Neonatology Practice Questions

Q: Neonate born at 34 weeks with premature rupture of membranes develops respiratory distress. CXR was performed. All are considered in differential diagnosis except:

Tetralogy of Fallot. ***Tetralogy of Fallot*** - **Tetralogy of Fallot** is a **cyanotic congenital heart defect** characterized by VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta. - It presents primarily with **cyanosis** (not respiratory distress) and would show **normal or oligemic lung fields** on CXR, not the diffuse parenchymal lung disease patterns seen in RDS, pneumonia, or alveolar proteinosis. - **Not part of the differential diagnosis** for a preterm neonate with PROM presenting with respiratory distress and lung infiltrates on imaging. *Congenital pneumonia* - This is a significant concern in a neonate born prematurely with **premature rupture of membranes (PROM)**, as ascending infection is a known risk factor. - Chest X-ray findings can include **diffuse hazy infiltrates** or **patchy consolidation**, consistent with infections. - Would be considered in the differential diagnosis. *Hyaline membrane disease* - Also known as **respiratory distress syndrome (RDS)**, this is common in **premature infants at 34 weeks** due to **surfactant deficiency**. - The chest X-ray typically shows **diffuse reticulogranular ground-glass opacities** and **air bronchograms**. - Most common cause of respiratory distress in preterm neonates and a key differential. *Congenital alveolar proteinosis* - This is a rare genetic disorder where **surfactant proteins accumulate in the alveoli**, leading to impaired gas exchange and respiratory distress. - Chest X-ray findings often include **diffuse alveolar infiltrates** or consolidation, which can resemble other neonatal lung diseases. - Though rare, must be considered in the differential for neonatal respiratory distress.

Q: A term neonate presents with respiratory distress. The chest X-ray is shown below. Which of the following radiological findings is seen?

Fluid in transverse fissure. ***Fluid in transverse fissure*** - The image shows **prominent linear opacities** in the lungs, particularly noticeable in the right lung consistent with **fluid accumulation within the fissures**. - This finding, along with other signs of fluid retention like **perihilar streaking** and **mild cardiomegaly**, is characteristic of **Transient Tachypnea of the Newborn (TTN)**, which results from delayed clearance of lung fluid at birth. *Chemical pneumonitis* - **Chemical pneumonitis** typically appears as **patchy or diffuse infiltrates** or consolidation on chest X-ray, often resulting from aspiration of gastric contents or meconium. - The X-ray findings here are more consistent with interstitial fluid rather than an inflammatory reaction to aspirated substances. *Air-leak* - **Air-leak syndromes** (e.g., pneumothorax, pneumomediastinum) would show collections of **free air** outside the lung parenchyma, such as an absent lung marking or air outlining mediastinal structures. - These findings are not present in the provided image. *Patchy atelectasis* - **Patchy atelectasis** would present as areas of **lung collapse**, often with volume loss or increased opacification in specific segments or lobes. - While there is some increased density, the predominant pattern is **interstitial prominence** and fissural fluid rather than focal collapse.

Q: The image shows:

Symmetrical IUGR. ***Symmetrical IUGR*** - The image displays a neonate with **proportionately small body parts**, including the head and trunk, which is characteristic of symmetrical intrauterine growth restriction. - This type of IUGR typically results from **early gestational insults** (e.g., genetic abnormalities, infections) affecting overall cell number and size. *Asymmetrical IUGR* - Asymmetrical IUGR (also known as "head-sparing" IUGR) is characterized by a **normal head size** relative to a disproportionately small body. - This condition usually occurs due to **late-onset fetal malnutrition** or placental insufficiency, where the brain is preferentially supplied with nutrients. *Proteus syndrome* - Proteus syndrome involves **overgrowth of various tissues** (skin, bone, adipose tissue), leading to asymmetrical and disorganized growth. - The image shows a uniformly small infant, not focal or multi-tissue overgrowth, ruling out Proteus syndrome. *Poland syndrome* - Poland syndrome is a rare birth defect characterized by **missing or underdeveloped muscles on one side of the body**, primarily affecting the chest and arm. - The infant in the image does not exhibit unilateral muscle deficiency or limb abnormalities typical of Poland syndrome.

Q: Which of the following is the first line of management of the condition shown?

Parenteral vitamin K. ***Parenteral vitamin K*** - The image shows an actively **bleeding umbilical stump**, which is a classic presentation of **vitamin K deficiency bleeding** (VKDB) in a neonate. - **Parenteral vitamin K** is the first-line treatment for VKDB because it rapidly replenishes clotting factors, addressing the underlying coagulopathy. *Silver nitrate topical application* - **Silver nitrate** is used to cauterize and treat **umbilical granulomas**, which appear as pinkish-red, moist, fleshy growths, typically not actively bleeding. - It would be ineffective and potentially harmful for an actively bleeding umbilical stump due to vitamin K deficiency. *Ligation of stump with silk thread* - **Ligation with a silk thread** is indicated for a persistent, non-bleeding **umbilical granuloma** that is not responsive to silver nitrate. - It is not appropriate for treating active bleeding due to coagulopathy and could worsen the condition if the underlying cause is not addressed. *Topical neosporin powder* - **Topical neosporin powder** is an antibiotic used for preventing **bacterial infections** of the umbilical stump or minor skin wounds. - It does not have any hemostatic properties and would not stop bleeding caused by a systemic clotting deficiency.

Q: An image of a newborn infant is shown. What is the most likely diagnosis?

Infant of diabetic mother. ***Infant of diabetic mother*** - The image depicts a **large for gestational age (LGA)** or **macrosomic** infant with a **plethoric appearance** and significant subcutaneous fat, which are classic signs of an infant of a diabetic mother. - Maternal hyperglycemia leads to fetal hyperinsulinemia, causing increased fetal growth and fat deposition. *Beckwith Wiedemann syndrome* - While infants with Beckwith-Wiedemann syndrome can be LGA, they typically present with characteristic features such as **macroglossia**, **omphalocele**, **ear creases/pits**, and **hemihyperplasia**, which are not clearly evident in this image. - The overall appearance of diffuse adiposity is more consistent with uncontrolled maternal diabetes. *Congenital hypothyroidism* - Infants with congenital hypothyroidism are often **hypotonic**, have a **hoarse cry**, prolonged jaundice, and a characteristic **coarse facial appearance** with a large tongue and umbilical hernia, and are typically *not* macrosomic. - The appearance in the image does not align with the typical features of congenital hypothyroidism. *IUGR baby* - An **intrauterine growth restriction (IUGR)** baby is small for gestational age (SGA) due to various factors impeding fetal growth. - The infant in the image is clearly **macrosomic**, and not small, directly contradicting the definition of IUGR.

Q: A 1-day-old neonate, born via home delivery, is brought with respiratory distress. The given CXR shows:

Congenital diaphragmatic hernia. ***Congenital diaphragmatic hernia*** - The chest X-ray likely shows bowel loops within the chest cavity, mediastinal shift, and an absent or poorly defined diaphragmatic outline, which are classic signs of a **congenital diaphragmatic hernia**. - A 1-day-old neonate with respiratory distress and these radiographic findings strongly suggests this diagnosis, as it results from incomplete **closure of the diaphragm** enabling abdominal organs to herniate into the thorax. *Hyaline membrane disease* - Characterized by **diffuse reticulogranular infiltrates** and **air bronchograms** due to surfactant deficiency. - Does not typically present with bowel loops in the chest or mediastinal shift. *Meconium aspiration syndrome* - CXR typically reveals **patchy infiltrates**, **hyperinflation**, and sometimes **pneumothorax** or **pleural effusions**. - There is no evidence of bowel in the chest or mediastinal shift characteristic of diaphragmatic hernia. *Transient Tachypnea of newborn* - CXR findings usually include **prominent perihilar streaking**, **fluid in the fissures**, and **hyperinflation**. - This condition resolves within 24-48 hours and doesn't involve herniated abdominal organs in the chest space.

Q: A newborn presents with the clinical features shown in the image below. What is the most likely diagnosis?

Trisomy 18. ***18 trisomy*** - The image shows a newborn with an **omphalocele (abdominal wall defect)** and characteristic **clenched hands with overlapping fingers**, which are common features of Trisomy 18 (Edwards syndrome). - Other typical features include **low-set ears**, **micrognathia**, **rocker-bottom feet**, and severe developmental delay, contributing to a poor prognosis. *21 trisomy* - Trisomy 21 (Down syndrome) typically presents with **upslanting palpebral fissures**, an **epicanthal fold**, a **single palmar crease**, and **intellectual disability**, which are not the prominent features seen here. - While congenital heart defects can be present in both, the specific hand posture and omphalocele are more indicative of Trisomy 18. *13 trisomy* - Trisomy 13 (Patau syndrome) is characterized by severe malformations, including **cleft lip and palate**, **polydactyly**, **cutis aplasia**, and **microphthalmia**, which are distinct from the features in the image. - **Holoprosencephaly** is also common in Trisomy 13, which is not suggested by the visual findings. *12 trisomy* - Trisomy 12 is **not a recognized viable chromosomal aneuploidy** in humans that leads to a distinct syndrome such as those related to chromosomes 13, 18, or 21. - Genetic disorders involving chromosome 12 are typically mosaic or involve partial aneuploidies.

Q: "Small for Date" (SFD) babies, also known as "small for gestational age" babies, weigh less than what percentile for the gestational age?

10^th percentile. ***10^th percentile*** - A baby is classified as **small for gestational age (SGA)** when their birth weight is below the **10th percentile** for their gestational age. - This definition helps identify infants who may be at increased risk for **perinatal morbidity and mortality** due to restricted growth. *20^th percentile* - A cutoff of the 20th percentile is generally considered within the **normal range** for birth weight. - Using this percentile would lead to an **overestimation** of infants experiencing growth restriction. *2^nd percentile* - While babies below the 2nd percentile are also considered SGA, this is a more **severe category** of growth restriction. - The standard definition for SGA encompasses all infants below the **10th percentile**, not just those with extreme growth deficits. *5^th percentile* - Similar to the 2nd percentile, the 5th percentile represents a subset of SGA babies with more **pronounced growth restriction**. - However, the universally accepted definition for **small for gestational age** uses the 10th percentile as the threshold.

Q: A term baby with birth weight of 2.8 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth ? I. The baby should be initiated on breastfeeding within one hour of birth II. The baby should be kept in a separate area from the mother III. The baby should be administered with 0.5 mg of vitamin K intramuscularly IV. The baby should be thoroughly examined for congenital malformations from head to toe Select the answer using the code given below :

I and IV. ***I and IV*** - **Early initiation of breastfeeding within one hour** is crucial for promoting bonding, establishing successful lactation, and providing the newborn with colostrum for immunity. - A comprehensive **head-to-toe examination for congenital malformations** is a standard part of immediate newborn care to identify any anomalies requiring further evaluation or intervention. *II and III* - **Keeping the baby with the mother (rooming-in)** is recommended to promote bonding, facilitate unrestricted breastfeeding, and enable continuous monitoring by the mother. - The standard dose of **vitamin K administered intramuscularly for a term baby is 1 mg**, not 0.5 mg, to prevent hemorrhagic disease of the newborn. *I and II* - While early breastfeeding (I) is correct, **keeping the baby in a separate area from the mother (II) is incorrect** as rooming-in is highly encouraged for newborn care. - Separating the baby can hinder initial bonding and interfere with an early and successful breastfeeding experience. *I and III* - **Early initiation of breastfeeding within one hour (I) is correct**, but the **dose of vitamin K (III) is incorrect**, as 1 mg is the standard, not 0.5 mg. - Incorrect medication dosages can have clinical implications, making this combination an unsuitable choice for correct initial care.

Question 1

Neonate born at 34 weeks with premature rupture of membranes develops respiratory distress. CXR was performed. All are considered in differential diagnosis except:

Accepted Answer

Tetralogy of Fallot

Answer

Congenital pneumonia

Answer

Hyaline membrane disease

Answer

Congenital alveolar proteinosis

Question 2

A term neonate presents with respiratory distress. The chest X-ray is shown below. Which of the following radiological findings is seen?

Accepted Answer

Fluid in transverse fissure

Answer

Chemical pneumonitis

Answer

Air-leak

Answer

Patchy atelectasis

Question 3

The image shows:

Accepted Answer

Symmetrical IUGR

Answer

Asymmetrical IUGR

Answer

Proteus syndrome

Answer

Poland syndrome

Question 4

Which of the following is the first line of management of the condition shown?

Accepted Answer

Parenteral vitamin K

Answer

Silver nitrate topical application

Answer

Ligation of stump with silk thread

Answer

Topical neosporin powder

Question 5

An image of a newborn infant is shown. What is the most likely diagnosis?

Accepted Answer

Infant of diabetic mother

Answer

Beckwith Wiedemann syndrome

Answer

Congenital hypothyroidism

Answer

IUGR baby

Question 6

A 1-day-old neonate, born via home delivery, is brought with respiratory distress. The given CXR shows:

Accepted Answer

Congenital diaphragmatic hernia

Answer

Hyaline membrane disease

Answer

Meconium aspiration syndrome

Answer

Transient Tachypnea of newborn

Question 7

A newborn presents with the clinical features shown in the image below. What is the most likely diagnosis?

Accepted Answer

Trisomy 18

Answer

Trisomy 21

Answer

Trisomy 13

Answer

Trisomy 12

Question 8

"Small for Date" (SFD) babies, also known as "small for gestational age" babies, weigh less than what percentile for the gestational age?

Accepted Answer

10^th percentile

Answer

20^th percentile

Answer

2^nd percentile

Answer

5^th percentile

Question 9

Which of the following are neonatal complications of maternal diabetes during pregnancy?
I. Hyperbilirubinemia
II. Hypocalcemia
III. Cardiomyopathy
IV. Hypoglycemia

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Question 10

A term baby with birth weight of 2.8 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth ?
I. The baby should be initiated on breastfeeding within one hour of birth
II. The baby should be kept in a separate area from the mother
III. The baby should be administered with 0.5 mg of vitamin K intramuscularly
IV. The baby should be thoroughly examined for congenital malformations from head to toe

Select the answer using the code given below :

Accepted Answer

I and IV

Answer

II and III

Answer

I and II

Answer

I and III

Neonatology — MCQs

Neonatology — MCQs

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