Neonatology Practice Questions

Q: Most common site for bone marrow aspiration in neonates is -

Anteromedial tibia. ***Anteromedial tibia*** - The **anteromedial tibia** is the preferred site in neonates due to its relatively **large marrow cavity**, superficial location, and reduced risk of vital organ injury. - This site is easily accessible and provides a good yield of marrow cells, making it suitable for diagnostic purposes in newborns. *Anterior superior iliac crest* - While a common site for bone marrow aspiration in older children and adults, the **anterior superior iliac crest** can be more challenging and poses a greater risk in neonates due to their smaller bone structures. - The iliac crest offers less bony prominence and a thinner cortex in neonates, increasing the difficulty of the procedure and potential for sampling error. *Posterior superior iliac crest* - The **posterior superior iliac crest** is another common site in older children and adults but is generally avoided in neonates due to the difficulty in positioning and the risk of damaging vital structures in the vicinity. - It requires prone positioning and offers less superficial bone, making it a less practical and safe choice for neonates compared to the tibia. *Sternum* - **Sternal aspiration** is generally contraindicated in neonates and young children due to the thinness of the sternal bone and proximity to vital structures like the heart and great vessels. - There is a high risk of **perforation** of the sternum and injury to underlying organs, making this site unsafe for bone marrow aspiration in this age group.

Q: Which of the following drugs is most commonly used for cardiovascular support in post-resuscitation care of neonates?

Dopamine. ***Dopamine*** - **Dopamine** is often the first-line vasopressor used in neonates for **hypotension** unresponsive to fluid resuscitation, especially in the context of post-resuscitation care, due to its dose-dependent effects on cardiac output and systemic vascular resistance. - It increases **cardiac contractility** and **heart rate** at moderate doses (beta-1 adrenergic effects) and can improve renal blood flow at lower doses. *Sodium Bicarbonate* - **Sodium bicarbonate** is used to correct severe metabolic acidosis but is generally not recommended in the initial stages of neonatal resuscitation or for routine cardiovascular support due to potential adverse effects like rebound acidosis and hypernatremia. - Its use is typically reserved for documented severe metabolic acidosis after adequate ventilation and circulation have been established. *Epinephrine* - **Epinephrine** is primarily used during active cardiorespiratory arrest for its potent vasoconstrictive and inotropic effects, and for sustained **bradycardia** unresponsive to ventilation and chest compressions. - While it has strong cardiovascular effects, it is not the most common drug for *post-resuscitation cardiovascular support* unless there is persistent shock or bradycardia despite dopamine. *Dobutamine* - **Dobutamine** is an inotropic agent primarily used to improve myocardial contractility and cardiac output with less chronotropic effect than dopamine, making it beneficial in conditions with low cardiac output and normal blood pressure. - It is less commonly used as an initial agent for post-resuscitation **hypotension** in neonates compared to dopamine, which also offers systemic vasoconstriction to raise blood pressure.

Q: Treatment of choice for symptomatic neonatal hypoglycemia is

10% dextrose. ***10% dextrose*** - For **symptomatic neonatal hypoglycemia**, 10% dextrose solution is the **standard initial treatment** with a bolus of 2 mL/kg (200 mg/kg) given IV over 5-10 minutes - This concentration safely and effectively raises blood glucose levels while minimizing the risk of **hyperglycemic rebound** or complications like **osmotic injury** - Followed by continuous infusion to maintain normoglycemia *Dextrose normal saline* - This combination is **not used** for acute hypoglycemia management as the saline component is unnecessary - The glucose concentration would be inadequate for rapid correction of **symptomatic neonatal hypoglycemia** - May lead to excessive fluid administration *5% dextrose* - A **5% dextrose solution** is insufficient to rapidly correct symptomatic neonatal hypoglycemia - Would require much faster infusion rates to deliver adequate glucose, potentially leading to **fluid overload** - May be used for maintenance therapy in asymptomatic cases *25% dextrose* - Too concentrated for routine neonatal use - carries significant risk of **vein sclerosis**, **osmotic injury**, and **rebound hypoglycemia** - Risk of extravasation injury and **hyperglycemia** - Reserved only for extreme cases under close monitoring with careful dilution

Q: Which of the following statements about cephalhematoma is correct?

It is hemorrhage between the skull and periosteum. ***It is hemorrhage between the skull and periosteum*** - A **cephalhematoma** is defined as a collection of blood between the **periosteum** and the underlying **skull bone** (subperiosteal). - Its boundaries are limited by the suture lines because the periosteum is firmly attached at these junctions, preventing blood from crossing. *It is hemorrhage within the subcutaneous tissue around the skull* - This description corresponds to a **caput succedaneum**, which involves **edema and hemorrhage** in the subcutaneous tissue, rather than between the skull and periosteum. - Unlike a cephalhematoma, a **caput succedaneum** can cross suture lines and is typically present at birth. *It is type of subdural hemorrhage* - A **subdural hemorrhage** involves bleeding between the **dura mater** and the **arachnoid mater** within the cranial vault. - This type of hemorrhage is a **neurological emergency** and is distinct from a cephalhematoma, which is an external scalp injury. *It is subperiosteal bleeding in the skull* - While this statement is technically correct (subperiosteal means under the periosteum), the **standard definition** specifically states "between the periosteum and the skull bone." - The distinction is important: **subperiosteal** could theoretically include bleeding within the periosteum itself, whereas the precise location is in the **potential space** between periosteum and bone. - Option A is more precise and is the preferred medical definition.

Q: A 45-day-old infant presents with seizures. Examination reveals he is icteric, has bulging fontanelles, and exhibits opisthotonic posture. Which of the following treatments is NOT indicated?

Chlorpromazine. ***Chlorpromazine*** - Chlorpromazine is an **antipsychotic medication** and is **contraindicated** in infants, especially in the presence of seizures and central nervous system (CNS) dysfunction, due to its potential to **lower the seizure threshold** and cause severe extrapyramidal symptoms. - Its mechanism of action via **dopamine receptor blockade** is not relevant for treating bilirubin encephalopathy or its symptoms. *Phototherapy* - Phototherapy is a primary treatment for **neonatal jaundice** to reduce unconjugated bilirubin levels and prevent neurotoxicity. - While the infant's condition suggests severe hyperbilirubinemia with complications, phototherapy would still be indicated as an initial step or adjunct to further interventions, especially if the bilirubin levels are still rising. *Exchange Transfusion* - Exchange transfusion is a **definitive treatment** for severe hyperbilirubinemia, especially when there are signs of **acute bilirubin encephalopathy (kernicterus)**, as suggested by seizures, bulging fontanelles, and opisthotonus. - It rapidly removes bilirubin from the blood and is crucial to prevent further neurological damage in such critical cases. *Phenobarbital* - Phenobarbital is an **anticonvulsant** used to manage seizures, which are a prominent symptom in this infant. - It can also help to **induce hepatic enzymes** involved in bilirubin metabolism, thereby potentially aiding in the reduction of bilirubin levels in cases of severe hyperbilirubinemia, though its primary role here would be seizure control.

Q: What is the most common cause of pneumonia in early onset sepsis in neonates?

Group B streptococcus. ***Group B streptococcus*** - **Group B Streptococcus (GBS)** is the leading cause of **early-onset sepsis** and pneumonia in neonates, typically acquired during passage through the birth canal. - Maternal GBS colonization is a significant risk factor, and GBS can cause **severe respiratory distress** in affected newborns. *H influenzae* - **_Haemophilus influenzae_** is a more common cause of **late-onset sepsis** or pneumonia in infants and children, rather than early-onset neonatal disease. - While it can cause neonatal infections, it is much less frequent than GBS in the early-onset period. *Coagulase positive staph aureus* - **_Staphylococcus aureus_** is a common cause of **nosocomial infections** or late-onset sepsis in neonates, particularly in ventilated or catheterized infants. - It is not the most common pathogen for community-acquired **early-onset neonatal pneumonia**. *Listeria* - **_Listeria monocytogenes_** can cause severe neonatal sepsis and pneumonia, often associated with maternal consumption of contaminated food. - While it is a significant pathogen, it is less common overall than GBS as a cause of early-onset neonatal pneumonia in most regions.

Q: Which of the following is NOT a recognized cause of neonatal bradycardia?

BCG Vaccine. ***BCG Vaccine*** - The **BCG vaccine** (Bacille Calmette-Guérin) is used to prevent tuberculosis and is not a known cause of **neonatal bradycardia**. - While it can cause local reactions or, rarely, disseminated disease in immunocompromised infants, it does not directly affect heart rate. *Hypoxia* - **Hypoxia** is a common and critical cause of **neonatal bradycardia**, as the heart attempts to conserve energy and oxygen in response to insufficient oxygen supply. - Severe or prolonged hypoxia can lead to **myocardial depression** and further compromise cardiac function. *Hypothermia* - **Hypothermia** (low body temperature) can significantly depress the **central nervous system** and **metabolic rate** in neonates. - This physiological response often leads to a decreased heart rate, resulting in **bradycardia**. *Head injury* - **Head injury** in neonates, especially severe forms, can increase **intracranial pressure** and stimulate the **vagal nerve**. - **Vagal stimulation** can lead to a decrease in heart rate, manifesting as **bradycardia**.

Q: Erythematous blotchy rash is seen on the abdomen, trunk, and face of a 3-day-old child along with yellowish papules. The child appears well. What is the appropriate management?

No treatment. ***No treatment (Correct Answer)*** The described symptoms—erythematous blotchy rash with yellowish papules on the abdomen, trunk, and face in a well-appearing 3-day-old neonate—are **classic for erythema toxicum neonatorum**. **Key Features:** - **Benign, self-limiting rash** of unknown etiology - Affects **50-70% of term newborns** - Typically appears on **days 2-5** of life - Characterized by **erythematous macules/patches** with overlying **yellowish-white papules/pustules** - Infant appears **well and thriving** - **Resolves spontaneously** within 1-2 weeks without treatment - Histology shows **eosinophils** in pustules **Management:** Reassurance to parents; no medical intervention required. --- *Topical steroid and antibiotic lotion (Incorrect)* This approach is inappropriate because erythema toxicum neonatorum is: - **Not an infection** (no bacterial or fungal cause) - **Not an inflammatory condition** requiring steroids - Misdiagnosis and overtreatment could lead to unnecessary side effects, antibiotic resistance, and mask other conditions --- *Topical steroid cream (Incorrect)* Topical steroids are: - **Unnecessary** for this benign, self-resolving condition - **Potentially harmful** in neonates (can cause skin atrophy, increased absorption) - Provide **no therapeutic benefit** for erythema toxicum neonatorum --- *Intravenous antibiotics (Incorrect)* Systemic antibiotics are: - **Entirely unwarranted** as this is a non-infectious, benign rash - Would represent **gross overtreatment** with significant risks - Contribute to **antibiotic resistance** - Carry risks of adverse reactions, disruption of normal flora, and unnecessary hospitalization **Differentials to consider (but not present here):** - Transient neonatal pustular melanosis (present at birth) - Neonatal acne (appears later, at 2-4 weeks) - Miliaria (smaller, clear vesicles) - Infectious causes (infant appears ill, requires septic workup)

Q: Which of the following is not a cause of neonatal anaemia?

Wilson's Disease. ***Wilson's Disease*** - Wilson's disease is a disorder of **copper metabolism** that typically manifests later in childhood or adolescence with **hepatic**, **neurological**, or **psychiatric symptoms**, not neonatal anemia. - While it can cause hemolytic anemia in older individuals due to copper toxicity, it is not a recognized cause of **neonatal anemia**. *Subgaleal Hemorrhage* - A subgaleal hemorrhage is a significant collection of blood in the **subgaleal space** of the scalp, which can lead to substantial **blood loss** and subsequent **neonatal anemia** due to a large potential space. - This type of hemorrhage is often associated with **vacuum extraction** or other traumatic deliveries. *Abruptio placentae* - **Abruptio placentae** involves the premature separation of the placenta from the uterine wall, leading to **fetal-maternal hemorrhage** and sometimes significant **fetal blood loss**. - This acute blood loss in the fetus can manifest as severe **neonatal anemia** at birth. *Diamond Blackfan syndrome* - **Diamond Blackfan syndrome** is a congenital red cell aplasia characterized by a failure of **red blood cell production** in the bone marrow. - This condition presents with severe **macrocytic anemia** early in infancy, often requiring transfusions.

Q: Which of the following is a common symptom of Hypoxic Ischemic Encephalopathy?

Seizures. ***Seizures*** - **Seizures** are a very common and early symptom of **Hypoxic-Ischemic Encephalopathy (HIE)** due to neuronal injury and dysfunction. - They can manifest in various forms, including tonic, clonic, or multifocal types, and often indicate the severity of brain damage. *Lower limbs affected more than upper limbs* - The pattern of motor impairment in HIE typically involves the **upper limbs more than the lower limbs** due to the specific vulnerability of cortical regions supplying the upper extremities and face. - This is in contrast to conditions like **cerebral palsy from periventricular leukomalacia**, which characteristically affects the lower limbs more. *Predominant trunk involvement* - While HIE can cause widespread neurological dysfunction, **isolated or predominant trunk involvement** is not a characteristic presenting symptom. - Motor deficits usually involve the extremities and cranial nerves, reflecting diffuse or focal brain injury. *Proximal muscles affected more than distal muscles* - The distribution of muscle weakness in HIE does not typically show a clear pattern of **proximal over distal involvement**. - Instead, the motor deficits are often widespread or show predilection for the upper extremities, depending on the extent and location of brain injury.

Question 1

Most common site for bone marrow aspiration in neonates is -

Accepted Answer

Anteromedial tibia

Answer

Anterior superior iliac crest

Answer

Posterior superior iliac crest

Answer

Sternum

Question 2

Which of the following drugs is most commonly used for cardiovascular support in post-resuscitation care of neonates?

Accepted Answer

Dopamine

Answer

Dobutamine

Answer

Epinephrine

Answer

Sodium Bicarbonate

Question 3

Treatment of choice for symptomatic neonatal hypoglycemia is

Accepted Answer

10% dextrose

Answer

Dextrose normal saline

Answer

5% dextrose

Answer

25% dextrose

Question 4

Which of the following statements about cephalhematoma is correct?

Accepted Answer

It is hemorrhage between the skull and periosteum

Answer

It is hemorrhage within the subcutaneous tissue around the skull

Answer

It is type of subdural hemorrhage

Answer

It is subperiosteal bleeding in the skull

Question 5

A 45-day-old infant presents with seizures. Examination reveals he is icteric, has bulging fontanelles, and exhibits opisthotonic posture. Which of the following treatments is NOT indicated?

Accepted Answer

Chlorpromazine

Answer

Phenobarbital

Answer

Phototherapy

Answer

Exchange Transfusion

Question 6

What is the most common cause of pneumonia in early onset sepsis in neonates?

Accepted Answer

Group B streptococcus

Answer

H influenzae

Answer

Coagulase positive staph aureus

Answer

Listeria

Question 7

Which of the following is NOT a recognized cause of neonatal bradycardia?

Accepted Answer

BCG Vaccine

Answer

Hypothermia

Answer

Head injury

Answer

Hypoxia

Question 8

Erythematous blotchy rash is seen on the abdomen, trunk, and face of a 3-day-old child along with yellowish papules. The child appears well. What is the appropriate management?

Accepted Answer

No treatment

Answer

Topical steroid and antibiotic lotion

Answer

Topical steroid cream

Answer

Intravenous antibiotics

Question 9

Which of the following is not a cause of neonatal anaemia?

Accepted Answer

Wilson's Disease

Answer

Subgaleal Hemorrhage

Answer

Abruptio placentae

Answer

Diamond Blackfan syndrome

Question 10

Which of the following is a common symptom of Hypoxic Ischemic Encephalopathy?

Accepted Answer

Seizures

Answer

Lower limbs affected more than upper limbs

Answer

Predominant trunk involvement

Answer

Proximal muscles affected more than distal muscles

Neonatology — MCQs

Neonatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?