Neonatology Practice Questions

Q: Which of the following is correct regarding "witch's milk"?

It is seen in full-term infants.. ***It is seen in full-term infants.*** - **Witch's milk** (neonatal galactorrhea) is a physiological phenomenon observed in newborns due to the **withdrawal of maternal hormones** (estrogens, progesterone, and prolactin) after birth. - These maternal hormones cross the placenta during pregnancy and stimulate the fetal breast tissue. - While it can occur in both preterm and term infants, it is **more commonly and prominently observed in full-term infants** who have had greater exposure to maternal hormones. - This condition typically appears 3-5 days after birth and resolves spontaneously within a few weeks. *It is caused by stimulation of foetal breast by calcitonin.* - **Calcitonin** is a hormone involved in calcium and bone metabolism, not breast development or milk production. - **Witch's milk** is caused by the withdrawal of maternal hormones (estrogens, progesterone, and prolactin) after birth, not calcitonin. *It is seen only in preterm infants.* - This is incorrect as witch's milk can occur in **both preterm and full-term infants**. - It is actually **more common in full-term newborns** due to their longer exposure to maternal hormones in utero. *It is caused by stimulation of foetal breast by progesterone.* - While **progesterone** is one of the maternal hormones involved, the mechanism is more accurately described as a **withdrawal phenomenon** rather than ongoing stimulation. - After birth, the sudden **withdrawal of maternal estrogens, progesterone, and prolactin** triggers the breast tissue to secrete milk. - The wording "stimulation by progesterone" is misleading as it suggests active stimulation rather than the withdrawal mechanism that actually causes the milk secretion.

Q: In a newborn, the Apgar score has been recorded at 1 minute of birth. Which one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?

3. ***3*** - The Apgar score is calculated based on five criteria: **Appearance**, **Pulse**, **Grimace**, **Activity**, and **Respiration** (APGAR). Each criterion is scored 0, 1, or 2. - Based on the given findings: - **Heart rate (Pulse)**: 92/min scores **1** (below 100/min). - **Respiratory effort (Respiration)**: Slow, irregular scores **1**. - **Muscle tone (Activity)**: Flaccid scores **0**. - **Reflex response (Grimace)**: No response scores **0**. - **Colour (Appearance)**: Body pink, extremities blue (acrocyanosis) scores **1**. - Summing these scores (1 + 1 + 0 + 0 + 1) gives a total Apgar score of **3**. *2* - This score would mean that the newborn has a **more severe depression** in vital signs compared to the actual findings. - A score of 2 would require at least one of the 1-point criteria to be a 0-point criterion or combination of a 0-point criterion become 1. *0* - An Apgar score of 0 would indicate that the infant has **no vital signs** (no heart rate, no respiratory effort, no muscle tone, no reflex response, and completely blue/pale). - This is not consistent with a heart rate of 92/min, slow/irregular respirations, and body pink color. *5* - An Apgar score of 5 would imply a **much healthier** newborn with better scores in most categories. - This would require findings such as a heart rate over 100 bpm, good crying, some flexion of extremities, or an all-pink appearance, which are not present here.

Q: Most common newborn rash which presents at 24-48 hours of life is

Erythema toxicum neonatorum. ***Erythematous papular pustular lesions*** - This description is characteristic of **Erythema toxicum neonatorum**, which is the **most common benign transient rash in newborns.** - It typically appears between **24 and 48 hours of life** and presents with discrete **erythematous macules**, papules, and pustules on a red base. *Milia* - Milia are **tiny, pearly white cysts** that are present from birth and are due to trapped keratin. - While common, they are **not typically red or pustular** and do not usually have a delayed onset at 24-48 hours specifically. *Transient neonatal pustular melanosis* - This rash is present at **birth** and consists of **non-erythematous pustules** that rupture to leave collarettes of scale and dark macules. - Unlike erythema toxicum, it **lacks the erythematous base** and is usually present earlier. *Erythematous maculopapular rash* - This is a **general description** that could fit several conditions but **lacks the specific pustular component** that is key to identifying erythema toxicum neonatorum. - While erythema toxicum has macules and papules, the **presence of pustules** is a hallmark.

Q: Which is the most common laryngeal abnormality that produces laryngeal stridor in a newborn?

Laryngomalacia. ***Laryngomalacia*** - **Laryngomalacia** is the most common cause of **congenital laryngeal stridor**, accounting for 60-70% of cases. - It results from the **floppiness of supraglottic structures** (epiglottis and arytenoids) that collapse inward during inspiration, causing stridor. *Congenital vocal cord paralysis* - While it can cause stridor, **congenital vocal cord paralysis** is much less common than laryngomalacia. - It typically results from neurological issues, and the stridor quality may differ. *Congenital web* - A **congenital web** is a rare cause of stridor, usually presenting with a **high-pitched persistent stridor** and often a weak cry. - The severity depends on the extent of the web across the glottis. *Congenital subglottic stenosis* - **Congenital subglottic stenosis** is the third most common cause of congenital stridor (after laryngomalacia and vocal cord paralysis). - It is characterized by narrowing of the airway below the vocal cords and often presents with biphasic stridor and recurrent croup-like symptoms.

Q: A 37-week small-for-date neonate is most likely to develop

Hypoglycaemia. ***Hypoglycaemia*** - **Small-for-date** neonates have reduced **glycogen stores** due to chronic fetal stress or placental insufficiency. - Their increased metabolic demands relative to limited energy reserves make them prone to **low blood glucose**. - This is the **most immediate metabolic complication** requiring urgent screening and management. *Hyaline membrane disease* - This condition, also known as **respiratory distress syndrome**, primarily affects **premature neonates** due to surfactant deficiency. - **Small-for-date infants** at term (37 weeks) typically have **accelerated lung maturity** due to chronic intrauterine stress, making them **less susceptible** to RDS compared to appropriately grown preterm infants. *Hypocalcaemia* - While neonates can experience hypocalcemia, it is particularly common in infants of **diabetic mothers**, those with **asphyxia**, or those born **prematurely**. - Small-for-date status alone isn't the primary risk factor for **neonatal hypocalcaemia**. *Hypothermia* - **Small-for-date** infants have a larger **surface area to body mass ratio** and reduced **subcutaneous fat**, which significantly increases heat loss. - This is indeed a **major risk** requiring immediate attention at birth (thermal protection, skin-to-skin care). - However, **hypoglycemia** is considered the **most characteristic metabolic derangement** and "most likely" complication specifically associated with SGA status, making it the best answer for this question.

Q: When should breastfeeding be initiated to an infant born via a normal delivery?

Within one hour of birth. ***Within one hour of birth*** - Initiating breastfeeding within the first hour of birth is recommended by global health organizations like WHO and UNICEF to optimize **breastfeeding success** and ensure the infant receives vital **colostrum**. - Early initiation helps establish **successful lactation** for the mother and provides the infant with immediate immunological benefits and nutritional support. - The guideline "within one hour" means breastfeeding should be initiated **as soon as possible** during this window, with earlier being preferable. *After 4 hours of birth* - Delaying breastfeeding beyond four hours can miss the critical window for establishing good feeding practices and the infant's **initial suckling reflex**. - This delay might lead to difficulties in latching and **lower rates of exclusive breastfeeding** in the long term. *Within half an hour* - Initiating breastfeeding within half an hour is **equally appropriate** and falls well within the WHO-recommended timeframe of one hour. - This option is not incorrect per se, but "within one hour" is the **standard guideline** most commonly cited in medical literature and policy documents. - Many institutions actually aim for breastfeeding within 30 minutes as a **best practice goal**. *Within 2–4 hours of birth* - This window is acceptable if there are initial medical concerns or delays, but it is **not the ideal time** for routine initiation of breastfeeding. - Waiting beyond one hour can reduce the infant's **alertness and readiness** to feed effectively, potentially leading to challenges.

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: 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.

Question 1

Which of the following is correct regarding "witch's milk"?

Accepted Answer

It is seen in full-term infants.

Answer

It is caused by stimulation of foetal breast by calcitonin.

Answer

It is seen only in preterm infants.

Answer

It is caused by stimulation of foetal breast by progesterone.

Question 2

In a newborn, the Apgar score has been recorded at 1 minute of birth. Which one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?

Accepted Answer

3

Answer

2

Answer

0

Answer

5

Question 3

To prevent neonatal tetanus in an infant born to a woman who has not been given Tetanus Toxoid (TT) appropriately during pregnancy, what should ideally be done?

Accepted Answer

Give one dose of TT to the mother and one dose of TIG to the infant within 6 hours of birth

Answer

Injection Tetanus Immunoglobulin (TIG) has to be administered to the infant within 6 hours of birth

Answer

Give one dose of TT to the mother and one dose of TIG to the infant after 72 hours of birth

Answer

Give one dose of TT to the mother immediately

Question 4

Most common newborn rash which presents at 24-48 hours of life is

Accepted Answer

Erythema toxicum neonatorum

Answer

Milia

Answer

Transient neonatal pustular melanosis

Answer

Erythematous maculopapular rash

Question 5

Which is the most common laryngeal abnormality that produces laryngeal stridor in a newborn?

Accepted Answer

Laryngomalacia

Answer

Congenital vocal cord paralysis

Answer

Congenital web

Answer

Congenital subglottic stenosis

Question 6

A 37-week small-for-date neonate is most likely to develop

Accepted Answer

Hypoglycaemia

Answer

Hyaline membrane disease

Answer

Hypocalcaemia

Answer

Hypothermia

Question 7

When should breastfeeding be initiated to an infant born via a normal delivery?

Accepted Answer

Within one hour of birth

Answer

After 4 hours of birth

Answer

Within half an hour

Answer

Within 2–4 hours of birth

Question 8

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 9

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 10

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

Neonatology — MCQs

Neonatology — MCQs

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