Q1. In newborn resuscitation, chest compressions are started only when: A. The baby is not breathing at birth B. The heart rate remains low DESPITE effective ventilation C. The Apgar score is below 5 D. Immediately, alongside the first breath ANSWER: B. Why: newborn arrest is almost always hypoxic. Aerating the lungs usually restores the heart rate, so compressions are reserved for persistent bradycardia after ventilation is confirmed effective. LEARNING POINT: if the heart rate is not rising, check the chest is moving before escalating.

Q2. Jaundice appearing within the first 24 hours of life is: A. Physiological and requires no action B. Always pathological and requires urgent investigation C. Normal in breastfed babies D. Only significant if the baby is unwell ANSWER: B — always pathological. Why: physiological jaundice does not appear this early. Early jaundice is usually haemolytic — rhesus or ABO incompatibility, or G6PD deficiency. LEARNING POINT: the timing of onset is the most useful single piece of information in neonatal jaundice.

Q3. A 5-day-old is sleepy, feeding poorly, with a temperature of 35.8°C. Membranes were ruptured for 22 hours before delivery. The correct action is: A. Reassure — there is no fever B. Septic screen and IMMEDIATE empirical antibiotics C. Advise feeding support and review in 48 hours D. Oral antibiotics at home ANSWER: B. Why: poor feeding, lethargy and temperature instability — including a LOW temperature — are classic non-specific signs of neonatal sepsis, and prolonged rupture of membranes is a risk factor. Newborns frequently do not mount a fever. LEARNING POINT: treat on suspicion; deterioration is measured in hours.

Q4. A breastfed baby remains jaundiced at 21 days with pale stools and dark urine. The essential next investigation is: A. Reassurance — this is breast milk jaundice B. SPLIT (conjugated and unconjugated) bilirubin C. Repeat in one week D. Stop breastfeeding ANSWER: B — split the bilirubin. Why: pale stools and dark urine indicate conjugated hyperbilirubinaemia. Breast milk jaundice is unconjugated. A raised conjugated fraction means cholestasis, and biliary atresia must be excluded urgently. LEARNING POINT: never attribute prolonged jaundice to breast milk without checking the split.

Q5. A term newborn is floppy with a heart rate of 50 after several inflation breaths. The FIRST thing to check is: A. Whether adrenaline has been drawn up B. Whether the chest is moving with each breath C. The Apgar score D. Blood glucose ANSWER: B — is the chest moving? Why: the commonest reason for a failing newborn resuscitation is that the airway is not open or the mask seal is poor, so no air is entering the lungs. Drugs and compressions cannot help an unventilated baby. LEARNING POINT: reposition, re-seal, confirm chest movement — then escalate.

Q6. Why does UNCONJUGATED hyperbilirubinaemia threaten the brain while conjugated does not? A. Unconjugated bilirubin is fat-soluble and crosses into the brain B. Conjugated bilirubin is more toxic but excreted C. Both cause kernicterus equally D. It is related to the blood group ANSWER: A — fat solubility. Why: unconjugated bilirubin is lipid-soluble, crosses the blood-brain barrier and deposits in the basal ganglia, producing permanent kernicterus. Conjugated bilirubin is water-soluble and does not do this — but signals liver or biliary disease. LEARNING POINT: the two fractions carry different risks and prompt different investigations.

Q7. On the routine newborn check, absent femoral pulses should raise suspicion of: A. Patent ductus arteriosus B. Coarctation of the aorta C. Innocent murmur D. Anaemia ANSWER: B — coarctation of the aorta. Why: narrowing distal to the arch reduces flow to the lower body, so femoral pulses are weak or absent. It may be masked while the ductus arteriosus remains open, and the baby can deteriorate abruptly when it closes. LEARNING POINT: every item on the newborn check exists because finding it early changes the outcome.