Neonatology — MCQs
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Which of the following statements about Kangaroo Mother Care is false?
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?
The most common bone fractured during birth is
Post term baby with tachypnea - commonest cause?
Which drug is primarily used in neonatal resuscitation?
Which of the following APGAR score ranges indicates that a newborn is 'at risk'?
Cause of greenish-black stool in a neonate -
In a term baby who is 72 hours old, breastfeeding well, and has a bilirubin level of 14 mg/dL, which of the following statements is true?
Which viral infection is known to cause a condition resembling erythroblastosis?
Which among the following is the most common infectious cause of neonatal blindness?
Neonatology Indian Medical PG Practice Questions and MCQs
Question 861: Which of the following statements about Kangaroo Mother Care is false?
- A. Can also be provided by the father.
- B. It is only applicable to mothers. (Correct Answer)
- C. It is especially beneficial for low birth weight infants.
- D. It provides effective thermal control.
Explanation: ***It is only applicable to mothers.*** - This statement is false because **Kangaroo Mother Care (KMC)** involves skin-to-skin contact, which can be provided by any adult caregiver, including the **father** or other family members, not exclusively the mother. - The benefits of KMC, such as **thermal regulation**, improved **bonding**, and **breastfeeding promotion**, are achieved regardless of whether the mother or another caregiver provides the contact. *Can also be provided by the father.* - This statement is true; **fathers** are increasingly recognized as important caregivers in providing **KMC**, offering similar benefits as when provided by the mother. - Involving fathers can enhance **parental bonding** and share the caregiving responsibilities for the infant, especially for **low birth weight** or **premature infants**. *It is especially beneficial for low birth weight infants.* - This statement is true; **KMC** is particularly recommended for **low birth weight (LBW)** infants, especially those weighing under 2500 grams, as it has been shown to reduce mortality and improve their health outcomes. - It helps stabilize **cardiorespiratory function**, promotes **weight gain**, and facilitates **exclusive breastfeeding** in these vulnerable infants. *It provides effective thermal control.* - This statement is true; **KMC** involves direct **skin-to-skin contact**, which helps regulate the infant's body temperature, preventing both **hypothermia** and **hyperthermia** more effectively than conventional incubators in some settings. - The caregiver's body acts as a **human incubator**, providing a stable and appropriate thermal environment for the infant.
Question 862: 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 863: The most common bone fractured during birth is
- A. Clavicle (Correct Answer)
- B. Scapula
- C. Radius
- D. Humerus
Explanation: ***Clavicle*** - The **clavicle** is the most common bone fractured during birth due to the stresses applied during delivery, especially in cases of shoulder dystocia. - Its relatively superficial location and slender shaft make it vulnerable to fracture as it may get compressed or stretched against the maternal pelvis. *Scapula* - Fractures of the **scapula** are extremely rare in newborns due to its protected position and broad, flat structure. - It would require a significant, unusual force to fracture the scapula during birth. *Radius* - While long bone fractures can occur, a **radial fracture** is less common than a clavicle fracture during birth. - Fractures of the radius typically occur from direct trauma or hyperextension injuries, rather than the compressive forces seen during normal birth. *Humerus* - Fractures of the **humerus** are less common than clavicle fractures but can occur, particularly in difficult deliveries or when excessive force is applied during extraction. - However, the clavicle remains the most frequently fractured bone overall in neonates during birth.
Question 864: Post term baby with tachypnea - commonest cause?
- A. Transient tachypnea of newborn
- B. Meconium aspiration syndrome (Correct Answer)
- C. Hyaline membrane disease
- D. Infection
Explanation: ***Meconium aspiration syndrome*** - Post-term infants are at increased risk of **meconium staining of amniotic fluid** and subsequent **meconium aspiration**, leading to respiratory distress. - Meconium in the lungs causes **airway obstruction**, chemical pneumonitis, and surfactant inactivation, resulting in tachypnea and hypoxemia. *Transient tachypnea of newborn* - This condition is more common in **term or late preterm infants delivered by C-section**, rather than post-term. - It is caused by **delayed reabsorption of fetal lung fluid**, leading to mild respiratory distress that typically resolves within 24-48 hours. *Hyaline membrane disease* - Also known as **respiratory distress syndrome**, this condition primarily affects **preterm infants** due to **surfactant deficiency**. - It would be highly unusual in a post-term infant, as surfactant production is mature by term or post-term. *Infection* - While infection (e.g., **neonatal sepsis**, pneumonia) can cause tachypnea in any newborn, it is **not the commonest cause of respiratory distress specifically in a post-term baby** with tachypnea. - Infection would typically be accompanied by other signs like fever/hypothermia, poor feeding, lethargy, or signs of systemic illness.
Question 865: Which drug is primarily used in neonatal resuscitation?
- A. Sodium bicarbonate
- B. Adrenaline (Correct Answer)
- C. Naloxone
- D. Atropine
Explanation: ***Adrenaline*** - **Adrenaline (epinephrine)** is the primary drug used in neonatal resuscitation when **bradycardia** (heart rate <60 bpm) persists despite adequate ventilation and chest compressions. - It acts as a **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility. - Administered intravenously or via endotracheal tube at a dose of **0.01-0.03 mg/kg**. *Sodium bicarbonate* - **Sodium bicarbonate** is rarely used in neonatal resuscitation due to concerns about potential side effects like **intracranial hemorrhage** and paradoxical intracellular acidosis. - Its use is generally reserved for prolonged resuscitation with documented **metabolic acidosis**. - Not recommended for routine use in the delivery room. *Naloxone* - **Naloxone** is an opioid antagonist used to reverse severe **respiratory depression** caused by maternal opioid administration shortly before delivery. - It is not indicated for primary resuscitation efforts in the absence of opioid exposure, and ventilation remains the priority. - Current NRP guidelines emphasize **ventilation over naloxone** administration. *Atropine* - **Atropine** is no longer recommended in neonatal resuscitation protocols. - It was previously considered for bradycardia but has been removed from **NRP guidelines** due to lack of evidence for efficacy. - **Adrenaline** has replaced atropine as the drug of choice for persistent bradycardia.
Question 866: Which of the following APGAR score ranges indicates that a newborn is 'at risk'?
- A. 7-10
- B. 4-6 (Correct Answer)
- C. Above 8
- D. 0-3
Explanation: ***4-6*** - This range indicates **moderate depression** or some difficulty adapting to extrauterine life, representing the newborn **"at risk"** category. - Newborns with this score require **intervention** such as stimulation, oxygen administration, or assisted ventilation. - This is the classic definition of an "at risk" newborn who needs close monitoring and support but is not in critical condition. *7-10* - An APGAR score in this range indicates that the newborn is **healthy** or has minimal adaptations to extrauterine life, and is **NOT considered "at risk"**. - Scores of 7, 8, 9, or 10 at both 1 and 5 minutes are typical for **normal newborns**. - These babies require routine care without special interventions. *0-3* - This range indicates **severe asphyxia** or critical depression, where the newborn is in **life-threatening condition**. - This is beyond "at risk" - these babies require **immediate resuscitation** and are in critical danger. - A score of 0-3 at 5 minutes is associated with significantly increased neonatal mortality and risk of neurological damage. *Above 8* - This range (9-10) overlaps with the 7-10 category and indicates an **excellent, healthy newborn**. - Scores of 9 and 10 show no signs of depression and represent optimal adaptation to extrauterine life. - These newborns are definitely **NOT at risk**.
Question 867: Cause of greenish-black stool in a neonate -
- A. Breakdown product of hemoglobin metabolism
- B. First intestinal discharge in newborns (Correct Answer)
- C. Urinary pigment found in normal excretion
- D. Hepatic pigment involved in bile production
Explanation: ***First intestinal discharge in newborns*** - The greenish-black stool in a neonate is characteristic of **meconium**, which is the first intestinal discharge. - Meconium is composed of materials ingested during the fetal period, including **vernix caseosa**, fine hair (lanugo), **intestinal epithelial cells**, mucus, and biliary secretions. *Breakdown product of hemoglobin metabolism* - While hemoglobin breakdown products (like **bilirubin**) contribute to the color of stool, this option is too general and doesn't specify the unique nature of **meconium**. - Bilirubin is primarily responsible for the yellow color of later infant stools, not the initial greenish-black of meconium. *Urinary pigment found in normal excretion* - **Urinary pigments** (like urochrome) are responsible for the color of urine, not stool. - This option refers to a completely different bodily excretion system. *Hepatic pigment involved in bile production* - This option likely refers to **bilirubin**, which is a hepatic pigment involved in bile production and contributes to stool color. - However, it doesn't fully capture the complex composition and unique appearance of **meconium** as the *first* stool.
Question 868: In a term baby who is 72 hours old, breastfeeding well, and has a bilirubin level of 14 mg/dL, which of the following statements is true?
- A. Exchange transfusion
- B. Continue to breastfeed (Correct Answer)
- C. Phototherapy
- D. None of the options
Explanation: ***Continue to breastfeed*** - A bilirubin level of **14 mg/dL at 72 hours of age** in a healthy, full-term, breastfeeding baby is usually within the range considered **physiological jaundice** and does not warrant stopping breastfeeding. - **Breastfeeding should continue** regardless of jaundice management, as interruption can cause a **decrease in milk supply** and may worsen jaundice by reducing bilirubin excretion through stool. - Continued breastfeeding (8-12 times per day) helps promote bilirubin clearance. *Exchange transfusion* - This is an **invasive procedure** reserved for very high bilirubin levels (typically **>20-25 mg/dL** in full-term infants depending on age and risk factors) or in cases of **acute bilirubin encephalopathy**. - A bilirubin level of 14 mg/dL is **well below the threshold** for exchange transfusion in a healthy term infant. *Phototherapy* - According to **AAP guidelines**, phototherapy thresholds are age-dependent: - At **72 hours of age**, phototherapy is typically considered at bilirubin levels **>15-18 mg/dL** in low-risk term infants. - At 14 mg/dL, **close monitoring** with repeat bilirubin measurement is appropriate, but phototherapy is generally **not yet indicated** for a healthy term infant without risk factors. *None of the options* - This option is incorrect because **continuing to breastfeed** is the appropriate and evidence-based management for this clinical scenario. - The other interventions (exchange transfusion, phototherapy) are **not indicated** at this bilirubin level and age in a healthy term infant.
Question 869: Which viral infection is known to cause a condition resembling erythroblastosis?
- A. EBV
- B. CMV
- C. Parvovirus B19 (Correct Answer)
- D. HSV
Explanation: ***Parvovirus B19*** - **Parvovirus B19** has a specific tropism for **erythroid progenitor cells** in the bone marrow. - In the fetus, congenital infection causes **severe anemia** due to destruction of red blood cell precursors, leading to **hydrops fetalis** with massive compensatory erythropoiesis. - This results in circulating **nucleated red blood cells (erythroblasts)**, hepatosplenomegaly from extramedullary hematopoiesis, and severe anemia - a picture closely **resembling erythroblastosis fetalis**. - Unlike the immune-mediated hemolysis in Rh isoimmunization, parvovirus causes direct viral destruction of erythroid precursors with similar clinical manifestations. *CMV* - **Cytomegalovirus (CMV)** is the most common congenital infection and can cause hepatosplenomegaly, jaundice, and thrombocytopenia. - However, CMV typically causes **direct hyperbilirubinemia** from hepatocellular damage rather than the hemolytic anemia pattern seen in erythroblastosis. - While CMV can affect hematopoiesis, it does not characteristically produce the massive erythroblast response and hydrops pattern typical of erythroblastosis fetalis. *EBV* - **Epstein-Barr virus (EBV)** primarily causes **infectious mononucleosis** in older children and adults, with atypical lymphocytosis. - EBV is rare in neonates and does not cause fetal hydrops or an erythroblastosis-like syndrome. - Associated with lymphoproliferative disorders and post-transplant complications rather than fetal anemia. *HSV* - **Herpes simplex virus (HSV)** causes disseminated neonatal infection with encephalitis, hepatitis, and mucocutaneous lesions. - HSV does not have tropism for erythroid precursors and does not cause the anemia, hydrops, or erythroblastosis-like picture. - Typically acquired perinatally rather than causing congenital infection with hematologic manifestations.
Question 870: Which among the following is the most common infectious cause of neonatal blindness?
- A. Klebsiella
- B. Enterobacter
- C. Chlamydia trachomatis (Correct Answer)
- D. Neisseria gonorrhoeae
Explanation: ***Chlamydia trachomatis*** - This is the **most common infectious cause of neonatal blindness** due to its high prevalence as the leading cause of neonatal conjunctivitis (50-60% of cases). - Although Chlamydia causes less severe conjunctivitis than Neisseria gonorrhoeae, its **much higher incidence** means it accounts for more **total cases of blindness** worldwide, especially in areas with limited healthcare access. - Infection occurs during passage through the birth canal of an infected mother, manifesting as **mucopurulent discharge** 5-14 days post-delivery. - Untreated cases can lead to **corneal scarring and blindness**, though this is preventable with timely antibiotic therapy. *Klebsiella* - While Klebsiella can cause neonatal infections, including sepsis and meningitis, it is **not a primary or common cause of neonatal blindness.** - **Ocular involvement** is rare and usually secondary to severe systemic infection rather than direct transmission during birth. *Enterobacter* - Similar to Klebsiella, **Enterobacter species** can cause **neonatal sepsis** and other infections, but they are not a leading cause of neonatal blindness. - **Ophthalmic manifestations** are uncommon and not characteristic of direct infectious blindness in newborns. *Neisseria gonorrhoeae* - This causes **severe hyperacute conjunctivitis** (ophthalmia neonatorum) within the first 5 days of life with high risk of rapid corneal ulceration and perforation. - While **more severe per case** than Chlamydia, gonococcal ophthalmia is **much less common** due to widespread maternal screening, prophylactic eye drops (erythromycin/tetracycline), and lower overall prevalence. - Therefore, despite its severity, it accounts for fewer total cases of neonatal blindness than Chlamydia.
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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