Neonatology Practice Questions

Q: Most common newborn rash which presents at 24-48 hours of life is

Erythema toxicum neonatorum. ***Erythematous papular pustular lesions*** - This description is characteristic of **Erythema toxicum neonatorum**, which is the **most common benign transient rash in newborns.** - It typically appears between **24 and 48 hours of life** and presents with discrete **erythematous macules**, papules, and pustules on a red base. *Milia* - Milia are **tiny, pearly white cysts** that are present from birth and are due to trapped keratin. - While common, they are **not typically red or pustular** and do not usually have a delayed onset at 24-48 hours specifically. *Transient neonatal pustular melanosis* - This rash is present at **birth** and consists of **non-erythematous pustules** that rupture to leave collarettes of scale and dark macules. - Unlike erythema toxicum, it **lacks the erythematous base** and is usually present earlier. *Erythematous maculopapular rash* - This is a **general description** that could fit several conditions but **lacks the specific pustular component** that is key to identifying erythema toxicum neonatorum. - While erythema toxicum has macules and papules, the **presence of pustules** is a hallmark.

Q: Apgar score is used in:

Newborn assessment. ***Newborn assessment*** - The **Apgar score** is a standardized clinical assessment tool used to evaluate the **physical condition of newborn infants** immediately after birth. - Developed by Dr. Virginia Apgar in 1952, it assesses five parameters at **1 minute and 5 minutes** after delivery (extended to 10, 15, and 20 minutes if needed). - The five components assessed are: - **A**ppearance (skin color): 0-2 points - **P**ulse (heart rate): 0-2 points - **G**rimace (reflex irritability): 0-2 points - **A**ctivity (muscle tone): 0-2 points - **R**espiration (breathing effort): 0-2 points - **Total score ranges from 0-10**, with scores of 7-10 considered normal, 4-6 indicating moderate distress, and 0-3 indicating severe distress requiring immediate resuscitation. - It helps **identify neonates requiring immediate medical intervention** and provides a standardized method for documenting the newborn's transition to extrauterine life. *Maternal health assessment* - Maternal health is assessed using different tools such as **antenatal risk scoring systems**, blood pressure monitoring, and laboratory investigations. - The Apgar score is specifically designed for **neonates, not mothers**. *Nutritional status evaluation* - Nutritional status is assessed using anthropometric measurements like **weight-for-height, BMI, MUAC** (mid-upper arm circumference), and biochemical markers. - The Apgar score does not evaluate nutritional parameters. *Infectious disease severity grading* - Infectious disease severity uses specific scoring systems like **APACHE II, SOFA score, or disease-specific criteria** (e.g., WHO classification for dengue severity). - The Apgar score is a **neonatal assessment tool**, not used for infectious disease evaluation.

Q: A 37-week small-for-date neonate is most likely to develop

Hypoglycaemia. ***Hypoglycaemia*** - **Small-for-date** neonates have reduced **glycogen stores** due to chronic fetal stress or placental insufficiency. - Their increased metabolic demands relative to limited energy reserves make them prone to **low blood glucose**. - This is the **most immediate metabolic complication** requiring urgent screening and management. *Hyaline membrane disease* - This condition, also known as **respiratory distress syndrome**, primarily affects **premature neonates** due to surfactant deficiency. - **Small-for-date infants** at term (37 weeks) typically have **accelerated lung maturity** due to chronic intrauterine stress, making them **less susceptible** to RDS compared to appropriately grown preterm infants. *Hypocalcaemia* - While neonates can experience hypocalcemia, it is particularly common in infants of **diabetic mothers**, those with **asphyxia**, or those born **prematurely**. - Small-for-date status alone isn't the primary risk factor for **neonatal hypocalcaemia**. *Hypothermia* - **Small-for-date** infants have a larger **surface area to body mass ratio** and reduced **subcutaneous fat**, which significantly increases heat loss. - This is indeed a **major risk** requiring immediate attention at birth (thermal protection, skin-to-skin care). - However, **hypoglycemia** is considered the **most characteristic metabolic derangement** and "most likely" complication specifically associated with SGA status, making it the best answer for this question.

Q: The appropriate treatment for the baby of a woman who is HBsAg positive but HBeAg negative is

Both active and passive immunisation soon after birth. **Both active and passive immunisation soon after birth** - **Active immunization** (Hepatitis B vaccine) provides long-term immunity by stimulating the infant's immune system to produce antibodies. - **Passive immunization** (Hepatitis B immune globulin, HBIG) provides immediate, short-term protection through pre-formed antibodies, crucial for preventing infection in the critical perinatal period. *Passive immunisation soon after birth but active immunisation after one year of age* - Delaying active immunization until after one year of age would leave a significant window during which the infant is vulnerable to **Hepatitis B infection** from the mother, as passive immunity is only temporary. - The combination of immediate active and passive immunisation is far more effective at preventing **perinatal transmission**. *Only active immunisation soon after birth* - Active immunization alone may not provide immediate enough protection through antibody development, leaving the infant susceptible to **Hepatitis B infection** during their first few weeks of life when exposure risk is highest. - The onset of protective immunity from the vaccine can take several weeks, which is insufficient for immediate protection against perinatal exposure. *Only passive immunisation soon after birth* - While passive immunisation provides immediate protection, it is only temporary and does not confer long-term immunity against **Hepatitis B**. - Without active immunisation, the infant would eventually lose the passively acquired antibodies and remain vulnerable to future **Hepatitis B exposures**.

Q: Neo-natal infection in a Hepatitis 'B' positive pregnant woman can be prevented by administering:

Vaccine and Immunoglobulin. ***Vaccine and Immunoglobulin*** - Administering both the **Hepatitis B vaccine** and **Hepatitis B immune globulin (HBIG)** provides both active and passive immunity to the newborn. - This combination is crucial for preventing perinatal transmission of HBV from an infected mother, significantly reducing the risk of the baby becoming a chronic carrier. *Hepatitis 'B' vaccine* - The vaccine alone provides **active immunity**, which takes time to develop, thus not offering immediate protection against acute exposure at birth. - While essential for long-term protection, it's insufficient as a sole measure for newborns at high risk of immediate infection. *Immunoglobulin* - **Hepatitis B immune globulin (HBIG)** provides **passive immunity**, offering immediate but short-term protection. - It contains pre-formed antibodies that neutralize the virus, but it does not confer lasting immunity. *Corticosteroids* - **Corticosteroids** are used as anti-inflammatory or immunosuppressive agents and have no role in preventing viral infections like Hepatitis B. - Their use in this context would be inappropriate and could even be harmful.

Q: Cephalhematomas are most commonly found over:

Parietal bone. ***Parietal bone*** - The **parietal bones** are the most common site for cephalhematomas due to their prominence and susceptibility to trauma during vaginal delivery [1]. - The **force of uterine contractions** and contact with the birth canal can cause blood vessels beneath the periosteum of the parietal bone to rupture [1]. *Occipital bone* - While possible, cephalhematomas are less commonly observed over the **occipital bone** compared to the parietal region. - The **occipital protrusion** is less frequently subjected to the specific shearing forces that cause subperiosteal bleeding. *Temporal bone* - Cephalhematomas over the **temporal bone** are rare, primarily because this area is less frequently directly impacted during birth. - The relatively thinner bone and surrounding muscles also provide some protection against the typical trauma leading to this condition. *Frontal bone* - Cephalhematomas are generally uncommon over the **frontal bone**. - This area is less exposed to direct pressure and friction from the maternal pelvis during delivery.

Q: What is the most common cause of intestinal obstruction in neonates?

Duodenal atresia. ***Duodenal atresia*** - **Duodenal atresia** is one of the **most common causes of intestinal obstruction** in neonates, accounting for approximately 30-40% of all neonatal intestinal obstructions. - It is a **congenital malformation** where the duodenum is completely blocked, leading to the characteristic **"double-bubble" sign** on X-ray (one bubble in the stomach and one in the proximal duodenum). - Strongly associated with **Down syndrome** (30% of cases) and **polyhydramnios** during pregnancy. - Presents with **bilious vomiting** within the first 24-48 hours of life. *Meconium ileus* - **Meconium ileus** accounts for only **10-15%** of neonatal intestinal obstruction cases. - It is strongly associated with **cystic fibrosis** (90% of meconium ileus cases have CF), with approximately 10-20% of CF newborns presenting with meconium ileus. - Caused by thick, inspissated meconium obstructing the terminal ileum. *Hirschsprung's disease* - **Hirschsprung's disease** causes functional obstruction due to **absence of ganglion cells** in the distal bowel (aganglionic segment). - Accounts for **15-20%** of neonatal intestinal obstruction cases. - Typically presents with **delayed passage of meconium** (>48 hours), abdominal distension, and bilious vomiting. *Volvulus neonatorium* - **Volvulus neonatorium** involves twisting of the intestine, often due to **intestinal malrotation**, leading to obstruction and vascular compromise. - Accounts for **10-15%** of cases and presents as a surgical emergency with bilious vomiting and potential bowel ischemia.

Question 1

To prevent neonatal tetanus in an infant born to a woman who has not been given Tetanus Toxoid (TT) appropriately during pregnancy, what should ideally be done?

Accepted Answer

Give one dose of TT to the mother and one dose of TIG to the infant within 6 hours of birth

Answer

Injection Tetanus Immunoglobulin (TIG) has to be administered to the infant within 6 hours of birth

Answer

Give one dose of TT to the mother and one dose of TIG to the infant after 72 hours of birth

Answer

Give one dose of TT to the mother immediately

Question 2

Most common newborn rash which presents at 24-48 hours of life is

Accepted Answer

Erythema toxicum neonatorum

Answer

Milia

Answer

Transient neonatal pustular melanosis

Answer

Erythematous maculopapular rash

Question 3

Apgar score is used in:

Accepted Answer

Newborn assessment

Answer

Maternal health assessment

Answer

Nutritional status evaluation

Answer

Infectious disease severity grading

Question 4

Meconium aspiration syndrome can be prevented by taking the following measures except :

Accepted Answer

Delivering the baby by emergency caesarean section

Answer

Amnioinfusion

Answer

Oropharyngeal suctioning

Answer

Suctioning of trachea through laryngoscope

Question 5

A 37-week small-for-date neonate is most likely to develop

Accepted Answer

Hypoglycaemia

Answer

Hyaline membrane disease

Answer

Hypocalcaemia

Answer

Hypothermia

Question 6

The appropriate treatment for the baby of a woman who is HBsAg positive but HBeAg negative is

Accepted Answer

Both active and passive immunisation soon after birth

Answer

Passive immunisation soon after birth but active immunisation after one year of age

Answer

Only active immunisation soon after birth

Answer

Only passive immunisation soon after birth

Question 7

A woman suffering from active tuberculosis not on ATT has a full term vaginal delivery. All the following should be done except:

Accepted Answer

BCG should be given to the neonate

Answer

Neonate should be isolated from mother

Answer

Breastfeed the neonate

Answer

Neonate should be given INH

Question 8

Neo-natal infection in a Hepatitis 'B' positive pregnant woman can be prevented by administering:

Accepted Answer

Vaccine and Immunoglobulin

Answer

Hepatitis 'B' vaccine

Answer

Immunoglobulin

Answer

Corticosteroids

Question 9

Cephalhematomas are most commonly found over:

Accepted Answer

Parietal bone

Answer

Occipital bone

Answer

Temporal bone

Answer

Frontal bone

Question 10

What is the most common cause of intestinal obstruction in neonates?

Accepted Answer

Duodenal atresia

Answer

Volvulus neonatorium

Answer

Hirschsprung's disease

Answer

Meconium ileus

Neonatology — MCQs

Neonatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?