Neonatology Practice Questions

Q: A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:

HSV II. ***HSV II*** - **Herpes simplex virus type 2 (HSV-2)** is the most common cause of **neonatal herpes**, presenting with neurological manifestations like encephalitis and characteristic vesicular skin lesions. - Transmission usually occurs during **vaginal delivery** from a mother with genital herpes, leading to widespread infection in the neonate. *Meningococci* - While *Neisseria meningitidis* can cause **meningitis** and **septicemia** in neonates, it does not typically produce vesicular skin lesions. - Its infections are more commonly associated with a **petechial or purpuric rash**, not vesicles. *Streptococci* - **Group B Streptococcus (GBS)** is a leading cause of **neonatal sepsis and meningitis**, but it does not cause vesicular skin lesions. - GBS typically presents with non-specific signs of sepsis or meningitis in neonates. *HSV I* - Although **herpes simplex virus type 1 (HSV-1)** can cause neonatal herpes, **HSV-2 remains the predominant cause** of vertically transmitted neonatal infection with encephalitis and disseminated disease. - HSV-1 is more commonly associated with **oral herpes (cold sores)** in older children and adults, though its incidence in neonatal infection is increasing.

Q: A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?

Obstruction in the circulation of the cerebrospinal fluid. ***Obstruction in the circulation of the cerebrospinal fluid*** - **Non-communicating hydrocephalus**, by definition, is caused by an **obstruction within the ventricular system** that prevents CSF from reaching the subarachnoid space. - In a newborn, common causes of such obstruction include **aqueductal stenosis** or malformations like **Dandy-Walker syndrome**. *Disturbances in the resorption of cerebrospinal fluid* - This typically leads to **communicating hydrocephalus**, where CSF can flow freely within the ventricles but is not adequately absorbed into the venous system. - Examples include **arachnoid granulations** dysfunction or **post-meningitic scarring**. *Excess production of cerebrospinal fluid* - This is a very rare cause of hydrocephalus, usually associated with conditions like a **choroid plexus papilloma**. - This would lead to a **communicating hydrocephalus** as the obstruction is not within the ventricular system itself. *Increased size of the head* - An **increased head size (macrocephaly)** is a *symptom* or *sign* of hydrocephalus in an infant, not a cause. - The elevated intracranial pressure from the accumulated CSF leads to the expansion of the skull bones before the sutures fuse.

Q: A 1 week old female infant with symptoms of vomiting and anorexia has a temperature of 102°F. A bulging fontanel is noted on physical examination. The most likely agent is?

Streptococcus agalactiae. ***Streptococcus agalactiae*** - This organism, also known as **Group B Streptococcus (GBS)**, is the **most common cause of bacterial meningitis** and sepsis in neonates (0-3 months). - The symptoms (fever, vomiting, anorexia, bulging fontanel) are classic signs of **meningitis** in a 1-week-old infant. *Haemophilus influenzae type b* - While a significant cause of meningitis, **Hib meningitis** is rare in infants under 2 months due to the presence of maternal antibodies and the later onset of vaccination. - Its incidence has also drastically decreased due to routine **Hib vaccination**. *Listeria monocytogenes* - **Listeria monocytogenes** can cause meningitis in neonates and is often acquired transplacentally or during birth. - While a possibility, it is generally **less common than GBS** as a cause of early-onset neonatal sepsis and meningitis. *Neisseria meningitidis* - **Meningococcal meningitis** is rare in infants under 3 months, with incidence increasing in older infants and young children. - This organism is more commonly associated with outbreaks and rapid progression in older populations.

Q: To assess thyroid profile of a newborn, which of the following is mandatory?

Measure both TSH and T4. ***Measure both TSH and T4*** - **Newborn screening** for congenital hypothyroidism typically involves measuring both **TSH** (thyroid-stimulating hormone) and **T4** (thyroxine). - Elevated TSH levels indicate **primary hypothyroidism**, where the thyroid gland is underactive, while low T4 levels confirm the reduced thyroid hormone production. *Measure T3 only* - **T3 (triiodothyronine)** is generally not the primary screening test for congenital hypothyroidism in newborns. - While T3 is an active form of thyroid hormone, its levels can be influenced by various factors and are less reliable than TSH and T4 for initial screening. *Measure TSH only* - Measuring only **TSH** can detect primary hypothyroidism, but it doesn't provide a complete picture of thyroid function. - In cases of **central (secondary or tertiary) hypothyroidism**, TSH levels might be normal or low, while T4 levels are reduced, which would be missed if only TSH were measured. *Measure T4 only* - Measuring only **T4** can help identify low thyroid hormone levels, but it doesn't differentiate between primary and central hypothyroidism. - To properly assess the cause of low T4, **TSH levels** are crucial to determine if the problem lies within the thyroid gland itself or higher up in the pituitary/hypothalamic axis.

Q: A newborn has been brought with seizures refractory to treatment and a continuous bruit through the anterior fontanelle. CT shows midline lesion with hypoechogenicity and dilated lateral ventricles. Most probable diagnosis is?

Vein of Galen malformation. ***Vein of Galen malformation*** - A **continuous bruit** over the anterior fontanelle in a newborn is a classic sign of a **Vein of Galen malformation**, indicating high blood flow through an arteriovenous shunt. - The imaging findings of a **midline hypoechoic lesion** (dilated venous structure) and **dilated lateral ventricles** (due to hydrocephalus from venous congestion or obstruction) are consistent with this diagnosis. *Teratoma* - While teratomas are **germ cell tumors** that can occur in the brain, they typically present as a more solid or mixed solid-cystic mass on imaging, not primarily as hypoechoic. - A teratoma would not typically produce a **continuous bruit** over the fontanelle. *Encephalocele* - An encephalocele is a **neural tube defect** involving protrusion of brain tissue and meninges through a skull defect, which would be evident on physical examination and imaging as a sac-like protrusion. - It does not present with a **continuous bruit** or an intracranial hypoechoic midline lesion like a vascular malformation. *Arachnoid cyst* - An arachnoid cyst is a **benign, fluid-filled sac** that typically appears as a well-demarcated, anechoic (on ultrasound) or CSF-attenuated lesion on CT, often displacing surrounding brain tissue. - It would not produce a **continuous bruit** and is not usually associated with the specific constellation of symptoms seen here.

Q: Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?

None of the above. ***None of the above*** - All listed interventions—**endotracheal tube intubation**, **chest compressions**, and **adrenaline administration**—are standard components of neonatal resuscitation when the heart rate remains below 60 beats/min despite initial steps. - This question asks which is *NOT* included, implying that all options are, in fact, appropriate interventions in this critical scenario. *Endotracheal tube intubation* - This is a critical step in **securing the airway** and ensuring effective positive pressure ventilation when other methods fail or prolonged mechanical ventilation is anticipated. - It's indicated if the heart rate remains below 60 bpm despite adequate bag-mask ventilation and chest compressions. *Chest compression* - **Chest compressions** are initiated when the heart rate is less than 60 bpm *after* 30 seconds of effective positive pressure ventilation. - They are used in conjunction with positive pressure ventilation to improve cardiac output and myocardial perfusion. *Adrenaline* - **Adrenaline** is administered if the heart rate remains below 60 bpm *despite* adequate ventilation and chest compressions. - It acts as a potent **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility.

Q: A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?

No active treatment required. ***No active treatment required*** - A total serum bilirubin of **14 mg/dL** on day 5 in an otherwise well, exclusively breastfed term neonate (birth weight 2700g, which is >2500g) falls within the **physiologic jaundice range** and below thresholds for intervention. - This level is considered **normal for breastfed infants** at this age and does not warrant medical intervention as per current guidelines. *Stop breastfeeding for 2 days* - This intervention, known as **breast milk jaundice interruption**, is usually reserved for higher bilirubin levels or if there is concern for significant breast milk jaundice, which is not indicated here. - Temporarily stopping breastfeeding can disrupt the establishment of breastfeeding and is generally discouraged unless strictly necessary. *Phototherapy* - **Phototherapy** is indicated for bilirubin levels typically >15-18 mg/dL in a healthy term neonate on day 5, depending on risk factors, which this infant does not meet. - It works by converting unconjugated bilirubin into water-soluble isomers that can be excreted more easily. *Exchange transfusion* - **Exchange transfusion** is reserved for severe hyperbilirubinemia, usually with bilirubin levels approaching or exceeding 20-25 mg/dL, especially if there are signs of **acute bilirubin encephalopathy**. - This level is far below the threshold for such an invasive procedure.

Q: Which among the following is NOT part of the classic clinical triad of necrotizing enterocolitis?

Metabolic acidosis. ***Metabolic acidosis*** - Metabolic acidosis is **not** part of the classic clinical triad of necrotizing enterocolitis, though it is a common laboratory finding in severe cases. - The **classic triad of NEC** consists of: **abdominal distension**, **bloody stools**, and **pneumatosis intestinalis** on radiography. - Metabolic acidosis occurs as a consequence of intestinal ischemia and sepsis but is not included in the defining triad. *Abdominal distension* - **Abdominal distension** is a cardinal clinical feature and part of the classic triad. - Results from intestinal inflammation, ileus, and gas accumulation. *Bloody stools* - **Bloody stools** (grossly bloody or occult blood positive) are part of the classic triad. - Reflect mucosal injury and intestinal necrosis. *Pneumatosis intestinalis* - **Pneumatosis intestinalis** (intramural gas on abdominal X-ray) is the pathognomonic radiological finding in the classic triad. - Indicates gas-forming bacterial invasion of the damaged intestinal wall.

Q: In a preterm baby with respiratory distress syndrome, which type of cell is deficient?

Type 2 alveolar cell. ***Type 2 alveolar cell*** - **Type 2 alveolar cells** (pneumocytes) are responsible for producing and secreting **surfactant**. - A deficiency in these cells, common in preterm infants, leads to insufficient surfactant, causing alveolar collapse and respiratory distress syndrome. *Type 1 alveolar cell* - **Type 1 alveolar cells** are primarily involved in **gas exchange** due to their thin, flat structure. - While essential for respiration, their deficiency is not the primary cause of respiratory distress syndrome in preterm infants. *Alveolar capillary endothelial cell* - **Alveolar capillary endothelial cells** form the walls of the capillaries surrounding the alveoli, facilitating the transfer of gases between the alveoli and blood. - They do not produce surfactant, and their deficiency is not the direct cause of respiratory distress syndrome. *Bronchial mucosal epithelial cell* - **Bronchial mucosal epithelial cells** line the airways and are involved in mucus production and ciliary clearance. - While important for respiratory function, their primary role is not in preventing alveolar collapse in respiratory distress syndrome.

Question 1

A newborn presents with petechiae, skin lesions, hematuria, and a platelet count of 22,000/L. This is most likely caused by:

Accepted Answer

Congenital CMV infection

Answer

Congenital rubella infection

Answer

Both CMV and rubella infection

Answer

Premature infants

Question 2

A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:

Accepted Answer

HSV II

Answer

Meningococci

Answer

Streptococci

Answer

HSV I

Question 3

A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?

Accepted Answer

Obstruction in the circulation of the cerebrospinal fluid

Answer

Disturbances in the resorption of cerebrospinal fluid

Answer

Excess production of cerebrospinal fluid

Answer

Increased size of the head

Question 4

A 1 week old female infant with symptoms of vomiting and anorexia has a temperature of 102°F. A bulging fontanel is noted on physical examination. The most likely agent is?

Accepted Answer

Streptococcus agalactiae

Answer

Haemophilus influenzae type b

Answer

Listeria monocytogenes

Answer

Neisseria meningitidis

Question 5

To assess thyroid profile of a newborn, which of the following is mandatory?

Accepted Answer

Measure both TSH and T4

Answer

Measure T3 only

Answer

Measure TSH only

Answer

Measure T4 only

Question 6

A newborn has been brought with seizures refractory to treatment and a continuous bruit through the anterior fontanelle. CT shows midline lesion with hypoechogenicity and dilated lateral ventricles. Most probable diagnosis is?

Accepted Answer

Vein of Galen malformation

Answer

Teratoma

Answer

Encephalocele

Answer

Arachnoid cyst

Question 7

Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?

Accepted Answer

None of the above

Answer

Endotracheal tube intubation

Answer

Chest compression

Answer

Adrenaline

Question 8

A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?

Accepted Answer

No active treatment required

Answer

Stop breastfeeding for 2 days

Answer

Phototherapy

Answer

Exchange transfusion

Question 9

Which among the following is NOT part of the classic clinical triad of necrotizing enterocolitis?

Accepted Answer

Metabolic acidosis

Answer

Bloody stools

Answer

Pneumatosis intestinalis

Answer

Abdominal distension

Question 10

In a preterm baby with respiratory distress syndrome, which type of cell is deficient?

Accepted Answer

Type 2 alveolar cell

Answer

Type 1 alveolar cell

Answer

Alveolar capillary endothelial cell

Answer

Bronchial mucosal epithelial cell

Neonatology — MCQs

Neonatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?