Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 821: According to neonatal resuscitation protocol, how much oxygen to give in a term neonate with apnea and bradycardia initially?

A. 100%
B. 21% (Correct Answer)
C. 50%
D. 30%

Explanation: ***21%*** - According to **NRP (Neonatal Resuscitation Program) 2020 guidelines**, for **term neonates (≥35 weeks gestation)** requiring resuscitation, the initial recommendation is to use **room air (21% oxygen)** to minimize the risk of hyperoxia and oxidative injury. - Multiple randomized controlled trials have demonstrated that room air is as effective as 100% oxygen for initial resuscitation. - Supplemental oxygen is only added if **oxygen saturation targets** are not met despite adequate ventilation, and should be titrated using **pulse oximetry**. *30%* - This concentration is **higher than room air** and is not the initial recommendation for term neonates needing resuscitation. - Starting with a higher oxygen concentration can lead to **oxidative stress** without immediate benefit. - Higher initial concentrations (21-30%) are reserved for **preterm neonates (<35 weeks)**. *100%* - Administering **100% oxygen** can be harmful to a neonate, potentially causing **oxidative injury** to developing organs, including the lungs, brain, and retina. - This was the old practice but has been **discontinued** based on evidence showing increased mortality and morbidity. - High concentrations are no longer recommended even in severe cases; oxygen should be titrated to saturation targets. *50%* - While lower than 100%, 50% oxygen is still **not the initial recommended concentration** for term neonates in resuscitation protocols. - The goal is to start with **21% oxygen** and gradually increase based on **pulse oximetry monitoring** and target saturation ranges if 21% is insufficient.

Question 822: Which of the following is the most common cause of early-onset neonatal sepsis?

A. Listeria monocytogenes
B. Group B Streptococcus (Correct Answer)
C. Klebsiella pneumoniae
D. Escherichia coli

Explanation: ***Group B Streptococcus*** - **Group B Streptococcus (GBS)**, or *Streptococcus agalactiae*, is the **most common bacterial cause of early-onset neonatal sepsis** (within the first 7 days of life) in many populations. - Transmission typically occurs vertically from the mother's vaginal flora during birth. - **Intrapartum antibiotic prophylaxis** in GBS-positive mothers has significantly reduced incidence in developed countries. *Escherichia coli* - **E. coli** is the **second most common cause of early-onset sepsis** and the **leading cause in preterm and very low birth weight infants**. - Can be transmitted from the maternal genital tract during delivery. - Associated with higher mortality rates than GBS, particularly in preterm neonates. *Listeria monocytogenes* - While *Listeria monocytogenes* can cause **neonatal sepsis and meningitis**, it is far less common than GBS or E. coli. - Associated with maternofetal transmission from **foodborne infection** in the mother. - Can cause early or late-onset disease. *Klebsiella pneumoniae* - *Klebsiella pneumoniae* is more commonly associated with **late-onset neonatal sepsis**, particularly in **premature or critically ill neonates** in NICU settings. - Often associated with **hospital-acquired infections** and invasive procedures. - In some regions, particularly in developing countries, it can also cause early-onset disease.

Question 823: Within how many hours should breastfeeding be initiated in a perfectly healthy child with no anatomical problems?

A. C. 24 hrs
B. B. 4 hrs
C. D. 48 hrs
D. A. 1 hour (Correct Answer)

Explanation: ***A. 1 hour*** - The World Health Organization (WHO) and UNICEF recommend initiating **breastfeeding within the first hour of birth** for healthy newborns. - Early initiation helps establish **successful breastfeeding**, promotes **maternal-infant bonding**, and facilitates the transfer of **colostrum**, which is rich in antibodies. *B. 4 hrs* - While better than much later initiation, waiting **4 hours** still misses the critical window of the first hour when the infant is often most alert and ready to feed. - This delay can reduce the likelihood of optimal breastfeeding outcomes. *C. 24 hrs* - Delaying breastfeeding for **24 hours** after birth can negatively impact the establishment of breastfeeding and deprive the newborn of early colostrum benefits. - This timeframe is significantly longer than the recommended period for initial feeding in a healthy infant. *D. 48 hrs* - Initiating breastfeeding after **48 hours** is considered a significant delay and is generally associated with difficulties in establishing breastfeeding and reduced breastfeeding duration. - By this point, the infant may be less receptive, and the mother's milk supply may not be as effectively stimulated.

Question 824: Which of the following is a common cause of late-onset jaundice in newborns?

A. Breast milk jaundice (Correct Answer)
B. Hemolytic disease of the newborn
C. Gilbert syndrome
D. Physiologic jaundice

Explanation: ***Breast milk jaundice*** - This condition typically presents with **unconjugated hyperbilirubinemia** after the first 5-7 days of life, peaking at 2-3 weeks and potentially lasting for several weeks to months. - It is thought to be related to substances in breast milk (such as beta-glucuronidase and pregnane-3α,20β-diol) that **enhance enterohepatic circulation of bilirubin** and may inhibit hepatic conjugation of bilirubin. - This is a **late-onset jaundice** and a diagnosis of exclusion after ruling out pathological causes. *Hemolytic disease of the newborn* - This is an **early-onset jaundice**, usually appearing within the first 24 hours of life due to rapid breakdown of red blood cells. - It is typically caused by **ABO or Rh incompatibility** between mother and fetus, leading to significant and often severe hyperbilirubinemia. - Not a cause of late-onset jaundice. *Gilbert syndrome* - While it causes **unconjugated hyperbilirubinemia**, it is an inherited disorder that usually presents later in life, often in adolescence or adulthood, particularly during periods of stress or fasting. - It results from a mild deficiency in UDP-glucuronyltransferase (UGT1A1) activity, not typically a cause of jaundice in the newborn period. *Physiologic jaundice* - This is a very common and normal type of jaundice that appears after 24 hours of life, peaks on days 3-5, and typically resolves within 7-10 days in full-term infants. - It is due to the newborn's immature liver and increased red blood cell turnover, but it is **not late-onset** as it appears and resolves within the first week.

Question 825: A neonate develops a respiratory infection shortly after birth, and the nasopharyngeal swab is positive for Respiratory Syncytial Virus (RSV) antigen. Which treatment is the most appropriate?

A. Supportive care (Correct Answer)
B. Oseltamivir
C. Amantadine
D. Acyclovir

Explanation: ***Supportive care*** - For most infants and neonates with RSV infection, **supportive care** is the mainstay of treatment, including **oxygen therapy**, nasal suctioning, and hydration. - **Ribavirin** (the only antiviral with activity against RSV) is rarely used due to limited efficacy, high cost, and potential toxicity; it may be considered only in **severe cases in immunocompromised patients**. - **Palivizumab** is a monoclonal antibody used for **prophylaxis** in high-risk infants, not for treatment of active infection. *Oseltamivir* - **Oseltamivir** is an antiviral drug primarily used for the treatment and prophylaxis of **influenza A and B viruses**. - It is **not effective** against **Respiratory Syncytial Virus (RSV)**. *Amantadine* - **Amantadine** is an antiviral medicine specifically used to treat and prevent **influenza A virus infections**. - It has **no antiviral activity** against **RSV** or other respiratory viruses. *Acyclovir* - **Acyclovir** is an antiviral drug indicated for the treatment of infections caused by **herpes simplex virus (HSV)** and **varicella-zoster virus (VZV)**. - It has **no role** in the management of **RSV infection**.

Question 826: What is the appropriate management protocol for a neonate who has meconium aspiration and does not initiate breathing after initial resuscitation steps including drying, stimulation, and repositioning?

A. Continue resuscitation with bag and mask ventilation (Correct Answer)
B. Immediate endotracheal intubation and suctioning
C. Administer surfactant therapy
D. Start chest compressions immediately

Explanation: ***Continue resuscitation with bag and mask ventilation*** - For a neonate with **meconium aspiration** who does not initiate breathing after initial attempts, the priority is to establish effective **ventilation** using a bag and mask. - This ensures adequate **oxygenation and ventilation** until the neonate can breathe independently or further interventions are necessary. *Immediate endotracheal intubation and suctioning* - **Routine intubation and tracheal suctioning** for non-vigorous neonates with meconium-stained amniotic fluid are **no longer recommended** by current guidelines. - Initial steps should focus on providing **positive pressure ventilation (PPV)** for infants who are not breathing or are gasping. *Administer surfactant therapy* - **Surfactant therapy** is used to treat **respiratory distress syndrome** or severe meconium aspiration syndrome once ventilation is established. - It is not an initial step for a neonate who has **not initiated breathing** and requires immediate resuscitation. *Start chest compressions immediately* - **Chest compressions** are indicated only if the **heart rate remains below 60 BPM**, despite adequate ventilation with 100% oxygen for **at least 30 seconds**. - Initiating compressions before confirming adequate ventilation and heart rate assessment is **premature and inappropriate**.

Question 827: An infant born at 35 weeks of gestation develops grunting, nasal flaring, and cyanosis shortly after birth. What is the most likely diagnosis?

A. Neonatal pneumonia
B. Transient tachypnea of the newborn
C. Respiratory distress syndrome (Correct Answer)
D. Congenital heart disease

Explanation: ***Respiratory distress syndrome*** - This condition is characterized by **respiratory distress** (grunting, nasal flaring, cyanosis) shortly after birth in a **premature infant** (35 weeks gestation) due to pulmonary **surfactant deficiency**. - **Surfactant deficiency** leads to alveolar collapse, decreased lung compliance, and impaired gas exchange. *Neonatal pneumonia* - While pneumonia can cause similar respiratory symptoms, it is less likely to appear **immediately after birth** in a premature infant without other signs of infection (e.g., fever, sepsis). - Diagnosis typically requires evidence of infection, such as abnormal chest X-ray findings with **infiltrates** and **leukocytosis**. *Transient tachypnea of the newborn* - This condition usually presents with **tachypnea** and mild respiratory distress, but it is typically **self-limiting** and resolves within 24-48 hours. - It is more common in **term or late preterm infants** delivered by C-section and is due to delayed clearance of fetal lung fluid, not surfactant deficiency. *Congenital heart disease* - While congenital heart disease can cause cyanosis and respiratory distress, the onset is often not **immediately after birth** and would typically be accompanied by other signs like heart murmurs or abnormal peripheral pulses. - The primary respiratory findings (grunting, nasal flaring) are more indicative of a **pulmonary issue** rather than a cardiac one, though severe cardiac issues can present this way.

Question 828: A newborn exhibits poor feeding, a weak cry, and generalized muscle weakness from birth. There is no significant maternal medical history. What is the most likely diagnosis?

A. Infant botulism from spore ingestion
B. Genetic condition leading to muscle weakness (Correct Answer)
C. Autoimmune neuromuscular disorder
D. Perinatal asphyxia with hypoxic-ischemic encephalopathy

Explanation: ***Genetic condition leading to muscle weakness*** - The presentation of poor feeding, weak cry, and generalized muscle weakness **from birth** in a newborn, especially with no significant maternal medical history, is highly suggestive of a **congenital neuromuscular disorder** of genetic origin. - Examples include **spinal muscular atrophy (SMA)**, **congenital myopathies**, and **congenital muscular dystrophies**, all of which manifest early in life due to genetic defects affecting muscle or nerve function. - SMA type 1 (Werdnig-Hoffmann disease) is the most common severe genetic cause, presenting with **severe hypotonia ("floppy baby"), weak cry, and feeding difficulties** from birth or early infancy. *Infant botulism from spore ingestion* - While infant botulism presents with **descending weakness, weak cry, and poor feeding**, it typically develops between **2-6 months of age** after ingestion of **Clostridium botulinum spores** (classically from honey, but also soil/dust). - It would **not be present from birth** as it requires postnatal exposure and has an incubation period. - Classic features include **constipation preceding weakness** and **dilated, sluggish pupils**. *Autoimmune neuromuscular disorder* - **Neonatal myasthenia gravis** involves maternal antibodies (anti-AChR) crossing the placenta from a mother with myasthenia gravis. - While it causes similar symptoms (**hypotonia, weak cry, feeding difficulties**), it is **transient** (resolves in 2-4 weeks) and requires a **mother with myasthenia gravis**, which is explicitly absent in this case. *Perinatal asphyxia with hypoxic-ischemic encephalopathy* - HIE can present with hypotonia in the acute phase, but typically has a **clear history of perinatal distress** (fetal heart rate abnormalities, meconium, low Apgar scores, need for resuscitation). - The scenario describes symptoms **from birth** without mention of birth complications, and HIE would have additional features like **seizures, altered consciousness, and multi-organ involvement**. - Chronic hypotonia from severe HIE would be associated with **cerebral palsy** and developmental delay over time.

Question 829: A 6-week-old infant presents with projectile, non-bilious vomiting after feeds and poor weight gain. On examination, the infant appears eager to feed and has visible gastric peristalsis. What is the most likely diagnosis?

A. Intussusception
B. Hirschsprung disease
C. Pyloric stenosis (Correct Answer)
D. Necrotizing enterocolitis

Explanation: ***Pyloric stenosis*** - This condition is characterized by **projectile, non-bilious vomiting** in young infants, classically presenting between **2-8 weeks of age**. - **Visible gastric peristalsis** (peristaltic waves moving from left to right across the upper abdomen) is a pathognomonic sign. - The infant appears **eager to feed** after vomiting, distinguishing it from other causes where the infant is typically lethargic and refuses feeds. - An **olive-shaped mass** may be palpable in the right upper quadrant (hypertrophied pylorus). *Intussusception* - While it can manifest with vomiting and poor feeding, **intussusception** typically presents with sudden onset of **severe, crampy abdominal pain** (drawing legs up, inconsolable crying) and **currant jelly stools**. - The peak incidence is between **6-36 months**, making it less likely in a 6-week-old infant. - Vomiting may be bilious, and lethargy occurs later as a sign of shock. *Hirschsprung disease* - This condition primarily presents with **delayed passage of meconium** (beyond 48 hours) in neonates and chronic **constipation** with **abdominal distension**. - Vomiting, when present, is typically **bilious** due to intestinal obstruction. - Not associated with projectile, non-bilious vomiting or visible peristalsis. *Necrotizing enterocolitis* - **Necrotizing enterocolitis (NEC)** is predominantly a disease of **premature infants**, especially those with very low birth weight. - Key features include **bilious vomiting**, **bloody stools**, **abdominal distension**, and signs of **sepsis** (temperature instability, apnea, lethargy). - Very rare in healthy, full-term infants at this age.

Question 830: A neonate develops severe jaundice and hepatosplenomegaly shortly after birth. Laboratory tests reveal elevated IgM antibodies against Toxoplasma gondii. What is the most likely route of transmission?

A. Ingestion of contaminated water
B. Vertical transmission from mother (Correct Answer)
C. Inhalation of oocysts
D. Vector-borne transmission

Explanation: ***Vertical transmission from mother*** - The presence of **IgM antibodies** in a neonate indicates a **recent or active infection**, which is characteristic of congenital infections. - **Toxoplasma gondii** can be transmitted **transplacentally** from an infected mother to her fetus, leading to symptoms like jaundice and hepatosplenomegaly at birth. *Ingestion of contaminated water* - This route of transmission is typical for acquiring Toxoplasma gondii in older children or adults, usually through oocysts in contaminated water or food. - It would not explain the congenital presentation with immediate symptoms and specific IgM antibodies in a neonate shortly after birth. *Inhalation of oocysts* - While Toxoplasma gondii oocysts can be airborne, inhalation is a rare route of infection compared to ingestion, and certainly not the primary mode of congenital transmission. - This route would be more likely to cause symptoms in an individual with a compromised immune system in an environment with high oocyst load, not a neonate. *Vector-borne transmission* - Toxoplasma gondii is not transmitted by vectors (such as mosquitoes or ticks), but rather through ingestion of contaminated food/water or vertical transmission. - This route is incorrect for Toxoplasma and would not explain the congenital symptoms observed.

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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