Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 801: A newborn presents with petechiae, skin lesions, hematuria, and a platelet count of 22,000/L. This is most likely caused by:

A. Congenital rubella infection
B. Both CMV and rubella infection
C. Congenital CMV infection (Correct Answer)
D. Premature infants

Explanation: ***Congenital CMV infection*** - **Congenital CMV** is the **most common congenital infection** (0.5-2% of live births) and presents with the classic triad of **petechiae**, **thrombocytopenia**, and **blueberry muffin rash** (dermal erythropoiesis). - The severe **thrombocytopenia** (platelet count 22,000/μL) with **petechiae**, **skin lesions**, and **hematuria** is characteristic of symptomatic congenital CMV. - Other features include **hepatosplenomegaly**, **microcephaly**, **periventricular calcifications**, **chorioretinitis**, and **sensorineural hearing loss**. - CMV is the leading **non-genetic cause of sensorineural hearing loss** and a major cause of neurodevelopmental disability. *Congenital rubella infection* - While **congenital rubella syndrome** can also cause **petechiae**, **thrombocytopenia**, and **blueberry muffin rash**, it is now **rare** due to widespread **rubella vaccination**. - Classic rubella triad: **Cardiac defects** (PDA, pulmonary stenosis), **cataracts**, and **sensorineural hearing loss**. - The question presentation is compatible with rubella, but **CMV is epidemiologically more likely** in the current era. *Both CMV and rubella infection* - While both infections can cause this presentation, this is **not an appropriate answer choice** for a single best answer question format. - In clinical practice and exam contexts, when presented with this constellation of findings, **congenital CMV** is the most likely diagnosis given its higher prevalence. - Questions should test the ability to identify the **most likely single diagnosis**, not list multiple possibilities. *Premature infants* - Prematurity alone does not cause the **specific constellation** of petechiae, distinct skin lesions (blueberry muffin spots), hematuria, and severe thrombocytopenia. - While premature infants may have **immature coagulation** and **fragile capillaries**, this presentation is **pathognomonic for congenital infection**, particularly TORCH infections. - The **blueberry muffin rash** specifically indicates **dermal erythropoiesis**, which is a feature of intrauterine infections, not prematurity.

Question 802: 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:

A. Meningococci
B. Streptococci
C. HSV I
D. HSV II (Correct Answer)

Explanation: ***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.

Question 803: 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?

A. Disturbances in the resorption of cerebrospinal fluid
B. Excess production of cerebrospinal fluid
C. Obstruction in the circulation of the cerebrospinal fluid (Correct Answer)
D. Increased size of the head

Explanation: ***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.

Question 804: 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?

A. Haemophilus influenzae type b
B. Listeria monocytogenes
C. Streptococcus agalactiae (Correct Answer)
D. Neisseria meningitidis

Explanation: ***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.

Question 805: To assess thyroid profile of a newborn, which of the following is mandatory?

A. Measure T3 only
B. Measure TSH only
C. Measure both TSH and T4 (Correct Answer)
D. Measure T4 only

Explanation: ***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.

Question 806: 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?

A. Teratoma
B. Vein of Galen malformation (Correct Answer)
C. Encephalocele
D. Arachnoid cyst

Explanation: ***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.

Question 807: Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?

A. Endotracheal tube intubation
B. Chest compression
C. Adrenaline
D. None of the above (Correct Answer)

Explanation: ***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.

Question 808: 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?

A. No active treatment required (Correct Answer)
B. Stop breastfeeding for 2 days
C. Phototherapy
D. Exchange transfusion

Explanation: ***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.

Question 809: Which among the following is NOT part of the classic clinical triad of necrotizing enterocolitis?

A. Bloody stools
B. Metabolic acidosis (Correct Answer)
C. Pneumatosis intestinalis
D. Abdominal distension

Explanation: ***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.

Question 810: In a preterm baby with respiratory distress syndrome, which type of cell is deficient?

A. Type 2 alveolar cell (Correct Answer)
B. Type 1 alveolar cell
C. Alveolar capillary endothelial cell
D. Bronchial mucosal epithelial cell

Explanation: ***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.

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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