Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 781: Earliest tumour to appear after birth is?

A. Sternomastoid tumour
B. Cystic hygroma (Correct Answer)
C. Branchial cyst
D. Lymphoma

Explanation: ***Cystic hygroma*** - A cystic hygroma is a **congenital lymphatic malformation** that is most commonly **present at birth or becomes evident in the immediate neonatal period**, making it the earliest to be clinically apparent among the given options. - It arises from sequestration of lymphatic tissue that fails to connect with the venous system, often presenting as a **soft, compressible, transilluminant mass** typically in the posterior triangle of the neck or axilla. - **60-80% are detected at birth**, and 90% by 2 years of age, making it the earliest "tumor" (though technically a malformation) to be recognized in newborns. *Sternomastoid tumour* - This is a fibrous pseudotumor (not a true neoplasm) within the **sternocleidomastoid muscle**, typically noticed at **2-4 weeks of age** following **birth trauma** or abnormal in-utero positioning. - It leads to **congenital muscular torticollis** and appears as a firm, non-tender, mobile mass in the muscle belly. - Though early, it appears **later than cystic hygroma** in the neonatal period. *Branchial cyst* - Branchial cysts are **congenital cervical anomalies** arising from remnants of the **branchial apparatus** that typically present **later in childhood or early adulthood** as they enlarge. - They are rarely symptomatic or clinically apparent at birth, often becoming evident only when infected or significantly enlarged. *Lymphoma* - Lymphomas are malignancies of lymphoid tissue that are **extremely rare in neonates** and infants. - Congenital lymphomas are exceptionally uncommon and not considered among the earliest tumors to appear after birth.

Question 782: A new born boy is having lumbosacral meningomyelocele and awaiting the surgical repair. The sac is best protected with sterile gauze piece soaked with

A. Mercurochrome
B. Methylene blue
C. Normal saline (Correct Answer)
D. Tincture benzoin

Explanation: ***Normal saline*** - **Normal saline** creates a moist environment, which prevents the delicate neural tissue within the **meningomyelocele sac** from drying out and sustaining further damage. - Using a sterile gauze soaked in normal saline also reduces the risk of infection by providing a clean barrier until surgical repair can be performed. - This is the **standard of care** for preoperative management of meningomyelocele. *Mercurochrome* - **Mercurochrome** contains mercury, which is highly toxic and can be absorbed through the delicate membranes of the meningomyelocele sac, causing systemic toxicity. - It is an antiseptic and not ideal for maintaining the delicate neural tissue's viability due to its potential for **chemical irritation** and damage. *Methylene blue* - **Methylene blue** is primarily used as a dye or for specific medical treatments, but it is not suitable for dressing a meningomyelocele due to its potential for irritation and lack of benefit in protecting neural tissue. - It does not provide the necessary hydration and protection for the exposed neural elements and may cause a **chemical burn** or local tissue damage. *Tincture benzoin* - **Tincture benzoin** is an adhesive protectant often used to improve adhesion of bandages or to protect skin, but it is **irritating** and not sterile. - It is definitely not indicated for direct application over exposed neural tissue as it can cause significant **chemical irritation** and inflammation.

Question 783: Which of the following is NOT a method by which incubator heat is delivered?

A. Conduction
B. Radiation
C. Sublimation (Correct Answer)
D. Convection

Explanation: ***Sublimation*** - **Sublimation** is the process where a solid changes directly into a gas without passing through a liquid phase (e.g., dry ice sublimating). - This is a **phase transition of matter**, NOT a mechanism of heat transfer. - Incubators do not use sublimation as a method of heat delivery. - The three methods of heat transfer are conduction, convection, and radiation - all of which are used in modern incubators. *Conduction* - Incubators DO use **conduction** to deliver heat through direct contact. - Heat is transferred from the warmed mattress and surrounding surfaces to the infant's skin. - Modern incubators are designed to provide safe conductive heating without causing burns. *Radiation* - **Radiant warmers** use infrared radiation to directly warm the infant without heating the surrounding air. - This method is particularly effective for sick neonates requiring easy access during procedures. *Convection* - Incubators use **forced convection** by circulating warm, humidified air around the infant. - This ensures **uniform temperature distribution** and maintains a stable thermal environment.

Question 784: In infants of diabetic mothers (IDM), when is ophthalmologic evaluation indicated?

A. At the time of diagnosis
B. Only if visual symptoms develop (Correct Answer)
C. After 5 years routinely
D. After developing diabetes

Explanation: ***Only if visual symptoms develop*** - Unlike **retinopathy of prematurity**, infants of diabetic mothers (IDMs) do not have a higher incidence of **retinopathy** or other **ocular abnormalities** at birth or in early infancy. - **Ophthalmologic evaluation** is generally reserved for IDMs who develop specific **visual symptoms** or signs of ocular pathology. *At the time of diagnosis* - Routine ophthalmologic screening at the time of diagnosis of IDM is **not standard practice**, as the risk of **congenital ocular anomalies** is not substantially elevated to warrant universal screening. - Initial management focuses on metabolic stability, especially **glucose control**, and screening for other common IDM-related complications like **cardiac defects** or **respiratory distress**. *After 5 years routinely* - There is **no evidence or recommendation** for routine ophthalmologic screening of IDMs specifically at the age of 5 years. - Regular **well-child check-ups** include basic vision screening, which would identify significant refractive errors or strabismus, but not specifically for diabetes-related ocular issues. *After developing diabetes* - While it is true that individuals with **type 1 or type 2 diabetes** require regular **ophthalmologic evaluations** for **diabetic retinopathy**, this refers to the child developing diabetes later in life, not being an IDM. - Being an IDM is a **risk factor for developing diabetes** later in life, but it doesn't automatically mean they have diabetes-related ocular issues from birth.

Question 785: A term infant is born to a known HIV-positive mother. She has been taking antiretroviral medications for the weeks prior to the delivery of her infant. Routine management of the healthy infant should include which of the following?

A. HIV ELISA on the infant to determine if congenital infection has occurred
B. Admission to the neonatal intensive care unit for close cardiovascular monitoring
C. Chest radiographs to evaluate for congenital Pneumocystis carinii
D. A course of zidovudine for the infant (Correct Answer)

Explanation: ***A course of zidovudine for the infant*** - This is the standard of care for newborns exposed to HIV prenatally, even if the mother received **antiretroviral therapy (ART)**. - **Zidovudine (AZT)** prophylaxis significantly reduces the risk of **perinatal HIV transmission**. *HIV ELISA on the infant to determine if congenital infection has occurred* - **HIV ELISA** tests detect **maternal antibodies** passed to the infant, which can persist for up to 18 months, leading to **false positive results**. - **HIV DNA PCR** or **RNA assays** are used to diagnose HIV infection in infants. *Admission to the neonatal intensive care unit for close cardiovascular monitoring* - Admission to the **NICU** is generally reserved for **premature** or **symptomatic infants**, or those with specific complications. - A **healthy, term infant** born to an HIV-positive mother on ART does not routinely require NICU admission. *Chest radiographs to evaluate for congenital Pneumocystis carinii* - **Pneumocystis jirovecii pneumonia (PJP)** typically presents in HIV-infected infants between **3 to 6 months of age**, not at birth. - Prophylaxis with **trimethoprim-sulfamethoxazole (TMP-SMX)** is initiated at 4-6 weeks of age for HIV-exposed infants.

Question 786: Estimation of the blood sugar is relevant in all except –

A. Large for date baby
B. Birth asphyxia
C. Rh Incompatibility
D. Baby of hypothyroid mother (Correct Answer)

Explanation: ***Baby of hypothyroid mother*** - While maternal hypothyroidism can affect fetal development and lead to various complications, it does not directly cause **neonatal hypoglycemia** or **hyperglycemia**, making routine blood sugar monitoring less critical unless other risk factors are present. - The primary concerns for a baby born to a hypothyroid mother are related to thyroid function itself, such as **congenital hypothyroidism**, not blood glucose dysregulation. *Large for date baby* - **Macrosomic infants**, especially those born to mothers with gestational diabetes, are at increased risk for **hypoglycemia** due to chronic fetal hyperinsulinemia. - Close monitoring of blood glucose levels is essential to prevent neurological damage from sustained low sugar. *Birth asphyxia* - Infants who experience **birth asphyxia** are under significant stress, which can deplete their glycogen stores and impair gluconeogenesis, leading to **hypoglycemia**. - Monitoring blood glucose is a critical component of their post-resuscitation care and management. *Rh Incompatibility* - Severe **Rh incompatibility** can lead to **hydrops fetalis** and other complications, including liver dysfunction and extramedullary hematopoiesis, which can impair glucose regulation. - These infants are at risk for both **hypoglycemia** due to increased metabolic demand and **hyperglycemia** secondary to stress and liver involvement, necessitating blood sugar monitoring.

Question 787: Which of the following is true regarding osteomyelitis in newborns?

A. Most common in diaphysis (Correct Answer)
B. Most common organism is E.coli
C. The infection is unifocal
D. Organisms are derived from maternal genital tract

Explanation: ***Most common in diaphysis*** - In neonates, **osteomyelitis** frequently affects the **diaphysis and metaphysis of long bones** due to differences in vascular supply and bone structure compared to older children and adults. - The **metaphyseal growth plate** acts as a barrier in older children, but in neonates, vessels often cross this plate, allowing infection to spread into the diaphysis and epiphysis. - This is the **characteristic feature** of neonatal osteomyelitis. *Most common organism is E.coli* - The **most common causative organism** for neonatal osteomyelitis is **Staphylococcus aureus** (50-60% of cases), not *E. coli*. - *E. coli* can cause neonatal osteomyelitis but is much less frequent than *Staphylococcus aureus* or Group B Streptococcus. *The infection is unifocal* - Neonatal osteomyelitis is characteristically **multifocal** in **30-40% of cases**, meaning it affects **multiple bones** simultaneously. - This is in contrast to older children and adults, where osteomyelitis tends to be unifocal (single site). *Organisms are derived from maternal genital tract* - While **Group B Streptococcus** (the second most common organism) can be acquired from the maternal genital tract during delivery, **Staphylococcus aureus** (the most common organism) is typically acquired **postnatally** from the hospital environment, skin colonization, or via indwelling catheters. - The **primary route** for neonatal osteomyelitis is **hematogenous spread** from bacteremia, rather than direct ascending infection from the birth canal. - Since S. aureus accounts for the majority of cases and is not maternally derived, this statement is not the best characterization of neonatal osteomyelitis.

Question 788: Most common cause of neonatal diarrhea worldwide is:

A. E. coli
B. Salmonella
C. Rotavirus (Correct Answer)
D. Shigella

Explanation: ***Rotavirus*** - **Rotavirus** is the **most common cause of severe acute diarrhea in infants and young children worldwide**, including the neonatal period. - It is responsible for significant morbidity and mortality, particularly in **developing countries** with limited access to clean water and sanitation. - The virus causes **watery diarrhea, vomiting, and dehydration**, which can be life-threatening in neonates. - **WHO** recognizes Rotavirus as the leading cause of severe diarrheal disease in children under 5 years globally. - Vaccination programs (Rotavac, Rotarix) have reduced incidence but it remains the predominant pathogen. *E. coli* - **Enteropathogenic E. coli (EPEC)** and **Enterotoxigenic E. coli (ETEC)** are important causes of neonatal diarrhea, especially in resource-limited settings. - EPEC causes diarrhea through attachment and effacement of intestinal mucosa. - ETEC is a major cause of traveler's diarrhea and endemic diarrhea in developing countries. - While significant, E. coli is the **most common bacterial cause** but not the overall most common cause when viruses are included. *Salmonella* - **Salmonella** causes gastroenteritis but is more common in **older infants and children**. - Often associated with **foodborne outbreaks**, fever, and sometimes bloody diarrhea. - Less frequent as a primary cause of neonatal diarrhea compared to Rotavirus or E. coli. *Shigella* - **Shigella** typically causes **dysentery (bloody diarrhea)** and is more common in **children over 6 months**. - Requires a lower infectious dose but is less prevalent in the immediate neonatal period. - Associated with poor hygiene and fecal-oral transmission in older children.

Question 789: What is the volume of reservoir bag used in neonatal resuscitation?

A. 1000 ml
B. 750 ml
C. 500 ml (Correct Answer)
D. 240 ml

Explanation: ***500 ml*** - A **500 mL self-inflating bag** is the **standard size** recommended for **neonatal resuscitation** by the Neonatal Resuscitation Program (NRP). - This volume provides an adequate **oxygen reservoir** while allowing controlled delivery of appropriate **tidal volumes (4-6 mL/kg)** for neonates. - The bag volume is larger than the delivered tidal volume to ensure consistent oxygen concentration and effective ventilation without requiring perfect compression technique. *1000 ml* - A **1000 mL bag** is designed for **adult resuscitation** and is unnecessarily large for neonatal use. - While it can be used if neonatal bags are unavailable, the larger size makes it more difficult to achieve consistent, controlled ventilation in neonates. *750 ml* - A **750 mL bag** is sometimes used for older infants or pediatric patients but is larger than the standard neonatal size. - While acceptable, the **500 mL bag** is preferred for term and preterm neonates. *240 ml* - A **240 mL bag** is **too small** to function effectively as a self-inflating bag for neonatal resuscitation. - This volume is insufficient to maintain an adequate **oxygen reservoir** and would compromise the ability to deliver consistent positive pressure ventilation.

Question 790: Bohn's nodules are

A. Cysts of gingiva in growing children
B. Cystic swellings in neonates (Correct Answer)
C. Warts on the tongue
D. Cysts associated with soft palate

Explanation: ***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.

Practice by Chapter

Neonatal Resuscitation

Practice Questions

Care of the Normal Newborn

Practice Questions

Prematurity and Low Birth Weight

Practice Questions

Respiratory Distress Syndrome

Practice Questions

Neonatal Jaundice

Practice Questions

Neonatal Sepsis

Practice Questions

Necrotizing Enterocolitis

Practice Questions

Intraventricular Hemorrhage

Practice Questions

Persistent Pulmonary Hypertension

Practice Questions

Perinatal Asphyxia

Practice Questions

Neonatal Seizures

Practice Questions

Congenital Anomalies

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free