10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free NPM questions are organized by exam domain, so you can see how each part of the Certification in Neonatal-Perinatal Medicine (NPM) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Respiratory 14% of exam
Question 1
Within 15 minutes of receiving poractant alfa, an infant born at 27 weeks on pressure-limited ventilation has an increase in exhaled tidal volume from 4.5 to 8.5 mL/kg without a change in settings. Arterial PaCO2 falls from 47 to 26 mm Hg. There is no significant endotracheal tube leak, and lung recruitment remains adequate. Oxygen has already been reduced to maintain the prescribed saturation range. Which ventilator adjustment most directly reduces excessive tidal volume while preserving end-expiratory recruitment?
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Correct answer: C - Decrease peak inspiratory pressure while maintaining the current PEEP
Question 2
At 36 weeks' postmenstrual age, an infant born at 25 weeks remains on nasal CPAP at 6 cm H2O with an FiO2 of 0.21. CPAP is still required for respiratory disease, but supplemental oxygen was used for only 20 days. For outcome classification using the Jensen 2019 definition, how should bronchopulmonary dysplasia be recorded?
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Correct answer: A - Grade 2, based on noninvasive positive airway pressure
Domain 2: Cardiovascular 10% of exam
Question 3
Echocardiography in a profoundly cyanotic term infant shows d-transposition of the great arteries, an intact ventricular septum, and a very restrictive atrial communication. Alprostadil has produced a widely patent ductus arteriosus, but arterial oxygen saturation remains 64% and lactate is rising despite effective ventilation. Ventricular systolic function is preserved. To improve systemic oxygen delivery before definitive repair, the priority is to:
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Correct answer: D - Perform urgent balloon atrial septostomy to improve mixing
Domain 3: Neurology and Neurodevelopmental Outcomes 9% of exam
Question 4
Four hours after an emergency delivery for placental abruption, a 38-week infant is lethargic, has decreased spontaneous activity, generalized hypotonia, and a weak suck. The cord arterial pH was 7.09 with a base deficit of 12 mmol/L, and assisted ventilation was required for 14 minutes after birth. Glucose is normal, no sedatives have been given, and there is no identified contraindication to cooling. Seizures have not been observed. Which conclusion should guide the time-sensitive neuroprotective plan?
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Correct answer: D - Initiate protocol-directed hypothermia; the combined perinatal and neurologic criteria are met
Domain 4: Immunology and Infectious Diseases
Question 5
Empiric ampicillin and gentamicin were started in a 39-week newborn with early tachypnea after maternal intrapartum fever. An adequate-volume blood culture was obtained before antibiotics and remains sterile after 48 hours of incubation. Tachypnea resolved by 6 hours; the infant has since fed normally with reassuring serial examinations and no focal evidence of infection. The only persisting concern is a mildly elevated C-reactive protein that is falling. Which antibiotic plan is supported by the AAP early-onset sepsis framework?
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Correct answer: C - Discontinue antibiotics and continue clinical observation
Domain 5: Nutrition
Question 6
A growing preterm infant has a sustained decline in weight-for-age trajectory despite tolerating all prescribed feeds. Delivered fortified human milk provides 80 kcal and 1.8 g of protein per 100 mL; intake is 160 mL/kg/day. There are no additional nutrient sources, edema, or intercurrent illness. The nutrition team is targeting 115-140 kcal/kg/day and 3.5-4.0 g protein/kg/day. Which assessment and adjustment best fit the delivered intake?
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Correct answer: B - Energy is 128 kcal/kg/day and protein is 2.88 g/kg/day; increase protein provision
Domain 8: Resuscitation and Stabilization
Question 7
During resuscitation of an apneic 39-week newborn, the ECG heart rate remains 45/min after 30 seconds of attempted mask ventilation. There has been no visible chest movement. Mask adjustment, airway repositioning, opening the mouth, and increasing inflation pressure have not established ventilation. No obstructing secretions are seen. What takes priority at this point in the AHA/AAP neonatal resuscitation sequence?
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Correct answer: B - Establish an alternative airway and ventilation that moves the chest
Domain 9: Genetics and Dysmorphism
Question 8
A term newborn who initially fed normally becomes lethargic and hyperventilates on day 3. A promptly processed plasma ammonia concentration is 640 micromol/L (laboratory upper limit, 80). Blood gas results are pH 7.52, PaCO2 24 mm Hg, and bicarbonate 19 mmol/L. The anion gap is 11 mmol/L (reference, 8-12), glucose is 78 mg/dL, and urine ketones are absent. Emergency metabolic treatment is being initiated. The biochemical pattern most strongly points to which underlying disorder?
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Correct answer: A - A urea-cycle defect impairing ammonia disposal
Domain 10: Water, Salt, Renal
Question 9
On day 9, a preterm infant's serum creatinine is 1.1 mg/dL, up from the previous nadir of 0.4 mg/dL measured 48 hours earlier. Urine output has remained 1.6 mL/kg/hour, and no kidney-support therapy has been used. The team is applying modified neonatal KDIGO criteria. Which entry best characterizes the kidney injury?
At retinal examination, an infant born at 25 weeks has stage 3 retinopathy of prematurity without plus disease. The ophthalmologist recommends treatment rather than continued surveillance. Which documented location would support that recommendation under the Early Treatment for Retinopathy of Prematurity criteria?