Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 881: Which of the following is a common symptom of Hypoxic Ischemic Encephalopathy?

A. Lower limbs affected more than upper limbs
B. Seizures (Correct Answer)
C. Predominant trunk involvement
D. Proximal muscles affected more than distal muscles

Explanation: ***Seizures*** - **Seizures** are a very common and early symptom of **Hypoxic-Ischemic Encephalopathy (HIE)** due to neuronal injury and dysfunction. - They can manifest in various forms, including tonic, clonic, or multifocal types, and often indicate the severity of brain damage. *Lower limbs affected more than upper limbs* - The pattern of motor impairment in HIE typically involves the **upper limbs more than the lower limbs** due to the specific vulnerability of cortical regions supplying the upper extremities and face. - This is in contrast to conditions like **cerebral palsy from periventricular leukomalacia**, which characteristically affects the lower limbs more. *Predominant trunk involvement* - While HIE can cause widespread neurological dysfunction, **isolated or predominant trunk involvement** is not a characteristic presenting symptom. - Motor deficits usually involve the extremities and cranial nerves, reflecting diffuse or focal brain injury. *Proximal muscles affected more than distal muscles* - The distribution of muscle weakness in HIE does not typically show a clear pattern of **proximal over distal involvement**. - Instead, the motor deficits are often widespread or show predilection for the upper extremities, depending on the extent and location of brain injury.

Question 882: 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 883: 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 884: A 45-day-old infant presents with seizures. Examination reveals he is icteric, has bulging fontanelles, and exhibits opisthotonic posture. Which of the following treatments is NOT indicated?

A. Chlorpromazine (Correct Answer)
B. Phenobarbital
C. Phototherapy
D. Exchange Transfusion

Explanation: ***Chlorpromazine*** - Chlorpromazine is an **antipsychotic medication** and is **contraindicated** in infants, especially in the presence of seizures and central nervous system (CNS) dysfunction, due to its potential to **lower the seizure threshold** and cause severe extrapyramidal symptoms. - Its mechanism of action via **dopamine receptor blockade** is not relevant for treating bilirubin encephalopathy or its symptoms. *Phototherapy* - Phototherapy is a primary treatment for **neonatal jaundice** to reduce unconjugated bilirubin levels and prevent neurotoxicity. - While the infant's condition suggests severe hyperbilirubinemia with complications, phototherapy would still be indicated as an initial step or adjunct to further interventions, especially if the bilirubin levels are still rising. *Exchange Transfusion* - Exchange transfusion is a **definitive treatment** for severe hyperbilirubinemia, especially when there are signs of **acute bilirubin encephalopathy (kernicterus)**, as suggested by seizures, bulging fontanelles, and opisthotonus. - It rapidly removes bilirubin from the blood and is crucial to prevent further neurological damage in such critical cases. *Phenobarbital* - Phenobarbital is an **anticonvulsant** used to manage seizures, which are a prominent symptom in this infant. - It can also help to **induce hepatic enzymes** involved in bilirubin metabolism, thereby potentially aiding in the reduction of bilirubin levels in cases of severe hyperbilirubinemia, though its primary role here would be seizure control.

Question 885: Which of the following statements about cephalhematoma is correct?

A. It is hemorrhage between the skull and periosteum (Correct Answer)
B. It is hemorrhage within the subcutaneous tissue around the skull
C. It is type of subdural hemorrhage
D. It is subperiosteal bleeding in the skull

Explanation: ***It is hemorrhage between the skull and periosteum*** - A **cephalhematoma** is defined as a collection of blood between the **periosteum** and the underlying **skull bone** (subperiosteal). - Its boundaries are limited by the suture lines because the periosteum is firmly attached at these junctions, preventing blood from crossing. *It is hemorrhage within the subcutaneous tissue around the skull* - This description corresponds to a **caput succedaneum**, which involves **edema and hemorrhage** in the subcutaneous tissue, rather than between the skull and periosteum. - Unlike a cephalhematoma, a **caput succedaneum** can cross suture lines and is typically present at birth. *It is type of subdural hemorrhage* - A **subdural hemorrhage** involves bleeding between the **dura mater** and the **arachnoid mater** within the cranial vault. - This type of hemorrhage is a **neurological emergency** and is distinct from a cephalhematoma, which is an external scalp injury. *It is subperiosteal bleeding in the skull* - While this statement is technically correct (subperiosteal means under the periosteum), the **standard definition** specifically states "between the periosteum and the skull bone." - The distinction is important: **subperiosteal** could theoretically include bleeding within the periosteum itself, whereas the precise location is in the **potential space** between periosteum and bone. - Option A is more precise and is the preferred medical definition.

Question 886: 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 887: A newborn presents with subconjunctival hemorrhage. The treatment is

A. No treatment (Correct Answer)
B. Antibiotic eye drops
C. Antibiotic and steroid drops
D. Aspiration

Explanation: ***No treatment*** - **Subconjunctival hemorrhage** in a newborn is typically **benign** and **resolves spontaneously** within **1-2 weeks**. - It is often caused by the trauma of birth and does not require intervention. *Antibiotic eye drops* - These are indicated for **bacterial conjunctivitis** or to prevent bacterial infection, which is not the case here. - Using antibiotics without a bacterial indication is unnecessary and can contribute to **antibiotic resistance**. *Aspiration* - **Aspiration** is an invasive procedure and is **not indicated** for a subconjunctival hemorrhage, which is a collection of blood under the conjunctiva. - It could cause further damage or introduce infection. *Antibiotic and steroid drops* - **Steroid drops** are typically used to reduce **inflammation**, which is not the primary issue in a subconjunctival hemorrhage. - Like plain antibiotic drops, the **antibiotic component** is not necessary in the absence of infection.

Question 888: 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.

Question 889: What is the typical lifespan of neonatal red blood cells (RBCs)?

A. 120-150 days
B. 150-200 days
C. 60-90 days (Correct Answer)
D. 90-120 days

Explanation: ***60-90 days*** - The typical lifespan of **neonatal red blood cells (RBCs)** is **60-90 days**, which is **shorter than adult RBCs** (120 days). - This reduced lifespan is due to **increased membrane fragility**, **higher metabolic rate**, and **immature enzyme systems** in neonatal erythrocytes. - Neonatal RBCs contain more **fetal hemoglobin (HbF)** and have structural differences that contribute to their shorter survival. - This shorter lifespan contributes to the **physiological anemia of infancy** seen in the first few months of life. *90-120 days* - This range represents the typical lifespan of **adult RBCs**, not neonatal RBCs. - Neonatal RBCs have a **demonstrably shorter lifespan** compared to adult erythrocytes. - Confusing adult and neonatal RBC lifespans is a common error in clinical practice. *120-150 days* - This range is **longer than even adult RBC lifespan** (typically 120 days). - This would be **highly atypical** for any normal erythrocyte population. *150-200 days* - This represents an **abnormally prolonged** RBC lifespan not seen in normal physiology. - Such extended survival would suggest **pathological conditions** affecting RBC destruction or measurement error.

Question 890: What is the standard duration used to define apnea of prematurity?

A. Between 10 and 15 sec
B. 20 sec (Correct Answer)
C. More than 30 sec
D. Less than 10 sec

Explanation: ***20 sec*** - Apnea of prematurity is defined as a cessation of breathing lasting **20 seconds or longer**, or a shorter pause in breathing accompanied by **bradycardia** (heart rate <100 bpm), **cyanosis**, or **pallor**. - This duration is crucial for determining the need for intervention and diagnosis in preterm infants. - The definition is standardized by the **American Academy of Pediatrics (AAP)** and is widely accepted in neonatal care. *Between 10 and 15 sec* - While pauses in breathing of this duration can be observed in preterm infants, they are usually considered **central periodic breathing** and not true apnea of prematurity unless accompanied by desaturation or bradycardia. - These shorter pauses are often considered benign, as significant physiological changes like bradycardia or cyanosis are less likely to occur. *More than 30 sec* - While a breathing cessation of more than 30 seconds certainly qualifies as apnea of prematurity, **20 seconds is the established minimum duration** for diagnosis. - Any apnea lasting longer than 20 seconds signifies a more severe event, indicating a greater risk to the infant. *Less than 10 sec* - Pauses in breathing lasting less than 10 seconds are generally considered **normal physiological variations** in both preterm and full-term infants. - These short pauses do not typically lead to significant oxygen desaturation or bradycardia and are not indicative of apnea of prematurity.

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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