Neonatology Practice Questions

Q: A 1-day-old neonate, born via home delivery, is brought with respiratory distress. The given CXR shows:

Congenital diaphragmatic hernia. ***Congenital diaphragmatic hernia*** - The chest X-ray likely shows bowel loops within the chest cavity, mediastinal shift, and an absent or poorly defined diaphragmatic outline, which are classic signs of a **congenital diaphragmatic hernia**. - A 1-day-old neonate with respiratory distress and these radiographic findings strongly suggests this diagnosis, as it results from incomplete **closure of the diaphragm** enabling abdominal organs to herniate into the thorax. *Hyaline membrane disease* - Characterized by **diffuse reticulogranular infiltrates** and **air bronchograms** due to surfactant deficiency. - Does not typically present with bowel loops in the chest or mediastinal shift. *Meconium aspiration syndrome* - CXR typically reveals **patchy infiltrates**, **hyperinflation**, and sometimes **pneumothorax** or **pleural effusions**. - There is no evidence of bowel in the chest or mediastinal shift characteristic of diaphragmatic hernia. *Transient Tachypnea of newborn* - CXR findings usually include **prominent perihilar streaking**, **fluid in the fissures**, and **hyperinflation**. - This condition resolves within 24-48 hours and doesn't involve herniated abdominal organs in the chest space.

Q: A newborn presents with the clinical features shown in the image below. What is the most likely diagnosis?

Trisomy 18. ***18 trisomy*** - The image shows a newborn with an **omphalocele (abdominal wall defect)** and characteristic **clenched hands with overlapping fingers**, which are common features of Trisomy 18 (Edwards syndrome). - Other typical features include **low-set ears**, **micrognathia**, **rocker-bottom feet**, and severe developmental delay, contributing to a poor prognosis. *21 trisomy* - Trisomy 21 (Down syndrome) typically presents with **upslanting palpebral fissures**, an **epicanthal fold**, a **single palmar crease**, and **intellectual disability**, which are not the prominent features seen here. - While congenital heart defects can be present in both, the specific hand posture and omphalocele are more indicative of Trisomy 18. *13 trisomy* - Trisomy 13 (Patau syndrome) is characterized by severe malformations, including **cleft lip and palate**, **polydactyly**, **cutis aplasia**, and **microphthalmia**, which are distinct from the features in the image. - **Holoprosencephaly** is also common in Trisomy 13, which is not suggested by the visual findings. *12 trisomy* - Trisomy 12 is **not a recognized viable chromosomal aneuploidy** in humans that leads to a distinct syndrome such as those related to chromosomes 13, 18, or 21. - Genetic disorders involving chromosome 12 are typically mosaic or involve partial aneuploidies.

Q: "Small for Date" (SFD) babies, also known as "small for gestational age" babies, weigh less than what percentile for the gestational age?

10^th percentile. ***10^th percentile*** - A baby is classified as **small for gestational age (SGA)** when their birth weight is below the **10th percentile** for their gestational age. - This definition helps identify infants who may be at increased risk for **perinatal morbidity and mortality** due to restricted growth. *20^th percentile* - A cutoff of the 20th percentile is generally considered within the **normal range** for birth weight. - Using this percentile would lead to an **overestimation** of infants experiencing growth restriction. *2^nd percentile* - While babies below the 2nd percentile are also considered SGA, this is a more **severe category** of growth restriction. - The standard definition for SGA encompasses all infants below the **10th percentile**, not just those with extreme growth deficits. *5^th percentile* - Similar to the 2nd percentile, the 5th percentile represents a subset of SGA babies with more **pronounced growth restriction**. - However, the universally accepted definition for **small for gestational age** uses the 10th percentile as the threshold.

Q: A term baby with birth weight of 2.8 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth ? I. The baby should be initiated on breastfeeding within one hour of birth II. The baby should be kept in a separate area from the mother III. The baby should be administered with 0.5 mg of vitamin K intramuscularly IV. The baby should be thoroughly examined for congenital malformations from head to toe Select the answer using the code given below :

I and IV. ***I and IV*** - **Early initiation of breastfeeding within one hour** is crucial for promoting bonding, establishing successful lactation, and providing the newborn with colostrum for immunity. - A comprehensive **head-to-toe examination for congenital malformations** is a standard part of immediate newborn care to identify any anomalies requiring further evaluation or intervention. *II and III* - **Keeping the baby with the mother (rooming-in)** is recommended to promote bonding, facilitate unrestricted breastfeeding, and enable continuous monitoring by the mother. - The standard dose of **vitamin K administered intramuscularly for a term baby is 1 mg**, not 0.5 mg, to prevent hemorrhagic disease of the newborn. *I and II* - While early breastfeeding (I) is correct, **keeping the baby in a separate area from the mother (II) is incorrect** as rooming-in is highly encouraged for newborn care. - Separating the baby can hinder initial bonding and interfere with an early and successful breastfeeding experience. *I and III* - **Early initiation of breastfeeding within one hour (I) is correct**, but the **dose of vitamin K (III) is incorrect**, as 1 mg is the standard, not 0.5 mg. - Incorrect medication dosages can have clinical implications, making this combination an unsuitable choice for correct initial care.

Q: Clinical features of an infant with Fetal growth retardation at birth include which of the following ? 1. Physical features give 'an old man look'. 2. Baby is alert, reflexes are normal. 3. Thick fat accumulates around shoulders of baby. Select the correct answer using the code given below :

1 and 2 only. ***1 and 2 only*** - Infants with **fetal growth restriction (FGR)** often have a **wasted appearance** with sparse subcutaneous fat, giving them an "old man look" due to prominence of skin folds and bones. - Despite their small size, typically FGR infants are **neurologically intact** at birth, maintaining normal alertness and reflexes. *1, 2 and 3* - This option is incorrect because the third statement, regarding **thick fat accumulation**, is not characteristic of FGR infants. FGR involves **poor fetal growth**, leading to reduced subcutaneous fat. - **Thick fat** would suggest normal or even accelerated growth, which is contrary to the definition of fetal growth restriction. *2 and 3 only* - This option is incorrect as it includes the incorrect statement about **thick fat accumulation** (statement 3) and omits the correct finding of an "old man look" (statement 1), which is a classic presentation of FGR. - While statement 2 is correct regarding alertness and reflexes, the inclusion of statement 3 makes this option invalid. *1 and 3 only* - This option is incorrect because statement 3, describing **thick fat accumulation**, is contrary to the features of FGR, which are characterized by **poor fat reserves** and a wasted appearance. - It also omits the correct statement about the baby being alert with normal reflexes (statement 2).

Q: Which of the following can be a complication in the baby due to post maturity of pregnancy ?

Meconium aspiration. ***Meconium aspiration*** - **Post-term pregnancies** (>42 weeks) are associated with **oligohydramnios** and **placental insufficiency**, leading to fetal distress - Fetal distress causes passage of **meconium** into amniotic fluid, which can be aspirated during gasping movements - **Meconium aspiration syndrome** is one of the **most characteristic complications** of post-maturity - This is the **most recognized** complication among the options listed *Hypoglycemia* - Post-term infants **ARE actually at risk** for hypoglycemia - Mechanism: **Placental insufficiency** leads to depleted fetal **glycogen stores** and subcutaneous fat - However, this is **less specific** to post-term pregnancy compared to meconium aspiration, as it occurs in multiple conditions - While medically correct, meconium aspiration is the more characteristic complication *Intraventricular hemorrhage* - This is primarily a complication of **prematurity**, especially in very low birth weight infants - Caused by fragility of the **germinal matrix** in preterm brains - **Not associated with post-term pregnancy** *Polycythemia* - Post-term infants **can develop polycythemia** (hematocrit >65%) - Mechanism: Chronic **placental insufficiency** → fetal hypoxia → increased **erythropoietin production** - While this is a recognized complication, **meconium aspiration** remains the **most classic and frequently tested** complication of post-maturity

Q: A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

Cephalhaematoma. ***Cephalhaematoma*** - A **cephalhaematoma** is a collection of blood between the **pericranium** and the skull bone, which is characteristically limited by the **suture lines**. This perfectly matches the clinical description. - It is often associated with **traumatic deliveries** like forceps delivery due to shearing forces on the skull and can appear hours to days after birth. *Subgaleal haemorrhage* - A **subgaleal haemorrhage** involves bleeding into the **potential space between the epicranial aponeurosis and the periosteum** (galea aponeurotica). - Unlike cephalhaematoma, it is **not limited by suture lines** and can spread across the entire scalp, potentially leading to significant blood loss. *Caput succedaneum* - **Caput succedaneum** is an **oedematous swelling of the fetal scalp** caused by pressure during head engagement, leading to fluid accumulation above the periosteum. - It is present at birth, often **crosses suture lines**, and usually resolves within a few days, differentiating it from a blood collection limited by sutures. *Intraventricular haemorrhage* - **Intraventricular haemorrhage** is bleeding into the brain's ventricular system and is a serious condition most commonly seen in **premature infants**. - It involves **bleeding within the brain** itself, not an external scalp swelling, and presents with neurological symptoms.

Q: Which of the following is correct regarding "witch's milk"?

It is seen in full-term infants.. ***It is seen in full-term infants.*** - **Witch's milk** (neonatal galactorrhea) is a physiological phenomenon observed in newborns due to the **withdrawal of maternal hormones** (estrogens, progesterone, and prolactin) after birth. - These maternal hormones cross the placenta during pregnancy and stimulate the fetal breast tissue. - While it can occur in both preterm and term infants, it is **more commonly and prominently observed in full-term infants** who have had greater exposure to maternal hormones. - This condition typically appears 3-5 days after birth and resolves spontaneously within a few weeks. *It is caused by stimulation of foetal breast by calcitonin.* - **Calcitonin** is a hormone involved in calcium and bone metabolism, not breast development or milk production. - **Witch's milk** is caused by the withdrawal of maternal hormones (estrogens, progesterone, and prolactin) after birth, not calcitonin. *It is seen only in preterm infants.* - This is incorrect as witch's milk can occur in **both preterm and full-term infants**. - It is actually **more common in full-term newborns** due to their longer exposure to maternal hormones in utero. *It is caused by stimulation of foetal breast by progesterone.* - While **progesterone** is one of the maternal hormones involved, the mechanism is more accurately described as a **withdrawal phenomenon** rather than ongoing stimulation. - After birth, the sudden **withdrawal of maternal estrogens, progesterone, and prolactin** triggers the breast tissue to secrete milk. - The wording "stimulation by progesterone" is misleading as it suggests active stimulation rather than the withdrawal mechanism that actually causes the milk secretion.

Q: In a newborn, the Apgar score has been recorded at 1 minute of birth. Which one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?

3. ***3*** - The Apgar score is calculated based on five criteria: **Appearance**, **Pulse**, **Grimace**, **Activity**, and **Respiration** (APGAR). Each criterion is scored 0, 1, or 2. - Based on the given findings: - **Heart rate (Pulse)**: 92/min scores **1** (below 100/min). - **Respiratory effort (Respiration)**: Slow, irregular scores **1**. - **Muscle tone (Activity)**: Flaccid scores **0**. - **Reflex response (Grimace)**: No response scores **0**. - **Colour (Appearance)**: Body pink, extremities blue (acrocyanosis) scores **1**. - Summing these scores (1 + 1 + 0 + 0 + 1) gives a total Apgar score of **3**. *2* - This score would mean that the newborn has a **more severe depression** in vital signs compared to the actual findings. - A score of 2 would require at least one of the 1-point criteria to be a 0-point criterion or combination of a 0-point criterion become 1. *0* - An Apgar score of 0 would indicate that the infant has **no vital signs** (no heart rate, no respiratory effort, no muscle tone, no reflex response, and completely blue/pale). - This is not consistent with a heart rate of 92/min, slow/irregular respirations, and body pink color. *5* - An Apgar score of 5 would imply a **much healthier** newborn with better scores in most categories. - This would require findings such as a heart rate over 100 bpm, good crying, some flexion of extremities, or an all-pink appearance, which are not present here.

Question 1

A 1-day-old neonate, born via home delivery, is brought with respiratory distress. The given CXR shows:

Accepted Answer

Congenital diaphragmatic hernia

Answer

Hyaline membrane disease

Answer

Meconium aspiration syndrome

Answer

Transient Tachypnea of newborn

Question 2

A newborn presents with the clinical features shown in the image below. What is the most likely diagnosis?

Accepted Answer

Trisomy 18

Answer

Trisomy 21

Answer

Trisomy 13

Answer

Trisomy 12

Question 3

"Small for Date" (SFD) babies, also known as "small for gestational age" babies, weigh less than what percentile for the gestational age?

Accepted Answer

10^th percentile

Answer

20^th percentile

Answer

2^nd percentile

Answer

5^th percentile

Question 4

Which of the following are neonatal complications of maternal diabetes during pregnancy?
I. Hyperbilirubinemia
II. Hypocalcemia
III. Cardiomyopathy
IV. Hypoglycemia

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Question 5

A term baby with birth weight of 2.8 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth ?
I. The baby should be initiated on breastfeeding within one hour of birth
II. The baby should be kept in a separate area from the mother
III. The baby should be administered with 0.5 mg of vitamin K intramuscularly
IV. The baby should be thoroughly examined for congenital malformations from head to toe

Select the answer using the code given below :

Accepted Answer

I and IV

Answer

II and III

Answer

I and II

Answer

I and III

Question 6

Clinical features of an infant with Fetal growth retardation at birth include which of the following ?

1. Physical features give 'an old man look'. 
2. Baby is alert, reflexes are normal. 
3. Thick fat accumulates around shoulders of baby.

Select the correct answer using the code given below :

Accepted Answer

1 and 2 only

Answer

1, 2 and 3

Answer

1 and 3 only

Answer

2 and 3 only

Question 7

Which of the following can be a complication in the baby due to post maturity of pregnancy ?

Accepted Answer

Meconium aspiration

Answer

Hypoglycemia

Answer

Intraventricular hemorrhage

Answer

Polycythemia

Question 8

A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

Accepted Answer

Cephalhaematoma

Answer

Subgaleal haemorrhage

Answer

Caput succedaneum

Answer

Intraventricular haemorrhage

Question 9

Which of the following is correct regarding "witch's milk"?

Accepted Answer

It is seen in full-term infants.

Answer

It is caused by stimulation of foetal breast by calcitonin.

Answer

It is seen only in preterm infants.

Answer

It is caused by stimulation of foetal breast by progesterone.

Question 10

In a newborn, the Apgar score has been recorded at 1 minute of birth. Which one of the following best reflects the Apgar score of this newborn infant on a scale of 0 to 10?

Accepted Answer

3

Answer

2

Answer

0

Answer

5

Neonatology — MCQs

Neonatology — MCQs

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