Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 841: 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.

Question 842: What is the most common cause of respiratory distress in preterm infants?

A. Congenital diaphragmatic hernia
B. Transient tachypnea of the newborn
C. Meconium aspiration syndrome
D. Respiratory distress syndrome (Correct Answer)

Explanation: ***Respiratory distress syndrome*** - This is the most common cause of respiratory distress in **preterm infants** due to **surfactant deficiency**, leading to atelectasis. - The risk is inversely proportional to gestational age, meaning the more premature the infant, the higher the risk. *Congenital diaphragmatic hernia* - This is a rare, severe condition where abdominal organs protrude into the chest cavity, compressing the lungs. - While it causes significant respiratory distress, it is a structural anomaly and not the most common cause overall in preterm infants. *Transient tachypnea of the newborn* - This condition is caused by delayed clearance of **fetal lung fluid** and is more common in **term or late preterm infants** delivered by C-section. - It typically resolves within 24-48 hours and is generally less severe than RDS. *Meconium aspiration syndrome* - This occurs when a fetus inhales meconium (fetal stool) mixed with amniotic fluid, typically in **post-term or stressed term infants**. - It is uncommon in preterm infants because they rarely pass meconium in utero due to immature gastrointestinal motility.

Question 843: Kangaroo Mother Care is primarily used for what purpose?

A. Breastfeeding
B. Thermal regulation (Correct Answer)
C. Weight monitoring
D. Vaccination

Explanation: ***Thermal regulation*** - **Kangaroo Mother Care (KMC)** primarily focuses on providing **skin-to-skin contact** between the mother (or another caregiver) and the baby. - This contact helps to **maintain the infant's body temperature**, especially crucial for **premature** and **low birth weight** babies, preventing **hypothermia**. *Breastfeeding* - While KMC can facilitate and promote **successful breastfeeding** due to the close contact, it is not its primary and sole purpose. - The direct skin-to-skin contact makes it easier for the baby to root and latch, but the core benefit extends beyond feeding. *Weight monitoring* - **Weight monitoring** is an important aspect of care for newborns, particularly those with low birth weight, but it is not the main function of KMC itself. - Although babies often gain weight effectively with KMC, weight monitoring is a separate healthcare intervention. *Vaccination* - **Vaccination** is a preventative health measure administered to protect infants from infectious diseases and is completely unrelated to KMC. - KMC provides fundamental care and support, whereas vaccination is a medical procedure.

Question 844: A preterm neonate in the NICU develops respiratory distress syndrome. What is the most likely cause of this condition?

A. Meconium aspiration
B. Congenital diaphragmatic hernia
C. Surfactant deficiency (Correct Answer)
D. Pulmonary hypoplasia

Explanation: ***Surfactant deficiency*** - **Respiratory distress syndrome (RDS)** in preterm neonates is primarily caused by **insufficient production of surfactant**. - **Surfactant** reduces alveolar surface tension, preventing atelectasis and ensuring adequate gas exchange. *Meconium aspiration* - This typically occurs in **term or post-term neonates** who experience fetal distress, leading to aspiration of meconium-stained amniotic fluid. - While it causes respiratory distress, it is uncommon in **preterm infants** as meconium passage is rare before term. *Congenital diaphragmatic hernia* - This is a **structural defect** where abdominal contents herniate into the chest, impairing lung development. - It would be evident on **prenatal imaging** or immediately after birth with severe respiratory distress and scaphoid abdomen. *Pulmonary hypoplasia* - This refers to **incomplete development of the lungs**, often associated with conditions like **oligohydramnios** or congenital diaphragmatic hernia. - While it causes respiratory distress, surfactant deficiency is a more direct and common cause of general RDS in preterm infants.

Question 845: A newborn presents with a bulging mass in the lumbar region. Which congenital condition is most likely?

A. Spina bifida (Correct Answer)
B. Hydrocephalus
C. Encephalocele
D. Sacrococcygeal teratoma

Explanation: ***Spina bifida*** - A **bulging mass in the lumbar region** of a newborn is a classic presentation of **spina bifida**, specifically a **myelomeningocele**, where the spinal cord and meninges protrude through an opening in the vertebrae. - This congenital condition results from incomplete closure of the **neural tube** during fetal development. - Most commonly occurs in the **lumbosacral region** and is covered by a thin membrane. *Hydrocephalus* - While hydrocephalus can occur concurrently with spina bifida (in up to 80% of cases), it is characterized by **excess cerebrospinal fluid** in the brain, leading to an enlarged head, not a bulging mass in the lumbar region. - It would typically present with signs of **increased intracranial pressure**, such as a bulging fontanelle or rapid head growth. *Sacrococcygeal teratoma* - A **congenital tumor** arising from pluripotent cells at the coccyx, presenting as a mass in the sacrococcygeal region. - Unlike myelomeningocele, it is typically a **solid or cystic mass** that arises from the coccyx rather than a defect in the vertebral column with neural tissue protrusion. - It is the most common tumor in neonates but less common than neural tube defects. *Encephalocele* - An encephalocele involves the **protrusion of brain tissue and meninges through a defect in the skull**, typically in the occipital or frontal regions, not the lumbar spine. - It presents as a sac-like protrusion on the head and is another form of neural tube defect affecting the cranial region.

Question 846: A newborn with persistent jaundice and clay-colored stools who is found to have conjugated hyperbilirubinemia is most likely diagnosed with what condition?

A. Physiological Jaundice
B. Breast Milk Jaundice
C. Biliary Atresia (Correct Answer)
D. Hemolytic Disease of the Newborn

Explanation: ***Biliary Atresia*** - **Conjugated hyperbilirubinemia** in a newborn with **persistent jaundice** and **clay-colored stools** is the classic presentation of biliary atresia. - The absence of bile flow into the intestine due to blocked bile ducts causes the stools to lose their normal color and bilirubin to accumulate in the blood. *Physiological Jaundice* - This is a **common, transient** condition in newborns, characterized by **unconjugated hyperbilirubinemia**. - It resolves spontaneously and typically presents with **normal stool color** as bile flow is unimpaired. *Breast Milk Jaundice* - This condition is also characterized by **unconjugated hyperbilirubinemia** and is generally benign. - While it can persist, it does not typically cause **clay-colored stools** or significant conjugated hyperbilirubinemia. *Hemolytic Disease of the Newborn* - This condition typically presents with **unconjugated hyperbilirubinemia** due to increased red blood cell breakdown. - Stool color would generally be normal, and there would be no direct obstruction of bile flow.

Question 847: A newborn is noted to have micrognathia, glossoptosis, and a cleft soft palate. Which syndrome is this presentation most consistent with?

A. Pierre Robin sequence (Correct Answer)
B. Down syndrome
C. Turner syndrome
D. Marfan syndrome

Explanation: ***Pierre Robin sequence*** - This is a classic **sequence** (not a syndrome) characterized by the triad of **micrognathia**, **glossoptosis** (posterior displacement of the tongue), and a **cleft soft palate**. - The small jaw (micrognathia) causes the tongue to fall back, which in turn prevents the palate from closing, leading to a cleft. - This represents a cascade of developmental events stemming from the primary anomaly of mandibular hypoplasia. *Down syndrome* - Characterized by **trisomy 21**, presenting with distinct facial features such as a flattened nasal bridge, upward-slanting eyes, and a single palmar crease. - While a **cleft palate** can occur, the combination with **micrognathia** and **glossoptosis** is not typically the primary diagnostic triad for Down syndrome. *Turner syndrome* - This is a chromosomal disorder (45, X) affecting females, characterized by features like **short stature**, **webbed neck**, and **ovarian dysgenesis**. - It does not primarily involve the oral-facial triad of micrognathia, glossoptosis, and cleft palate. *Marfan syndrome* - An inherited disorder of connective tissue, primarily affecting the skeletal, ocular, and cardiovascular systems. - Key features include **tall stature**, **long limbs and fingers (arachnodactyly)**, **pectus excavatum**, and **aortic root dilation**. It does not typically present with the specific oral malformations described.

Question 848: A newborn presents with microcephaly, jaundice, and hepatosplenomegaly. The mother experienced a flu-like illness during pregnancy. What is the most likely diagnosis?

A. Congenital cytomegalovirus infection (Correct Answer)
B. Congenital rubella syndrome
C. Congenital syphilis
D. Neonatal sepsis

Explanation: ***Congenital cytomegalovirus infection*** - **Microcephaly**, **jaundice**, and **hepatosplenomegaly** are classic signs of congenital CMV infection due to widespread organ damage. - The mother's flu-like illness during pregnancy is a common symptom of **primary CMV infection**, which is often asymptomatic or mild in adults. *Congenital rubella syndrome* - While it can cause **microcephaly** and **hepatosplenomegaly**, **jaundice** is less prominent, and the classic triad often includes **cataracts**, **cardiac defects** (e.g., patent ductus arteriosus), and **sensorineural hearing loss**. - The maternal illness would typically be characterized by a **rash** rather than just flu-like symptoms. *Congenital syphilis* - Can cause **hepatosplenomegaly** and **jaundice**, but **microcephaly** is not a typical feature. - Characteristic findings usually include **snuffles**, **bone abnormalities** (e.g., periostitis), and a **maculopapular rash**, which are not mentioned. *Neonatal sepsis* - Can present with **jaundice** and **hepatosplenomegaly**, and in severe cases, neurological involvement leading to symptoms like poor feeding or lethargy, but **microcephaly** is not a direct consequence. - It usually presents acutely in the postnatal period and is not directly linked to a maternal flu-like illness in pregnancy in the same way congenital infections are.

Question 849: Colour of stools in breastfed newborn is -

A. Red
B. Green
C. Black
D. Golden (Correct Answer)

Explanation: ***Golden*** - The typical color of stool in healthy, breastfed newborns is **golden-yellow** to **mustard-yellow**. - This color is due to the presence of **bilirubin**, a byproduct of red blood cell breakdown, which is normal in breastfed infants. *Green* - While occasional green stools can be normal, particularly with **iron supplementation** or a **foremilk-hindmilk imbalance**, consistently bright green stools without other causes might indicate rapid transit. - Darker green stools can also be seen in newborns passing **meconium** initially, but this typically transitions to yellow within the first few days. *Red* - **Red stools** in a newborn are a concerning sign, often indicating the presence of **blood** in the stool. - This could be due to anal fissures, infections, allergies, or other gastrointestinal pathologies, requiring medical evaluation. *Black* - **Black, tarry stools** in a newborn usually indicate the passage of **meconium**, which is normal in the first few days of life. - However, persistent black stools after the meconium phase can signify **upper gastrointestinal bleeding** (melena) and warrant immediate medical attention.

Question 850: All are true about sacrococcygeal teratoma except which of the following?

A. If associated with hydrops, should be resected antenatally
B. Most common tumor of fetus
C. In most cases, it is visible externally.
D. Not associated with increased serum markers (Correct Answer)

Explanation: **Not associated with increased serum markers** - Sacrococcygeal teratomas (SCTs) are **germ cell tumors** that ARE associated with elevated levels of **alpha-fetoprotein (AFP)** and sometimes **beta-human chorionic gonadotropin (β-hCG)** in both maternal serum and fetal blood, making this statement **false**. - The measurement of these tumor markers is crucial for diagnosis, monitoring, and predicting prognosis in cases of SCT. - This is the EXCEPT answer because SCTs are definitively associated with increased AFP levels. *In most cases, it is visible externally.* - The majority of sacrococcygeal teratomas are **external with a minor presacral component (Type I - 47%)** or predominantly external with a significant intrapelvic component (Type II - 35%), making them visible externally. - Only Type III and Type IV teratomas have a larger internal component that might not be readily visible externally. - This statement is TRUE. *If associated with hydrops, should be resected antenatally* - The presence of **hydrops fetalis** in sacrococcygeal teratoma indicates severe fetal compromise, often due to **high-output cardiac failure** from large vascular shunting within the tumor. - In carefully selected cases with hydrops, **antenatal intervention** may include fetoscopic laser ablation of feeding vessels, radiofrequency ablation, or rarely open fetal surgery for tumor debulking/resection to prevent fetal demise. - While technically challenging and performed only at specialized fetal surgery centers, antenatal intervention **can be considered** in severe cases to improve outcomes, making this statement TRUE in the context of "should be considered" for management. - Alternatively, EXIT procedure (Ex-Utero Intrapartum Treatment) may be planned for delivery. *Most common tumor of fetus* - Sacrococcygeal teratoma (SCT) is indeed the **most common tumor diagnosed in the fetal and neonatal period**, with an incidence of about 1 in 30,000 to 40,000 live births. - It arises from totipotent cells in Hensen's node (primitive knot), which is located in the sacrococcygeal region. - This statement is TRUE.

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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