Neonatology Practice Questions

Q: Clinical features of an infant with Fetal growth retardation at birth include which of the following ? 1. Physical features give 'an old man look'. 2. Baby is alert, reflexes are normal. 3. Thick fat accumulates around shoulders of baby. Select the correct answer using the code given below :

1 and 2 only. ***1 and 2 only*** - Infants with **fetal growth restriction (FGR)** often have a **wasted appearance** with sparse subcutaneous fat, giving them an "old man look" due to prominence of skin folds and bones. - Despite their small size, typically FGR infants are **neurologically intact** at birth, maintaining normal alertness and reflexes. *1, 2 and 3* - This option is incorrect because the third statement, regarding **thick fat accumulation**, is not characteristic of FGR infants. FGR involves **poor fetal growth**, leading to reduced subcutaneous fat. - **Thick fat** would suggest normal or even accelerated growth, which is contrary to the definition of fetal growth restriction. *2 and 3 only* - This option is incorrect as it includes the incorrect statement about **thick fat accumulation** (statement 3) and omits the correct finding of an "old man look" (statement 1), which is a classic presentation of FGR. - While statement 2 is correct regarding alertness and reflexes, the inclusion of statement 3 makes this option invalid. *1 and 3 only* - This option is incorrect because statement 3, describing **thick fat accumulation**, is contrary to the features of FGR, which are characterized by **poor fat reserves** and a wasted appearance. - It also omits the correct statement about the baby being alert with normal reflexes (statement 2).

Q: Which of the following can be a complication in the baby due to post maturity of pregnancy ?

Meconium aspiration. ***Meconium aspiration*** - **Post-term pregnancies** (>42 weeks) are associated with **oligohydramnios** and **placental insufficiency**, leading to fetal distress - Fetal distress causes passage of **meconium** into amniotic fluid, which can be aspirated during gasping movements - **Meconium aspiration syndrome** is one of the **most characteristic complications** of post-maturity - This is the **most recognized** complication among the options listed *Hypoglycemia* - Post-term infants **ARE actually at risk** for hypoglycemia - Mechanism: **Placental insufficiency** leads to depleted fetal **glycogen stores** and subcutaneous fat - However, this is **less specific** to post-term pregnancy compared to meconium aspiration, as it occurs in multiple conditions - While medically correct, meconium aspiration is the more characteristic complication *Intraventricular hemorrhage* - This is primarily a complication of **prematurity**, especially in very low birth weight infants - Caused by fragility of the **germinal matrix** in preterm brains - **Not associated with post-term pregnancy** *Polycythemia* - Post-term infants **can develop polycythemia** (hematocrit >65%) - Mechanism: Chronic **placental insufficiency** → fetal hypoxia → increased **erythropoietin production** - While this is a recognized complication, **meconium aspiration** remains the **most classic and frequently tested** complication of post-maturity

Q: A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

Cephalhaematoma. ***Cephalhaematoma*** - A **cephalhaematoma** is a collection of blood between the **pericranium** and the skull bone, which is characteristically limited by the **suture lines**. This perfectly matches the clinical description. - It is often associated with **traumatic deliveries** like forceps delivery due to shearing forces on the skull and can appear hours to days after birth. *Subgaleal haemorrhage* - A **subgaleal haemorrhage** involves bleeding into the **potential space between the epicranial aponeurosis and the periosteum** (galea aponeurotica). - Unlike cephalhaematoma, it is **not limited by suture lines** and can spread across the entire scalp, potentially leading to significant blood loss. *Caput succedaneum* - **Caput succedaneum** is an **oedematous swelling of the fetal scalp** caused by pressure during head engagement, leading to fluid accumulation above the periosteum. - It is present at birth, often **crosses suture lines**, and usually resolves within a few days, differentiating it from a blood collection limited by sutures. *Intraventricular haemorrhage* - **Intraventricular haemorrhage** is bleeding into the brain's ventricular system and is a serious condition most commonly seen in **premature infants**. - It involves **bleeding within the brain** itself, not an external scalp swelling, and presents with neurological symptoms.

Q: Which of the following is correct regarding "witch's milk"?

It is seen in full-term infants.. ***It is seen in full-term infants.*** - **Witch's milk** (neonatal galactorrhea) is a physiological phenomenon observed in newborns due to the **withdrawal of maternal hormones** (estrogens, progesterone, and prolactin) after birth. - These maternal hormones cross the placenta during pregnancy and stimulate the fetal breast tissue. - While it can occur in both preterm and term infants, it is **more commonly and prominently observed in full-term infants** who have had greater exposure to maternal hormones. - This condition typically appears 3-5 days after birth and resolves spontaneously within a few weeks. *It is caused by stimulation of foetal breast by calcitonin.* - **Calcitonin** is a hormone involved in calcium and bone metabolism, not breast development or milk production. - **Witch's milk** is caused by the withdrawal of maternal hormones (estrogens, progesterone, and prolactin) after birth, not calcitonin. *It is seen only in preterm infants.* - This is incorrect as witch's milk can occur in **both preterm and full-term infants**. - It is actually **more common in full-term newborns** due to their longer exposure to maternal hormones in utero. *It is caused by stimulation of foetal breast by progesterone.* - While **progesterone** is one of the maternal hormones involved, the mechanism is more accurately described as a **withdrawal phenomenon** rather than ongoing stimulation. - After birth, the sudden **withdrawal of maternal estrogens, progesterone, and prolactin** triggers the breast tissue to secrete milk. - The wording "stimulation by progesterone" is misleading as it suggests active stimulation rather than the withdrawal mechanism that actually causes the milk secretion.

Q: In a newborn, the Apgar score has been recorded at 1 minute of birth. Which one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?

3. ***3*** - The Apgar score is calculated based on five criteria: **Appearance**, **Pulse**, **Grimace**, **Activity**, and **Respiration** (APGAR). Each criterion is scored 0, 1, or 2. - Based on the given findings: - **Heart rate (Pulse)**: 92/min scores **1** (below 100/min). - **Respiratory effort (Respiration)**: Slow, irregular scores **1**. - **Muscle tone (Activity)**: Flaccid scores **0**. - **Reflex response (Grimace)**: No response scores **0**. - **Colour (Appearance)**: Body pink, extremities blue (acrocyanosis) scores **1**. - Summing these scores (1 + 1 + 0 + 0 + 1) gives a total Apgar score of **3**. *2* - This score would mean that the newborn has a **more severe depression** in vital signs compared to the actual findings. - A score of 2 would require at least one of the 1-point criteria to be a 0-point criterion or combination of a 0-point criterion become 1. *0* - An Apgar score of 0 would indicate that the infant has **no vital signs** (no heart rate, no respiratory effort, no muscle tone, no reflex response, and completely blue/pale). - This is not consistent with a heart rate of 92/min, slow/irregular respirations, and body pink color. *5* - An Apgar score of 5 would imply a **much healthier** newborn with better scores in most categories. - This would require findings such as a heart rate over 100 bpm, good crying, some flexion of extremities, or an all-pink appearance, which are not present here.

Q: Most common newborn rash which presents at 24-48 hours of life is

Erythema toxicum neonatorum. ***Erythematous papular pustular lesions*** - This description is characteristic of **Erythema toxicum neonatorum**, which is the **most common benign transient rash in newborns.** - It typically appears between **24 and 48 hours of life** and presents with discrete **erythematous macules**, papules, and pustules on a red base. *Milia* - Milia are **tiny, pearly white cysts** that are present from birth and are due to trapped keratin. - While common, they are **not typically red or pustular** and do not usually have a delayed onset at 24-48 hours specifically. *Transient neonatal pustular melanosis* - This rash is present at **birth** and consists of **non-erythematous pustules** that rupture to leave collarettes of scale and dark macules. - Unlike erythema toxicum, it **lacks the erythematous base** and is usually present earlier. *Erythematous maculopapular rash* - This is a **general description** that could fit several conditions but **lacks the specific pustular component** that is key to identifying erythema toxicum neonatorum. - While erythema toxicum has macules and papules, the **presence of pustules** is a hallmark.

Q: Apgar score is used in:

Newborn assessment. ***Newborn assessment*** - The **Apgar score** is a standardized clinical assessment tool used to evaluate the **physical condition of newborn infants** immediately after birth. - Developed by Dr. Virginia Apgar in 1952, it assesses five parameters at **1 minute and 5 minutes** after delivery (extended to 10, 15, and 20 minutes if needed). - The five components assessed are: - **A**ppearance (skin color): 0-2 points - **P**ulse (heart rate): 0-2 points - **G**rimace (reflex irritability): 0-2 points - **A**ctivity (muscle tone): 0-2 points - **R**espiration (breathing effort): 0-2 points - **Total score ranges from 0-10**, with scores of 7-10 considered normal, 4-6 indicating moderate distress, and 0-3 indicating severe distress requiring immediate resuscitation. - It helps **identify neonates requiring immediate medical intervention** and provides a standardized method for documenting the newborn's transition to extrauterine life. *Maternal health assessment* - Maternal health is assessed using different tools such as **antenatal risk scoring systems**, blood pressure monitoring, and laboratory investigations. - The Apgar score is specifically designed for **neonates, not mothers**. *Nutritional status evaluation* - Nutritional status is assessed using anthropometric measurements like **weight-for-height, BMI, MUAC** (mid-upper arm circumference), and biochemical markers. - The Apgar score does not evaluate nutritional parameters. *Infectious disease severity grading* - Infectious disease severity uses specific scoring systems like **APACHE II, SOFA score, or disease-specific criteria** (e.g., WHO classification for dengue severity). - The Apgar score is a **neonatal assessment tool**, not used for infectious disease evaluation.

Q: A 37-week small-for-date neonate is most likely to develop

Hypoglycaemia. ***Hypoglycaemia*** - **Small-for-date** neonates have reduced **glycogen stores** due to chronic fetal stress or placental insufficiency. - Their increased metabolic demands relative to limited energy reserves make them prone to **low blood glucose**. - This is the **most immediate metabolic complication** requiring urgent screening and management. *Hyaline membrane disease* - This condition, also known as **respiratory distress syndrome**, primarily affects **premature neonates** due to surfactant deficiency. - **Small-for-date infants** at term (37 weeks) typically have **accelerated lung maturity** due to chronic intrauterine stress, making them **less susceptible** to RDS compared to appropriately grown preterm infants. *Hypocalcaemia* - While neonates can experience hypocalcemia, it is particularly common in infants of **diabetic mothers**, those with **asphyxia**, or those born **prematurely**. - Small-for-date status alone isn't the primary risk factor for **neonatal hypocalcaemia**. *Hypothermia* - **Small-for-date** infants have a larger **surface area to body mass ratio** and reduced **subcutaneous fat**, which significantly increases heat loss. - This is indeed a **major risk** requiring immediate attention at birth (thermal protection, skin-to-skin care). - However, **hypoglycemia** is considered the **most characteristic metabolic derangement** and "most likely" complication specifically associated with SGA status, making it the best answer for this question.

Question 1

Clinical features of an infant with Fetal growth retardation at birth include which of the following ?

1. Physical features give 'an old man look'. 
2. Baby is alert, reflexes are normal. 
3. Thick fat accumulates around shoulders of baby.

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Question 2

Which of the following can be a complication in the baby due to post maturity of pregnancy ?

Accepted Answer

Meconium aspiration

Answer

Hypoglycemia

Answer

Intraventricular hemorrhage

Answer

Polycythemia

Question 3

A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

Accepted Answer

Cephalhaematoma

Answer

Subgaleal haemorrhage

Answer

Caput succedaneum

Answer

Intraventricular haemorrhage

Question 4

Which of the following is correct regarding "witch's milk"?

Accepted Answer

It is seen in full-term infants.

Answer

It is caused by stimulation of foetal breast by calcitonin.

Answer

It is seen only in preterm infants.

Answer

It is caused by stimulation of foetal breast by progesterone.

Question 5

In a newborn, the Apgar score has been recorded at 1 minute of birth. Which one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?

Accepted Answer

3

Answer

2

Answer

0

Answer

5

Question 6

To prevent neonatal tetanus in an infant born to a woman who has not been given Tetanus Toxoid (TT) appropriately during pregnancy, what should ideally be done?

Accepted Answer

Give one dose of TT to the mother and one dose of TIG to the infant within 6 hours of birth

Answer

Injection Tetanus Immunoglobulin (TIG) has to be administered to the infant within 6 hours of birth

Answer

Give one dose of TT to the mother and one dose of TIG to the infant after 72 hours of birth

Answer

Give one dose of TT to the mother immediately

Question 7

Most common newborn rash which presents at 24-48 hours of life is

Accepted Answer

Erythema toxicum neonatorum

Answer

Milia

Answer

Transient neonatal pustular melanosis

Answer

Erythematous maculopapular rash

Question 8

Apgar score is used in:

Accepted Answer

Newborn assessment

Answer

Maternal health assessment

Answer

Nutritional status evaluation

Answer

Infectious disease severity grading

Question 9

Meconium aspiration syndrome can be prevented by taking the following measures except :

Accepted Answer

Delivering the baby by emergency caesarean section

Answer

Amnioinfusion

Answer

Oropharyngeal suctioning

Answer

Suctioning of trachea through laryngoscope

Question 10

A 37-week small-for-date neonate is most likely to develop

Accepted Answer

Hypoglycaemia

Answer

Hyaline membrane disease

Answer

Hypocalcaemia

Answer

Hypothermia

Neonatology — MCQs

Neonatology — MCQs

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