MCQs In Family Medicine - Pediatrics

Q 18. A baby born very prematurely (weight 1500 grams or less) is ready to breastfeed

when he:

a. has successfully taken breast milk by

bottle.

b. has first fed by spoon or cup.

c. is showing sucking movements.

d. is able to mouth a pacifier.

Answer :

The answer is C. Research has established that a premature baby can go to breast earlier than he can feed from devices.

Q 19. You are working with a late preterm infant (born at 34 to 36 weeks gestation) who had been in the hospital NICU since birth 10 days ago. The baby falls readily asleep at breast each time you assist mom to latch. Her milk supply is plentiful because of pumping. What is the MOST LIKELY cause for this infant

to be unable to sustain his latch at breast?

a. His suck has low intraoral pressure (vacuum) due to gestational age.

b. Prematurity causes sleepiness at breast until about 40 weeks gestation.

c. This infant was fed with a bottle during his NICU stay.

d. The mother has delayed lactogenesis resulting from her premature delivery.

The answer is A. Intensity of suction (intraoral negative pressure) increases with gestational age. The infant uses suction (negative pressure) to draw the maternal nipple into the oral cavity for effective breastfeeding.

However, waiting until infants reach 40 weeks gestation is not best practice. Several interventions effectively achieve transfer of  breastmilk at breast prior to 40 weeks. Infants can sometimes struggle with the different

flow rates between bottles and breast, but simply giving bottles in the NICU does not lead to latching problems. Our scenario states that this mom did not experience delayed lactogenesis because her milk supply was preserved with the use of a hospitalgrade electric breast pump.

20. A pregnant woman is worried that her milk may not come in with her second baby. She said she never actually got milk after her first baby’s birth, and never got engorged. Which of the following birth complications is MOST related to delayed onset lactogenesis?

a. Cesarean birth

b. Retained placental fragment

c. Premature birth

d. Episiotomy

The answer is B. A retained placental fragment is the most likely factor associated with delayed onset of lactogenesis. cesarean surgery may also delay onset of lactogenesis.

Q 21. When selecting a drug to be given to a breastfeeding woman, which of the following drug properties is MOST IMPORTANT to consider?

a. Absorption from the GI tract

b. Protein binding

c. Milk/plasma ratio

d. Pediatric half-life

Q 22. You are assisting a mother of a late preterm infant to latch to the breast. Mother is making sufficient milk with pumping support, but the baby cannot latch and maintain feeding for more than a few moments before slipping off the breast. What should be your NEXT action?

a. Tell mom that direct breastfeeding is too tiring to the infant, and give her a bottle and teat system.

b. Urge her to continue pumping until the infant is ready for breastfeeding, approximately her original due date.

c. Suggest using a thin silicone nipple shield to keep the nipple extended in the baby’s mouth during feeds.

d. Help her use a tube-feeding device to provide extra breastmilk at the breast.

Q 23. You are working with a mom and a 2-week-old premature baby born at 36 weeks gestation. Mom is

complementing baby after every breastfeeding with a bottle of her expressed breastmilk. Baby is currently

gaining appropriate weight. What should be your NEXT step in promoting this baby towards exclusively?

a. Tell mom she no longer needs to use a breast pump since baby is gaining weight.

b. Discuss with mom how to wean off the bottles and recheck baby’s weight in 3–5 days.

c. Tell mom not to give baby any more bottles because she has a good milk supply.

d. Nothing. Mom is content with her current situation