Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 881: 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 882: 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 883: 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 884: 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 885: 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 886: 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 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: 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**.

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: Which of the following statements about Kernicterus is TRUE?

A. Prematurity is the primary cause of Kernicterus
B. Kernicterus is due to Unconjugated Hyperbilirubinemia (Correct Answer)
C. Kernicterus is not associated with increased morbidity.
D. Yellowish staining occurs primarily in the Cerebellum in Kernicterus

Explanation: ***Kernicterus is due to Unconjugated Hyperbilirubinemia*** - **Kernicterus** is a rare but severe neurological condition caused by **high levels of unconjugated bilirubin** in a newborn's blood. - **Unconjugated bilirubin** is lipophilic and can cross the **blood-brain barrier**, particularly when levels are excessively high or the barrier is compromised. *Prematurity is the primary cause of Kernicterus* - **Prematurity** is a **major risk factor** for kernicterus, as premature infants have immature livers, reduced albumin binding sites, and a less developed blood-brain barrier. - However, the primary cause is the **unconjugated hyperbilirubinemia** itself, which can occur in both term and preterm infants, though it is more common and severe in prematures. *Yellowish staining occurs primarily in the Cerebellum in Kernicterus* - While kernicterus does affect the **cerebellum**, the **primary and most characteristic sites** of bilirubin deposition are the **basal ganglia**, hippocampus, and brainstem nuclei. - The **basal ganglia** are the predominant target, not the cerebellum, making this statement anatomically incorrect. *Kernicterus is not associated with increased morbidity.* - Kernicterus is associated with **significant morbidity** and can lead to permanent neurological damage, including **cerebral palsy**, hearing loss, intellectual disabilities, and gaze abnormalities. - It is a medical emergency that requires prompt diagnosis and treatment to prevent long-term neurological sequelae.

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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