Neonatology Practice Questions

Q: Bohn's nodules are

Cystic swellings in neonates. ***Cystic swellings in neonates*** - **Bohn's nodules** are benign, small, white-to-yellow epithelial cysts found on the **buccal and lingual aspects of the alveolar ridges** of newborns. - They are remnants of the dental lamina and typically **resolve spontaneously** within a few weeks or months after birth. *Cysts of gingiva in growing children* - While similar in appearance, **gingival cysts of the newborn** are specifically found on the gingiva, whereas Bohn's nodules often appear on the alveolar ridge, distant from the gingival margin itself. - The term "growing children" is too broad, as Bohn's nodules are exclusively a **neonatal finding**. *Warts on the tongue* - **Warts on the tongue** are typically caused by viral infections (e.g., HPV) and present as papillomatous or verrucous lesions, which are distinct from the smooth, cystic appearance of Bohn's nodules. - Bohn's nodules are found on the alveolar ridges, not directly on the tongue surface. *Cysts associated with soft palate* - Cysts associated with the soft palate would generally include conditions like **palatal cysts of the newborn** (Epstein pearls), which are located on the median palatal raphe. - Bohn's nodules are specifically found on the **alveolar ridges**, not the soft palate.

Q: Most common cause of convulsion on the first day of life in a newborn is:

Perinatal asphyxia. ***Perinatal asphyxia*** - **Perinatal asphyxia** (hypoxic-ischemic encephalopathy) is the most common cause of seizures in the first 24 hours of life in neonates. - The resulting **cerebral injury** from oxygen deprivation and ischemia leads to neuronal excitability and seizure activity. - Accounts for the majority of seizures presenting on day 1 of life, particularly following difficult deliveries or fetal distress. *Hypoglycemia* - While **hypoglycemia** can cause seizures in newborns, it is generally less common than perinatal asphyxia as the primary cause on the very first day. - Seizures due to hypoglycemia often occur in vulnerable infants like those with **diabetic mothers**, intrauterine growth restriction, or those experiencing a sudden drop in glucose. - Usually presents within 2-3 hours after birth in at-risk infants. *Hypocalcemia* - **Early neonatal hypocalcemia** can cause seizures, but typically presents slightly later, usually after 24-48 hours of life. - More common in infants with **low birth weight**, prematurity, birth asphyxia, or those born to diabetic mothers. - Related to immature parathyroid function and increased phosphate load. *Head injury* - **Birth trauma** with intracranial hemorrhage can cause seizures through direct neuronal damage, but is less frequent than perinatal asphyxia as a cause of day 1 seizures. - Risk factors include **difficult instrumental deliveries**, macrosomia, and precipitous labor. - Incidence has decreased significantly with improved obstetric practices.

Q: Most common lesion in fetal toxoplasmosis is -

Chorioretinitis. **Chorioretinitis** - **Chorioretinitis** is the most common and classic ocular manifestation of congenital toxoplasmosis, leading to vision impairment and potential blindness. - The parasite (Toxoplasma gondii) has a predilection for retinal tissue, causing inflammation and scarring. *Encephalitis* - While **encephalitis** (inflammation of the brain) can occur in congenital toxoplasmosis, particularly with intracranial calcifications, it is not the single most common lesion compared to chorioretinitis. - Neurological manifestations are significant but often accompany or are less frequent than ocular involvement. *GI involvement* - **Gastrointestinal involvement** is rare in congenital toxoplasmosis and is not considered a common lesion. - The primary targets of the parasite in congenital infection are the central nervous system and the eyes. *Pulmonary involvement* - **Pulmonary involvement** is also uncommon in congenital toxoplasmosis and is not a typical manifestation. - Severe cases of disseminated toxoplasmosis, particularly in immunocompromised individuals, might show lung involvement, but this is not the most common lesion in fetal infection.

Q: Normal reticulocyte count at birth is

2-6%. ***2-6%*** - At birth, the normal **reticulocyte count** is elevated primarily due to the physiological stress of **adapting to extrauterine life** and increased erythropoiesis. - This higher range reflects the body's need for a rapid turnover of red blood cells to meet oxygen demands after birth. *1-2%* - This range is considered a **normal reticulocyte count** for **older children and adults**, indicating a steady state of red blood cell production. - It does not account for the **physiological erythropoietic surge** observed in healthy neonates. *6-10%* - While higher than adult levels, a range of **6-10%** in a neonate would still be considered unusually high and might suggest **pathological hemolysis** or significant **blood loss**. - Without other supporting clinical signs, this level is typically higher than the **physiological norm**. *30-40%* - A reticulocyte count of **30-40%** at birth is **extremely elevated** and is highly indicative of a severe underlying condition such as **hemolytic disease of the newborn** or significant **neonatal hemorrhage**. - This level is far beyond the **normal physiological response** and requires urgent investigation.

Q: A neonate on routine examination at birth was found to have hepatomegaly. Rest of the examination was essentially unremarkable. On investigations, Anti-HCMV antibodies were found to be positive. What sequelae in later life is the child at risk of?

Sensorineural hearing loss. ***Sensorineural hearing loss*** - **Congenital CMV infection** is the leading cause of non-genetic sensorineural hearing loss (SNHL) in children, affecting a significant proportion of infected neonates. - SNHL can be **progressive, unilateral or bilateral**, and may manifest years after birth, necessitating long-term audiological monitoring. *Intellectual disability* - While CMV can cause **neurological complications** and intellectual disability, these are more common in symptomatic congenital CMV infections with **microcephaly, intracranial calcifications**, or severe neurological impairment at birth. - In a neonate with only hepatomegaly and no overt neurological signs, **SNHL is a more prevalent and specific long-term sequelae** than intellectual disability. *Renal failure* - **Kidney involvement** in congenital CMV is rare and generally not a primary long-term sequela. - Though CMV can rarely cause interstitial nephritis or direct viral cytopathic effects in the kidneys, leading to transient renal dysfunction, it **does not typically lead to progressive renal failure** in later life. *Hepatic fibrosis* - While congenital CMV can cause **hepatitis** and hepatomegaly, significant long-term hepatic fibrosis directly attributable to CMV, leading to liver failure in later life, is **uncommon**. - Most hepatic abnormalities in congenital CMV tend to **resolve spontaneously**, and severe chronic liver disease is rare.

Q: A poverty-stricken mother suffering from active tuberculosis delivers a baby. Which one of the following would be the most appropriate advice in her case?

Breast feeding and isoniazid administration. ***Breast feeding and isoniazid administration*** - **Breastfeeding** is safe and encouraged for infants of mothers with active tuberculosis, as the benefits of breast milk (nutrition, antibodies) outweigh the minimal risk of TB transmission through milk. - **Isoniazid (INH) chemoprophylaxis** for the infant provides additional protection in high-risk exposure settings, particularly when the mother has active pulmonary TB and close contact is inevitable. - This approach represents a conservative strategy prioritizing immediate chemoprophylaxis in a poverty-stricken setting where follow-up may be challenging. *Breast feeding and BCG immunization* - **Breastfeeding** is beneficial and appropriate. - **BCG immunization** at birth is the current standard recommendation per WHO and IAP guidelines for infants born to TB-positive mothers. - However, in settings with very high exposure risk and uncertain follow-up, some protocols additionally recommend INH prophylaxis, making the first option more comprehensive for this specific scenario. *Expressed breast milk and BCG immunization* - Expressing breast milk offers no significant additional protection against TB transmission compared to direct breastfeeding. - Direct breastfeeding has additional benefits for mother-infant bonding and is not contraindicated in maternal TB. - While **BCG immunization** is appropriate, this option unnecessarily complicates feeding. *Stop feeds and isoniazid administration* - **Stopping breastfeeding** is not indicated and would deprive the infant of essential nutrition and passive immunity. - Breastfeeding is not contraindicated in maternal tuberculosis. - While **isoniazid administration** may be appropriate, cessation of feeding is an incorrect recommendation.

Q: Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:

Withhold breast feeding. ***Withhold breast feeding*** - For mothers with **drug-sensitive tuberculosis**, breastfeeding is **strongly encouraged** by WHO and CDC guidelines as the benefits far outweigh any theoretical risks. - Tuberculosis is **not transmitted through breast milk**, and the nutritional and immunological benefits of breastfeeding are crucial for the newborn. - With appropriate maternal treatment and **INH prophylaxis** for the baby, breastfeeding poses no significant risk and should **never be withheld**. *Administer INH to the baby* - **Isoniazid (INH) prophylaxis** for 6 months is the standard of care for newborns exposed to maternal tuberculosis. - This protects the infant from potential infection via respiratory droplets while the mother is receiving treatment. - After completing prophylaxis, BCG vaccination is given if tuberculosis is excluded. *Separate the baby from mother immediately* - **Immediate routine separation** is generally not recommended for drug-sensitive TB if the mother has been on appropriate treatment for at least 2 weeks and is clinically improving. - **Rooming-in is encouraged** with respiratory hygiene measures (mask wearing, hand hygiene, covering mouth when coughing). - Separation may be considered only for untreated or inadequately treated mothers, or those with multi-drug resistant TB. *Ask mother to ensure proper disposal of sputum* - **Proper sputum disposal** and adherence to respiratory hygiene are essential infection control measures. - This reduces environmental contamination and protects healthcare workers, family members, and the newborn from infectious aerosols. - This is a standard precaution for all tuberculosis patients regardless of drug sensitivity.

Q: A blood specimen for neonatal thyroid screening is obtained on:

48 hours after birth. ***48 hours after birth*** - Neonatal thyroid screening is optimally performed at **48-72 hours** after birth, with **48 hours** being the most practical timing in current practice. - This timing balances two important factors: avoiding the **physiological TSH surge** that occurs in the first 24 hours, while ensuring screening occurs **before early hospital discharge**. - According to **IAP (Indian Academy of Pediatrics)** and international guidelines, screening at 48 hours allows accurate detection of congenital hypothyroidism while being realistic for modern obstetric practices where most mothers are discharged within 48 hours. - The **thyroid-stimulating hormone (TSH)** levels have normalized sufficiently by 48 hours to minimize false-positive results. *Cord blood* - Cord blood is not used for routine neonatal thyroid screening because **maternal thyroid hormones** (T4 and T3) cross the placenta and can mask congenital hypothyroidism in the newborn. - It does not reflect the newborn's **independent thyroid function**, which is essential for identifying congenital disorders. *24 hours after birth* - Drawing blood at 24 hours is generally **too early** for optimal thyroid screening, as the **postnatal TSH surge** is still significant. - This timing would result in a higher rate of **false-positive results**, leading to unnecessary follow-up tests and parental anxiety. - However, if discharge occurs before 48 hours, screening at 24 hours is preferable to missing screening entirely. *72 hours after birth* - While 72 hours was traditionally recommended for thyroid screening, it is **no longer practical** in the era of early hospital discharge. - Most mothers and babies are discharged within **48 hours**, making 72-hour screening logistically difficult and risking missed screening. - Current guidelines recommend **48-72 hours OR at discharge, whichever is earlier**, making 48 hours the most optimal single timepoint.

Question 1

Bohn's nodules are

Accepted Answer

Cystic swellings in neonates

Answer

Cysts of gingiva in growing children

Answer

Warts on the tongue

Answer

Cysts associated with soft palate

Question 2

Most common cause of convulsion on the first day of life in a newborn is:

Accepted Answer

Perinatal asphyxia

Answer

Hypoglycemia

Answer

Hypocalcemia

Answer

Head injury

Question 3

Most common lesion in fetal toxoplasmosis is -

Accepted Answer

Chorioretinitis

Answer

Encephalitis

Answer

GI involvement

Answer

Pulmonary involvement

Question 4

Normal reticulocyte count at birth is

Accepted Answer

2-6%

Answer

1-2%

Answer

6-10%

Answer

30-40%

Question 5

A neonate on routine examination at birth was found to have hepatomegaly. Rest of the examination was essentially unremarkable. On investigations, Anti-HCMV antibodies were found to be positive. What sequelae in later life is the child at risk of?

Accepted Answer

Sensorineural hearing loss

Answer

Intellectual disability

Answer

Renal failure

Answer

Hepatic fibrosis

Question 6

A poverty-stricken mother suffering from active tuberculosis delivers a baby. Which one of the following would be the most appropriate advice in her case?

Accepted Answer

Breast feeding and isoniazid administration

Answer

Breast feeding and BCG immunization

Answer

Expressed breast milk and BCG immunization

Answer

Stop feeds and isoniazid administration

Question 7

Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:

Accepted Answer

Withhold breast feeding

Answer

Administer INH to the baby

Answer

Separate the baby from mother immediately

Answer

Ask mother to ensure proper disposal of sputum

Question 8

Symptomatic neonatal CNS involvement is most commonly seen in which group of congenital intrauterine infections?

Accepted Answer

CMV and toxoplasmosis

Answer

Rubella and toxoplasmosis

Answer

CMV and syphilis

Answer

Rubella and HSV

Question 9

A 32-year-old woman with diabetes mellitus delivers a child after 38 weeks of gestation. Which of the following is the most likely abnormality that might be encountered in this child at birth?

Accepted Answer

Hypoglycemia

Answer

Cataracts

Answer

Hyperbilirubinemia

Answer

Low birth weight

Question 10

A blood specimen for neonatal thyroid screening is obtained on:

Accepted Answer

48 hours after birth

Answer

Cord blood

Answer

24 hours after birth

Answer

72 hours after birth

Neonatology — MCQs

Neonatology — MCQs

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