 g.
Mother has blood type 0 (1) group, Rh negative, child - 0 (1) group, rhesus positive. The results of the
blood test: bilirubin is 64 μmol / l, hemoglobin 160 g / l. Which of the diagnoses is the most probable?
A Hemolytic disease of the newborn, jaundice-anemic form
B Intracranial neonatal birth trauma
C Asphyxiation of newborn severe degree
D Postpartum tumor
E Fetal infection
53
The boy was born in asphyxia on the 40th week of pregnancy. This is the 6th pathological pregnancy
(with threat of breakdown, gestosis of the 1st type in the 2d half of pregnancy). The child is from the
third parturition. Mother is 40 years old. The condition of the child is heavy, due to the signs of
immaturity, symptoms of hydrocephalus. Baby’s weight is 2 kg. Skin is pale with yellow shading.
Acrocyanosisis noticed. Heart tones are deaf, with coarse systolic murmur at all the points. The
abdomen is enlarged, the liver is +3 cm. Urine is saturated, feces are light. There are signs of
chorioretinitis. Your previous diagnosis is:
A Congenital toxoplasmosis
B Hemolytic neonatal disease
C Sepsis
D Congenital heart defect
E Congenital hepatitis
54
A child is 1 month old. During childbirth, weakness of labor activity was observed. There is difficulty in
movements in the shoulders. Objectively: the left arm hangs over the body, the upper part of it is
slightly turned inward, the forearm is pronated and bent in elbow joint, and the palm is turned back and
out. At the left, Moro reflection is negative; Babkin's and Robinson's reflexes are much lowered. The
muscular hypotension has appeared on the left upper extremity. What is the most likely pathology that
causes such a picture?
A Duchen - Erb paralysis
B Degerin - Klyumpke paralysis
C Left-hand hemiparesis
D Upper paraparesis
E Double hemiplegia
55
On the 3rd day of life, fever is noted in a newborn child. Body temperature has been increased up to
38.5 C. Objectively: the baby is restless, mucous membranes and skin are dry. What is the most
appropriate tactic of patient management?
A Release the baby from the diaper, additionally, inject 5% solution of Glucose up to 100 ml
B 0.1 ml 50% analgin solution in muscle
C Purpose of a blend of lithium
D Infusion therapy
E Antibiotic
56
The girl is from the second pregnancy, proceeding with the threat of interruption on 25-27
weeks, chronic fetoplacental insufficiency. At childbirth, there was single tight umbilical cord loop
around the neck of the fetus, difficulty in removing of the shoulders. After birth, baby is estimated on
the Apgar scale for 1 minute: no respiration, heart rate - 50 per minute, total cyanosis, atone, areflexia.
What is the evaluation by Apgar score in this case?
A 1 point
B 2 points
C 3 points
D 4 points
E 0 points
57
A 12-year-old child was born from a second pregnancy, proceeding against the background of a
woman's toxicosis, chronic adnexitis. After birth the child’s weight was 2900 g, the length - 52 cm. Apgar
score: 4-6 points. Objectively: the child's condition is heavy. Crying of quiet, congenital reflexes are
depressed, muscular tone is lowered. Skin with grey coloration. Acrocyanosisis detected. Breathing is
superficial and non-rhythmic, 70 / min. Auscultatory: there is weakened breath, various moist rales.
Heart rate-140 / min. Liver is +2 cm. Meconium was excreted. What is the previous diagnosis?
A Fetal pneumonia
B Early postnatal pneumonia
C Postnatal pneumonia
D Sepsis
E Primary diffuse atelectasis
58
The parturition has ended by the childbirth of alive, full-grown girl, without asphyxia. Objectively: child is
sluggish, the skin is pale, slightly yellowish. There is no edema. Abdomen is soft, liver and spleen are
enlarged. The mother’s blood group is A [II] Rh negative, the child’s one - A [II] Rh positive. What
pathology can be assumed at the baby?
A Hemolytic disease of the newborns
B Violation of cerebral circulation
C Abnormalities of development of parenchymal organs
D Physiological jaundice
E Intracranial traumatic brain injury
59
A newborn with gestational age of 31 weeks has hypotension and suppression of consciousness. The
results of the blood test analyses: hematocrit is 35%; levels of erythrocytes, protein have been increased
while glucose content has been reduced. This data match the clinical picture of:
A Intracranial hemorrhage.
B Meningitis.
C Sepsis.
D Anemia
E Fetal Infections
60
In a boy with the age of 4 days of life, manifestations of hemorrhagic disease of newborns have
appeared in a kind of melena. Which drug should a doctor appoint in the first hours of life for the
prevention of this disease?
A Vikasol
B Calcium gluconate
C Dicinone
D Aminocaproic acid
E Vitamin C.
61
The child was born from the second premature childbirth with a body weight of 1800g and estimation
by Apgar score of 7 points, Silverman scale - 3 points. Since 2 hours after birth, the condition of the child
has worsened. The child began to moan. Shortness of breath has appeared. There is perioral cyanosis
and acrocyanosis. Exhalation is difficult, sonorous. Percussion of the lungs reveals tympanitis,
auscultatory - diffuse crepitation. Tachycardia is noticed. What is the most likely diagnosis?
A Respiratory distress syndrome
B Fetal pneumonia
C Aspiration pneumonia
D Perinatal injury of the central nervous system
E Bronchopulmonary dysplasia
62
In the newborn with asphyxia at birth, apnea and bradycardia has been observed. Heart rate was 70
beats per minute. Immediately, artificial lung ventilation with 100% oxygen has been started using a
mask and bag Ambu. After 30 seconds, the heart rate has not changed. What should be the next step of
resuscitation activities?
A Indirect heart massage
B Tactile stimulation
C Continue to ventilate
D Sodium hydrogen carbonate interstitial
E Epinephrine is intracranial
63
Weight of the body of a newborn child is 2000 g. Gestation period - 30 weeks. Since 3 hours after birth,
suffocation and acrocyanosis have appeared. Objectively: respiratory rate - 80 / min, there are evident
expiratory noises, heart rate - 186 / min. The percussion sound is shortened and crepitation is heard.
The physician suspected respiratory distress syndrome. Which study is the most necessary to confirm
the diagnosis?
A Radiography of the respiratory organs
B Blood test
C Biochemical examination of serum
D Blood Pressure Measurement
E Electrocardiography
64
A neonate was born from the 1st gestation on term. The jaundice was revealed on the 2nd
day of life, then it became more acute. The adynamia, vomiting and hepatomegaly were
observed. Indirect bilirubin level was 275мmol/L, direct bilirubin level - 5мmol/L,
Hb - 150 g/l. Mother’s blood group – 0(I), Rh+, child’s blood group- A(II), Rh+. What is the
most probable diagnosis?
A Hemolytic disease of the neonate (АВО incompatibility), icteric type
B Jaundice due to conjugation disorder
C Hepatitis
D Physiological jaundice
E Hemolytic disease of the neonate (Rh – incompatibility)
65
A baby boy was born in time, it was his mother's 1st pregnancy. The jaundice was revealed
on the 2nd day of life, then it progressed. The adynamia, vomiting and hepatomegaly were
presented. The indirect bilirubin level was 275 mcmol/L, the direct bilirubin level - 5
mcmol/L, Hb- 150 g/L. Mother's blood group - 0(I), Rh+, child's blood group - A(II), Rh+. Make a diagnosis.
A Hemolytic disease of newborn (АВО incompatibility), icteric type
B Jaundice due to conjugation disorder
C Hepatitis
D Physiological jaundice
E Hemolytic disease of newborn (Rh - incompatibility)
66
A woman delivered a child. It was her fifth pregnancy but the first delivery. Mother's blood
group is A(II)Rh-, newborn's - A(II)Rh+. The level of indirect bilirubin in umbilical
blood was 58 micromole/l, haemoglobin - 140 g/l, RBC- 3,8*1012/l. In 2 hours the
level of indirect bilirubin turned 82 micromole/l. The hemolytic disease of newborn
(icteric-anemic type, Rh-incompatibility) was diagnosed. Choose the therapeutic tactics:
A Replacement blood transfusion (conservative therapy)
B Conservative therapy
C Blood transfusion (conservative therapy)
D Symptomatic therapy
E Antibiotics
67
A baby was born at 36 weeks of gestation. Delivery was normal, by natural way. The baby
has a large cephalohematoma. The results of blood count are: Hb- 120g/l, Er- 3,5*1012/l, total serum
bilirubin - 123 mmol/l, direct bilirubin - 11 mmol/l, indirect - 112 mmol/l. What are causes of
hyperbilirubinemia in this case?
A Erythrocyte hemolysis
B Intravascular hemolysis
C Disturbance of the conjugative function of liver
D Bile condensing
E Mechanical obstruction of the bile outflow
68
Full term newborn has developed jaundice at 10 hours of age. Hemolytic disease of
newborn due to Rh-incompatibility was diagnosed. 2 hours later the infant has indirect
serum bilirubin level increasing up to 14 mmol/L ?. What is most appropriate for treatment of
hyperbilirubinemia in this infant?
A Exchange blood transfusion
B Phototherapy
C Phenobarbital
D Intestinal sorbents
E Infusion therapy
69
A 6 week old child is admitted because of tachypnea. Birth had been uneventful, although
conjunctivitis developed on the third day of life and lasted for about 2 weeks. Physical
examination reveals tachypnea, bilateral inspiratory crackles and single expiratory
wheezing. Bilateral pneumonia is evident on chest X-ray. The child is afebrile and has no
history of fever. White blood cell count is 15*109/l, with 28% of eosinophils. The
most likely cause of this child's symptoms is:
A Clamydia trachomanis
B Pneumocystis carinii
C Mycoplasma pneumoniae
D Visceral larva migrans
E Varicella
70
A full term infant was born after a normal pregnancy, delivery, however, was complicated by
marginal placental detachment. At 12 hours of age the child, although appearing to be in
good health, passes a bloody meconium stool. For determining the cause of the bleeding,
which of the following diagnostic procedures should be performed first?
?A
Barium enema
B An Apt test
C Gastric lavage with normal saline
D An upper gastrointestinal series
E Platelet count, prothrombin time, and partial thromboplastin time
71
In the 43rd week of gestation a long, thin infant was delivered. He is apneic, limp, pale, and
covered with "pea soup" amniotic fluid. The first step in the resuscitation of this infant at
delivery should be:
A Suction of the trachea under direct vision
B Artificial ventilation with bag and mask
C Artificial ventilation with endotracheal tube
D Administration of 100% oxygen by mask
E Catheterization of the umbilical vein
72
A newborn aged 3 days with hyperbilirubinemia (428 mkmol/L) developed following
disorders. From beginning there were severe jaundice with poor suckling, hypotonia and
hypodynamia. Little bit later periodical excitation, neonatal convulsions and neonatal
primitive reflexes loss are noted. Now physical examination reveals convergent squint,
rotatorynystagmus and setting sun eye sign. How to explain this condition?
A Encephalopathy due to hyperbilirubinemia
B Skull injury
C Brain tumour
D Hydrocephalus
E Spastic cerebral palsy
73
Apgar test done on a newborn girl at 1st and 5th minute after birth gave the result of 7-8
scores. During the delivery there was a short-term difficulty with extraction of shoulder
girdle. After birth the child had the proximal extremity dysfunction and the arm couldn't be
raised from the side. The shoulder was turned inwards, the elbow was flexed, there was
also forearm pronation, obstetric palsy of brachial plexus. What is the clinical diagnosis?
A Duchenne-Erb palsy
B Trauma of thoracic spine
C Right hand osteomyelitis
D Intracranial haemorrhage
E Trauma of right hand soft tissues
74
A full-term child survived antenatal and intranatal hypoxia, it was born in asphyxia (2-5
points on Apgar score). After birth the child has progressing excitability, there are also
vomiting, nystagmus, spasms, strabismus, spontaneous Moro's and Babinsky's reflexes.
What localization of intracranial hemorrhage is the most probable?
A Subarachnoid hemorrhage
B Small cerebral tissue hemorrhages
C Subdural hemorrhage
D Periventricular hemorrhages
E Hemorrhages into the brain ventricles
75
A full-term infant is 3 days old. On the different parts of skin there are erythemas, erosive
spots, cracks, areas of epidermis peeling. The infant has scalded skin syndrome. Nikolsky's
symptom is positive. General condition of the infant is grave. Anxiety, hyperesthesia,
febrile temperature are evident. What is the most probable diagnosis?
A Exfoliative dermatitis
B Phlegmon of newborn
C Finger's pseudofurunculosis
D Impetigo neonatorum
E Mycotic erythema
76
A neonate from gestation with severe gestosis of the second half was born on the 41st
week with 2400 g birth weight and 50cm long. On physical examination: skin is flaccid,
subcutaneous fatty cellular tissue is thin, muscle hypotonia, new-born period reflexes are
decreased. Internal organs are without pathological changes. How would you estimate this
child?
A Term infant with pre-natal growth retardation
B Premature infant
C Immature infant
D Postmature infant
E Term infant with normal body weight
77
A child from the first non-complicated pregnancy but complicated labor had cephalhematoma. On the
second day there developed jaundice. On the 3th day appeared changes of neurologic status: nystagmus,
Graefe's sign. Urea is yellow, feces- golden-yellow. Mother's blood group is А(II)Rh-, child- А(II)Rh+. On the
third day child's Hb is 200 g/L, RBC- 6,1*1012/L, bilirubin in blood - 58 mkmol/L due to unconjugated
bilirubin, Ht- 0,57. What is the child's jaundice explanation?
A Brain delivery trauma
B Physiologic jaundice
C Hemolytic disease of newborn
D Bile ducts atresia
E Fetal hepatitis
78
A child was delivered severely premature. After the birth the child has RI symptoms,
anasarca, fine bubbling moist rales over the lower lobe of the right lung. Multiple skin
extravasations, bloody foam from the mouth have occured after the 2 day. On chest X-ray:
atelectasis of the lower lobe of the right lung. In blood: Hb-100 g/L, Ht- 0,45. What is the
most probable diagnosis?
A Edematous-hemorrhagic syndrome
B Disseminated intravascular clotting syndrome
C Pulmonary edema
D Hyaline membrane disease
E Congenital pneumonia
79
An infant is 2d.o. It was full-term born with signs of intrauterine infection, that's why it was
prescribed antibiotics. Specify, why the gap between antibiotic introductions to the
new-born children is longer and dosage is smaller compared to the older children and
adults?
A The newborns have a lower level of glomerular filtration
B The newborns have lower concentration of protein and albumins in blood
C The newborns have reduced activity of glucuroniltransferase
D The newborns have diminished blood pH
E The newborns have bigger hematocrit
80
A 40 h.o. child age has hyperosthesia, CNS depression, dyspepsia. Sepsis is suspected.
What should the differential diagnosis be made with?
A Hypoglycemia
B Hypocalcemia
C Hyperbilirubinemia
D Hyperkaliemia
E Hypomagnesemia
81
A mother of a newborn child suffers from chronic pyelonephritis. She had acute respiratory
viral disease before the labor. Labor in time, with prolonged period without waters. A child
had erythematous eruption on the 2 day, then there were seropurulent vesicles for about
1cm large. Nikolsky's symptom is positive. Erosions have occured after vesicle rupture. The
child is flabby. The temperature is subfebrile. What is the most probable diagnosis?
A Newborn pemphigus
B Vesiculopustulosis
C Pseudofurunculosis
D Sepsis
E Ritter's dermatitis
82
Mother of a newborn child suffers from chronoc pyelonephritis. She survived acute
respiratory viral infection directly before labour. Delivery was at term, the period before
discharge of waters was prolonged. On the 2-nd day the child got erythematous rash, later
on - vesicles about 1 cm large with seropurulent content. Nikolsky's symptom is positive.
Dissection of vesicles results in erosions. The child is inert, body temperature is subfebrile.
What is the most probable diagnosis?
A Impetigo neonatorum
B Vesicular pustulosis
C Pseudofurunculosis
D Sepsis
E Ritter's dermatitis
83
A child was born at 34 weeks of gestation in bad condition. The cardinal symptoms show
respiratoty disorders: sound prolonged expiration, additional muscles taking part in
breathing, crepitation rales on the background of the rough breath sounds. Assesment
according to Silverman's scale was 0, in 3 hours- 6 with presence of clinical data. What
diagnostic method can determine pneumopathy's type in the child?
A Chest X-ray
B Blood test
C Blood gases
D Proteinogram
E Immunologic investigation
84
A child is 1 day old. During delivery there had been problems with extraction of shoulders.
Body weight is 4300,0. Right arm hangs down along the body, hand is pronated, movement
in the arm is absent. "Scarf" symptom is positive. What is the most probable diagnosis?
A Total right-sided obstetric paralysis
B Proximal right-sided obstetric paralysis
C Distal right-sided obstetric paralysis
D Hemiparesis
E Tetraparesis
85
A newborn child has purulent discharges from the umbilical wound, skin around the umbilicus is swollen.
Objectively: the child's skin is pale, of yellow-greyish colour, generalized hemorrhagic rash. Body
temperature is of hectic nature. What is the most probable diagnosis?
A Sepsis
B Hemorrhagic disease of newborn
C Hemolytic disease of newborn
D Thrombocytopathy
E Omphalitis
86
On the third day of life an infant's skin got icteric coloring. The child was born with body
weight of 3,200 kg, body length of 52 cm. The child is active. There is puerile respiration
above the lungs. Respiratory rate is 36/min, heart sounds are rhythmic, heart rate is
130/min. Abdomen is soft, liver comes out from the edge of costal arch by 2 cm, spleen is
not palpable. Feces are in form of meconium. What is the most probable diagnosis?
A Physiologic jaundice
B Hemolytic disease of newborn
C Neonatal sepsis
D Minkowsky-Shauffard disease
E Biliary tracts atresia
87
A full-term infant has respiratory rate of 26/min, heart rate of 90/min, blue skin, muscle
hypotonia. During catheter suction of mucus and amniotic fluid from the nose and mouth
the child reacted with a grimace. Low reflexes. Auscultation revealed weakened vesicular
respiration above lungs. Heart sounds are loud. After 5 minutes the respiration became
rhythmic, at the rate of 38/min, heart rate of 120/min. What is the most likely diagnosis?
A Asphyxia
B Inborn pneumonia
C Birth trauma
D Bronchopulmonary dysplasia
E Respiratory distress syndrome
88
On the 6th day of life a child got multiple vesicles filled with seropurulent fluid in the region of occiput,
neck and buttocks. General condition of the child is normal. What disease should be suspected?
A Vesiculopustulosis
B Impetigo neonatorum
C Miliaria
D Impetigo
E Epidermolysisbullosa
89
A full-term newborn was born with body weight of 4000 g, body length of 57 cm. Reaction to the
postnatal check was absent. There was diffuse cyanosis, heart rate of 80/min. What
resuscitation measures should be taken?
A Start ALV with a mask
B Give 100\% oxygen
C Intubate the child and start ALV
D Start tactile stimulation
E Give an injection of naloxone
90
On the 3rd day of life a baby presented with haemorrhagic rash, bloody vomit, black stool.
Examination revealed anaemia, extended coagulation time, hypoprothrombinemia, normal
thrombocyte rate. What is the optimal therapeutic tactics?
A Vitamin K
B Sodium ethamsylate
C Epsilon-aminocapronic acid
D Fibrinogen
E Calcium gluconate
91
After birth a child was pale and had arrhythmical breathing. Oxygen therapy didn't have any
effect. Pulse was weak and rapid. It was difficult to measure arterial pressure accurately.
There were no edemata. What is the most likely reason for these symptoms?
A Asphyxia
B Congestive heart failure
C Intracranial haematoma
D Intrauterine sepsis
E Congenital pneumonia
92
On the 1st day of life a full-term girl (2nd labour) weighing 3500g, with Apgar score of 8 points,
presented with jaundice. Indirect bilirubin of blood - was 80 micromole/l, 6 hours later - 160
micromole/l. What is the optimal method of treatment?
A Exchange blood transfusion
B Phototherapy
C Infusion therapy
D Phenobarbital treatment
E Enterosorbents
93
A full-term baby was born with body weight of 3200 g, body length of 50 cm, Apgar score 8-10 points. What is the optimum time for the first breast-feeding?
A First 30 minutes
B First 6 hours
C First 24 hours
D First 48 hours
E After 48 hours
94
A full-term baby (the 1st uncomplicated pregnancy, difficult labour) had a cephalogematoma.
On the 2nd day there was jaundice, on the third the following changes in neurological status
appeared: nystagmus, Graefe syndrome. Urine was yellow, feces were of golden-yellow
colour. Mother's blood group is A (II) Rh$^-$, the baby's one - A (II) Rh$^+$. On the third day
the child's Hb was 200g/l, RBCs - $6,1\cdot10^{12}$/l, blood bilirubin - 58 micromole/l at the
expense of unbound fraction. What caused the jaundice in the child?
A Craniocerebral birth trauma
B Physiological jaundice
C Neonatal anaemia
D Biliary atresia
E Fetal hepatitis
95
A child was born at a gestational age of 34 weeks in grave condition. The leading symptoms
were respiratory distress symptoms, namely sonorous and prolonged expiration, involving
additional muscles into respiratory process. The Silverman score at birth was 0 points, in 3
hours it was 3 points with clinical findings. Which diagnostic study will allow to diagnose the
form of pneumopathy?
A X-ray of chest
B Clinical blood test
C Determination of blood gas composition
D Proteinogram
E Immunoassay
96
Examination of a newborn revealed skin redness that appeared immediately after birth and
reached the maximum intensity on the second day of life. What is your provisional diagnosis?
A Simple erythema
B Toxic erythema
C Transient erythema
D Erythema nodosum
E Annular erythema
97
A child is 2 days old. He was born with a weight of 2900 kg, body length of 50 cm. On
examination the skin is intensely red, elastic, with preserved turgor. Puerile respiration is
present. Respiration rate - 40/min, cardiac sounds are rhythmic, sonorous. HR- 138/min. The
abdomen is soft. The liver extends 2 cm below the costal margin. Diuresis is sufficient. Stool is
in form of meconium. What is the most likely diagnosis?
A Physiological erythema of the newborn
B Toxic erythema of the newborn
C Neonatal phlegmon
D Erysipelas
E Exfoliative Ritter's dermatitis
98
A baby born after fast labour has palsy of hand muscles. Grasp reflex is absent, as well as
hand-to-mouth reflex. Hand sensitivity is absent. What is the most likely diagnosis?
A Dejerine-Klumpke palsy
B Duchenne-Erb's palsy
C Total lesion of the brachial plexus
D Muscle paresis
E Bernard-Horner syndrome
99
A newborn (mother’s I pregnancy) weighing 3500 g presents with jaundice, lethargy, reduced reflexes.
Objectively: second grade jaundice of skin with saffron tint, liver - +2cm, spleen - +1 cm. Urine and feces
are yellow. Blood count: Hb- 100 g/l, RBCs - 3, 2 · 1012/l, WBCs - 18, 7 · 109/l, mother’s blood type - 0(I)
Rh(+), baby’s blood type - А(II) Rh(-), bilirubin - 170 mmol/l, indirect fraction. ALT, AST rates are normal.
What disease is the child most likely to have?
A Hemolytic disease of newborn, AB0-conflict
B Perinatal hepatitis
C Hemolytic disease of newborn, Rh-conflict
D Biliary atresia
E Physiologic jaundice
100
All the joints on the left elbow of a newborn are extended, the whole arm hangs vertically along
the trunk with the forearm pronated. Active movements in the elbow joint are absent but present
in the shoulder joint. The hand is flattened, atrophied, cold to the touch, hangs passively. Grasp
reflex and hand-mouth reflex on the affected side are missing. Haemogram values are normal.
What is the most likely diagnosis?
A Inferior distal obstetrical paralysis
B Osteomyelitis
C Proximal obstetrical paralysis
D Complete obstetrical paralysis
E Hypoxic-ischemic encephalopathy
101
A lumbar puncture was performed for a newborn suspected of having an intracranial birth injury. Bloody
cerebrospinal fluid was obtained. What hemorrhage occurred in this case?
A. Subarachnoid
B Cephalohematoma
C Epidural
D Supratentorial
E Subtentorial
102
A 2 month old full-term child was born with weight 3500 g and was on the mixed feeding. Current weight
is 4900 g. Evaluate the current weight of the child:
A Corresponding to the age
B 150 g less than necessary
C Hypotrophy of the I grade
D Hypotrophy of the II grade
E Paratrophy of the I grade
103
Examination of a full-term 6-day-old infant revealed that different areas of skin had erythemas, flaccid
bubbles, eroded surface, cracks, peeling of the epidermis looking like being scalded with boiling water.
There was positive Nikolsky's symptom. General condition of the child was serious. The child was restless,
hypersensitive, febrile. What is the most likely diagnosis in this case?
A Ritter's exfoliative dermatitis
B Neonatal phlegmon
C Finger's pseudofurunculosis
D Neonatal pemphigus
E Epidermolysis
104
During the first home visit to a full-term boy after his discharge from the maternity hospital a pediatrician
revealed a symmetrical swelling of mammae without skin changes over them, swelling of the scrotum.
The body temperature was of 36,5oC. The baby was calm, sucked the mother's breast actively. What
condition should you think of?
A Hormonal crisis of the newborn
B Neonatal mastitis
C Sclerema
D Necrotic neonatal phlegmon
E Congenital adrenal dysfunction
105
A full-term neonate weighing 4500 g was born asphyxiated with Apgar score of 4-6 points. During the
delivery shoulder dystocia occurred. Neurologic assessment revealed non-focal neurologic symptoms,
total flaccid paresis of the upper extremities since the arm was atonic and pronated. Grasping, Babkin's
and Moro's reflexes were absent. What segments of spinal cord had been affected?
A СV - ThI
B СI - СII
C СIII - СIV
D ThI - ThV
E ThVI - ThVІІ
106
10 days after birth, a newborn developed a sudden fever up to 38,1oC. Objectively: the skin in the region
of navel, abdomen and chest is erythematous; there are multiple pea-sized blisters with no infiltration at
the base; single bright red moist erosions with epidermal fragments on the periphery. What is your
provisional diagnosis?
A Epidemic pemphigus of newborn
B Syphilitic pemphigus
C Streptococcal impetigo
D Vulgar impetigo
E Atopic dermatitis
107
At the first minute of life a full-term infant born with umbilical cord entangled around his neck has total
cyanosis, apnea, HR- 80/min, hypotonia and areflexia. There are no signs of meconium aspiration. After
the airway suctioning the newborn did not start breathing. What is the next action of the doctor?
AALV with a 100% O2 mask
B Intravenous administration of adrenaline
C Intravenous administration of etamsylate
D Tracheal intubation and ALV
E Stimulation of the skin along the spine
108
A child from primipregnancy was born in a term labor and has body weight of 4000 g and body length of
57 cm. When born, he was nonresponsive to examination. Diagniosis is diffuse. Heart rate is 80/min. What
resuscitation measures should be prescribed?
A Begin ALV with mask
B Introduce 100% oxygen
C Intubate and begin ALV
D Tactile stimulation
E Administer naloxone
109
A baby was born by a young smoker. The labourwas complicated by uterine inertia, difficult delivery of
the baby’s head and shoulders. The baby’s Apgar score was 4. Which of the following is a risk factor for a
spinal cord injury?
A Difficult delivery of the head and shoulders
B Young age of the mother
C Pernicious habits
D Uterine inertia
E Chronic hypoxia
110. A newborn infant (the firstlabor, lasted for 26 hours) is 1-day-old, postmature; body weight is 3850
g; body length is 52 cm. Delivery was performed by applying obstetrical forceps in sincipital presentation,
Apgar score is 1/3. The face is bluish-pale. The head is thrown back; severe birth trauma is present; the
infant is excitable, shrill "cerebral scream"is present; the eyes are half-open; facial expression is attentive;
hyperesthesia, hypersthenia and readiness for convulsions are present. Liquor has high content of
erythrocytes, lymphocytic cytosis occurs. The most likely diagnosis is:
A Subarachnoid hemorrhage
B Epidural hemorrhage
C Subdural hemorrhage
D Intraventricular hemorrhage
E Intracerebral hemorrhage
111. A child is 1 day old. During delivery there had been problems with extraction of shoulders. Body
weight is 4300,0. Right arm hangs down along the body, hand is pronated, movement in the arm is absent.
"Scarf"symptom is positive. What is the most probable diagnosis?
A Total right-sided obstetric paralysis
B Proximal right-sided obstetric paralysis
C Distal right-sided obstetric paralysis
D Hemiparesis
E Tetraparesis
112. A boy was born at 32 weeks gestation. 2 hours after birth he developed respiratory distress. The RD
severity assessed by Silverman score was 5. The respiratory disorders progressed, respiratory failure
couldn’t be eliminated by Martin-Bouyer CPAP (continuous positive airway pressure). Ro-gram of lungs
shows reticular and nodular pattern, air bronhogram. What is the most likely cause of respiratory distress
syndrome?
A Hyaline membrane disease
B Segmental atelectasis
C Bronchopulmonary dysplasia
D Congenital pulmonary emphysema
E Edematous hemorrhagic syndrome
113. A full-term newborn child has a diagnosis newborn’s Rh-factor hemolytic disease. Bilirubin rate is
critical. The child’s blood group is B(III), his mother’s blood group - A(II). The child has indication for
hemotransfusion. What donor blood must be chosen?
A Blood group B(III)Rh−
B Blood group A(II)Rh−
C Blood group B(III)Rh+
D Blood group A(II)Rh+
E Blood group O(I)Rh−
114. On the 2nd day of life a full-term boy developed mild jaundice of skin and mucous membranes, the
general condition of the child is normal. Blood test results: indirect hyperbilirubinemia - 120 mmol/l. The
child’s blood group is A(II) Rh(+), his mother’s blood group - B(III) Rh(+). What is the doctor’s tactics of
choice?
A No drug therapy
B Treatment with enterosorbents
C Treatment with prednisolone
D Treatment with cholekinetics
E Blood transfusion
115. A 28 year old woman had the second labour and born a girl with manifestations of anemia and
progressing jaundice. The child’s weight was 3 400 g, the length was 52 cm. The woman’s blood group is
B (III) Rh−, the father’s blood group is A (III) Rh+, the child’s blood group is B (III) Rh+. What is the cause of
anemia?
A Rhesus incompatibility
B Antigen A incompatibility
C Antigen B incompatibility
D Antigen AB incompatibility
E Intrauterine infection
116. A newborn infant has mild cyanosis, diaphoresis, poor peripheral pule, hepatomegaly and
cardiomegaly. Respiratory rate is 60 breaths per minute, and heart rate is 230 beats per minute. The child
most likely has congestive heart failure caused by:
A Paroxysmal atrial tachycardia
B A ventricular septal defect and transposition of the great vessels
C Atrial flutter and partial atrioventricular block
D Hypoplastic left heart syndrome
E A large atrial septal defect and valvular pulmonary stenosis
117. An infant is full-term. Delivery was pathological, with breech presentation. Examination of the
infant revealed limited abduction of the right leg to 50o, positive "clicking"symptom on the right,
asymmetric inguinal folds. What is the most probable diagnosis?
A Inborn dislocation of the right hip
B Inborn dislocation of both hips
C Varus deformity of both femoral necks
D Fracture of both femoral necks
E Right hip dysplasia
118. A neonatologist examining a fullterm mature baby revealed the shortening and external rotation of
the newborn’s lower extremity. Clinical examination revealed positive Ortolani sign, symptom of nonvanishing pulse, additional skin folds on the internal surface of thigh. What is the most likely diagnosis?
A Congenital hip dislocation
B Dysplasia of the hip joint
C Varus deformity of the femoral neck
D Femoral neck fracture
E Fracture of the femoral shaft