Neonatology Practice Questions

Q: Identify the congenital defect seen in this baby.

Encephalocele. ***Encephalocele*** - A **neural tube defect** where brain tissue and/or meninges protrude through a **skull defect**, typically at the **occiput**, presenting as a cystic sac-like mass. - The image shows a characteristic **posterior cystic mass** protruding from the occipital region, which is pathognomonic for **occipital encephalocele**. *Craniorachischisis totalis* - The most severe **neural tube defect** with complete failure of neural tube closure involving both **cranial and spinal regions** along the entire length. - Would show extensive exposed **brain and spinal cord tissue** throughout the neural axis, not a localized occipital cystic mass. *Cystic hygroma* - A **lymphatic malformation** presenting as a multicystic, translucent mass typically in the **neck or axilla**. - Appears as **fluid-filled cystic structures** without neural tissue involvement and lacks the occipital location seen in this image. *Cervical meningocele* - A **localized spina bifida** where only **meninges** protrude through a cervical spine defect, forming a sac-like protrusion. - Limited to the **cervical/neck region** without cranial involvement, unlike the occipital location demonstrated here.

Q: Which of the following interventions is being done in this neonate?

Nasal CPAP and orogastric tube to decompress stomach. ***Nasal CPAP and orogastric tube to decompress stomach*** - The image shows a neonate with a device inserted into the nostrils for **nasal continuous positive airway pressure (nCPAP)**, used to support breathing. - Additionally, a tube is visible in the neonate's mouth leading to the stomach, which is an **orogastric (OG) tube** used for feeding or stomach decompression, especially important when using CPAP as air can be swallowed. *Positive pressure ventilation and NG tube to decompress stomach* - This option refers to positive pressure ventilation, which typically involves an **endotracheal tube** or mask/bag, neither of which is clearly depicted as the primary respiratory support. - An **NG tube (nasogastric tube)** would be inserted through the nose, but the tube shown for gastric access is in the mouth (orogastric). *Surfactant therapy and NG tube to decompress stomach* - **Surfactant therapy** is administered directly into the lungs, usually via an endotracheal tube, and is not a visible intervention in the image itself. - As noted previously, the tube for gastric decompression appears to be **orogastric**, not nasogastric. *Oxygen hood* - An **oxygen hood** is a clear plastic dome placed over the neonate's head to deliver oxygen, which is not what is shown in the image. - The visible tubes are for respiratory support and gastric access, indicating a more direct and invasive form of intervention than an oxygen hood.

Q: All are true about the image shown except:

Hairy pinna. ***Hairy pinna*** - **Hairy pinna** (hypertrichosis pinnae auris) is a condition characterized by excessive hair growth on the external ear, primarily affecting adult males, and is **not associated** with neonatal macrosomia or maternal diabetes. - This is the correct answer as it is the statement that is **NOT true** about infants of diabetic mothers. *Term large for date* - The image depicts a **macrosomic** infant, often described as "large for gestational age" or "large for date," which is a **classic finding** in infants of mothers with **gestational diabetes mellitus**. - Infants of diabetic mothers tend to be larger due to the effects of **maternal hyperglycemia** and resultant fetal **hyperinsulinemia** *in utero*. *High packed cell volume* - Infants of diabetic mothers are prone to **polycythemia**, which is an **elevated packed cell volume (hematocrit)**. - Polycythemia in these infants results from **chronic intrauterine hypoxia**, leading to increased **erythropoietin production** and compensatory red blood cell proliferation. - This can lead to complications including hyperbilirubinemia and increased blood viscosity. *Hyperinsulinemia* - **Hyperinsulinemia** *in utero* is a **hallmark** of infants born to mothers with poorly controlled diabetes, as the fetal pancreas produces excess insulin in response to maternal hyperglycemia. - This excess insulin acts as a **growth factor**, contributing to the **macrosomia** and organomegaly seen in these infants. - Postnatally, hyperinsulinemia predisposes to **neonatal hypoglycemia** as the glucose supply from the mother is suddenly discontinued.

Q: A neonate presents with the condition shown in the image below. This condition has all of the following features EXCEPT:

Satellite lesions. ***Satellite lesions*** - **Satellite lesions** (smaller lesions located near a main rash) are characteristic of certain fungal infections like candidiasis or some viral rashes, but not of **collodion baby/harlequin ichthyosis**, which is suggested by the image. - The image shows features consistent with a severe congenital ichthyosis, where **skin scaling** and **facial deformities** are prominent, not scattered papules or pustules. *Ectropion* - **Ectropion** (eversion of the eyelids) is clearly visible in the image, where the eyelids are pulled outwards, exposing the conjunctiva. - This is a common feature in conditions like **collodion baby** and **harlequin ichthyosis** due to the restrictive outer skin layer. *Eclabium* - **Eclabium** (eversion of the lips) is also distinctly present in the image, with the lips appearing stretched and everted. - This is another characteristic manifestation of severe congenital ichthyosis, resulting from the **tight, hardened skin** around the mouth. *Hard elastic scales over the neck area* - The image shows **thickened, furrowed, and scaly skin** texture, particularly noticeable around the neck area (indicated by the arrow), which aligns with the description of **hard, elastic scales**. - This is a hallmark feature of **ichthyosis**, where there is impaired skin barrier function and excessive scale production.

Q: The mother is concerned about the whitish material in the groin of the child. Which is incorrect?

Mostly seen in post-dated delivery. ***Mostly seen in post-dated delivery*** ✗ **INCORRECT STATEMENT** - This is the **FALSE statement** and therefore the correct answer to this negative question. - Vernix caseosa is **most prominent in preterm and term infants**, NOT in post-dated deliveries. - The amount of vernix **decreases significantly or is largely absent** in post-term deliveries (>42 weeks). - Post-term infants often present with **dry, peeling, parchment-like skin** due to absence of protective vernix. *Prevents transepidermal water loss* ✓ **TRUE STATEMENT** - **Vernix caseosa** acts as a **natural moisturizer** and forms a protective barrier on the newborn's skin. - This barrier is crucial in preventing excessive **water loss** from the delicate skin, especially during the transition from aqueous to air environment. - The WHO recommends delaying the first bath to preserve this protective function. *Prevents development of skin infection* ✓ **TRUE STATEMENT** - Vernix contains **antimicrobial peptides** and proteins including **lysozyme**, lactoferrin, and defensins. - These components contribute to the newborn's **innate immunity**, helping to **protect against bacterial and fungal infections** at birth. - Studies show vernix has bactericidal activity against common pathogens like E. coli and Group B Streptococcus. *Vernix caseosa* ✓ **TRUE IDENTIFICATION** - The whitish, creamy material coating the infant in the image, particularly prominent in skin creases like the groin, is characteristic of **vernix caseosa**. - Composed of **sebaceous secretions**, **desquamated fetal epidermal cells**, and lanugo hair. - Formation begins around **20 weeks of gestation** and peaks at term delivery.

Q: The following image shows which test being performed in a neonate?

Guthrie test. ***Guthrie test*** - The image shows a **heel prick test** being performed to collect blood samples on a **filter paper card** (Guthrie card) for newborn screening. - The Guthrie test refers to a specific bacterial inhibition assay that was historically used to detect **phenylketonuria (PKU)** from these collected blood spots, and the term is often used synonymously with newborn screening using filter paper blood spots. *Hypoglycemia screening test* - While blood can be obtained via heel prick for hypoglycemia screening, it typically involves using a **glucometer for immediate measurement**, not collecting dried blood spots on a filter card for later lab analysis. - The card in the image is clearly labeled for "Neonatal Screening," indicating a broader screening purpose. *Foot print test* - A footprint test involves taking an **impression of the baby's foot**, usually with ink, for identification purposes. - It does not involve blood collection or medical testing for metabolic disorders. *Heel prick test* - A heel prick test is the **method of obtaining the blood sample** from the neonate's heel. - However, the question asks what test is being performed, and the sample collection on a **Guthrie card** indicates a specific set of newborn screening tests, often broadly referred to as the Guthrie test.

Q: All are true about the image shown except:

Alert baby. ***Alert baby*** - The infant in the image appears to be severely **emaciated** and is typical of an **SGA infant** or **IUGR**. - These infants are typically **hypoglycemic** and **hypothermic**, making them unlikely to be "alert" but rather **lethargic**. *Term small for date* - The infant shows signs of **intrauterine growth restriction (IUGR)**, presenting with features like **scanty subcutaneous fat** and a relatively **large head** for the body, indicative of a severe wasting process. - The appearance aligns with that of a symmetrical or asymmetrical IUGR baby, which is also referred to as **small for gestational age**. *Large head with loss of subcutaneous fat* - The image shows a disproportionately **large head** in comparison to a very thin body, characteristic of **head sparing** seen in **asymmetrical IUGR** infants where the head growth is prioritized over body fat and length. - The visible **ribs** and **sunken cheeks** confirm significant **loss of subcutaneous fat**, a classic sign of chronic intrauterine malnutrition. *Hairy pinna* - **Hairy pinna** (excessive hair on the ears) can be observed in the image, which is a known feature associated with **intrauterine growth restriction** and specific syndromes like **Cornelia de Lange syndrome**. - This observation further supports the diagnosis of an infant with **growth abnormalities**.

Q: What test is being performed on this neonate in the NICU?

Moro's reflex. ***Moro's reflex*** - The image shows the neonate with arms abducted and extended, and fingers open, characteristic of the **Moro reflex** which is elicited by a sudden sensation of falling or loud noise. - This **primitive reflex** is present at birth and usually disappears by 3-6 months; its assessment is part of a routine neurological examination in newborns. *Transcutaneous bilirubinometry* - This is a non-invasive method to measure **bilirubin levels** in newborns by placing a device on the skin, and the image does not depict such a device or measurement. - While important in the NICU for monitoring **jaundice**, it is not what is being demonstrated in the visual. *Apgar score* - The **Apgar score** is assessed at 1 and 5 minutes after birth, evaluating five parameters: appearance, pulse, grimace, activity, and respiration. - This is a clinical scoring system that cannot be solely determined from a single still image of the baby's posture, as it involves dynamic assessment. *Capillary refill time* - **Capillary refill time** is assessed by blanching the skin (often on the palm or sole) and observing how long it takes for the color to return. - The image does not show direct palpation or measurement of capillary refill, which is a key indicator of **circulation** and hydration status.

Q: All are true about the swelling on scalp of a 2-day old neonate except: (Recent NEET Pattern 2016-17)

Heals from periphery. ***Heals from periphery*** - This is the **INCORRECT statement** about cephalohematoma in a neonate - Cephalohematomas do NOT heal from the periphery like a skin wound - Instead, the blood clot gradually **liquefies and is reabsorbed** over weeks to months (typically 2-3 months) - Resorption occurs uniformly or may even start centrally, not from the edges - This is the **exception** among the given statements *Sub-periosteal bleeding with gradual hardening* - This accurately describes **cephalohematoma**, a common birth injury - It is a **subperiosteal collection of blood** confined by suture lines - The blood undergoes **organization and calcification** over time, leading to gradual hardening - A bony rim may be palpable at the edges after 2-3 weeks *Can lead to prolongation of physiological Jaundice* - Breakdown of red blood cells within the cephalohematoma releases **bilirubin** - This increased bilirubin load can contribute to **prolonged physiological jaundice** - The large blood collection acts as an extravascular source of bilirubin *Painless* - Cephalohematoma is generally **painless** to touch for the neonate - Unlike caput succedaneum or infections, the blood collection does not cause acute pain - The swelling may appear large but is not tender

Question 1

Identify the congenital defect seen in this baby.

Accepted Answer

Encephalocele

Answer

Craniorachischisis totalis

Answer

Cystic hygroma

Answer

Cervical meningocele

Question 2

Which of the following interventions is being done in this neonate?

Accepted Answer

Nasal CPAP and orogastric tube to decompress stomach

Answer

Positive pressure ventilation and NG tube to decompress stomach

Answer

Surfactant therapy and NG tube to decompress stomach

Answer

Oxygen hood

Question 3

All are true about the image shown except:

Accepted Answer

Hairy pinna

Answer

Term large for date

Answer

High packed cell volume

Answer

Hyperinsulinemia

Question 4

A neonate presents with the condition shown in the image below. This condition has all of the following features EXCEPT:

Accepted Answer

Satellite lesions

Answer

Ectropion

Answer

Eclabium

Answer

Hard elastic scales over the neck area

Question 5

The mother is concerned about the whitish material in the groin of the child. Which is incorrect?

Accepted Answer

Mostly seen in post-dated delivery

Answer

Prevents transepidermal water loss

Answer

Prevents development of skin infection

Answer

Vernix caseosa

Question 6

Lesion at \qquad level leads to deformity shown in neonate born after prolonged labor?

Accepted Answer

C5-C8

Answer

C1-C3

Answer

C3-C5

Answer

C8-T1

Question 7

The following image shows which test being performed in a neonate?

Accepted Answer

Guthrie test

Answer

Hypoglycemia screening test

Answer

Foot print test

Answer

Heel prick test

Question 8

All are true about the image shown except:

Accepted Answer

Alert baby

Answer

Term small for date

Answer

Large head with loss of subcutaneous fat

Answer

Hairy pinna

Question 9

What test is being performed on this neonate in the NICU?

Accepted Answer

Moro's reflex

Answer

Transcutaneous bilirubinometry

Answer

Apgar score

Answer

Capillary refill time

Question 10

All are true about the swelling on scalp of a 2-day old neonate except: (Recent NEET Pattern 2016-17)

Accepted Answer

Heals from periphery

Answer

Can lead to prolongation of physiological Jaundice

Answer

Painless

Answer

Sub-periosteal bleeding with gradual hardening

Neonatology — MCQs

Neonatology — MCQs

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