The diagnosis of primary pulmonary hypertension of

Question 1 of 5

The diagnosis of primary pulmonary hypertension of the newborn (PPHN) is confirmed by

A. echocardiography B. chest radiography C. electrocardiography D. cardiac catheterization

Correct Answer: A

Rationale: Echocardiography (A) confirms PPHN by showing right-to-left shunting, per diagnostic standards.

Question 2 of 5

Cyanosis becomes evident clinically when the unsaturated hemoglobin is equal or more than

A. 1 gm B. 3 gm C. 5 gm D. 7 gm

Correct Answer: C

Rationale: Cyanosis appears when deoxygenated hemoglobin â‰¥5 g/dL (C), per clinical thresholds.

Question 3 of 5

A full-term newborn male whose mother had reactive Venereal Disease Research Laboratory (VDRL) and microhemagglutination assay-Treponema pallidum (MHA-TP) results at the time of delivery was evaluated. He was anemic and had thrombocytopenia and mild hepatomegaly. He also had a desquamative skin rash consistent with congenital syphilis. His CSF was clear, with 5 white blood cells (WBCs), 0 RBCs, protein of $80 \mathrm{mg} / \mathrm{dL}$, and glucose of $49 \mathrm{mg} / \mathrm{dL}$; the CSF VDRL result was nonreactive. Based on this examination, which of the following is true?

A. The patient has symptomatic congenital syphilis but not neurosyphilis and can therefore be treated with benzathine penicillin. B. The patient may be treated with a combination of ampicillin and gentamicin for 7-10 days. C. Neurosyphilis cannot be ruled out in this infant; therefore, he should be treated as though he had neurosyphilis. D. All cases of neurosyphilis would have CSF pleocytosis and a reactive CSF VDRL result.

Correct Answer: C

Rationale: Symptomatic congenital syphilis requires ruling out neurosyphilis with CSF evaluation; normal CSF does not exclude it, necessitating full treatment.

Question 4 of 5

Oral rehydration is the treatment of choice for all children with gastroenteritis EXCEPT those with

A. high fever B. ileus and coma C. Shigella dysenteriae D. poor skin turgor, sunken fontanel, dry mouth, and decreased urine output

Correct Answer: B

Rationale: Ileus and coma indicate severe illness requiring IV rehydration, not oral.

Question 5 of 5

A 4-year-old male is brought to your office because of a circular reddish rash under his armpit. The child has been afebrile and has had no other systemic symptoms. The rash is not pruritic. The child's parents state that they have recently returned from a vacation in Massachusetts on Cape Cod and that a small tick had been removed from the same area where the rash is now. The only abnormality on the examination is the circular, flat, erythematous rash that is about $6 \mathrm{~cm}$ in diameter and is not tender. The appropriate next step in treating this patient is to

A. order a test for serum antibodies against Borrelia burgdorferi to confirm that the child has Lyme disease B. begin treatment with doxycycline C. begin treatment with amoxicillin D. begin treatment with ceftriaxone

Correct Answer: C

Rationale: Erythema migrans after a tick bite in an endemic area (Cape Cod) indicates early Lyme disease; amoxicillin is appropriate for children.

The diagnosis of primary pulmonary hypertension of the newborn (PPHN) is confirmed by

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