Neonatology Practice Questions

Q: Colour of stools in breastfed newborn is -

Golden. ***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.

Q: What is the recommended technique for performing chest compressions on a newborn?

Using two thumbs on the lower third of the sternum. ***Using two thumbs on the lower third of the sternum*** - The **two-thumb encircling technique** is recommended for newborns, especially when two rescuers are present, as it provides better coronary and cerebral perfusion pressures compared to the two-finger technique. - Compressions should be applied to the **lower third of the sternum**, just below the nipple line, to avoid injury to the xiphoid process. *Using two fingers on the middle third of the sternum* - The **two-finger technique** can be used if there is only one rescuer, but it is generally less effective in generating optimal perfusion than the two-thumb technique. - Compressing the **middle third of the sternum** is incorrect; the appropriate landmark is the lower third. *Using three fingers on the lower third of the sternum* - Using **three fingers** is generally not a standard recommended technique for neonatal CPR, as it can be difficult to achieve the correct depth and pressure distribution. - While the **lower third of the sternum** is correct, the multiple finger approach is less precise than the two-thumb or two-finger methods. *Using the palm on the lower third of the sternum* - Using the **palm of the hand** is too broad and provides excessive pressure for a fragile newborn's chest, risking serious injury to internal organs or ribs. - This technique is more appropriate for **adult CPR** and should not be applied to neonates.

Q: Which of the following statements about erythema toxicum is true?

Occurs mainly in the neonatal period. ***Occurs mainly in the neonatal period*** - **Erythema toxicum neonatorum (ETN)** is a condition that occurs **exclusively in the neonatal period**, typically appearing within the first 24-72 hours of life and rarely persisting beyond 2 weeks. - This is the **most comprehensive and defining feature** of ETN - the temporal occurrence defines the condition itself. - While other statements may be true, this captures the essential pathognomonic characteristic. *Common in term babies* - This statement is **medically accurate** - ETN affects 40-70% of full-term newborns. - However, it is **less specific** than stating it occurs in the neonatal period, as it doesn't capture the temporal aspect that defines the condition. - The condition is rare in preterm infants (<37 weeks gestation). *Lesions contain many eosinophils* - This statement is **also medically accurate** - Wright-stained smears of pustule contents characteristically show numerous **eosinophils**, which is a diagnostic feature. - Skin biopsy reveals subcorneal or intraepidermal pustules with eosinophils. - However, this is a **microscopic finding** rather than the primary clinical defining feature of the condition. *Can be life-threatening* - This is **FALSE** - ETN is a completely benign and self-limiting condition. - It resolves spontaneously without treatment and causes no systemic symptoms or complications. - No intervention is required beyond reassurance to parents.

Q: Which of the following statements is true for physiological jaundice in neonate?

Starts on 2nd day of life. ***Starts on 2nd day of life*** - Physiological jaundice typically appears after the first 24 hours of life, usually peaking between the 3rd and 5th day and resolving within 1-2 weeks. - This delay is due to the newborn infant's immature liver enzymes (like **UGT**) needing time to adequately conjugate bilirubin. *Occurs in the first 6 hours of delivery* - Jaundice occurring within the first 24 hours of life is considered **pathological** and requires immediate investigation to rule out serious conditions like hemolytic disease of the newborn. - **Physiological jaundice** is a diagnosis of exclusion and does not manifest so early. *Can cause kernicterus* - **Physiological jaundice** is by definition a benign, self-limiting condition with bilirubin levels that do not reach neurotoxic thresholds. - **Kernicterus** (bilirubin encephalopathy) occurs only with severe unconjugated hyperbilirubinemia seen in **pathological conditions**, not true physiological jaundice. - The distinction between physiological and pathological jaundice is crucial for clinical management. *Best treated by phototherapy* - Most cases of **physiological jaundice** are mild and resolve spontaneously without intervention, only requiring monitoring. - **Phototherapy** is reserved for cases where bilirubin levels exceed specific thresholds, which are higher than what is typically seen in normal physiological jaundice.

Q: What is the IV dose per kg of 1:10000 concentration of epinephrine in a pre-term baby in milliliters (ml)?

0.1 ml. ***0.1 ml*** - The recommended **IV dose of epinephrine** for a preterm baby in a 1:10,000 concentration is **0.01 mg/kg**. - Since 1:10,000 solution contains 0.1 mg/ml, the volume administered would be **0.1 mL/kg** (0.01 mg/kg divided by 0.1 mg/mL). *0.2 ml* - This dose would be twice the recommended starting dose, increasing the risk of **epinephrine side effects** such as **tachycardia** or **arrhythmias**. - **Overdosing** with epinephrine can lead to significant **cardiovascular complications**, which are particularly dangerous in fragile preterm infants. *0.3 ml* - This volume is three times the standard **epinephrine dose**, significantly increasing the likelihood of toxicity. - Delivering such a high dose could cause severe adverse effects including **hypertension**, **myocardial ischemia**, or **intracranial hemorrhage** in a preterm infant. *0.4 ml* - This dose is four times higher than what is typically recommended, posing a considerable threat to the infant's health. - Administering this much epinephrine would significantly elevate the risk of **life-threatening arrhythmias** and **cardiovascular collapse**.

Q: A 1-day-old male baby delivered by LSCS presents with swelling over the back in the midline. What is the most likely diagnosis?

Spina bifida. ***Spina bifida*** - A **midline swelling over the back in a newborn** is the classic presentation of **spina bifida**, which refers to incomplete closure of the vertebral column. - This can manifest as **meningocele** (herniation of meninges alone) or **myelomeningocele** (herniation of meninges and neural tissue), both presenting as visible midline swellings. - Spina bifida is the **most appropriate clinical diagnosis** for this presentation and is what would be documented in medical records and managed by pediatric neurosurgeons. - Associated features may include a **translucent sac**, leakage of CSF, and neurological deficits depending on the type. *Neural tube defect* - While technically correct as spina bifida is a type of neural tube defect, this term is too **broad and non-specific** for clinical diagnosis. - Neural tube defects include anencephaly, encephalocele, and spina bifida - the term is more useful for **epidemiological or embryological discussions** rather than clinical diagnosis. - In clinical practice, we specify the **exact type** (spina bifida, anencephaly, etc.) rather than using the umbrella term. *Meningocele* - Meningocele is a **specific subtype of spina bifida** where only meninges protrude through the vertebral defect without neural tissue. - Without imaging or surgical exploration, we cannot definitively distinguish meningocele from myelomeningocele based on external appearance alone. - Therefore, **"spina bifida"** is the more appropriate initial diagnosis, with the specific subtype determined by further evaluation. *Dermal sinus* - A dermal sinus is a **tract connecting the skin to deeper structures**, typically presenting as a small **pit or dimple** rather than a swelling. - It may have a tuft of hair or discharge but does not present as a prominent midline swelling as described in this case.

Q: Meconium can be passed up to how many days in a healthy baby?

2. ***2*** - Most healthy term infants pass **meconium** within the first 24 hours of life (90-95%). - Passage of meconium up to **48 hours (2 days)** can still occur in healthy term infants. - **Failure to pass meconium by 48 hours** warrants investigation for potential underlying conditions such as **Hirschsprung disease**, meconium plug syndrome, or intestinal obstruction. - This is the accepted standard in pediatric practice for initiating evaluation. *3* - Waiting **72 hours (3 days)** before investigating delayed meconium passage is not recommended. - By 3 days, the delay is considered **abnormal** and should have already prompted medical evaluation. - Most guidelines recommend investigation by **48 hours**, not 72 hours. *5* - A delay in meconium passage for **5 days** represents a significant abnormality requiring urgent evaluation. - Such delays are typically associated with conditions like **Hirschsprung disease**, intestinal atresia, or other causes of obstruction. - This duration would never be considered normal in a healthy baby. *7* - A delay of **7 days** would be a severe abnormality indicating serious underlying pathology. - This would require urgent medical and likely surgical intervention. - Complete failure to pass meconium for this duration strongly suggests **intestinal obstruction or severe motility disorder**.

Q: What sound does the examiner hear when the Ortolani test is positive?

Clunk of entry on abduction and flexion of the hip. ***Clunk of entry on abduction and flexion of the hip*** - A positive **Ortolani test** involves hearing a distinct "clunk" as the **femoral head** reduces back into the acetabulum. - This maneuver is performed by **abducting and flexing** the hip from an adducted position in an infant with a dislocated hip. *Clunk of entry on extension and adduction of the hip* - This description is incorrect; the Ortolani test is performed with hip **flexion and abduction**, not extension and adduction. - **Reduction** of the femoral head typically occurs with abduction, not adduction. *Click of exit on abduction and flexion of the hip* - The Ortolani test indicates **reduction** of a dislocated hip, which is characterized by a "clunk" of entry, not a "click of exit." - A "click of exit" when abducting and flexing the hip is more characteristic of the **Barlow maneuver's** results, which tests for reducibility and dislocation. *Click of exit on extension and adduction of the hip* - This describes neither the correct maneuver nor the characteristic sound of a positive Ortolani test. - The Ortolani test focuses on **reducing a dislocated hip** with a distinct "clunk" during a flexion and abduction maneuver.

Question 1

Colour of stools in breastfed newborn is -

Accepted Answer

Golden

Answer

Red

Answer

Green

Answer

Black

Question 2

What is the recommended technique for performing chest compressions on a newborn?

Accepted Answer

Using two thumbs on the lower third of the sternum

Answer

Using two fingers on the middle third of the sternum

Answer

Using three fingers on the lower third of the sternum

Answer

Using the palm on the lower third of the sternum

Question 3

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

Accepted Answer

Not associated with increased serum markers

Answer

If associated with hydrops, should be resected antenatally

Answer

Most common tumor of fetus

Answer

In most cases, it is visible externally.

Question 4

Which of the following statements about the tests for hip instability in neonates is not true?

Accepted Answer

Ortolani's test is a single maneuver.

Answer

They are performed at 2 - 3 days of birth.

Answer

In Ortolani's test, the examiner's fingers rest on the greater trochanter.

Answer

In Barlow's test, the examiner's thumb is placed in the groin.

Question 5

Which of the following statements about erythema toxicum is true?

Accepted Answer

Occurs mainly in the neonatal period

Answer

Common in term babies

Answer

Lesions contain many eosinophils

Answer

Can be life-threatening

Question 6

Which of the following statements is true for physiological jaundice in neonate?

Accepted Answer

Starts on 2nd day of life

Answer

Occurs in the first 6 hours of delivery

Answer

Best treated by phototherapy

Answer

Can cause kernicterus

Question 7

What is the IV dose per kg of 1:10000 concentration of epinephrine in a pre-term baby in milliliters (ml)?

Accepted Answer

0.1 ml

Answer

0.3 ml

Answer

0.4 ml

Answer

0.2 ml

Question 8

A 1-day-old male baby delivered by LSCS presents with swelling over the back in the midline. What is the most likely diagnosis?

Accepted Answer

Spina bifida

Answer

Neural tube defect

Answer

Dermal sinus

Answer

Meningocele

Question 9

Meconium can be passed up to how many days in a healthy baby?

Accepted Answer

2

Answer

3

Answer

5

Answer

7

Question 10

What sound does the examiner hear when the Ortolani test is positive?

Accepted Answer

Clunk of entry on abduction and flexion of the hip

Answer

Clunk of entry on extension and adduction of the hip

Answer

Click of exit on abduction and flexion of the hip

Answer

Click of exit on extension and adduction of the hip

Neonatology — MCQs

Neonatology — MCQs

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