Neonatology Practice Questions

Q: The lesions seen on this infant's face are usually associated with?

Congenital rubella. ***Congenital rubella*** - The image likely displays a **"blueberry muffin" rash**, which is a classic sign of congenital rubella syndrome due to **dermal erythropoiesis**. - Infants with congenital rubella also commonly present with other severe anomalies such as **cataracts**, **heart defects** (e.g., patent ductus arteriosus), and **sensorineural hearing loss**. *Acquired rubella* - This is a milder disease in older children and adults, characterized by a **maculopapular rash** that originates on the face and spreads downwards. - It does not typically cause the severe, disseminated cutaneous lesions or systemic congenital abnormalities seen in the infant. *Rubeola* - Also known as measles, rubeola presents with a fierce maculopapular rash, **Koplik spots** in the mouth, and symptoms of cough, coryza, and conjunctivitis. - The rash is not characteristically described as "blueberry muffin" and it is not associated with congenital deformities from maternal infection. *Syphilis* - Congenital syphilis can cause a variety of skin lesions, including a **bullous rash** or a copper-colored maculopapular rash, but not typically the "blueberry muffin" purpuric lesions. - Other manifestations of congenital syphilis include **bone abnormalities**, **hepatosplenomegaly**, and **rhinitis** (snuffles).

Q: Which one of the following life-threatening congenital anomalies in the newborn presents with polyhydramnios, aspiration pneumonia, excessive salivation and difficulty in passing a nasogastric tube?

Tracheo-esophageal fistula. ***Tracheo-esophageal fistula*** - This condition presents with **polyhydramnios** due to the fetus being unable to swallow amniotic fluid, **excessive salivation** from accumulated secretions in the blind-ending esophageal pouch, and difficulty passing a **nasogastric tube** because of the esophageal obstruction. - **Aspiration pneumonia** is a common complication as saliva and gastric contents can be aspirated into the lungs through the fistula. *Choanal atresia* - Characterized by **blocked nasal passages**, leading to **cyclical cyanosis** relieved by crying, but not typically associated with polyhydramnios or excessive salivation in this manner. - While it can cause respiratory distress, it does not involve esophageal obstruction or directly cause aspiration pneumonia from swallowed fluids. *Gastroschisis* - This is an **abdominal wall defect** where intestines protrude outside the body, unrelated to swallowing difficulties, polyhydramnios caused by inability to swallow, or excessive salivation. - It does not involve difficulty in passing a nasogastric tube or directly cause aspiration pneumonia. *Diaphragmatic hernia* - Involves **abdominal contents herniating into the chest cavity**, leading to **pulmonary hypoplasia** and respiratory distress. - It does not explain polyhydramnios due to impaired swallowing, excessive salivation, or the characteristic inability to pass a nasogastric tube.

Q: Jitteriness can be distinguished from seizures by all of the following except -

Frequency of movement. ***Frequency of movement*** - Both **seizures** and **jitteriness** can present with frequent, repetitive movements. The frequency alone is not a reliable distinguishing factor between the two. - The **quality and pattern** of the movements, rather than just their frequency, are more indicative for differentiation. *Sensitivity to stimulus* - **Jitteriness** is typically sensitive to external stimuli such as touch, loud noises, or light, which can exacerbate or stop the movements. - **Seizures**, particularly generalized tonic-clonic seizures, are generally not influenced by external stimuli once they have begun. *Abnormality of Gaze* - **Seizures** often involve an **abnormal gaze**, such as sustained ocular deviation or nystagmus, which is a key clinical sign. - In contrast, **jitteriness** rarely presents with significant or sustained abnormalities of gaze; the infant's eyes usually remain responsive and can follow objects. *Autonomic disturbance* - **Seizures** are frequently accompanied by **autonomic disturbances**, including changes in heart rate, blood pressure, temperature, apnea, or skin color changes (e.g., cyanosis). - **Jitteriness** typically lacks these prominent autonomic signs, with vital signs generally remaining stable.

Q: Late metabolic acidosis is seen in-

Preterm baby getting cow milk. ***Preterm baby getting cow milk*** - **Preterm infants** have immature kidneys with reduced ability to excrete **acidic metabolites**. - **Cow milk-based formulas** have a higher protein and mineral content, leading to a greater **acid load** which can exacerbate the metabolic acidosis in preterm infants. *Term infant given formula feed* - Term infants generally have more mature renal function capable of handling the **acid load** from formula feeding. - While formula feeding can contribute to a higher renal solute load than breast milk, it rarely results in **late metabolic acidosis** in otherwise healthy term infants. *Long term breast feeding* - **Breast milk** has a lower protein content and a more balanced mineral composition, resulting in a significantly lower **renal solute load** and acid load compared to formula. - It is protective against metabolic acidosis and is the preferred feeding method for infants. *None of the options* - This option is incorrect because **preterm infants fed cow milk-based formula** are indeed at risk for late metabolic acidosis due to their immature kidneys and the higher acid load from the formula.

Q: A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Antiepileptic of choice shall be:

Phenobarbitone. ***Phenobarbitone*** - **Phenobarbitone** is the **first-line antiepileptic drug** recommended for neonatal seizures due to its established efficacy and safety profile in this population. - It acts primarily by **potentiating GABAA receptor-mediated chloride currents**, leading to central nervous system depression and seizure control. *Lorazepam* - While **benzodiazepines** like lorazepam can be used for acute seizure cessation, especially status epilepticus, they are generally **not the first-line choice for maintenance therapy** due to potential sedation and respiratory depression in neonates. - Its short duration of action and risk of rebound seizures make it less suitable as a sole agent for ongoing seizure control. *Levetiracetam* - **Levetiracetam** is an increasingly common antiepileptic in neonates, but its long-term efficacy and safety, particularly regarding neurodevelopmental outcomes, are **still under investigation** compared to phenobarbitone. - While it may be used as a second-line agent or in specific situations, it is **not universally considered the first-line drug of choice** for neonatal seizures. *Phenytoin* - **Phenytoin** is typically considered a **second-line or third-line antiepileptic** for neonatal seizures, primarily used if phenobarbitone is ineffective. - Its use is limited by potential side effects such as **cardiac arrhythmias, hypotension, and infiltration at the injection site**, which can be particularly concerning in premature infants.

Q: Congenital Rubella syndrome may have the following clinical features, except

Hydrocephalus. ***Hydrocephalus*** - **Hydrocephalus** is generally *not* a characteristic feature of **congenital rubella syndrome (CRS)**. - While many devastating neurological developmental abnormalities can occur in utero, **hydrocephalus** specifically is not one of them. - CRS is associated with **microcephaly** (small brain), not hydrocephalus (enlarged ventricles). *Microcephaly* - **Microcephaly**, or an abnormally small head, is a common neurological sequel of **congenital rubella syndrome** due to brain damage. - The rubella virus can interfere with cell proliferation during fetal development, leading to **poor brain growth**. *Neonatal hepatitis* - **Neonatal hepatitis** can occur as part of the systemic manifestations of **congenital rubella syndrome**, resulting in **jaundice** and **liver dysfunction**. - The rubella virus can infect various organs, including the liver, causing inflammation and damage. *Congenital cataract* - **Congenital cataracts** are a classic ocular manifestation of **congenital rubella syndrome**, often leading to significant visual impairment. - The rubella virus can directly infect the developing lens, causing opacification. - Cataracts are part of the classic triad of CRS along with **cardiac defects** and **deafness**.

Q: A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:

HSV II. ***HSV II*** - **Herpes simplex virus type 2 (HSV-2)** is the most common cause of **neonatal herpes**, presenting with neurological manifestations like encephalitis and characteristic vesicular skin lesions. - Transmission usually occurs during **vaginal delivery** from a mother with genital herpes, leading to widespread infection in the neonate. *Meningococci* - While *Neisseria meningitidis* can cause **meningitis** and **septicemia** in neonates, it does not typically produce vesicular skin lesions. - Its infections are more commonly associated with a **petechial or purpuric rash**, not vesicles. *Streptococci* - **Group B Streptococcus (GBS)** is a leading cause of **neonatal sepsis and meningitis**, but it does not cause vesicular skin lesions. - GBS typically presents with non-specific signs of sepsis or meningitis in neonates. *HSV I* - Although **herpes simplex virus type 1 (HSV-1)** can cause neonatal herpes, **HSV-2 remains the predominant cause** of vertically transmitted neonatal infection with encephalitis and disseminated disease. - HSV-1 is more commonly associated with **oral herpes (cold sores)** in older children and adults, though its incidence in neonatal infection is increasing.

Q: A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?

Obstruction in the circulation of the cerebrospinal fluid. ***Obstruction in the circulation of the cerebrospinal fluid*** - **Non-communicating hydrocephalus**, by definition, is caused by an **obstruction within the ventricular system** that prevents CSF from reaching the subarachnoid space. - In a newborn, common causes of such obstruction include **aqueductal stenosis** or malformations like **Dandy-Walker syndrome**. *Disturbances in the resorption of cerebrospinal fluid* - This typically leads to **communicating hydrocephalus**, where CSF can flow freely within the ventricles but is not adequately absorbed into the venous system. - Examples include **arachnoid granulations** dysfunction or **post-meningitic scarring**. *Excess production of cerebrospinal fluid* - This is a very rare cause of hydrocephalus, usually associated with conditions like a **choroid plexus papilloma**. - This would lead to a **communicating hydrocephalus** as the obstruction is not within the ventricular system itself. *Increased size of the head* - An **increased head size (macrocephaly)** is a *symptom* or *sign* of hydrocephalus in an infant, not a cause. - The elevated intracranial pressure from the accumulated CSF leads to the expansion of the skull bones before the sutures fuse.

Q: To assess thyroid profile of a newborn, which of the following is mandatory?

Measure both TSH and T4. ***Measure both TSH and T4*** - **Newborn screening** for congenital hypothyroidism typically involves measuring both **TSH** (thyroid-stimulating hormone) and **T4** (thyroxine). - Elevated TSH levels indicate **primary hypothyroidism**, where the thyroid gland is underactive, while low T4 levels confirm the reduced thyroid hormone production. *Measure T3 only* - **T3 (triiodothyronine)** is generally not the primary screening test for congenital hypothyroidism in newborns. - While T3 is an active form of thyroid hormone, its levels can be influenced by various factors and are less reliable than TSH and T4 for initial screening. *Measure TSH only* - Measuring only **TSH** can detect primary hypothyroidism, but it doesn't provide a complete picture of thyroid function. - In cases of **central (secondary or tertiary) hypothyroidism**, TSH levels might be normal or low, while T4 levels are reduced, which would be missed if only TSH were measured. *Measure T4 only* - Measuring only **T4** can help identify low thyroid hormone levels, but it doesn't differentiate between primary and central hypothyroidism. - To properly assess the cause of low T4, **TSH levels** are crucial to determine if the problem lies within the thyroid gland itself or higher up in the pituitary/hypothalamic axis.

Question 1

The lesions seen on this infant's face are usually associated with?

Accepted Answer

Congenital rubella

Answer

Acquired rubella

Answer

Rubeola

Answer

Syphilis

Question 2

Which one of the following life-threatening congenital anomalies in the newborn presents with polyhydramnios, aspiration pneumonia, excessive salivation and difficulty in passing a nasogastric tube?

Accepted Answer

Tracheo-esophageal fistula

Answer

Choanal atresia

Answer

Gastroschisis

Answer

Diaphragmatic hernia

Question 3

Jitteriness can be distinguished from seizures by all of the following except -

Accepted Answer

Frequency of movement

Answer

Sensitivity to stimulus

Answer

Abnormality of Gaze

Answer

Autonomic disturbance

Question 4

Late metabolic acidosis is seen in-

Accepted Answer

Preterm baby getting cow milk

Answer

Term infant given formula feed

Answer

Long term breast feeding

Answer

None of the options

Question 5

A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Antiepileptic of choice shall be:

Accepted Answer

Phenobarbitone

Answer

Lorazepam

Answer

Levetiracetam

Answer

Phenytoin

Question 6

A newborn presents with petechiae, skin lesions, hematuria, and a platelet count of 22,000/L. This is most likely caused by:

Accepted Answer

Congenital CMV infection

Answer

Congenital rubella infection

Answer

Both CMV and rubella infection

Answer

Premature infants

Question 7

Congenital Rubella syndrome may have the following clinical features, except

Accepted Answer

Hydrocephalus

Answer

Microcephaly

Answer

Neonatal hepatitis

Answer

Congenital cataract

Question 8

A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:

Accepted Answer

HSV II

Answer

Meningococci

Answer

Streptococci

Answer

HSV I

Question 9

A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?

Accepted Answer

Obstruction in the circulation of the cerebrospinal fluid

Answer

Disturbances in the resorption of cerebrospinal fluid

Answer

Excess production of cerebrospinal fluid

Answer

Increased size of the head

Question 10

To assess thyroid profile of a newborn, which of the following is mandatory?

Accepted Answer

Measure both TSH and T4

Answer

Measure T3 only

Answer

Measure TSH only

Answer

Measure T4 only

Neonatology — MCQs

Neonatology — MCQs

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