What is the average weight gain of the neonate per day after the initial weight loss period?
What is the most common cause of pneumonia in early onset sepsis in neonates?
Which of the following drugs is most commonly used for cardiovascular support in post-resuscitation care of neonates?
Treatment of choice for symptomatic neonatal hypoglycemia is
Which of the following is NOT a recognized cause of neonatal bradycardia?
Which of the following is not a cause of neonatal anaemia?
A 3-month-old child presents with indrawing of the chest and a respiratory rate of 52 breaths per minute. This condition can be classified as:
Chronic lung disease in infancy is defined as
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?
Further investigation is essential in a newborn with which of the following conditions?
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 11: 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 12: 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 13: 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 14: 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 15: 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 16: 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 17: A 3-month-old child presents with indrawing of the chest and a respiratory rate of 52 breaths per minute. This condition can be classified as:
- A. SIRS
- B. Respiratory distress (Correct Answer)
- C. Tachypnoea
- D. ARDS
Explanation: ***Respiratory distress*** - **Indrawing of the chest** is a classic sign of increased work of breathing, indicating the child is struggling to oxygenate. - A respiratory rate of **52 breaths per minute in a 3-month-old** is significantly elevated and, combined with indrawing, points to respiratory distress. - According to **WHO IMCI guidelines**, chest indrawing in a child with fast breathing is classified as **pneumonia/respiratory distress** requiring immediate treatment. *SIRS* - **Systemic Inflammatory Response Syndrome (SIRS)** criteria are typically more comprehensive and include fever or hypothermia, tachycardia, tachypnea, and abnormal white blood cell count. - While tachypnea is present, the other defining features of SIRS are not fully met by the information provided, nor does indrawing directly classify as SIRS. *Tachypnoea* - **Tachypnoea** refers specifically to an elevated respiratory rate, which is present (52 breaths per minute). - However, the presence of **chest indrawing** indicates more than just rapid breathing; it signifies significant respiratory effort and compromise. - The classification must capture both the elevated rate and the increased work of breathing. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a severe form of lung injury characterized by widespread inflammation, hypoxemia, and bilateral infiltrates on chest imaging. - While respiratory distress is a feature of ARDS, the given information is insufficient to diagnose ARDS, which requires specific criteria relating to oxygenation and radiological findings.
Question 18: 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 19: 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 20: 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.