Neonatology Practice Questions

Q: A woman delivered a baby of 2.2 kg weight. Her LMP is not known. Which of the following is NOT used to assess the maturity of the baby?

Weight of the baby. To assess the maturity (gestational age) of a newborn, clinicians rely on physical and neurological characteristics that evolve predictably with fetal age. **Why "Weight of the baby" is the correct answer:** The weight of a baby is a measure of **growth**, not **maturity**. While there is a general correlation between weight and gestational age, weight can be misleading. For example, a "Small for Gestational Age" (SGA) baby may be full-term (mature) but weigh only 2.0 kg due to intrauterine growth restriction (IUGR). Conversely, an "Infant of a Diabetic Mother" (IDM) may be preterm (immature) but weigh 4.0 kg. Therefore, weight cannot reliably determine if a baby is preterm or term. **Explanation of Incorrect Options (Maturity Indicators):** These features are components of the **New Ballard Score** or **Expanded Dubowitz Score**, used to estimate gestational age: * **Sole creases:** These appear first on the anterior portion and progress to the heel as the fetus matures. A full-term baby has creases covering the entire sole. * **Ear cartilage:** In very preterm babies, the pinna is flat and lacks recoil. As maturity increases, cartilage develops, making the ear firm with immediate recoil. * **Breast nodule:** The size of the breast tissue (measured in mm) increases with gestational age, influenced by maternal hormones in the final weeks of pregnancy. **Clinical Pearls for NEET-PG:** * **New Ballard Score:** The most commonly used clinical tool to assess gestational age (valid for 20–44 weeks). It assesses 6 physical and 6 neuromuscular criteria. * **Preterm vs. SGA:** Always distinguish between the two. A baby <2.5 kg is "Low Birth Weight," but only a baby born <37 weeks is "Preterm." * **Neuromuscular signs:** Features like the **Square window**, **Arm recoil**, and **Popliteal angle** are also vital indicators of maturity.

Q: A newborn weighing 1000 g is born at 30 weeks gestational age with respiratory distress within 1 hour of birth. All of the following are diagnostic possibilities EXCEPT?

Bronchopulmonary dysplasia. **Explanation:** The core concept in this question is the **timing of clinical presentation**. The infant is presenting with respiratory distress within **one hour of birth**, which indicates an acute, early-onset condition. **Why Bronchopulmonary Dysplasia (BPD) is the correct answer:** BPD is a **chronic lung disease** of prematurity. By definition, it is diagnosed in infants who require supplemental oxygen for at least 28 days or beyond 36 weeks of postmenstrual age. It is a sequela of neonatal respiratory distress and its management (oxygen toxicity, barotrauma), not a cause of distress in the immediate postnatal period. Therefore, it cannot be a diagnostic possibility within the first hour of life. **Analysis of incorrect options:** * **Hyaline Membrane Disease (HMD/RDS):** This is the most common cause of distress in a 30-week preterm infant (1000g) due to surfactant deficiency. It typically presents within minutes to a few hours after birth. * **Diaphragmatic Hernia:** This is a structural anomaly that presents with immediate respiratory distress, a scaphoid abdomen, and shifted heart sounds at birth. * **Pulmonary Hemorrhage:** Often seen in very low birth weight (VLBW) infants, it can occur early, especially in the context of severe RDS or a large patent ductus arteriosus (PDA). **NEET-PG High-Yield Pearls:** * **HMD X-ray:** Characterized by a "Ground Glass" appearance and air bronchograms. * **BPD Definition:** Oxygen requirement at 28 days of life (Northway criteria) or 36 weeks PMA (NIH criteria). * **Surfactant:** Produced by Type II pneumocytes; the L/S ratio > 2 indicates lung maturity. * **Immediate distress + Scaphoid abdomen:** Always suspect Congenital Diaphragmatic Hernia (CDH). Bag and mask ventilation is contraindicated in CDH.

Q: Which of the following is not a feature of fetal alcohol syndrome?

Large proportionate body. **Explanation:** Fetal Alcohol Syndrome (FAS) occurs due to the teratogenic effects of maternal alcohol consumption during pregnancy. Alcohol crosses the placental barrier, leading to multi-organ developmental defects [1], [2]. **Why "Large proportionate body" is the correct answer:** Alcohol is a potent inhibitor of cell proliferation and protein synthesis. Instead of large size, FAS is characterized by **Intrauterine Growth Retardation (IUGR)** and postnatal growth deficiency [1]. Affected infants are typically small for gestational age and remain in the lower percentiles for height and weight throughout childhood. Therefore, a "large proportionate body" is the opposite of what is clinically observed. **Analysis of incorrect options:** * **Microcephaly (A):** Alcohol is neurotoxic to the developing brain. Reduced brain volume and head circumference (microcephaly) are hallmark features [2]. * **Low intelligence (B):** Alcohol is the leading preventable cause of intellectual disability worldwide. It causes structural brain abnormalities leading to cognitive impairment and behavioral issues [1]. * **Intrauterine growth retardation (D):** As mentioned, alcohol restricts fetal growth, leading to permanent deficits in size and weight [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Facial Features:** Look for the classic triad: **Short palpebral fissures**, **Smooth philtrum**, and a **Thin upper lip (vermilion border)** [1]. * **Cardiac Defects:** The most common association is a **Ventricular Septal Defect (VSD)**. * **Mechanism:** Alcohol induces oxidative stress and interferes with cell adhesion molecules (like L1-CAM), disrupting neuronal migration [2]. * **Safe Limit:** There is **no known safe amount** of alcohol consumption during pregnancy.

Q: In necrotizing enterocolitis, what is the earliest change seen on X-ray abdomen?

Non-specific bowel dilatation. **Explanation:** Necrotizing Enterocolitis (NEC) is the most common gastrointestinal emergency in neonates, particularly preterm infants. Understanding the radiological progression is crucial for early diagnosis and management. **1. Why "Non-specific bowel dilatation" is correct:** The earliest radiological sign of NEC is **generalized, non-specific bowel dilatation** (ileus). This occurs due to intestinal ischemia and dysmotility, leading to gas accumulation before structural damage like intramural air or perforation becomes visible. It is often described as "fixed" or "persistent" loops on serial X-rays. **2. Why the other options are incorrect:** * **B. Gas in the intestinal wall (Pneumatosis intestinalis):** This is the **pathognomonic** (most characteristic) sign of NEC, but it is a later finding than simple dilatation. It indicates that gas-producing bacteria have invaded the bowel wall. * **C. Gas in the splenic flexure:** This is not a specific diagnostic feature of NEC. While gas distribution can vary, localized gas in the splenic flexure is more commonly associated with Hirschsprung disease (cutoff sign). * **D. Ground glass appearance:** This typically suggests **ascites** (peritoneal fluid) or can be seen in Meconium Ileus. In NEC, it may indicate bowel wall edema or perforation with fluid leak, but it is not the earliest sign. **Clinical Pearls for NEET-PG:** * **Pathognomonic Sign:** Pneumatosis intestinalis (linear or cystic lucencies in the bowel wall). * **Sign of Perforation:** Pneumoperitoneum (Football sign, Rigler’s sign, or air under the diaphragm). * **Sign of Advanced Disease:** Portal venous gas (indicates severe necrosis). * **Bell’s Staging:** Used to classify NEC severity based on clinical and radiological findings. * **Most common site:** Terminal ileum and proximal colon.

Q: A 26-year-old primigravida develops gestational diabetes and remains hyperglycemic during the remainder of her pregnancy. Which of the following abnormalities in the newborn child is likely related to the maternal hyperglycemia?

Increased birth weight. **Explanation:** The correct answer is **C. Increased birth weight (Macrosomia).** **Pathophysiology:** The underlying mechanism is explained by the **Pedersen Hypothesis**. Maternal hyperglycemia leads to fetal hyperglycemia because glucose crosses the placenta via facilitated diffusion. In response, the fetal pancreas undergoes islet cell hyperplasia and secretes excess insulin (fetal hyperinsulinemia). Since insulin is a potent anabolic hormone and a structural analogue of Insulin-like Growth Factor (IGF-1), it promotes excessive deposition of fat and glycogen in fetal tissues, leading to **macrosomia** (birth weight >4000g or >90th percentile). **Analysis of Incorrect Options:** * **A. Ambiguous genitalia:** This is typically caused by Congenital Adrenal Hyperplasia (CAH) or chromosomal abnormalities, not maternal glucose levels. * **B. Cretinism:** This results from untreated congenital hypothyroidism (iodine deficiency or thyroid dysgenesis), not maternal diabetes. * **D. Sheehan syndrome:** This is a maternal complication involving postpartum pituitary necrosis due to severe obstetric hemorrhage; it does not occur in the newborn. **NEET-PG High-Yield Pearls:** * **Most common cardiac anomaly** in infants of diabetic mothers (IDM): Hypertrophic Cardiomyopathy (specifically asymmetric septal hypertrophy). * **Most specific anomaly:** Caudal Regression Syndrome (Sacral agenesis). * **Metabolic complications in IDM:** Hypoglycemia (due to persistent hyperinsulinemia after cord clamping), Hypocalcemia, Hypomagnesemia, and Polycythemia. * **Respiratory:** Increased risk of Respiratory Distress Syndrome (RDS) because hyperinsulinemia inhibits surfactant production by type II pneumocytes.

Q: A 32-week, 1400 g neonate is born to a primigravida. The baby did not require resuscitation and showed stable vitals. The baby was transferred to the NICU. How will you manage the feeding of this patient?

Start total enteral feeding; IV feeding is not required.. ### Explanation The management of feeding in a preterm neonate depends on the **gestational age, birth weight, and clinical stability**. **1. Why Option A is Correct:** According to standard neonatology protocols (including AIIMS and NNF guidelines), stable neonates born at **≥32 weeks** of gestation with a birth weight of **≥1200–1500 g** can usually tolerate **total enteral nutrition** from the first day of life. Since this neonate is 32 weeks, weighs 1400 g, and is hemodynamically stable (no resuscitation required, stable vitals), there is no contraindication to starting full enteral feeds (preferably via orogastric tube or paladai/spoon). Intravenous (IV) fluids are generally not required if the baby can meet their fluid and caloric requirements enterally. **2. Why Other Options are Incorrect:** * **Options B, C, and D:** These options suggest starting IV or parenteral feeding. IV fluids/Parenteral nutrition are typically reserved for babies **<32 weeks**, those weighing **<1200–1500 g**, or those who are **clinically unstable** (e.g., respiratory distress, sepsis, or birth asphyxia). Delaying enteral feeding (as suggested in C and D) unnecessarily increases the risk of catheter-related infections and delays gut maturation. **3. Clinical Pearls for NEET-PG:** * **Trophic Feeding (Minimal Enteral Nutrition):** Starting small volumes (10–15 ml/kg/day) of milk to "prime" the gut without expecting nutritional weight gain. Indicated in very low birth weight (VLBW) infants who are not yet ready for full feeds. * **Feeding Methods by Gestation:** * ** 34 weeks:** Direct breastfeeding. * **Choice of Milk:** Expressed Breast Milk (EBM) is the gold standard to prevent Necrotizing Enterocolitis (NEC).

Q: Stroke bite lesions are seen in which of the following conditions?

Macular staining of infant. **Explanation:** **Macular staining of the infant** (Option C), also known as **Nevus Simplex**, is the most common vascular lesion in neonates. These are capillary malformations characterized by pale pink, maculopapular lesions. They are colloquially named based on their location: * **"Stork bite":** When located on the nape of the neck. * **"Angel kiss":** When located on the eyelids or glabella. These lesions are benign, blanch on pressure, and typically fade within the first year of life (except for nuchal lesions, which may persist). **Why other options are incorrect:** * **Sturge-Weber Syndrome (A):** Associated with a **Port-wine stain** (Nevus Flammeus). Unlike stork bites, these are usually unilateral, follow the trigeminal nerve distribution, do not cross the midline, and do not fade with age. * **Blue Rubber Bleb Nevus Syndrome (B):** A rare condition characterized by multiple cutaneous and gastrointestinal venous malformations (hemangiomas) that appear as bluish, rubbery blebs. * **Craniofacial Nevus (D):** A general term often used to describe larger melanocytic nevi or port-wine stains, but it is not the specific clinical term for the transient macular stains seen in newborns. **High-Yield Clinical Pearls for NEET-PG:** * **Nevus Simplex (Stork bite):** Most common; transient; fades spontaneously. * **Nevus Flammeus (Port-wine stain):** Permanent; grows with the child; associated with Sturge-Weber syndrome (glaucoma, seizures, tram-track calcifications). * **Salmon Patch:** Another synonym for Nevus Simplex. * **Management:** Reassurance is the key, as no treatment is required for stork bites.

Question 1

A woman delivered a baby of 2.2 kg weight. Her LMP is not known. Which of the following is NOT used to assess the maturity of the baby?

Accepted Answer

Weight of the baby

Answer

Sole creases

Answer

Ear cartilage

Answer

Breast nodule

Question 2

What is true about Hyaline membrane disease?

Accepted Answer

Functional residual capacity (FRC) is below the closing volume

Answer

Functional residual capacity (FRC) is above the closing volume

Answer

Functional residual capacity (FRC) is equal to the closing volume

Answer

Functional residual capacity (FRC) does not depend on the closing volume

Question 3

A newborn weighing 1000 g is born at 30 weeks gestational age with respiratory distress within 1 hour of birth. All of the following are diagnostic possibilities EXCEPT?

Accepted Answer

Bronchopulmonary dysplasia

Answer

Diaphragmatic hernia

Answer

Hyaline membrane disease

Answer

Pulmonary hemorrhage

Question 4

Which of the following is not a feature of fetal alcohol syndrome?

Accepted Answer

Large proportionate body

Answer

Microcephaly

Answer

Low intelligence

Answer

Intrauterine growth retardation

Question 5

In necrotizing enterocolitis, what is the earliest change seen on X-ray abdomen?

Accepted Answer

Non-specific bowel dilatation

Answer

Gas in the intestinal wall

Answer

Gas in the splenic flexure

Answer

Ground glass appearance

Question 6

A 26-year-old primigravida develops gestational diabetes and remains hyperglycemic during the remainder of her pregnancy. Which of the following abnormalities in the newborn child is likely related to the maternal hyperglycemia?

Accepted Answer

Increased birth weight

Answer

Ambiguous genitalia

Answer

Cretinism

Answer

Sheehan syndrome

Question 7

During neonatal resuscitation, when should chest compressions be started, and what is the ideal ratio of chest compressions to ventilation?

Accepted Answer

Heart rate less than 60 beats/min; 3:1

Answer

Heart rate less than 60 beats/min; 30:2

Answer

Heart rate less than 100 beats/min; 2:1

Answer

Heart rate less than 100 beats/min; 15:1

Question 8

A 32-week, 1400 g neonate is born to a primigravida. The baby did not require resuscitation and showed stable vitals. The baby was transferred to the NICU. How will you manage the feeding of this patient?

Accepted Answer

Start total enteral feeding; IV feeding is not required.

Answer

Start IV feeding with minimal enteral feeding.

Answer

Start IV feeding and introduce enteral feeding on the 2nd day of life.

Answer

Start parenteral feeding and institute oral feeding on the 2nd day of life.

Question 9

Respiratory distress syndrome in the newborn is commonly associated with which of the following conditions, except?

Accepted Answer

Intrauterine growth retardation

Answer

Diabetic pregnancy

Answer

Prematurity

Answer

Following an elective cesarean section

Question 10

Stroke bite lesions are seen in which of the following conditions?

Accepted Answer

Macular staining of infant

Answer

Sturge-Weber syndrome

Answer

Blue rubber bleb nevus syndrome

Answer

Craniofacial nevus

Neonatology — MCQs

Neonatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?