Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 831: 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.

Question 832: A premature infant born at 28 weeks presents with respiratory distress syndrome. What is the most likely cause of this condition?

A. Patent ductus arteriosus
B. Meconium aspiration
C. Surfactant deficiency (Correct Answer)
D. Transient tachypnea of the newborn

Explanation: ***Surfactant deficiency*** - **Premature infants**, especially those born before 34 weeks of gestation, have immature lungs that produce insufficient amounts of **surfactant**. - **Surfactant** is crucial for reducing surface tension in the alveoli, preventing their collapse and ensuring proper gas exchange. Its deficiency leads to **respiratory distress syndrome (RDS)**. *Patent ductus arteriosus* - While common in premature infants and can exacerbate respiratory distress, **patent ductus arteriosus** (PDA) is a cardiac issue related to the shunting of blood, not the primary cause of respiratory distress syndrome itself. - PDA typically presents with signs of **heart failure** and **pulmonary overcirculation** rather than primary lung immaturity. *Meconium aspiration* - **Meconium aspiration syndrome** occurs when a fetus inhales meconium (fetal stool) into the lungs, usually in association with **post-term pregnancy** or **fetal distress**. - This infant is premature (28 weeks), making meconium aspiration highly unlikely as a primary cause of RDS. *Transient tachypnea of the newborn* - **Transient tachypnea of the newborn (TTN)** is typically seen in **term or near-term infants** following a **cesarean section** or rapid vaginal delivery, resulting from retained fetal lung fluid. - TTN usually resolves within 24-48 hours and is not characterized by the severe respiratory failure associated with **surfactant deficiency** in premature infants.

Question 833: In neonatal resuscitation, when are chest compressions indicated?

A. HR < 60/min (Correct Answer)
B. HR < 100/min
C. Absent breathing
D. Cyanosis

Explanation: ***HR < 60/min*** - **Chest compressions** are indicated in neonatal resuscitation when the **heart rate (HR)** remains **below 60 beats per minute** despite **adequate ventilation** for 30-60 seconds. - This threshold signifies severe bradycardia that is unresponsive to initial respiratory support and requires direct circulatory assistance. *HR < 100/min* - A heart rate **below 100 beats per minute** but **above 60 beats per minute** in a neonate typically indicates the need for continued **positive pressure ventilation (PPV)**. - Chest compressions are not initiated at this heart rate unless it further deteriorates to less than 60 bpm. *Absent breathing* - **Absent breathing** (apnea) in a neonate is an indication for initiating **positive pressure ventilation (PPV)**. - Chest compressions are only considered if the heart rate remains critically low despite effective ventilation. *Cyanosis* - **Cyanosis** (bluish discoloration of the skin) is a common sign of **hypoxemia** in newborns and usually indicates the need for **oxygen supplementation** and/or **positive pressure ventilation (PPV)**. - While it suggests respiratory distress, it does not directly trigger chest compressions unless associated with severe bradycardia.

Question 834: A preterm infant with a history of respiratory distress syndrome presents with a continuous murmur and bounding pulses. An echocardiogram reveals a patent ductus arteriosus (PDA). What is the first-line medical treatment for closing a PDA in preterm infants?

A. Propranolol
B. Indomethacin (Correct Answer)
C. Digoxin
D. Alprostadil

Explanation: ***Correct: Indomethacin*** - Indomethacin is a **prostaglandin synthesis inhibitor** (COX inhibitor) that leads to the constriction of the **ductus arteriosus** in preterm infants. - It is considered **first-line medical therapy** for hemodynamically significant patent ductus arteriosus (PDA) in preterm infants due to its efficacy in promoting ductal closure. - Mechanism: Blocks prostaglandin E2 production, which normally keeps the ductus arteriosus patent in fetal life. *Incorrect: Propranolol* - **Propranolol** is a **beta-blocker** primarily used to treat conditions like hypertension, angina, and certain arrhythmias. - It is **not indicated** for the closure of a PDA and would not be effective in this scenario. *Incorrect: Digoxin* - **Digoxin** is a cardiac glycoside used to improve **cardiac contractility** and control ventricular rate in certain heart conditions. - It does **not promote PDA closure** and is typically used for heart failure or supraventricular tachyarrhythmias. *Incorrect: Alprostadil* - **Alprostadil** is a **prostaglandin E1 analog** that **maintains patency** of the ductus arteriosus. - It is specifically used in infants with **ductal-dependent congenital heart defects** (e.g., critical coarctation, transposition of great arteries, pulmonary atresia) to ensure blood flow, which is the **opposite effect** desired for PDA closure.

Question 835: A neonate born to a mother with a history of opioid use during pregnancy presents with irritability, tremors, high-pitched cry, and poor feeding. What is the most appropriate initial management?

A. Immediate thyroid hormone replacement therapy
B. Empiric broad-spectrum antibiotics
C. Botulinum immunoglobulin (BIG-IV) administration
D. Supportive care with observation (swaddling, frequent feeding, minimal stimulation) (Correct Answer)

Explanation: ***Neonatal abstinence syndrome, start supportive care and observe*** - The combination of **irritability**, **tremors**, **high-pitched cry**, **poor feeding**, and maternal **opioid use during pregnancy** is highly suggestive of **neonatal abstinence syndrome (NAS)**. - Initial management for NAS involves **supportive care** including swaddling, frequent small feedings, minimal stimulation, and careful observation using standardized scoring (Finnegan score); pharmacotherapy (morphine or methadone) is reserved for severe cases that fail non-pharmacological measures. *Congenital hypothyroidism, begin thyroid hormone replacement* - While **hypotonia** and poor feeding can be symptoms of **congenital hypothyroidism**, the acute presentation of **irritability, tremors, and high-pitched cry** combined with maternal **opioid use** points strongly to NAS rather than hypothyroidism. - **Thyroid hormone replacement** is the correct treatment for congenital hypothyroidism, but newborn screening results typically take days, and this acute presentation requires immediate recognition of withdrawal. *Neonatal sepsis, initiate broad-spectrum antibiotics* - **Neonatal sepsis** can cause poor feeding and irritability, but the constellation of **tremors, high-pitched cry**, and **maternal opioid use history** makes NAS the primary diagnosis. - While sepsis must always be considered in ill-appearing neonates, **antibiotics** are for bacterial infection, not drug withdrawal; NAS symptoms typically emerge 24-72 hours after birth, not immediately. *Botulism, administer botulinum antitoxin* - **Infant botulism** presents with **descending flaccid paralysis, hypotonia**, and poor feeding due to neurotoxin-induced muscle paralysis, typically from **ingestion of *Clostridium botulinum* spores** (e.g., honey exposure after 6 months). - This neonate shows **increased irritability and tremors** (hyperexcitability), not the flaccid paralysis of botulism; **botulinum immunoglobulin** (BIG-IV) is not indicated for NAS.

Question 836: A preterm infant in the NICU is receiving Kangaroo Mother Care (KMC). Despite this, the infant is not gaining weight adequately. Analyze the situation and determine the most appropriate next step.

A. Increase the frequency of KMC sessions
B. Add supplemental tube feeding (Correct Answer)
C. Switch to conventional incubator care
D. Perform a complete nutritional assessment

Explanation: ***Add supplemental tube feeding*** - While KMC provides numerous benefits, **inadequate weight gain** indicates insufficient caloric intake. Therefore, **supplemental tube feeding** is the most direct way to ensure the infant receives adequate nutrition for growth. - This approach directly addresses the metabolic needs of a preterm infant who may not be able to consume enough through breastfeeding alone, even with the support of KMC. *Perform a complete nutritional assessment* - While a complete nutritional assessment is a good general practice, it is not the most immediate and appropriate next step when a preterm infant is demonstrating **inadequate weight gain** despite KMC. - The assessment may provide a deeper understanding, but the pressing issue is the lack of weight gain, which needs a more direct intervention like supplemental feeding. *Increase the frequency of KMC sessions* - Increasing the frequency of KMC sessions primarily enhances bonding, thermal regulation, and maternal milk production readiness, but it does **not directly address the caloric deficit** leading to inadequate weight gain. - Although KMC indirectly supports breastfeeding, if weight gain is already insufficient, more KMC alone without increased nutrition intake is unlikely to resolve the problem. *Switch to conventional incubator care* - Switching to conventional incubator care would remove the infant from the benefits of KMC, such as improved thermoregulation, reduced infections, and enhanced parent-infant bonding, with **no direct benefit for weight gain**. - This action would potentially exacerbate issues KMC helps to mitigate, and it does not provide any additional nutritional support.

Question 837: A term newborn at 48 hours of age with jaundice has a bilirubin level of 20 mg/dL. Which treatment would be required immediately?

A. Phototherapy (Correct Answer)
B. Ursodeoxycholic acid
C. Intravenous immunoglobulin
D. Exchange transfusion

Explanation: ***Phototherapy*** - A bilirubin level of **20 mg/dL** in a 48-hour-old term newborn is **critically high** and requires **immediate intensive phototherapy** to prevent neurotoxicity. - According to **AAP guidelines**, this level is at the phototherapy threshold and approaching exchange transfusion levels (20-22 mg/dL at 48 hours). - **Intensive phototherapy** is the **first-line immediate treatment** that should be initiated without delay, as it converts unconjugated bilirubin into water-soluble isomers for excretion. - While this level is concerning, **intensive phototherapy is started first**, with close monitoring and preparation for exchange transfusion if bilirubin continues to rise or phototherapy fails. *Ursodeoxycholic acid* - This medication is used for **cholestatic liver diseases** to increase bile flow and protect hepatocytes. - It has **no role in treating unconjugated hyperbilirubinemia** and does not lower bilirubin levels rapidly enough for acute neonatal jaundice. *Intravenous immunoglobulin* - **IVIG** is used specifically for **isoimmune hemolytic disease** (Rh or ABO incompatibility) to reduce antibody-mediated hemolysis. - While it may be considered if hemolysis is documented, it is **not the primary immediate treatment** for hyperbilirubinemia itself; phototherapy directly addresses the elevated bilirubin. - IVIG is an adjunct therapy, not first-line management. *Exchange transfusion* - **Exchange transfusion** is reserved for **very high bilirubin levels** (typically >25 mg/dL in term infants at this age) unresponsive to intensive phototherapy, or when there are signs of **acute bilirubin encephalopathy**. - At 20 mg/dL, while this is critically high and near the threshold, the **immediate first step is intensive phototherapy**, not exchange transfusion. - Exchange transfusion would be prepared for and performed if phototherapy fails to reduce levels adequately within 4-6 hours or if bilirubin continues to rise.

Question 838: A preterm infant (32 weeks gestation) is stable in the NICU and receiving Kangaroo Mother Care (KMC). Despite good thermal stability and bonding, the infant is not gaining adequate weight. What is the most likely reason?

A. Inadequate supplemental feeding (Correct Answer)
B. KMC contraindicated at this gestational age
C. Need for incubator instead of KMC
D. Insufficient duration of KMC sessions

Explanation: ***Inadequate supplemental feeding*** - While KMC provides excellent thermal regulation, bonding, and physiological stability, **preterm infants have high nutritional demands** due to rapid growth and physiological immaturity. - Poor weight gain despite successful KMC most commonly indicates **insufficient caloric intake**, requiring assessment and optimization of feeding regimen (breast milk fortification, increased feeding frequency, or supplemental feeding). - KMC actually **enhances feeding outcomes** by promoting breastfeeding and better metabolic stability, but adequate nutrition must still be ensured through appropriate feeding support. *Insufficient duration of KMC sessions* - While longer KMC duration is beneficial for bonding and physiological stability, **inadequate weight gain** is primarily a nutritional issue, not a KMC duration issue. - Evidence shows even intermittent KMC provides significant benefits; duration alone would not explain poor weight gain if feeding is adequate. *Need for incubator instead of KMC* - **KMC is superior to incubator care** for stable preterm infants in terms of mortality, infection rates, breastfeeding success, and neurodevelopmental outcomes. - Since the infant is described as stable with good thermal regulation, switching to an incubator would not address the weight gain issue and would lose KMC benefits. *KMC contraindicated at this gestational age* - KMC is **recommended for stable preterm infants** regardless of gestational age, including those born at 32 weeks. - The infant's stability indicates KMC is appropriate; gestational age is not the issue here.

Question 839: What is the most appropriate method to measure fever in a newborn?

A. Oral thermometer
B. Axillary thermometer
C. Rectal thermometer (Correct Answer)
D. Ear thermometer

Explanation: ***Rectal thermometer*** - Rectal temperature measurement is considered the **gold standard** for accuracy in newborns and infants due to its proximity to the body's core temperature. - It provides the most reliable indicator of **true body temperature**, which is crucial for identifying fever in this vulnerable population. *Oral thermometer* - Oral temperature measurement is **not feasible** in newborns and infants due to their inability to hold the thermometer under their tongue and keep their mouths closed. - This method is also less accurate in young children who may be breathing through their mouths or consuming liquids, affecting readings. *Axillary thermometer* - Axillary temperature measurement is a **convenient and non-invasive** method, but it is generally less accurate and reliable than rectal temperatures in newborns. - Readings can be influenced by environmental factors and the placement of the thermometer, potentially leading to **underestimation of fever**. *Ear thermometer* - Ear (tympanic) thermometers can be **less accurate in newborns** due to their small ear canals and the technique required for proper placement. - The accuracy can also be affected by **earwax** or improper positioning, making it less reliable for critical fever assessment in infants.

Question 840: A newborn presents with cyanosis that worsens with feeding and improves with crying. What is the most likely diagnosis?

A. Choanal Atresia (Correct Answer)
B. Tetralogy of Fallot
C. Transposition of Great Arteries
D. Patent Ductus Arteriosus

Explanation: ***Choanal Atresia*** - **Cyanosis** that worsens with feeding and improves with crying is a **classic presentation** of choanal atresia, as the infant cannot breathe through the nose while suckling. - The condition is caused by the **failure of the posterior nasal passages to canalize** during fetal development. *Tetralogy of Fallot* - Characterized by **cyanotic spells** (tet spells) which are sudden, profound cyanosis and hyperpnea, often triggered by crying or feeding, but the cyanosis would not typically improve with crying. - Involves **four defects**: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. *Transposition of Great Arteries* - Presents with **severe cyanosis at birth** that does not significantly improve with crying, as there is a fundamental separation of pulmonary and systemic circulations. - Survival depends on mixing of oxygenated and deoxygenated blood through a **patent ductus arteriosus (PDA)** or **patent foramen ovale (PFO)**. *Patent Ductus Arteriosus* - Typically presents with a **continuous "machinery-like" murmur** and signs of **heart failure**, not primarily with cyanosis that fluctuates with feeding. - This condition involves a persistent connection between the **aorta and pulmonary artery** after birth, leading to left-to-right shunting.

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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