Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 871: Which of the following is a classic triad of congenital rubella syndrome?

A. Patent ductus arteriosus, cataracts, and deafness (Correct Answer)
B. Hepatosplenomegaly, mental retardation, and deafness
C. Chorioretinitis, multiorgan failure, and pneumonitis
D. None of the options

Explanation: ***Patent ductus arteriosus, cataracts, and deafness*** - This is the **classic triad** of congenital rubella syndrome, reflecting the damage caused by the rubella virus to the developing fetus's **heart, eyes, and ears**. - **Patent ductus arteriosus** is a common cardiac defect, **cataracts** affect vision, and **sensorineural deafness** is a prevalent auditory defect. *Hepatosplenomegaly, intellectual disability, and deafness* - While **deafness** is part of the rubella triad, **hepatosplenomegaly** and **intellectual disability** are more common features of other congenital infections like **cytomegalovirus (CMV)**, not the classic rubella triad. - **Intellectual disability** can occur with severe rubella, but it's not considered a core component of the classic diagnostic triad. *Chorioretinitis, multiorgan failure, and pneumonitis* - **Chorioretinitis** is a hallmark of congenital toxoplasmosis and CMV infection, not typically seen with congenital rubella. - **Multiorgan failure** and **pneumonitis** are severe, non-specific complications that can occur with various congenital infections but are not part of rubella's classic presentation. *None of the options* - This option is incorrect as the first option accurately describes the **classic triad of congenital rubella syndrome**.

Question 872: 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 873: Erythematous blotchy rash is seen on the abdomen, trunk, and face of a 3-day-old child along with yellowish papules. The child appears well. What is the appropriate management?

A. Topical steroid and antibiotic lotion
B. Topical steroid cream
C. Intravenous antibiotics
D. No treatment (Correct Answer)

Explanation: ***No treatment (Correct Answer)*** The described symptoms—erythematous blotchy rash with yellowish papules on the abdomen, trunk, and face in a well-appearing 3-day-old neonate—are **classic for erythema toxicum neonatorum**. **Key Features:** - **Benign, self-limiting rash** of unknown etiology - Affects **50-70% of term newborns** - Typically appears on **days 2-5** of life - Characterized by **erythematous macules/patches** with overlying **yellowish-white papules/pustules** - Infant appears **well and thriving** - **Resolves spontaneously** within 1-2 weeks without treatment - Histology shows **eosinophils** in pustules **Management:** Reassurance to parents; no medical intervention required. --- *Topical steroid and antibiotic lotion (Incorrect)* This approach is inappropriate because erythema toxicum neonatorum is: - **Not an infection** (no bacterial or fungal cause) - **Not an inflammatory condition** requiring steroids - Misdiagnosis and overtreatment could lead to unnecessary side effects, antibiotic resistance, and mask other conditions --- *Topical steroid cream (Incorrect)* Topical steroids are: - **Unnecessary** for this benign, self-resolving condition - **Potentially harmful** in neonates (can cause skin atrophy, increased absorption) - Provide **no therapeutic benefit** for erythema toxicum neonatorum --- *Intravenous antibiotics (Incorrect)* Systemic antibiotics are: - **Entirely unwarranted** as this is a non-infectious, benign rash - Would represent **gross overtreatment** with significant risks - Contribute to **antibiotic resistance** - Carry risks of adverse reactions, disruption of normal flora, and unnecessary hospitalization **Differentials to consider (but not present here):** - Transient neonatal pustular melanosis (present at birth) - Neonatal acne (appears later, at 2-4 weeks) - Miliaria (smaller, clear vesicles) - Infectious causes (infant appears ill, requires septic workup)

Question 874: 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 875: Most common site for bone marrow aspiration in neonates is -

A. Anterior superior iliac crest
B. Posterior superior iliac crest
C. Sternum
D. Anteromedial tibia (Correct Answer)

Explanation: ***Anteromedial tibia*** - The **anteromedial tibia** is the preferred site in neonates due to its relatively **large marrow cavity**, superficial location, and reduced risk of vital organ injury. - This site is easily accessible and provides a good yield of marrow cells, making it suitable for diagnostic purposes in newborns. *Anterior superior iliac crest* - While a common site for bone marrow aspiration in older children and adults, the **anterior superior iliac crest** can be more challenging and poses a greater risk in neonates due to their smaller bone structures. - The iliac crest offers less bony prominence and a thinner cortex in neonates, increasing the difficulty of the procedure and potential for sampling error. *Posterior superior iliac crest* - The **posterior superior iliac crest** is another common site in older children and adults but is generally avoided in neonates due to the difficulty in positioning and the risk of damaging vital structures in the vicinity. - It requires prone positioning and offers less superficial bone, making it a less practical and safe choice for neonates compared to the tibia. *Sternum* - **Sternal aspiration** is generally contraindicated in neonates and young children due to the thinness of the sternal bone and proximity to vital structures like the heart and great vessels. - There is a high risk of **perforation** of the sternum and injury to underlying organs, making this site unsafe for bone marrow aspiration in this age group.

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: Further investigation is essential in a newborn with which of the following conditions?

A. Vaginal bleed
B. Subconjunctival hemorrhage
C. Lens opacity (Correct Answer)
D. Erythema toxicum

Explanation: ***Lens opacity*** - A **lens opacity** in a newborn suggests congenital **cataracts**, which can lead to permanent vision impairment if not identified and treated early. - **Investigation is essential** to identify underlying causes such as **TORCH infections** (Toxoplasmosis, Rubella, CMV, HSV), **metabolic disorders** (galactosemia, Lowe syndrome), **genetic syndromes**, or **chromosomal abnormalities**. - Early detection and management are crucial to prevent **amblyopia** (lazy eye) and optimize visual development during the **critical period** of visual maturation. - Investigations include: TORCH titers, urine for reducing substances, metabolic screening, and genetic evaluation. *Erythema toxicum* - This is a common, **benign newborn rash** characterized by blotchy red macules and papules with central vesicles or pustules. - It typically resolves spontaneously within days to a few weeks and requires **no specific investigation or treatment**. *Vaginal bleed* - A small amount of **vaginal bleeding** in female newborns is usually due to the temporary withdrawal of maternal hormones (e.g., estrogen) after birth. - This is a **physiologic response** and generally self-resolves, requiring no further investigation unless excessive or prolonged. *Subconjunctival hemorrhage* - This occurs due to the rupture of tiny blood vessels in the eye during the birthing process, often associated with **vaginal delivery**. - It is a **benign condition** that resolves on its own within a couple of weeks and does not affect vision.

Question 878: 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 879: 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 880: What is the most common cause of pneumonia in early onset sepsis in neonates?

A. H influenzae
B. Coagulase positive staph aureus
C. Group B streptococcus (Correct Answer)
D. Listeria

Explanation: ***Group B streptococcus*** - **Group B Streptococcus (GBS)** is the leading cause of **early-onset sepsis** and pneumonia in neonates, typically acquired during passage through the birth canal. - Maternal GBS colonization is a significant risk factor, and GBS can cause **severe respiratory distress** in affected newborns. *H influenzae* - **_Haemophilus influenzae_** is a more common cause of **late-onset sepsis** or pneumonia in infants and children, rather than early-onset neonatal disease. - While it can cause neonatal infections, it is much less frequent than GBS in the early-onset period. *Coagulase positive staph aureus* - **_Staphylococcus aureus_** is a common cause of **nosocomial infections** or late-onset sepsis in neonates, particularly in ventilated or catheterized infants. - It is not the most common pathogen for community-acquired **early-onset neonatal pneumonia**. *Listeria* - **_Listeria monocytogenes_** can cause severe neonatal sepsis and pneumonia, often associated with maternal consumption of contaminated food. - While it is a significant pathogen, it is less common overall than GBS as a cause of early-onset neonatal pneumonia in most regions.

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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