Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 851: 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 852: A newborn after prolonged labour is not breathing well and after 30 seconds of receiving 100% oxygen by bag and mask, heart rate is 88 beats per minute. What is the next step in management?

A. Discontinue oxygen and ventilation
B. Discontinue oxygen, continue ventilation
C. Continue oxygen and ventilation (Correct Answer)
D. Start chest compressions

Explanation: ***Continue oxygen and ventilation*** - A **heart rate less than 100 beats per minute** in a newborn needing resuscitation indicates ongoing compromise, mandating continued positive pressure ventilation. - The goal is to achieve a heart rate above 100 bpm, regular breathing, and improving oxygen saturation, which requires continued support. *Discontinue oxygen and ventilation* - This action would be appropriate only if the newborn's heart rate was **above 100 bpm** and they were breathing effectively. - Discontinuing support when the heart rate is 88 bpm would lead to further deterioration and potentially irreversible harm. *Discontinue oxygen, continue ventilation* - Reducing oxygen to room air might be considered if the newborn's **heart rate improves** and oxygen saturations are appropriate, but not when the heart rate is still below 100 bpm. - Continuing ventilation without adequate oxygen when indicated could be detrimental, as the goal is to improve oxygen delivery to tissues. *Start chest compressions* - Chest compressions are indicated when the newborn's heart rate remains **below 60 beats per minute** despite 30 seconds of effective positive pressure ventilation. - In this scenario, the heart rate is 88 bpm, which is above the threshold for initiating chest compressions but still requires continued ventilatory support.

Question 853: 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 854: 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 855: What is the recommended technique for performing chest compressions on a newborn?

A. Using two fingers on the middle third of the sternum
B. Using two thumbs on the lower third of the sternum (Correct Answer)
C. Using three fingers on the lower third of the sternum
D. Using the palm on the lower third of the sternum

Explanation: ***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.

Question 856: 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 857: 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 858: 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 859: Meconium can be passed up to how many days in a healthy baby?

A. 2 (Correct Answer)
B. 3
C. 5
D. 7

Explanation: ***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**.

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

Practice Questions

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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