Neonatology Practice Questions

Q: Which of the following causes can result in an infant being large for gestational age, EXCEPT?

Maternal smoking. **Explanation:** **Large for Gestational Age (LGA)** is defined as a birth weight >90th percentile for a specific gestational age. The correct answer is **Maternal smoking** because it is a well-known cause of **Intrauterine Growth Restriction (IUGR)** and Small for Gestational Age (SGA) infants, not LGA. **Why Maternal Smoking is the correct answer:** Nicotine and carbon monoxide in cigarette smoke cause vasoconstriction of placental vessels and increase carboxyhemoglobin levels. This leads to chronic fetal hypoxia and reduced nutrient delivery, resulting in decreased birth weight. **Analysis of Incorrect Options:** * **Maternal Diabetes Mellitus:** This is the most common cause of LGA. Maternal hyperglycemia leads to fetal hyperglycemia, which stimulates the fetal pancreas to secrete excess **insulin** (a potent growth hormone), causing macrosomia and organomegaly. * **Hydrops Fetalis:** Excessive fluid accumulation in fetal compartments (edema, ascites, pleural effusion) significantly increases the total birth weight, often placing the infant in the LGA category despite potential underlying growth issues. * **Genetic Predisposition:** Constitutional factors, such as tall/large parents or certain overgrowth syndromes (e.g., **Beckwith-Wiedemann Syndrome**), are common non-pathological and pathological causes of LGA. **High-Yield Clinical Pearls for NEET-PG:** * **Beckwith-Wiedemann Syndrome Triad:** Macrosomia, Omphalocele, and Macroglossia. * **Infant of Diabetic Mother (IDM):** Look for complications like hypoglycemia, hypocalcemia, hyperbilirubinemia, and **Hypertrophic Cardiomyopathy** (asymmetric septal hypertrophy). * **SGA vs. LGA:** Maternal hypertension and smoking are the top causes of SGA; Maternal obesity and diabetes are the top causes of LGA.

Q: What is the weight range for a Low Birth Weight (LBW) baby?

1.5-2.5 kg. ### Explanation **Correct Answer: D. 1.5-2.5 kg** **Understanding the Concept:** The World Health Organization (WHO) defines **Low Birth Weight (LBW)** as a birth weight of **less than 2,500 grams (2.5 kg)**, regardless of gestational age. This measurement is taken immediately after birth (ideally within the first hour). LBW is a critical indicator of neonatal health as it is associated with increased risks of hypothermia, hypoglycemia, infection, and long-term neurodevelopmental delays. **Analysis of Options:** * **Option D (1.5-2.5 kg):** This represents the standard range for LBW. Specifically, a baby weighing between 1,500g and 2,499g falls into this category. * **Options A & B (2.6-2.9 kg):** These weights are considered **Normal Birth Weight**. In the Indian context, the average birth weight is approximately 2.7–2.9 kg, but medically, any weight $\geq$ 2.5 kg is not classified as LBW. * **Option C (3.2-3.5 kg):** This is the ideal/average birth weight range for infants in developed countries and is well above the LBW threshold. **High-Yield Clinical Pearls for NEET-PG:** To excel in Neonatology questions, remember the specific WHO sub-classifications: 1. **Low Birth Weight (LBW):** 90th percentile or > 4,000 grams (Macrosomia). **Key Fact:** In India, the prevalence of LBW is high (approx. 20-30%), primarily due to intrauterine growth restriction (IUGR) and maternal malnutrition, whereas in developed nations, prematurity is the leading cause.

Q: A newborn presents with frothing of the mouth and cyanosis on day one. What is the most probable diagnosis?

Esophageal atresia. ### Explanation **Correct Option: D. Esophageal Atresia** The classic clinical triad of **Esophageal Atresia (EA)** includes **frothing/drooling** at the mouth, **choking**, and **cyanosis** (often triggered by feeding attempts). * **Mechanism:** In EA, the esophagus ends in a blind pouch. Saliva cannot pass into the stomach, leading to accumulation in the upper pouch and subsequent overflow into the trachea (aspiration) or out of the mouth (frothing). * **Cyanosis:** This occurs due to laryngospasm or aspiration of saliva/feeds. If a **Tracheoesophageal Fistula (TEF)** is also present (most common type is Type C), air enters the stomach, and gastric acid can reflux into the lungs, worsening respiratory distress. **Why other options are incorrect:** * **A & B (Lung Hypoplasia/Lung Cyst):** These typically present with primary respiratory distress (tachypnea, grunting, retractions) immediately after birth, but they do not cause excessive oral frothing or drooling. * **C (Diaphragmatic Hernia):** While this causes severe cyanosis and respiratory distress, the hallmark signs are a **scaphoid abdomen** and shifted heart sounds. It does not typically present with frothing. **NEET-PG High-Yield Pearls:** * **Most Common Type:** Type C (85%) – Proximal atresia with distal TEF. * **Initial Diagnostic Step:** Attempt to pass a stiff, radio-opaque **nasogastric (NG) tube**; it will meet resistance and "coil" in the upper pouch (confirmed on X-ray). * **Associated Anomalies:** Look for **VACTERL** association (Vertebral, Anal, Cardiac, TEF, Renal, Limb). The most common cardiac defect is VSD. * **Antenatal Clue:** Polyhydramnios (due to inability of the fetus to swallow amniotic fluid).

Q: Which of the following is not a feature of neonatal lupus erythematosus?

Anti-Ro positivity. **Explanation:** Neonatal Lupus Erythematosus (NLE) is a rare acquired autoimmune disorder caused by the transplacental passage of maternal IgG autoantibodies (specifically **Anti-Ro/SSA** and **Anti-La/SSB**) into the fetal circulation. **Why Option C is the correct answer:** The question asks which is **not** a feature of the disease. While Anti-Ro positivity is the *cause* of the condition, the antibodies are found in the **mother’s serum**. In the neonate, these are passively acquired antibodies that disappear by 6–8 months of age as maternal IgG degrades. Therefore, Anti-Ro positivity is a **pathogenetic mechanism**, not a clinical "feature" or manifestation of the disease in the infant itself in the way that skin lesions or heart blocks are. **Analysis of other options:** * **A. Cutaneous lesions:** These are the most common manifestation. They typically appear as erythematous, annular (target-like) plaques, often in a "raccoon-eye" distribution. They are transient and resolve without scarring. * **B. Heart block:** Congenital Heart Block (usually third-degree) is the most serious complication. Unlike the skin or blood findings, the damage to the conduction system is **permanent** and irreversible. * **D. Thrombocytopenia:** Hematological abnormalities (thrombocytopenia, neutropenia, or anemia) and hepatobiliary involvement are common but transient systemic features of NLE. **High-Yield Clinical Pearls for NEET-PG:** * **Most common feature:** Cutaneous lesions. * **Most serious feature:** Third-degree (complete) AV block (requires a permanent pacemaker). * **Antibody association:** Anti-Ro (SSA) is most strongly associated with heart block; Anti-La (SSB) is also frequently present. * **Prognosis:** All features are reversible except for the heart block. * **Maternal status:** Many mothers are asymptomatic at the time of delivery but may later develop SLE or Sjögren’s syndrome.

Q: A 1-day-old baby boy has developed abdominal distension and bilious emesis. Prenatal history was significant for areas of echogenic bowel seen on ultrasound. An abdominal radiograph and contrast enema were performed. Based on these findings, what is the most likely diagnosis?

Cystic fibrosis. ***Cystic fibrosis*** - **Prenatal echogenic bowel** combined with **neonatal bilious emesis** and **abdominal distension** on day 1 strongly suggests **meconium ileus**, which is pathognomonic for cystic fibrosis. - The **ground-glass appearance** on abdominal X-ray (**Neuhauser sign**) and **microcolon** on contrast enema are classic imaging findings confirming meconium ileus in cystic fibrosis. *Duodenal atresia* - Typically presents with **double bubble sign** on abdominal X-ray, showing dilated stomach and proximal duodenum. - While it causes **bilious vomiting**, it doesn't cause **echogenic bowel** on prenatal ultrasound or the specific imaging findings described. *Gastroenteritis* - **Not a day-1 neonatal diagnosis** as infectious gastroenteritis requires exposure to pathogens after birth. - Presents with **diarrhea** and **fever**, not the constellation of prenatal echogenic bowel and immediate postnatal bilious vomiting. *Malrotation with volvulus* - Diagnosed with **upper GI series/barium swallow** showing abnormal **ligament of Treitz** position and **corkscrew appearance** of twisted bowel. - While it causes **bilious vomiting**, it doesn't typically present with **prenatal echogenic bowel** or the specific contrast enema findings of microcolon.

Q: Collection of sero-sanguineous fluid in the scalp is known as what?

It is limited to the periosteum. The question refers to **Cephalhematoma**, which is a collection of blood between the skull bone and its overlying periosteum. ### **Explanation of the Correct Option** **C. It is limited to the periosteum:** This is the defining anatomical feature of a cephalhematoma. Because the bleeding occurs beneath the periosteum, the collection is trapped by the fibrous attachments of the periosteum at the cranial sutures. Therefore, a cephalhematoma **does not cross suture lines**, making it well-demarcated and limited to a single bone (usually the parietal). ### **Why Other Options are Incorrect** * **A. It is present at birth:** Incorrect. Unlike Caput Succedaneum, which is present at the time of delivery, a cephalhematoma usually **appears hours to days after birth** as the slow subperiosteal bleeding accumulates. * **B. It does not cause jaundice:** Incorrect. As the trapped blood breaks down and is reabsorbed, it can lead to **unconjugated hyperbilirubinemia**, increasing the risk of neonatal jaundice. * **D. It disappears within a few hours:** Incorrect. Cephalhematomas take **weeks to months** to resolve. They may also undergo calcification, leading to a "hard" feel on palpation. ### **High-Yield Clinical Pearls for NEET-PG** * **Caput Succedaneum:** Superficial edema (sero-sanguineous) above the periosteum; **crosses suture lines**; present at birth; disappears in 48–72 hours. * **Subgaleal Hemorrhage:** Bleeding between the aponeurosis and periosteum. It is the most dangerous because it can hold a large volume of blood, leading to hemorrhagic shock. * **Management:** Most cephalhematomas require **observation only**. Incision and drainage are contraindicated due to the high risk of infection (osteomyelitis).

Q: A 3-month-old boy is brought to the physician because his parents cannot find one of his testicles. Physical examination confirms the parents' observation. Which of the following is the most likely diagnosis?

Cryptorchidism. **Explanation:** **Cryptorchidism** (undescended testis) is the most common congenital abnormality of the male endocrine/reproductive tract. It refers to the failure of one or both testes to descend into the scrotum. In a 3-month-old infant with a non-palpable or missing testis on examination, this is the most probable diagnosis. While many testes descend spontaneously by 3–4 months of age, the condition is considered pathological if they remain undescended beyond 6 months. **Analysis of Incorrect Options:** * **Anorchia:** This refers to the complete absence of one or both testes (vanishing testis syndrome). It is much rarer than cryptorchidism and is usually a diagnosis of exclusion confirmed via surgical exploration or imaging. * **Klinefelter Syndrome (47, XXY):** This typically presents post-puberty with small, firm testes, gynecomastia, and infertility. It does not typically present as a "missing" testis in infancy. * **Macroorchidism:** This refers to abnormally large testes, commonly associated with Fragile X Syndrome. It is the opposite of the clinical finding described. **NEET-PG High-Yield Pearls:** * **Most common site:** The inguinal canal is the most frequent location for an undescended testis. * **Management:** The gold standard treatment is **Orchidopexy**, ideally performed between **6 to 12 months** of age to preserve fertility and allow for early detection of malignancy. * **Complications:** Increased risk of **Infertility** (due to higher core body temperature) and **Testicular Germ Cell Tumors** (Seminoma is the most common). Note: Orchidopexy reduces the risk of infertility but does not completely eliminate the increased risk of malignancy; it primarily makes the testis accessible for screening. * **Retractile Testis:** A common differential where the testis can be manipulated into the scrotum and stays there (due to an overactive cremasteric reflex); this does not require surgery.

Q: All of the following are true about Cephalohematoma except?

May cross suture lines. **Explanation:** The correct answer is **D (May cross suture lines)** because this statement is false. A **Cephalohematoma** is a subperiosteal hemorrhage, meaning the blood collection occurs between the skull bone and its covering, the periosteum. Since the periosteum is firmly attached to the edges of each individual cranial bone at the **suture lines**, the bleeding is strictly confined to the surface of that specific bone. Therefore, it **does not cross suture lines**. **Analysis of other options:** * **Option A:** It typically appears several hours after birth and may **increase in size for 12–24 hours** as the slow capillary leak continues. * **Option B:** It is defined as a **subperiosteal hemorrhage**, usually involving the parietal or occipital bones. * **Option C:** As the trapped blood breaks down and is reabsorbed, it increases the bilirubin load on the neonatal liver, which **may lead to hyperbilirubinemia (jaundice)**. **High-Yield Clinical Pearls for NEET-PG:** * **Cephalohematoma vs. Caput Succedaneum:** Caput is a soft tissue edema (subcutaneous) that *is* present at birth and *does* cross suture lines. * **Subgaleal Hemorrhage:** This occurs between the aponeurosis and periosteum. It is the most dangerous as it can cross sutures and hold a massive volume of blood, leading to shock. * **Management:** Most cephalohematomas resolve spontaneously within weeks. **Incision and drainage are contraindicated** due to the high risk of secondary infection (osteomyelitis).

Question 1

Which of the following causes can result in an infant being large for gestational age, EXCEPT?

Accepted Answer

Maternal smoking

Answer

Hydrops fetalis

Answer

Genetic predisposition

Answer

Maternal diabetes mellitus

Question 2

What is the weight range for a Low Birth Weight (LBW) baby?

Accepted Answer

1.5-2.5 kg

Answer

2.6-2.9 kg

Answer

2.7-2.9 kg

Answer

3.2-3.5 kg

Question 3

A newborn presents with frothing of the mouth and cyanosis on day one. What is the most probable diagnosis?

Accepted Answer

Esophageal atresia

Answer

Lung hypoplasia

Answer

Lung cyst

Answer

Diaphragmatic hernia

Question 4

Which of the following is not a feature of neonatal lupus erythematosus?

Accepted Answer

Anti-Ro positivity

Answer

Cutaneous lesions

Answer

Heart block

Answer

Thrombocytopenia

Question 5

A 1-day-old baby boy has developed abdominal distension and bilious emesis. Prenatal history was significant for areas of echogenic bowel seen on ultrasound. An abdominal radiograph and contrast enema were performed. Based on these findings, what is the most likely diagnosis?

Accepted Answer

Cystic fibrosis

Answer

Duodenal atresia

Answer

Gastroenteritis

Answer

Malrotation with volvulus

Question 6

Collection of sero-sanguineous fluid in the scalp is known as what?

Accepted Answer

It is limited to the periosteum

Answer

It is present at birth

Answer

It does not cause jaundice in the newborn

Answer

It disappears within a few hours of birth

Question 7

A female infant is born approximately 10 weeks prematurely (at 30 weeks) and weighs 1710 gm. She has respiratory distress syndrome and is treated with exogenous surfactant. She is intubated endotracheally with mechanical ventilation immediately after birth. Over the first 4 days after birth, the ventilator pressure and the fraction of inspired oxygen are reduced. Beginning on the fifth day after birth, she has brief desaturations that become more persistent. She needs increased ventilator and oxygen support on the seventh day after birth. She becomes cyanotic. Further examination, echocardiogram, and x-rays reveal left atrial enlargement, an enlarged pulmonary artery, increased pulmonary vasculature, and a continuous machine-like murmur. Which of the following is the most likely diagnosis?

Accepted Answer

Patent ductus arteriosus

Answer

Persistent foramen ovale

Answer

Ventricular septal defect

Answer

Pulmonary stenosis

Question 8

A neonate with multiple congenital anomalies has severe pulmonary hypoplasia of one lung. This is MOST likely secondary to which of the following congenital problems?

Accepted Answer

Diaphragmatic defect

Answer

Endocardial cushion defect

Answer

Esophageal atresia

Answer

Gastroschisis

Question 9

A 3-month-old boy is brought to the physician because his parents cannot find one of his testicles. Physical examination confirms the parents' observation. Which of the following is the most likely diagnosis?

Accepted Answer

Cryptorchidism

Answer

Anorchia

Answer

Klinefelter syndrome

Answer

Macroorchidism

Question 10

All of the following are true about Cephalohematoma except?

Accepted Answer

May cross suture lines

Answer

Increases in size for 12-24 hours after birth

Answer

It is a subperiosteal hemorrhage

Answer

May be associated with jaundice

Neonatology — MCQs

Neonatology — MCQs

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