Neonatology Practice Questions

Q: The appropriate treatment for the baby of a woman who is HBsAg positive but HBeAg negative is

Both active and passive immunisation soon after birth. **Both active and passive immunisation soon after birth** - **Active immunization** (Hepatitis B vaccine) provides long-term immunity by stimulating the infant's immune system to produce antibodies. - **Passive immunization** (Hepatitis B immune globulin, HBIG) provides immediate, short-term protection through pre-formed antibodies, crucial for preventing infection in the critical perinatal period. *Passive immunisation soon after birth but active immunisation after one year of age* - Delaying active immunization until after one year of age would leave a significant window during which the infant is vulnerable to **Hepatitis B infection** from the mother, as passive immunity is only temporary. - The combination of immediate active and passive immunisation is far more effective at preventing **perinatal transmission**. *Only active immunisation soon after birth* - Active immunization alone may not provide immediate enough protection through antibody development, leaving the infant susceptible to **Hepatitis B infection** during their first few weeks of life when exposure risk is highest. - The onset of protective immunity from the vaccine can take several weeks, which is insufficient for immediate protection against perinatal exposure. *Only passive immunisation soon after birth* - While passive immunisation provides immediate protection, it is only temporary and does not confer long-term immunity against **Hepatitis B**. - Without active immunisation, the infant would eventually lose the passively acquired antibodies and remain vulnerable to future **Hepatitis B exposures**.

Q: Neo-natal infection in a Hepatitis 'B' positive pregnant woman can be prevented by administering:

Vaccine and Immunoglobulin. ***Vaccine and Immunoglobulin*** - Administering both the **Hepatitis B vaccine** and **Hepatitis B immune globulin (HBIG)** provides both active and passive immunity to the newborn. - This combination is crucial for preventing perinatal transmission of HBV from an infected mother, significantly reducing the risk of the baby becoming a chronic carrier. *Hepatitis 'B' vaccine* - The vaccine alone provides **active immunity**, which takes time to develop, thus not offering immediate protection against acute exposure at birth. - While essential for long-term protection, it's insufficient as a sole measure for newborns at high risk of immediate infection. *Immunoglobulin* - **Hepatitis B immune globulin (HBIG)** provides **passive immunity**, offering immediate but short-term protection. - It contains pre-formed antibodies that neutralize the virus, but it does not confer lasting immunity. *Corticosteroids* - **Corticosteroids** are used as anti-inflammatory or immunosuppressive agents and have no role in preventing viral infections like Hepatitis B. - Their use in this context would be inappropriate and could even be harmful.

Q: Cephalhematomas are most commonly found over:

Parietal bone. ***Parietal bone*** - The **parietal bones** are the most common site for cephalhematomas due to their prominence and susceptibility to trauma during vaginal delivery [1]. - The **force of uterine contractions** and contact with the birth canal can cause blood vessels beneath the periosteum of the parietal bone to rupture [1]. *Occipital bone* - While possible, cephalhematomas are less commonly observed over the **occipital bone** compared to the parietal region. - The **occipital protrusion** is less frequently subjected to the specific shearing forces that cause subperiosteal bleeding. *Temporal bone* - Cephalhematomas over the **temporal bone** are rare, primarily because this area is less frequently directly impacted during birth. - The relatively thinner bone and surrounding muscles also provide some protection against the typical trauma leading to this condition. *Frontal bone* - Cephalhematomas are generally uncommon over the **frontal bone**. - This area is less exposed to direct pressure and friction from the maternal pelvis during delivery.

Q: What is the most common cause of intestinal obstruction in neonates?

Duodenal atresia. ***Duodenal atresia*** - **Duodenal atresia** is one of the **most common causes of intestinal obstruction** in neonates, accounting for approximately 30-40% of all neonatal intestinal obstructions. - It is a **congenital malformation** where the duodenum is completely blocked, leading to the characteristic **"double-bubble" sign** on X-ray (one bubble in the stomach and one in the proximal duodenum). - Strongly associated with **Down syndrome** (30% of cases) and **polyhydramnios** during pregnancy. - Presents with **bilious vomiting** within the first 24-48 hours of life. *Meconium ileus* - **Meconium ileus** accounts for only **10-15%** of neonatal intestinal obstruction cases. - It is strongly associated with **cystic fibrosis** (90% of meconium ileus cases have CF), with approximately 10-20% of CF newborns presenting with meconium ileus. - Caused by thick, inspissated meconium obstructing the terminal ileum. *Hirschsprung's disease* - **Hirschsprung's disease** causes functional obstruction due to **absence of ganglion cells** in the distal bowel (aganglionic segment). - Accounts for **15-20%** of neonatal intestinal obstruction cases. - Typically presents with **delayed passage of meconium** (>48 hours), abdominal distension, and bilious vomiting. *Volvulus neonatorium* - **Volvulus neonatorium** involves twisting of the intestine, often due to **intestinal malrotation**, leading to obstruction and vascular compromise. - Accounts for **10-15%** of cases and presents as a surgical emergency with bilious vomiting and potential bowel ischemia.

Q: A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken? 1. The baby should be exclusively breast fed for first six months 2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight 3. Baby should be kept with mother and kangaroo care to be given Select the correct answer using the code given below:

1 and 3 only. ***1 and 3 only*** - **Exclusive breastfeeding** for the first six months is crucial for **nutrition** and **immunity**, especially for low birth weight babies. - **Kangaroo Mother Care (KMC)**, involving skin-to-skin contact, helps regulate the baby's temperature, promotes bonding, and supports weight gain in LBW infants. *2 and 3 only* - While **Kangaroo Mother Care (KMC)** is appropriate for this baby, the recommendation to delay vaccination is incorrect. - **BCG vaccination** should be given at birth to babies weighing **≥2 kg** as per IAP guidelines, so a 2.2 kg baby qualifies for immediate vaccination. *1 and 2 only* - **Exclusive breastfeeding** is appropriate, but delaying vaccinations is not indicated for a baby weighing 2.2 kg. - **BCG** is given at birth for babies ≥2 kg, and routine immunization schedule should be followed without delay based on birth weight alone. *1, 2 and 3* - While statements 1 and 3 correctly identify beneficial practices (exclusive breastfeeding and kangaroo care), statement 2 is incorrect. - **Vaccination guidelines** (IAP/UIP) recommend administering **BCG at birth** for babies ≥2 kg, and routine immunizations as per schedule without weight-based delays for a 2.2 kg baby.

Q: Least chances of perinatal transmission are seen in?

HSV. ***HSV*** - **Perinatal transmission of HSV** is rare, occurring in approximately 1 in 3,000 to 1 in 20,000 live births, primarily from contact with maternal genital lesions during vaginal delivery. - Transmission rates are lowest when the mother has **recurrent herpes lesions** due to the presence of maternal antibodies offering some fetal protection. *Rubella* - **Congenital rubella syndrome** carries a high risk of transmission (up to 90%) if the mother contracts rubella in the first trimester. - It can lead to severe birth defects such as **heart abnormalities**, **cataracts**, and **deafness**. *Hepatitis B* - The risk of **vertical transmission of Hepatitis B** is significant, especially if the mother is HBeAg-positive (up to 90%). - Without intervention, chronic infection develops in 70-90% of infected infants, often leading to **liver disease** later in life. *CMV* - **Congenital CMV infection** is the most common congenital viral infection, with a transmission rate of 30-40% in primary maternal infection. - It can cause severe neurological deficits, **sensorineural hearing loss**, and **developmental delays** in affected infants.

Q: Which of the following are causes of neonatal seizures? 1. Hypernatremia 2. Hypomagnesemia 3. Hypocalcemia 4. Hyponatremia

1, 2, 3, and 4. ***1, 2, 3, and 4*** - **All listed electrolyte imbalances** can disrupt neuronal function and lead to neonatal seizures. - **Severe shifts** in sodium, calcium, and magnesium levels directly impact neuronal excitability. *2, 4 only* - This option is incorrect because **hypernatremia** and **hypocalcemia** are also significant causes of neonatal seizures. - Electrolyte disturbances such as **hypomagnesium** and **hyponatremia** can cause neonatal seizures, but they are not the only ones. *1, 3, 4 only* - This choice is incorrect as it **excludes hypomagnesemia**, which is a known cause of neonatal seizures. - **Severely deranged sodium and calcium levels** are important causes, but magnesium disturbances also contribute. *1, 2, 3 only* - This option is incorrect because **hyponatremia** is a well-established cause of neonatal seizures. - While hypernatremia, hypomagnesemia, and hypocalcemia can cause seizures, **hyponatremia** can also lead to cerebral edema and subsequent seizure activity.

Q: One day after delivery, an African American female newborn develops yellow discoloration of the eyes. She was born at term via uncomplicated vaginal delivery and weighed 3.4 kg (7 lb 8 oz). Her mother did not receive prenatal care. Examination shows scleral icterus and mild hepatosplenomegaly. Laboratory studies show: Hemoglobin 10.7 g/dL Reticulocytes 3.5% Maternal blood group O, Rh-negative Fetal blood group A, Rh-negative Serum bilirubin, total 6.1 mg/dL Serum bilirubin, direct 0.4 mg/dL Which of the following is the most likely cause of this patient's condition?

Transfer of Anti-A antibodies. ***Transfer of Anti-A antibodies*** - The mother is **blood group O**, which naturally produces **anti-A and anti-B antibodies**. Since the infant is **blood group A**, these maternal *IgG antibodies* can cross the placenta and cause **hemolysis** in the infant [1], [2]. - This leads to **neonatal jaundice** (due to increased bilirubin from hemolysis) and **anemia** (hemoglobin 10.7 g/dL), with a compensatory **reticulocytosis** (3.5%) [1]. The **splenomegaly** can also be attributed to increased red blood cell destruction [3]. *Binding of Rhesus immune globulins* - The mother is **Rh-negative** and the infant is also **Rh-negative**. Therefore, **Rh incompatibility** is not the cause of the hemolytic disease in this newborn [1]. - **Rhesus immune globulin** is given to **Rh-negative mothers** to prevent alloimmunization against **Rh-positive fetal red blood cells**, which is not relevant here. *Viral infiltration of the bone marrow* - While **viral infections** can cause **hepatosplenomegaly** and **anemia**, they typically suppress red blood cell production, leading to a **low reticulocyte count**, not the **elevated reticulocyte count** seen in this infant. - **Jaundice** associated with viral infections is usually due to **hepatitis** (elevated direct bilirubin), which is not the primary pattern shown here [3]. *Polymerization of deoxygenated hemoglobin* - This process is characteristic of **sickle cell disease**, where **sickle hemoglobin (HbS)** polymerizes, causing red blood cell sickling. - While it can cause **anemia** and **splenomegaly**, it does not typically present as **acute severe jaundice** in the newborn period and is not associated with **ABO incompatibility**.

Question 1

The appropriate treatment for the baby of a woman who is HBsAg positive but HBeAg negative is

Accepted Answer

Both active and passive immunisation soon after birth

Answer

Passive immunisation soon after birth but active immunisation after one year of age

Answer

Only active immunisation soon after birth

Answer

Only passive immunisation soon after birth

Question 2

A woman suffering from active tuberculosis not on ATT has a full term vaginal delivery. All the following should be done except:

Accepted Answer

BCG should be given to the neonate

Answer

Neonate should be isolated from mother

Answer

Breastfeed the neonate

Answer

Neonate should be given INH

Question 3

Neo-natal infection in a Hepatitis 'B' positive pregnant woman can be prevented by administering:

Accepted Answer

Vaccine and Immunoglobulin

Answer

Hepatitis 'B' vaccine

Answer

Immunoglobulin

Answer

Corticosteroids

Question 4

Cephalhematomas are most commonly found over:

Accepted Answer

Parietal bone

Answer

Occipital bone

Answer

Temporal bone

Answer

Frontal bone

Question 5

What is the most common cause of intestinal obstruction in neonates?

Accepted Answer

Duodenal atresia

Answer

Volvulus neonatorium

Answer

Hirschsprung's disease

Answer

Meconium ileus

Question 6

A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken?

1. The baby should be exclusively breast fed for first six months
2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight
3. Baby should be kept with mother and kangaroo care to be given

Select the correct answer using the code given below:

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 7

Least chances of perinatal transmission are seen in?

Accepted Answer

HSV

Answer

Rubella

Answer

Hepatitis B

Answer

CMV

Question 8

Which of the following are causes of neonatal seizures?

1. Hypernatremia
2. Hypomagnesemia
3. Hypocalcemia
4. Hyponatremia

Accepted Answer

1, 2, 3, and 4

Answer

2,4 only

Answer

1, 3, 4 only

Answer

1, 2, 3 only

Question 9

Which of the following is a true statement about congenital CMV infection?

Accepted Answer

If mother is IgG positive for CMV prior to conception, the child is less likely to develop severe infection

Answer

About 20-30% of the infections are symptomatic

Answer

Triad of SNHL, periventricular calcification and enamel hypoplasia

Answer

Most children asymptomatic at birth can develop conductive hearing loss later in life

Question 10

One day after delivery, an African American female newborn develops yellow discoloration of the eyes. She was born at term via uncomplicated vaginal delivery and weighed 3.4 kg (7 lb 8 oz). Her mother did not receive prenatal care. Examination shows scleral icterus and mild hepatosplenomegaly. Laboratory studies show:
Hemoglobin 10.7 g/dL
Reticulocytes 3.5%
Maternal blood group O, Rh-negative
Fetal blood group A, Rh-negative
Serum bilirubin, total 6.1 mg/dL
Serum bilirubin, direct 0.4 mg/dL
Which of the following is the most likely cause of this patient's condition?

Accepted Answer

Transfer of Anti-A antibodies

Answer

Binding of Rhesus immune globulins

Answer

Viral infiltration of the bone marrow

Answer

Polymerization of deoxygenated hemoglobin

Neonatology — MCQs

Neonatology — MCQs

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