Neonatology — MCQs
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Which of the following methods is not recommended for resuscitating a newborn baby with a heart rate less than 60 beats per minute?
Which viral infection is known to cause a condition resembling erythroblastosis?
Which of the following is not a cause of neonatal anaemia?
Which of the following drugs is most commonly used for cardiovascular support in post-resuscitation care of neonates?
Chronic lung disease in infancy is defined as
What is the average weight gain of the neonate per day after the initial weight loss period?
There is overlapping of skull sutures which can be reduced with gentle pressure. What is the grade of moulding?
Which test is used to diagnose congenital syphilis in a newborn born to a syphilitic mother?
Treatment of choice for symptomatic neonatal hypoglycemia is
Which of the following is NOT a recognized cause of neonatal bradycardia?
Neonatology Indian Medical PG Practice Questions and MCQs
Question 871: Which of the following methods is not recommended for resuscitating a newborn baby with a heart rate less than 60 beats per minute?
- A. oxygen therapy
- B. tactile stimulation
- C. chest compression
- D. slapping the back (Correct Answer)
Explanation: ***Slapping the back*** - This method is **contraindicated** and **harmful** for newborn resuscitation as it can cause trauma and does not effectively improve heart rate or ventilation. - Previous practices involving forceful stimulation are now recognized as unsafe and ineffective, with current guidelines emphasizing gentle stimulation or medical interventions. *Chest compression* - **Chest compressions** are indicated when a newborn's heart rate remains below **60 beats per minute** despite adequate ventilation with positive pressure ventilation (PPV). - This intervention helps to circulate oxygenated blood to vital organs and is a critical component of neonatal resuscitation for severe bradycardia. *Oxygen therapy* - **Oxygen therapy** with positive pressure ventilation (PPV) is the **first-line intervention** for newborns with heart rate below 60 bpm after initial steps. - It helps to improve oxygen saturation, support ventilation, and may improve heart rate before chest compressions are needed. *Tactile stimulation* - **Tactile stimulation**, such as gently rubbing the back or flicking the soles of the feet, is an initial step in newborn resuscitation for mild respiratory depression. - However, for a heart rate **below 60 bpm** (as in this question's scenario), tactile stimulation alone is **insufficient** and **not appropriate** - immediate positive pressure ventilation and chest compressions are required instead. - Tactile stimulation is only useful during initial assessment and for mild depression, not for established bradycardia requiring advanced resuscitation.
Question 872: 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 873: Which of the following is not a cause of neonatal anaemia?
- A. Subgaleal Hemorrhage
- B. Abruptio placentae
- C. Wilson's Disease (Correct Answer)
- D. Diamond Blackfan syndrome
Explanation: ***Wilson's Disease*** - Wilson's disease is a disorder of **copper metabolism** that typically manifests later in childhood or adolescence with **hepatic**, **neurological**, or **psychiatric symptoms**, not neonatal anemia. - While it can cause hemolytic anemia in older individuals due to copper toxicity, it is not a recognized cause of **neonatal anemia**. *Subgaleal Hemorrhage* - A subgaleal hemorrhage is a significant collection of blood in the **subgaleal space** of the scalp, which can lead to substantial **blood loss** and subsequent **neonatal anemia** due to a large potential space. - This type of hemorrhage is often associated with **vacuum extraction** or other traumatic deliveries. *Abruptio placentae* - **Abruptio placentae** involves the premature separation of the placenta from the uterine wall, leading to **fetal-maternal hemorrhage** and sometimes significant **fetal blood loss**. - This acute blood loss in the fetus can manifest as severe **neonatal anemia** at birth. *Diamond Blackfan syndrome* - **Diamond Blackfan syndrome** is a congenital red cell aplasia characterized by a failure of **red blood cell production** in the bone marrow. - This condition presents with severe **macrocytic anemia** early in infancy, often requiring transfusions.
Question 874: Which of the following drugs is most commonly used for cardiovascular support in post-resuscitation care of neonates?
- A. Dobutamine
- B. Epinephrine
- C. Sodium Bicarbonate
- D. Dopamine (Correct Answer)
Explanation: ***Dopamine*** - **Dopamine** is often the first-line vasopressor used in neonates for **hypotension** unresponsive to fluid resuscitation, especially in the context of post-resuscitation care, due to its dose-dependent effects on cardiac output and systemic vascular resistance. - It increases **cardiac contractility** and **heart rate** at moderate doses (beta-1 adrenergic effects) and can improve renal blood flow at lower doses. *Sodium Bicarbonate* - **Sodium bicarbonate** is used to correct severe metabolic acidosis but is generally not recommended in the initial stages of neonatal resuscitation or for routine cardiovascular support due to potential adverse effects like rebound acidosis and hypernatremia. - Its use is typically reserved for documented severe metabolic acidosis after adequate ventilation and circulation have been established. *Epinephrine* - **Epinephrine** is primarily used during active cardiorespiratory arrest for its potent vasoconstrictive and inotropic effects, and for sustained **bradycardia** unresponsive to ventilation and chest compressions. - While it has strong cardiovascular effects, it is not the most common drug for *post-resuscitation cardiovascular support* unless there is persistent shock or bradycardia despite dopamine. *Dobutamine* - **Dobutamine** is an inotropic agent primarily used to improve myocardial contractility and cardiac output with less chronotropic effect than dopamine, making it beneficial in conditions with low cardiac output and normal blood pressure. - It is less commonly used as an initial agent for post-resuscitation **hypotension** in neonates compared to dopamine, which also offers systemic vasoconstriction to raise blood pressure.
Question 875: Chronic lung disease in infancy is defined as
- A. Need for supplemental oxygen at 36 weeks postmenstrual age (Correct Answer)
- B. Tachypnoea > 50 breaths/ min within 1 week of birth
- C. Presence of bilateral infiltrates on chest Xray for 2 weeks
- D. Reticulogranular pattern on chest Xray for 6 weeks
Explanation: ***Need for supplemental oxygen at 36 weeks after conception*** - **Chronic lung disease (CLD)**, also known as **bronchopulmonary dysplasia (BPD)**, is defined by the need for **supplemental oxygen** at 36 weeks postmenstrual age (corrected gestational age) or at 56 days postnatal age, whichever comes first, for infants born before 32 weeks gestation. - This definition reflects persistent respiratory morbidity requiring ongoing support, indicative of lung injury and abnormal development. *Tachypnoea > 50 breaths/ min within 1 week of birth* - **Tachypnoea** within the first week of birth can be a symptom of various neonatal respiratory conditions, such as **transient tachypnoea of the newborn (TTN)** or **respiratory distress syndrome (RDS)**, but it is not a defining feature of CLD. - CLD is characterized by a *prolonged* need for respiratory support, not just an acute symptom in the first week. *Presence of bilateral infiltrates on chest Xray for 2 weeks* - **Bilateral infiltrates** on a chest X-ray over two weeks could suggest conditions like **pneumonia** or **ARDS**, but it is not the diagnostic criterion for CLD. - The definition of CLD focuses on the physiological need for oxygen, rather than specific radiographic findings in isolation. *Reticulogranular pattern on chest Xray for 6 weeks* - A **reticulogranular pattern** on chest X-ray is characteristic of **respiratory distress syndrome (RDS)**, typically seen in premature infants due to surfactant deficiency. - While RDS can precede CLD, a **reticulogranular pattern** typically improves with treatment (surfactant therapy, ventilation) and does not persist for 6 weeks as a defining feature of chronic lung disease.
Question 876: What is the average weight gain of the neonate per day after the initial weight loss period?
- A. 5-10 g
- B. 25-30 g (Correct Answer)
- C. 50-60 g
- D. 100-150 g
Explanation: ***25-30 g*** - After the initial physiological weight loss (typically 5-10% of birth weight in the first few days), healthy term neonates should gain approximately **25-30 grams per day**. - This consistent weight gain indicates adequate feeding and healthy development in the first month of life. *5-10 g* - This range is too low for the average daily weight gain after the initial weight loss period. - A gain of only **5-10 g per day** would suggest inadequate feeding or an underlying medical issue. *50-60 g* - This rate of weight gain is typically seen in **older infants** (e.g., 2-3 months of age) or in cases of catch-up growth, not usually in the immediate neonatal period after initial weight loss. - While rapid growth can occur, 50-60 g/day is above the average for a neonate. *100-150 g* - This is an **excessively high** rate of daily weight gain for a neonate. - Such rapid weight gain is not typical and could potentially indicate measurement error or an unusual metabolic state.
Question 877: There is overlapping of skull sutures which can be reduced with gentle pressure. What is the grade of moulding?
- A. Grade 1
- B. Grade 2 (Correct Answer)
- C. Grade 3
- D. Grade 4
Explanation: ***Grade 2*** - **Grade 2 moulding** is characterized by overriding of the skull sutures that can be reduced with gentle pressure. This indicates moderate moulding of the fetal head. - This degree of moulding is a common finding during labor and delivery and usually resolves without intervention. *Grade 1* - **Grade 1 moulding** involves the apposition (touching) of the skull bones without actual overlap. - It signifies minimal moulding of the fetal head. *Grade 3* - **Grade 3 moulding** involves significant overlapping of the skull sutures that is fixed and cannot be reduced with gentle pressure. - This indicates severe moulding and may sometimes be associated with increased risk of intracranial complications. *Grade 4* - There is no universally recognized "Grade 4" for fetal head moulding in standard classifications. - Moulding is typically classified up to Grade 3, indicating increasing severity.
Question 878: Which test is used to diagnose congenital syphilis in a newborn born to a syphilitic mother?
- A. Detection of IgG
- B. ZN staining
- C. Detection of IgM (Correct Answer)
- D. FTA-ABS test
Explanation: ***Detection of IgM*** - The presence of **IgM antibodies** in a newborn suggests active infection because maternal IgM does not cross the placenta. - This indicates the newborn's immune system has produced its own antibodies in response to *Treponema pallidum* infection. *Detection of IgG* - **Maternal IgG antibodies can cross the placenta**, so detecting IgG in a newborn does not differentiate between passive transfer from the mother and active newborn infection. - While total IgG might be elevated due to infection, specific IgM is a more reliable indicator of active congenital syphilis. *ZN staining* - **Ziehl-Neelsen (ZN) staining** is used to identify **acid-fast bacteria**, such as *Mycobacterium tuberculosis*, not spirochetes like *Treponema pallidum*. - *Treponema pallidum* is typically visualized using darkfield microscopy or silver stains due to its thin, helical shape. *FTA-ABS test* - The **Fluorescent Treponemal Antibody Absorption (FTA-ABS)** test detects specific antibodies against *Treponema pallidum* but primarily measures IgG, which can be maternally transferred. - While it confirms exposure, an IgM-specific FTA-ABS would be more definitive for congenital syphilis, but the general FTA-ABS test alone is not sufficient to diagnose active infection in a newborn.
Question 879: Treatment of choice for symptomatic neonatal hypoglycemia is
- A. Dextrose normal saline
- B. 5% dextrose
- C. 10% dextrose (Correct Answer)
- D. 25% dextrose
Explanation: ***10% dextrose*** - For **symptomatic neonatal hypoglycemia**, 10% dextrose solution is the **standard initial treatment** with a bolus of 2 mL/kg (200 mg/kg) given IV over 5-10 minutes - This concentration safely and effectively raises blood glucose levels while minimizing the risk of **hyperglycemic rebound** or complications like **osmotic injury** - Followed by continuous infusion to maintain normoglycemia *Dextrose normal saline* - This combination is **not used** for acute hypoglycemia management as the saline component is unnecessary - The glucose concentration would be inadequate for rapid correction of **symptomatic neonatal hypoglycemia** - May lead to excessive fluid administration *5% dextrose* - A **5% dextrose solution** is insufficient to rapidly correct symptomatic neonatal hypoglycemia - Would require much faster infusion rates to deliver adequate glucose, potentially leading to **fluid overload** - May be used for maintenance therapy in asymptomatic cases *25% dextrose* - Too concentrated for routine neonatal use - carries significant risk of **vein sclerosis**, **osmotic injury**, and **rebound hypoglycemia** - Risk of extravasation injury and **hyperglycemia** - Reserved only for extreme cases under close monitoring with careful dilution
Question 880: Which of the following is NOT a recognized cause of neonatal bradycardia?
- A. Hypothermia
- B. Head injury
- C. Hypoxia
- D. BCG Vaccine (Correct Answer)
Explanation: ***BCG Vaccine*** - The **BCG vaccine** (Bacille Calmette-Guérin) is used to prevent tuberculosis and is not a known cause of **neonatal bradycardia**. - While it can cause local reactions or, rarely, disseminated disease in immunocompromised infants, it does not directly affect heart rate. *Hypoxia* - **Hypoxia** is a common and critical cause of **neonatal bradycardia**, as the heart attempts to conserve energy and oxygen in response to insufficient oxygen supply. - Severe or prolonged hypoxia can lead to **myocardial depression** and further compromise cardiac function. *Hypothermia* - **Hypothermia** (low body temperature) can significantly depress the **central nervous system** and **metabolic rate** in neonates. - This physiological response often leads to a decreased heart rate, resulting in **bradycardia**. *Head injury* - **Head injury** in neonates, especially severe forms, can increase **intracranial pressure** and stimulate the **vagal nerve**. - **Vagal stimulation** can lead to a decrease in heart rate, manifesting as **bradycardia**.
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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