Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 791: Most common cause of convulsion on the first day of life in a newborn is:

A. Perinatal asphyxia (Correct Answer)
B. Hypoglycemia
C. Hypocalcemia
D. Head injury

Explanation: ***Perinatal asphyxia*** - **Perinatal asphyxia** (hypoxic-ischemic encephalopathy) is the most common cause of seizures in the first 24 hours of life in neonates. - The resulting **cerebral injury** from oxygen deprivation and ischemia leads to neuronal excitability and seizure activity. - Accounts for the majority of seizures presenting on day 1 of life, particularly following difficult deliveries or fetal distress. *Hypoglycemia* - While **hypoglycemia** can cause seizures in newborns, it is generally less common than perinatal asphyxia as the primary cause on the very first day. - Seizures due to hypoglycemia often occur in vulnerable infants like those with **diabetic mothers**, intrauterine growth restriction, or those experiencing a sudden drop in glucose. - Usually presents within 2-3 hours after birth in at-risk infants. *Hypocalcemia* - **Early neonatal hypocalcemia** can cause seizures, but typically presents slightly later, usually after 24-48 hours of life. - More common in infants with **low birth weight**, prematurity, birth asphyxia, or those born to diabetic mothers. - Related to immature parathyroid function and increased phosphate load. *Head injury* - **Birth trauma** with intracranial hemorrhage can cause seizures through direct neuronal damage, but is less frequent than perinatal asphyxia as a cause of day 1 seizures. - Risk factors include **difficult instrumental deliveries**, macrosomia, and precipitous labor. - Incidence has decreased significantly with improved obstetric practices.

Question 792: A neonate on routine examination at birth was found to have hepatomegaly. Rest of the examination was essentially unremarkable. On investigations, Anti-HCMV antibodies were found to be positive. What sequelae in later life is the child at risk of?

A. Intellectual disability
B. Renal failure
C. Sensorineural hearing loss (Correct Answer)
D. Hepatic fibrosis

Explanation: ***Sensorineural hearing loss*** - **Congenital CMV infection** is the leading cause of non-genetic sensorineural hearing loss (SNHL) in children, affecting a significant proportion of infected neonates. - SNHL can be **progressive, unilateral or bilateral**, and may manifest years after birth, necessitating long-term audiological monitoring. *Intellectual disability* - While CMV can cause **neurological complications** and intellectual disability, these are more common in symptomatic congenital CMV infections with **microcephaly, intracranial calcifications**, or severe neurological impairment at birth. - In a neonate with only hepatomegaly and no overt neurological signs, **SNHL is a more prevalent and specific long-term sequelae** than intellectual disability. *Renal failure* - **Kidney involvement** in congenital CMV is rare and generally not a primary long-term sequela. - Though CMV can rarely cause interstitial nephritis or direct viral cytopathic effects in the kidneys, leading to transient renal dysfunction, it **does not typically lead to progressive renal failure** in later life. *Hepatic fibrosis* - While congenital CMV can cause **hepatitis** and hepatomegaly, significant long-term hepatic fibrosis directly attributable to CMV, leading to liver failure in later life, is **uncommon**. - Most hepatic abnormalities in congenital CMV tend to **resolve spontaneously**, and severe chronic liver disease is rare.

Question 793: A poverty-stricken mother suffering from active tuberculosis delivers a baby. Which one of the following would be the most appropriate advice in her case?

A. Breast feeding and BCG immunization
B. Breast feeding and isoniazid administration (Correct Answer)
C. Expressed breast milk and BCG immunization
D. Stop feeds and isoniazid administration

Explanation: ***Breast feeding and isoniazid administration*** - **Breastfeeding** is safe and encouraged for infants of mothers with active tuberculosis, as the benefits of breast milk (nutrition, antibodies) outweigh the minimal risk of TB transmission through milk. - **Isoniazid (INH) chemoprophylaxis** for the infant provides additional protection in high-risk exposure settings, particularly when the mother has active pulmonary TB and close contact is inevitable. - This approach represents a conservative strategy prioritizing immediate chemoprophylaxis in a poverty-stricken setting where follow-up may be challenging. *Breast feeding and BCG immunization* - **Breastfeeding** is beneficial and appropriate. - **BCG immunization** at birth is the current standard recommendation per WHO and IAP guidelines for infants born to TB-positive mothers. - However, in settings with very high exposure risk and uncertain follow-up, some protocols additionally recommend INH prophylaxis, making the first option more comprehensive for this specific scenario. *Expressed breast milk and BCG immunization* - Expressing breast milk offers no significant additional protection against TB transmission compared to direct breastfeeding. - Direct breastfeeding has additional benefits for mother-infant bonding and is not contraindicated in maternal TB. - While **BCG immunization** is appropriate, this option unnecessarily complicates feeding. *Stop feeds and isoniazid administration* - **Stopping breastfeeding** is not indicated and would deprive the infant of essential nutrition and passive immunity. - Breastfeeding is not contraindicated in maternal tuberculosis. - While **isoniazid administration** may be appropriate, cessation of feeding is an incorrect recommendation.

Question 794: Cataracts and PDA in a newborn suggests in utero infection with which viral family?

A. Togavirus (Correct Answer)
B. Adenovirus
C. Paramyxovirus
D. Picornavirus

Explanation: ***Togavirus*** is the correct answer. **Congenital rubella syndrome**, caused by the **rubella virus** (family Togaviridae), is classically associated with the triad of **cataracts**, **patent ductus arteriosus (PDA)**, and **sensorineural hearing loss**. The virus crosses the placenta and can cause widespread damage to the developing fetus, particularly during the first trimester when organogenesis occurs. *Adenovirus* is incorrect. Adenoviruses typically cause respiratory tract infections, conjunctivitis, and gastroenteritis in newborns, but are not known to cause congenital abnormalities like cataracts and PDA. While they can infect newborns, their presentation does not include the specific congenital malformations seen with rubella. *Paramyxovirus* is incorrect. The Paramyxovirus family includes viruses like measles and mumps, which can cause severe infections but are not typically associated with congenital cataracts and PDA. Measles can lead to complications in pregnancy such as preterm birth or miscarriage, but not the specific triad of congenital rubella syndrome. *Picornavirus* is incorrect. The Picornavirus family includes enteroviruses (like poliovirus, coxsackievirus) and rhinovirus. While some enteroviruses can cause severe systemic infections in newborns (e.g., myocarditis with coxsackievirus), they are not primarily associated with cataracts and PDA as congenital anomalies.

Question 795: A 32-year-old woman with diabetes mellitus delivers a child after 38 weeks of gestation. Which of the following is the most likely abnormality that might be encountered in this child at birth?

A. Hypoglycemia (Correct Answer)
B. Cataracts
C. Hyperbilirubinemia
D. Low birth weight

Explanation: ***Hypoglycemia*** - Infants of diabetic mothers are at **highest risk for hypoglycemia** as the most common and immediate metabolic complication at birth. - Pathophysiology: Chronic exposure to high maternal glucose causes **fetal pancreatic beta-cell hyperplasia** and hyperinsulinemia. - After birth, when the continuous glucose supply from the mother is abruptly interrupted, the infant's hyperactive pancreas continues to produce excessive insulin, leading to a **rapid drop in blood glucose**. - Occurs in **25-50% of infants of diabetic mothers** and requires urgent monitoring and management. *Cataracts* - **Congenital cataracts** are associated with genetic syndromes (e.g., galactosemia), intrauterine infections (TORCH - especially rubella), or metabolic disorders, but are **not a typical complication** of maternal diabetes mellitus. - While poorly controlled maternal diabetes can cause various fetal complications, cataracts are not among the primary or common consequences. *Hyperbilirubinemia* - Infants of diabetic mothers can develop **hyperbilirubinemia**, often secondary to **polycythemia** (increased red blood cell mass due to chronic intrauterine hypoxia) and increased hemolysis. - However, while this is a recognized complication, **hypoglycemia is more immediate, more common, and requires more urgent management** at birth compared to hyperbilirubinemia. - Hyperbilirubinemia typically manifests later (after 24 hours), whereas hypoglycemia occurs immediately after birth. *Low birth weight* - Maternal diabetes (especially gestational or poorly controlled pre-gestational diabetes) typically leads to **macrosomia** (birth weight >4 kg), not low birth weight. - Excessive fetal growth is stimulated by maternal hyperglycemia → fetal hyperinsulinemia → anabolic effects. - **Low birth weight** is associated with maternal conditions like chronic hypertension, preeclampsia, placental insufficiency, or intrauterine growth restriction—not uncomplicated maternal diabetes.

Question 796: A blood specimen for neonatal thyroid screening is obtained on:

A. Cord blood
B. 48 hours after birth (Correct Answer)
C. 24 hours after birth
D. 72 hours after birth

Explanation: ***48 hours after birth*** - Neonatal thyroid screening is optimally performed at **48-72 hours** after birth, with **48 hours** being the most practical timing in current practice. - This timing balances two important factors: avoiding the **physiological TSH surge** that occurs in the first 24 hours, while ensuring screening occurs **before early hospital discharge**. - According to **IAP (Indian Academy of Pediatrics)** and international guidelines, screening at 48 hours allows accurate detection of congenital hypothyroidism while being realistic for modern obstetric practices where most mothers are discharged within 48 hours. - The **thyroid-stimulating hormone (TSH)** levels have normalized sufficiently by 48 hours to minimize false-positive results. *Cord blood* - Cord blood is not used for routine neonatal thyroid screening because **maternal thyroid hormones** (T4 and T3) cross the placenta and can mask congenital hypothyroidism in the newborn. - It does not reflect the newborn's **independent thyroid function**, which is essential for identifying congenital disorders. *24 hours after birth* - Drawing blood at 24 hours is generally **too early** for optimal thyroid screening, as the **postnatal TSH surge** is still significant. - This timing would result in a higher rate of **false-positive results**, leading to unnecessary follow-up tests and parental anxiety. - However, if discharge occurs before 48 hours, screening at 24 hours is preferable to missing screening entirely. *72 hours after birth* - While 72 hours was traditionally recommended for thyroid screening, it is **no longer practical** in the era of early hospital discharge. - Most mothers and babies are discharged within **48 hours**, making 72-hour screening logistically difficult and risking missed screening. - Current guidelines recommend **48-72 hours OR at discharge, whichever is earlier**, making 48 hours the most optimal single timepoint.

Question 797: 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?

A. Choanal atresia
B. Gastroschisis
C. Diaphragmatic hernia
D. Tracheo-esophageal fistula (Correct Answer)

Explanation: ***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.

Question 798: Jitteriness can be distinguished from seizures by all of the following except -

A. Sensitivity to stimulus
B. Abnormality of Gaze
C. Autonomic disturbance
D. Frequency of movement (Correct Answer)

Explanation: ***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.

Question 799: Most common cause of intermittent stridor in a 10-day-old child shortly after birth is:

A. Hypertrophy of turbinate
B. Laryngomalacia (Correct Answer)
C. Foreign body
D. Vocal nodule

Explanation: ***Laryngomalacia*** - This is the **most common cause** of congenital stridor, typically becoming noticeable within the first few weeks of life, consistent with a 10-day-old child. - The stridor is characteristically **intermittent**, worsens with crying or feeding, and improves when prone, due to the collapse of supraglottic structures. *Hypertrophy of turbinate* - While nasal issues can cause **stertor** (a snoring sound), hypertrophy of turbinates is not a common cause of stridor in an infant. - **Stridor** originates from the larynx or trachea, not the nasal passages. *Foreign body* - An aspirated foreign body would typically cause **acute-onset stridor** that is often continuous and associated with choking or coughing spells, rather than intermittent symptoms starting shortly after birth. - This is a less likely etiology for intermittent stridor developing within the first two weeks of life. *Vocal nodule* - Vocal nodules are generally associated with **hoarseness** or a change in voice quality, and typically require chronic vocal abuse to develop. - They are exceptionally rare in neonates and would not present as intermittent stridor.

Question 800: A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Antiepileptic of choice shall be:

A. Phenobarbitone (Correct Answer)
B. Lorazepam
C. Levetiracetam
D. Phenytoin

Explanation: ***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.

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

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