Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 851: Which of the following statements about erythema toxicum is true?

A. Common in term babies
B. Lesions contain many eosinophils
C. Can be life-threatening
D. Occurs mainly in the neonatal period (Correct Answer)

Explanation: ***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.

Question 852: 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.

Question 853: Which of the following statements is true for physiological jaundice in neonate?

A. Occurs in the first 6 hours of delivery
B. Best treated by phototherapy
C. Starts on 2nd day of life (Correct Answer)
D. Can cause kernicterus

Explanation: ***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.

Question 854: 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 855: Which of the following is the most characteristic feature of cephalhematoma?

A. Ventouse delivery is a risk factor
B. Typically does not cross the suture lines. (Correct Answer)
C. May not be present at birth and can appear later.
D. None of the options

Explanation: ***Typically does not cross the suture lines*** - A **cephalhematoma** is a collection of blood between the skull bone and its periosteum, which is firmly attached at the **suture lines**. - This anatomical boundary prevents the blood from spreading across the sutures, resulting in a swelling that is **confined to a single cranial bone**. - This is the **most characteristic feature** that differentiates cephalhematoma from **caput succedaneum**, which crosses suture lines. *May not be present at birth and can appear later* - While it may not always be immediately apparent, cephalhematomas typically **develop within hours of birth** and are usually visible within the **first few days**. - Their presence is almost always directly related to **birth trauma** during delivery. - However, this temporal feature is **less specific** than the anatomical confinement. *Ventouse delivery is a risk factor* - While **ventouse delivery** (vacuum extraction) is a known **risk factor** for birth trauma, including **cephalhematoma**, this statement describes an **etiological factor**, not a characteristic *feature* of the condition itself. - The question asks for the **most characteristic *feature*** of a cephalhematoma, which is its anatomical confinement to one cranial bone. *None of the options* - This option is incorrect because the statement that a cephalhematoma **does not cross suture lines** is indeed the **hallmark characteristic** of this condition.

Question 856: Which of the following statements about the tests for hip instability in neonates is not true?

A. They are performed at 2 - 3 days of birth.
B. Ortolani's test is a single maneuver. (Correct Answer)
C. In Ortolani's test, the examiner's fingers rest on the greater trochanter.
D. In Barlow's test, the examiner's thumb is placed in the groin.

Explanation: ***Ortolani's test is a single maneuver.*** - This statement is **TRUE** and therefore the incorrect answer to this "not true" question. - **Ortolani's test** is indeed a **single, distinct maneuver** used to **reduce a dislocated hip** back into the acetabulum. - **Barlow's test** is a separate, single maneuver used to **dislocate an unstable hip**. - While these two tests are typically performed **sequentially** during hip examination for **developmental dysplasia of the hip (DDH)**, each represents a distinct, single maneuver with specific technique and purpose. - The fact that they are performed together does not make either test any less of a "single maneuver." *They are performed at 2 - 3 days of birth.* - This statement is **TRUE**. - The **Barlow** and **Ortolani maneuvers** are crucial for early detection of DDH and are ideally performed at **birth** and in the immediate **neonatal period** (within the first few days, typically **2-3 days**). - These tests are part of routine **newborn examination** and may be repeated at subsequent well-child visits. *In Ortolani's test, the examiner's fingers rest on the greater trochanter.* - This statement is **TRUE**. - During the **Ortolani maneuver**, the examiner's fingers are placed over the **greater trochanter**, applying gentle upward (anterior) pressure as the hip is **abducted**. - This technique helps to **reduce a dislocated hip** into the acetabulum, producing a palpable **"clunk"** or sensation of reduction. *In Barlow's test, the examiner's thumb is placed in the groin.* - This statement is **TRUE**. - In the **Barlow maneuver**, the examiner's thumb is positioned on the **inner thigh** near the **groin/adductor region**, while the fingers are placed over the **greater trochanter**. - This hand placement allows for **downward and posterior pressure** with **adduction** to attempt to **dislocate an unstable hip** from the acetabulum. **Note:** All four statements in this question are medically accurate. This question may require review as it asks for a "not true" statement when all options are true.

Question 857: What is the IV dose per kg of 1:10000 concentration of epinephrine in a pre-term baby in milliliters (ml)?

A. 0.3 ml
B. 0.4 ml
C. 0.2 ml
D. 0.1 ml (Correct Answer)

Explanation: ***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**.

Question 858: A 1-day-old male baby delivered by LSCS presents with swelling over the back in the midline. What is the most likely diagnosis?

A. Spina bifida (Correct Answer)
B. Neural tube defect
C. Dermal sinus
D. Meningocele

Explanation: ***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.

Question 859: A newborn with blood group O positive, whose mother is Rh negative, has a cord bilirubin level of 7 mg/dl. What is the appropriate treatment?

A. Check Direct Coomb's Test (DCT) (Correct Answer)
B. Monitor bilirubin levels
C. Prepare for exchange transfusion
D. Start phototherapy

Explanation: ***Check Direct Coomb's Test (DCT)*** - The scenario describes a newborn with blood group O positive and an Rh-negative mother, which raises suspicion for **ABO incompatibility** (or less likely Rh incompatibility if the mother was previously sensitized). A cord bilirubin of 7 mg/dl is **significantly elevated at birth** (normal <2 mg/dl) and warrants immediate investigation for hemolytic disease. - A **positive Direct Coomb's Test (DCT)** indicates that the infant's red blood cells are coated with maternal antibodies, confirming immune-mediated hemolysis and guiding further management decisions. - This is the **appropriate first step** - establishing the diagnosis before initiating treatment allows for targeted and appropriate management. *Monitor bilirubin levels* - While monitoring bilirubin levels is an essential part of management, simply monitoring without further investigation is **insufficient** given the elevated cord bilirubin and high-risk factors for hemolysis. - The initial step should be to determine the *cause* of the elevated bilirubin through diagnostic testing (DCT), not just to observe its progression without understanding the underlying pathology. *Prepare for exchange transfusion* - An exchange transfusion is a **high-risk procedure** reserved for severe hyperbilirubinemia unresponsive to phototherapy, or when there are signs of acute bilirubin encephalopathy. - A cord bilirubin of 7 mg/dl, while elevated, does not immediately necessitate exchange transfusion without further assessment, DCT confirmation, and initial management steps like phototherapy. *Start phototherapy* - **Phototherapy** is the primary treatment for neonatal hyperbilirubinemia, but it is typically initiated based on age-specific bilirubin levels and risk factors *after* the cause has been investigated. - While this infant is at high risk and will likely need phototherapy, the **first step** is to confirm the hemolytic nature of the jaundice with a DCT, as a cord bilirubin of 7 mg/dl at birth is significant and requires immediate diagnostic clarity to guide management intensity.

Question 860: What sound does the examiner hear when the Ortolani test is positive?

A. Clunk of entry on extension and adduction of the hip
B. Click of exit on abduction and flexion of the hip
C. Clunk of entry on abduction and flexion of the hip (Correct Answer)
D. Click of exit on extension and adduction of the hip

Explanation: ***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.

Practice by Chapter

Neonatal Resuscitation

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Care of the Normal Newborn

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Prematurity and Low Birth Weight

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Respiratory Distress Syndrome

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Neonatal Jaundice

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Neonatal Sepsis

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Necrotizing Enterocolitis

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Intraventricular Hemorrhage

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Persistent Pulmonary Hypertension

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Perinatal Asphyxia

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Neonatal Seizures

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Congenital Anomalies

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