Neonatology Practice Questions

Q: Which of the following is NOT a characteristic radiographic finding in transient tachypnea of the newborn?

Air bronchogram. **Explanation:** **Transient Tachypnea of the Newborn (TTN)**, also known as "Wet Lung Disease," is caused by delayed clearance of fetal lung fluid. The correct answer is **Air Bronchogram** because this is a hallmark radiographic finding of **Hyaline Membrane Disease (HMD/RDS)**, not TTN. In HMD, alveoli collapse due to surfactant deficiency, while the larger airways remain open, creating the air bronchogram effect. **Analysis of Options:** * **Air Bronchogram (Correct):** This indicates alveolar collapse or consolidation. In TTN, the alveoli are filled with fluid, not collapsed, so air bronchograms are typically absent. * **Mild Pleural Effusion:** As fetal lung fluid is cleared via lymphatics, excess fluid often accumulates in the pleural space, visible on X-ray. * **Reticular Shadows:** These represent "perihilar streaking," which corresponds to engorged lymphatic vessels and interstitial fluid radiating from the hilum. * **Prominent Interlobar Fissure:** Fluid often traps in the horizontal or oblique fissures (especially the right minor fissure), a classic sign of TTN. **Clinical Pearls for NEET-PG:** * **Risk Factors:** Elective C-section (lack of "thoracic squeeze"), maternal diabetes, and prematurity. * **Clinical Course:** Onset is usually within 2 hours of birth; it is self-limiting and typically resolves within 48–72 hours. * **Management:** Supportive care (oxygen via hood or nasal CPAP). * **X-ray Summary:** Hyperinflation, perihilar streaking, fluid in fissures, and cardiomegaly (mild). If you see "ground-glass opacities," think RDS instead.

Q: Immune hydrops is associated with:

Rh incompatibility. **Explanation:** **Hydrops Fetalis** is defined as the abnormal accumulation of fluid in two or more fetal compartments (e.g., ascites, pleural effusion, pericardial effusion, or skin edema). It is broadly classified into **Immune** and **Non-Immune** types. **Why Rh Incompatibility is Correct:** Immune hydrops is primarily caused by **Rh isoimmunization**. When an Rh-negative mother is sensitized to Rh-positive fetal red blood cells, maternal IgG antibodies cross the placenta and cause **immune-mediated hemolysis** in the fetus. This leads to severe fetal anemia, which triggers high-output cardiac failure and decreased hepatic protein synthesis (hypoalbuminemia), resulting in generalized edema (hydrops). **Why Other Options are Incorrect:** * **Thalassemia (specifically Alpha-Thalassemia Major/Hb Bart’s):** This is the most common cause of **Non-Immune Hydrops** worldwide. Since the hemolysis is due to a genetic defect in hemoglobin chain synthesis and not an antibody-antigen reaction, it is classified as non-immune. * **Hereditary Spherocytosis & Sickle Cell Anemia:** While these are hemolytic anemias, they rarely cause hydrops fetalis. Sickle cell anemia typically does not manifest in utero because fetal hemoglobin (HbF) inhibits sickling. If they were to cause hydrops, it would still be categorized as **Non-Immune**. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of Hydrops Fetalis overall:** Non-immune causes (>90% of cases in developed regions due to Rhogam prophylaxis). * **Most common cause of Non-Immune Hydrops:** Cardiovascular anomalies. * **Diagnostic Tool:** Middle Cerebral Artery (MCA) peak systolic velocity (Doppler) is used to detect fetal anemia non-invasively. * **Liley’s Chart:** Used to predict the severity of fetal hemolysis by measuring bilirubin (ΔOD450) in amniotic fluid.

Q: What is the most common cause of respiratory distress in newborns?

Transient tachypnea of the newborn. **Explanation:** **Transient Tachypnea of the Newborn (TTN)** is the most common cause of respiratory distress in newborns, accounting for approximately 40-50% of cases. It is caused by **delayed resorption of fetal lung fluid** by the pulmonary lymphatic system. It typically affects term or late-preterm infants, especially those born via Cesarean section (due to the lack of the "thoracic squeeze" that occurs during vaginal delivery). Clinically, it presents as early-onset tachypnea that usually resolves within 24–72 hours. **Analysis of Incorrect Options:** * **Hyaline Membrane Disease (RDS):** This is the most common cause of respiratory distress in **preterm** infants due to surfactant deficiency. While significant, it is less common than TTN in the overall neonatal population. * **Congenital Pneumonia:** While a common cause of neonatal sepsis and distress, it is statistically less frequent than TTN. It often presents with a history of prolonged rupture of membranes or maternal fever. * **Congenital Diaphragmatic Hernia (CDH):** This is a structural emergency characterized by a scaphoid abdomen and respiratory distress. While high-yield, it is a rare occurrence compared to the transient physiological delay of TTN. **NEET-PG High-Yield Pearls:** * **Chest X-ray (TTN):** Shows "wet pleura," prominent vascular markings (sunburst appearance), and fluid in the interlobar fissures. * **Chest X-ray (RDS):** Shows a classic "ground-glass appearance" with air bronchograms. * **Risk Factors for TTN:** C-section, maternal asthma, and maternal diabetes. * **Management:** TTN is self-limiting; management is supportive (oxygen via hood or CPAP).

Q: The classic triad of congenital rubella includes all of the following except?

Retinitis. The classic triad of Congenital Rubella Syndrome (CRS), also known as **Gregg’s Triad**, consists of specific ocular, auditory, and cardiac malformations. **Explanation of the Correct Answer:** **C. Retinitis** is the correct answer because it is not part of the classic triad. While ocular involvement is common in CRS, the hallmark finding is **Cataract** (typically bilateral and "pearly"). While "Salt and Pepper Retinopathy" is a frequent finding in CRS, it is not part of the defining triad and usually does not affect vision as severely as cataracts. **Explanation of Incorrect Options:** * **A. Cataract:** This is the primary ocular component of the triad. It results from the virus interfering with lens fiber development during the first trimester. * **B. Deafness:** Sensorineural hearing loss is the **most common** manifestation of CRS. It may be the only finding in late-gestation infections. * **D. Congenital Heart Disease:** This is the third component of the triad. The most characteristic lesion is **Patent Ductus Arteriosus (PDA)**, followed by peripheral pulmonary artery stenosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common finding:** Sensorineural hearing loss. * **Most common cardiac lesion:** PDA. * **Ocular findings:** "Pearly" cataracts, microphthalmia, and **Salt and Pepper Retinopathy** (the most common ocular sign, though not in the triad). * **Dermal finding:** "Blueberry muffin" spots (extramedullary hematopoiesis). * **Radiology:** "Celery stalking" (longitudinal radiolucent striations in the metaphysis of long bones). * **Risk:** The risk of fetal infection is highest (up to 90%) if the mother is infected before 11 weeks of gestation.

Q: The risk of neonatal chickenpox is maximum if maternal infection occurs:

Within five days of delivery. **Explanation:** The risk of severe neonatal chickenpox is highest when maternal varicella occurs **within 5 days before to 2 days after delivery**. This specific window is critical because of the timing of transplacental antibody transfer. When a mother develops varicella, it takes approximately 5 days for her body to produce **IgG antibodies**. If delivery occurs within this 5-day window, the virus crosses the placenta and infects the fetus, but the protective maternal antibodies have not yet developed or been transferred. Consequently, the neonate receives a high viral load without passive immunity, leading to severe, disseminated, and potentially fatal disease (neonatal varicella). **Analysis of Options:** * **Options A & B (First/Second Trimester):** Infection during early pregnancy (especially weeks 13–20) can lead to **Congenital Varicella Syndrome**, characterized by limb hypoplasia, cicatricial skin scarring, and microcephaly. While serious, the risk of transmission is low (~2%), and it does not cause the acute neonatal chickenpox described. * **Option D (Six weeks of delivery):** If infection occurs weeks before delivery, the mother has sufficient time to transfer protective IgG antibodies to the fetus, resulting in a much milder or asymptomatic course for the newborn. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** If maternal infection occurs in the "danger window" (5 days before to 2 days after), the neonate must receive **Varicella-Zoster Immunoglobulin (VZIG)** immediately after birth. * **Treatment:** If the neonate develops symptoms, **Intravenous Acyclovir** is the treatment of choice. * **Incubation Period:** The incubation period for varicella is 10–21 days. * **Contagiousness:** Patients are contagious from 48 hours before the rash appears until all lesions have crusted over.

Q: A 32-year-old woman, gravida 4, para 3, at 39 weeks gestation presents to the labor and delivery ward with painful contractions. Her prenatal course was unremarkable. Examination shows that her cervix is 5 cm dilated, 100% effaced, and the fetal heart rate is in the 130s and reactive. She is given meperidine for pain control. She progresses rapidly and less than 2 hours later delivers a 3.345 kg male fetus. The one-minute APGAR score is 1, and the infant is making little respiratory effort. Which of the following is the most appropriate next step in management?

Naloxone. **Explanation:** The clinical scenario describes **neonatal opioid respiratory depression** resulting from the administration of meperidine (Pethidine) to the mother shortly before delivery. Meperidine and its active metabolite, normeperidine, cross the placenta and can cause central nervous system and respiratory depression in the newborn, especially if delivery occurs within 1–4 hours of administration. **Why Naloxone is correct:** Naloxone is a competitive opioid antagonist that rapidly reverses the effects of opioids. In a neonate with a low APGAR score (1) and poor respiratory effort following maternal opioid administration, Naloxone is the definitive treatment to restore spontaneous respiration. *Note: Initial neonatal resuscitation (warming, drying, stimulating, and bag-mask ventilation) should always be prioritized, but Naloxone is the specific pharmacological intervention required here.* **Why other options are incorrect:** * **Blood transfusion:** Indicated for neonatal shock or severe anemia (e.g., abruption or vasa previa), not for isolated respiratory depression. * **Glucose:** Used for neonatal hypoglycemia, which may cause lethargy but is not the primary concern following maternal opioid use. * **Sodium bicarbonate:** Used in prolonged resuscitation for documented metabolic acidosis; it is not a first-line agent and can worsen intracellular acidosis if ventilation is inadequate. **NEET-PG High-Yield Pearls:** * **Timing:** Opioids given to the mother <4 hours before delivery pose the highest risk for neonatal depression. * **Contraindication:** Avoid Naloxone in neonates of **opioid-dependent mothers** (chronic use), as it can precipitate acute, life-threatening withdrawal seizures. * **Meperidine:** It is known for causing more prolonged neonatal depression than shorter-acting opioids like Fentanyl due to its long-half-life metabolite, normeperidine.

Q: What is the best feeding procedure for a 32-week preterm infant weighing 1400 gm with stable vitals admitted to the NICU?

Total enteral nutrition. **Explanation:** The management of feeding in preterm infants depends on gestational age, birth weight, and clinical stability. For a **32-week preterm infant weighing 1400g who is hemodynamically stable**, the current standard of care is the early initiation of **Total Enteral Nutrition (TEN)**. **Why Option A is Correct:** At 32 weeks, most infants have developed sufficient sucking and swallowing coordination (which typically matures by 32–34 weeks) or can tolerate gavage feeding. If the vitals are stable and there are no contraindications (like abdominal distension or respiratory distress), early enteral feeding—preferably with **expressed breast milk (EBM)**—is encouraged. It promotes gut maturation, prevents mucosal atrophy, and reduces the risk of sepsis compared to prolonged IV access. **Why Other Options are Incorrect:** * **Option B & D:** Delaying feeds or keeping the infant on "IV fluids only" is no longer recommended for stable infants. Early "trophic feeding" or full enteral feeding (if tolerated) prevents metabolic bone disease and promotes faster weight gain. * **Option C:** **Total Parenteral Nutrition (TPN)** is reserved for extremely premature infants (<28 weeks), very low birth weight infants (<1000g), or those with surgical gut conditions who cannot tolerate any enteral intake. It carries risks of cholestasis and catheter-related infections. **NEET-PG High-Yield Pearls:** * **Sucking-Swallowing Coordination:** Usually appears by **32–34 weeks**. * **Choice of Milk:** EBM is the gold standard. If unavailable, donor human milk is preferred over formula. * **Feeding Method:** * **>34 weeks:** Direct breastfeeding/Spoon feeding. * **32–34 weeks:** Sips/Spoon/Paladai feeding. * **<32 weeks:** Gavage (Nasogastric/Orogastric) feeding. * **Trophic Feeding:** Also known as "Minimal Enteral Nutrition," it involves small volumes (10–20 ml/kg/day) to "prime" the gut.

Q: What is the most common manifestation of congenital toxoplasmosis?

Chorioretinitis. **Explanation:** Congenital Toxoplasmosis is caused by the transplacental transmission of *Toxoplasma gondii*. While many neonates are asymptomatic at birth, **Chorioretinitis** is the most common clinical manifestation overall. It occurs in approximately 75-80% of affected children, often presenting as blurred vision or strabismus later in life, even if the child appeared normal at birth. **Analysis of Options:** * **B. Chorioretinitis (Correct):** It is the most frequent finding and is often bilateral. It represents the "late" manifestation of the infection and is part of the classic Sabin’s Triad. * **A. Hydrocephalus:** This is a classic feature (part of the triad) but is less common than chorioretinitis. It typically results from obstructive aqueductal stenosis. * **C. Calcification:** Specifically **intracranial diffuse calcifications**. While highly characteristic of Toxoplasmosis (distinguishing it from the periventricular calcifications of CMV), they occur in only about 50-60% of symptomatic cases. * **D. Convulsions:** These are a secondary neurological complication resulting from intracranial damage/calcifications but are not the primary or most common diagnostic sign. **High-Yield Pearls for NEET-PG:** 1. **Sabin’s Triad:** Chorioretinitis, Hydrocephalus, and Intracranial Calcifications. 2. **Calcification Pattern:** Diffuse/Scattered (Toxoplasmosis) vs. Periventricular (CMV). 3. **Transmission Risk:** The risk of transmission increases with gestational age (highest in the 3rd trimester), but the **severity** of fetal damage is highest if infected in the 1st trimester. 4. **Treatment:** Spiramycin (to prevent transmission) or Pyrimethamine + Sulfadiazine + Folinic acid (for fetal/neonatal infection).

Q: Which of the following is NOT a component of Kangaroo Mother Care?

Nutritional supplements. **Explanation:** Kangaroo Mother Care (KMC) is a standardized, evidence-based protocol designed primarily for low-birth-weight (LBW) and preterm infants. According to the World Health Organization (WHO), KMC consists of three essential components: 1. **Kangaroo Position:** Continuous and prolonged **skin-to-skin contact** (Option A) between the caregiver and the infant. This provides thermal regulation, reduces apnea, and promotes bonding. 2. **Kangaroo Nutrition:** Promotion of **exclusive breastfeeding** (Option B). Skin-to-skin contact stimulates the release of oxytocin and prolactin, facilitating successful lactation. 3. **Kangaroo Discharge:** **Early discharge** (Option C) from the hospital with regular follow-up. This reduces the risk of nosocomial infections and decreases the burden on healthcare facilities. **Nutritional supplements (Option D)** are **NOT** a component of KMC. While LBW infants may eventually require fortification or supplements based on clinical need, they are not part of the defined KMC triad. KMC specifically emphasizes the adequacy of breast milk. **High-Yield Clinical Pearls for NEET-PG:** * **Eligibility:** KMC can be started once the baby is hemodynamically stable (even if still on oxygen or IV fluids). * **Duration:** Minimum duration should be **1 hour** per session (to avoid frequent handling stress). Ideally, it should be practiced as close to 24 hours a day as possible. * **Benefits:** It reduces neonatal mortality by up to 40% in LBW infants, prevents hypothermia, and decreases the incidence of sepsis. * **Provider:** While the mother is the primary provider, any family member (father, grandmother) can provide KMC.

Q: A diabetic female at 40 weeks of gestation delivered a baby by elective cesarean section. Soon after birth, the baby developed respiratory distress. What is the most likely diagnosis?

Transient tachypnea of the newborn. ### Explanation **Correct Option: A. Transient Tachypnea of the Newborn (TTN)** The most likely diagnosis is TTN, also known as "Wet Lung Syndrome." The primary pathophysiology is the **delayed clearance of fetal lung fluid**. During a normal vaginal delivery, the "thoracic squeeze" helps expel fluid, and hormonal changes (catecholamines/steroids) trigger the switch from fluid secretion to absorption via epithelial sodium channels (ENaC). In this case, the two major risk factors are: 1. **Elective Cesarean Section:** The baby misses the mechanical squeeze and the hormonal surge associated with labor. 2. **Maternal Diabetes:** Hyperinsulinemia in the fetus can delay the maturation of lung fluid clearance mechanisms. **Why other options are incorrect:** * **B. Congenital Diaphragmatic Hernia:** Typically presents with a scaphoid abdomen and severe respiratory distress immediately at birth. Bowel sounds may be heard in the chest. * **C. Tracheoesophageal Fistula:** Usually presents with excessive salivation, choking, and cyanosis during the first feed, rather than isolated respiratory distress immediately after birth. * **D. Hyaline Membrane Disease (RDS):** While maternal diabetes is a risk factor for RDS (insulin antagonizes cortisol's effect on surfactant), RDS is primarily a disease of **preterm** infants. This baby is full-term (40 weeks), making TTN significantly more likely. **High-Yield Clinical Pearls for NEET-PG:** * **Chest X-ray in TTN:** Shows prominent vascular markings (sunburst appearance), fluid in interlobar fissures, and occasionally pleural effusion. * **Management:** Usually self-limiting within 24–72 hours; requires only supportive care (oxygen/CPAP). * **Key Differentiator:** If the question mentions "Term/Near-term + LSCS," think **TTN**. If it mentions "Preterm + Ground glass opacities," think **RDS**.

Question 1

Which of the following is NOT a characteristic radiographic finding in transient tachypnea of the newborn?

Accepted Answer

Air bronchogram

Answer

Mild pleural effusion

Answer

Reticular shadows

Answer

Prominent interlobar fissure

Question 2

Immune hydrops is associated with:

Accepted Answer

Rh incompatibility

Answer

Thalassemia

Answer

Hereditary spherocytosis

Answer

Sickle cell anemia

Question 3

What is the most common cause of respiratory distress in newborns?

Accepted Answer

Transient tachypnea of the newborn

Answer

Congenital pneumonia

Answer

Hyaline membrane disease

Answer

Congenital diaphragmatic hernia

Question 4

The classic triad of congenital rubella includes all of the following except?

Accepted Answer

Retinitis

Answer

Cataract

Answer

Deafness

Answer

Congenital Heart Disease

Question 5

The risk of neonatal chickenpox is maximum if maternal infection occurs:

Accepted Answer

Within five days of delivery

Answer

During the first trimester

Answer

During the second trimester

Answer

Within six weeks of delivery

Question 6

A 32-year-old woman, gravida 4, para 3, at 39 weeks gestation presents to the labor and delivery ward with painful contractions. Her prenatal course was unremarkable. Examination shows that her cervix is 5 cm dilated, 100% effaced, and the fetal heart rate is in the 130s and reactive. She is given meperidine for pain control. She progresses rapidly and less than 2 hours later delivers a 3.345 kg male fetus. The one-minute APGAR score is 1, and the infant is making little respiratory effort. Which of the following is the most appropriate next step in management?

Accepted Answer

Naloxone

Answer

Blood transfusion

Answer

Glucose

Answer

Sodium bicarbonate

Question 7

What is the best feeding procedure for a 32-week preterm infant weighing 1400 gm with stable vitals admitted to the NICU?

Accepted Answer

Total enteral nutrition

Answer

Start IV fluids; introduce feeding from the second day

Answer

Total parenteral nutrition

Answer

IV fluid only

Question 8

What is the most common manifestation of congenital toxoplasmosis?

Accepted Answer

Chorioretinitis

Answer

Hydrocephalus

Answer

Calcification

Answer

Convulsions

Question 9

Which of the following is NOT a component of Kangaroo Mother Care?

Accepted Answer

Nutritional supplements

Answer

Skin-to-skin contact

Answer

Exclusive breastfeeding

Answer

Early discharge

Question 10

A diabetic female at 40 weeks of gestation delivered a baby by elective cesarean section. Soon after birth, the baby developed respiratory distress. What is the most likely diagnosis?

Accepted Answer

Transient tachypnea of the newborn

Answer

Congenital diaphragmatic hernia

Answer

Tracheoesophageal fistula

Answer

Hyaline membrane disease

Neonatology — MCQs

Neonatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?