Neonatology Practice Questions

Q: A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken? 1. The baby should be exclusively breast fed for first six months 2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight 3. Baby should be kept with mother and kangaroo care to be given Select the correct answer using the code given below:

1 and 3 only. ***1 and 3 only*** - **Exclusive breastfeeding** for the first six months is crucial for **nutrition** and **immunity**, especially for low birth weight babies. - **Kangaroo Mother Care (KMC)**, involving skin-to-skin contact, helps regulate the baby's temperature, promotes bonding, and supports weight gain in LBW infants. *2 and 3 only* - While **Kangaroo Mother Care (KMC)** is appropriate for this baby, the recommendation to delay vaccination is incorrect. - **BCG vaccination** should be given at birth to babies weighing **≥2 kg** as per IAP guidelines, so a 2.2 kg baby qualifies for immediate vaccination. *1 and 2 only* - **Exclusive breastfeeding** is appropriate, but delaying vaccinations is not indicated for a baby weighing 2.2 kg. - **BCG** is given at birth for babies ≥2 kg, and routine immunization schedule should be followed without delay based on birth weight alone. *1, 2 and 3* - While statements 1 and 3 correctly identify beneficial practices (exclusive breastfeeding and kangaroo care), statement 2 is incorrect. - **Vaccination guidelines** (IAP/UIP) recommend administering **BCG at birth** for babies ≥2 kg, and routine immunizations as per schedule without weight-based delays for a 2.2 kg baby.

Q: Least chances of perinatal transmission are seen in?

HSV. ***HSV*** - **Perinatal transmission of HSV** is rare, occurring in approximately 1 in 3,000 to 1 in 20,000 live births, primarily from contact with maternal genital lesions during vaginal delivery. - Transmission rates are lowest when the mother has **recurrent herpes lesions** due to the presence of maternal antibodies offering some fetal protection. *Rubella* - **Congenital rubella syndrome** carries a high risk of transmission (up to 90%) if the mother contracts rubella in the first trimester. - It can lead to severe birth defects such as **heart abnormalities**, **cataracts**, and **deafness**. *Hepatitis B* - The risk of **vertical transmission of Hepatitis B** is significant, especially if the mother is HBeAg-positive (up to 90%). - Without intervention, chronic infection develops in 70-90% of infected infants, often leading to **liver disease** later in life. *CMV* - **Congenital CMV infection** is the most common congenital viral infection, with a transmission rate of 30-40% in primary maternal infection. - It can cause severe neurological deficits, **sensorineural hearing loss**, and **developmental delays** in affected infants.

Q: Which of the following are causes of neonatal seizures? 1. Hypernatremia 2. Hypomagnesemia 3. Hypocalcemia 4. Hyponatremia

1, 2, 3, and 4. ***1, 2, 3, and 4*** - **All listed electrolyte imbalances** can disrupt neuronal function and lead to neonatal seizures. - **Severe shifts** in sodium, calcium, and magnesium levels directly impact neuronal excitability. *2, 4 only* - This option is incorrect because **hypernatremia** and **hypocalcemia** are also significant causes of neonatal seizures. - Electrolyte disturbances such as **hypomagnesium** and **hyponatremia** can cause neonatal seizures, but they are not the only ones. *1, 3, 4 only* - This choice is incorrect as it **excludes hypomagnesemia**, which is a known cause of neonatal seizures. - **Severely deranged sodium and calcium levels** are important causes, but magnesium disturbances also contribute. *1, 2, 3 only* - This option is incorrect because **hyponatremia** is a well-established cause of neonatal seizures. - While hypernatremia, hypomagnesemia, and hypocalcemia can cause seizures, **hyponatremia** can also lead to cerebral edema and subsequent seizure activity.

Q: One day after delivery, an African American female newborn develops yellow discoloration of the eyes. She was born at term via uncomplicated vaginal delivery and weighed 3.4 kg (7 lb 8 oz). Her mother did not receive prenatal care. Examination shows scleral icterus and mild hepatosplenomegaly. Laboratory studies show: Hemoglobin 10.7 g/dL Reticulocytes 3.5% Maternal blood group O, Rh-negative Fetal blood group A, Rh-negative Serum bilirubin, total 6.1 mg/dL Serum bilirubin, direct 0.4 mg/dL Which of the following is the most likely cause of this patient's condition?

Transfer of Anti-A antibodies. ***Transfer of Anti-A antibodies*** - The mother is **blood group O**, which naturally produces **anti-A and anti-B antibodies**. Since the infant is **blood group A**, these maternal *IgG antibodies* can cross the placenta and cause **hemolysis** in the infant [1], [2]. - This leads to **neonatal jaundice** (due to increased bilirubin from hemolysis) and **anemia** (hemoglobin 10.7 g/dL), with a compensatory **reticulocytosis** (3.5%) [1]. The **splenomegaly** can also be attributed to increased red blood cell destruction [3]. *Binding of Rhesus immune globulins* - The mother is **Rh-negative** and the infant is also **Rh-negative**. Therefore, **Rh incompatibility** is not the cause of the hemolytic disease in this newborn [1]. - **Rhesus immune globulin** is given to **Rh-negative mothers** to prevent alloimmunization against **Rh-positive fetal red blood cells**, which is not relevant here. *Viral infiltration of the bone marrow* - While **viral infections** can cause **hepatosplenomegaly** and **anemia**, they typically suppress red blood cell production, leading to a **low reticulocyte count**, not the **elevated reticulocyte count** seen in this infant. - **Jaundice** associated with viral infections is usually due to **hepatitis** (elevated direct bilirubin), which is not the primary pattern shown here [3]. *Polymerization of deoxygenated hemoglobin* - This process is characteristic of **sickle cell disease**, where **sickle hemoglobin (HbS)** polymerizes, causing red blood cell sickling. - While it can cause **anemia** and **splenomegaly**, it does not typically present as **acute severe jaundice** in the newborn period and is not associated with **ABO incompatibility**.

Q: An 18-day-old newborn has difficulty feeding and diarrhea for 2 days. During this period he has vomited after each of his feeds. He was born at 28 weeks' gestation and weighed 1100-g (2-lb 7-oz). His feeds consist of breast milk and cow milk based-formula. He appears lethargic. His temperature is 36.4°C (97.5°F), pulse is 120/min, respirations are 67/min and blood pressure is 70/35 mm Hg. Examination shows diffuse abdominal tenderness; rigidity and guarding are present. Bowel sounds are absent. Test of the stool for occult blood is positive. His hemoglobin concentration is 12.8 g/dL, leukocyte count is 18,000/mm3 and platelet count is 78,000/mm3. An x-ray of the abdomen is shown. Which of the following is the most likely diagnosis?

Necrotizing enterocolitis. ***Necrotizing enterocolitis*** - The clinical presentation of a **premature newborn** with **feeding difficulties**, **abdominal distention** and **tenderness**, **bloody stools**, and **lethargy**, combined with an **abdominal X-ray demonstrating pneumatosis intestinalis**, is highly suggestive of **necrotizing enterocolitis (NEC)**. - The associated **thrombocytopenia** and **leukocytosis** further support a severe inflammatory process characteristic of NEC in preterm infants. *Intussusception* - Typically presents with **sudden onset of intermittent, severe abdominal pain**, often marked by drawing up of legs, and **currant jelly stools** (mucus and blood). - Although it can cause abdominal tenderness and lethargy, it's less common in neonates and pneumatosis intestinalis is not a feature. *Meckel diverticululum* - Often causes **painless rectal bleeding** due to ectopic gastric mucosa, or symptoms of obstruction (e.g., intussusception, volvulus). - It does not typically present with diffuse abdominal tenderness, rigidity, feeding intolerance, and pneumatosis intestinalis. *Hypertrophic pyloric stenosis* - Characterized by **projectile, non-bilious vomiting** and a **palpable olive-shaped mass** in the epigastrium, usually appearing between 3-6 weeks of age. - It does not cause bloody diarrhea, diffuse abdominal tenderness, or pneumatosis intestinalis.

Q: A boy born vaginally in the 36th week of gestation to a 19-year-old woman (gravida 3, para 1) is assessed on his 2nd day of life. His vitals include: blood pressure is 85/40 mm Hg, pulse is 161/min, axillary temperature is 36.6°C (98.0°F), and respiratory rate is 44/min. He appears to be lethargic; his skin is jaundiced and slight acrocyanosis with several petechiae is noted. Physical examination reveals nystagmus, muffled heart sounds with a continuous murmur, and hepatosplenomegaly. The boy’s birth weight is 1.93 kg (4.25 lb) and Apgar scores at the 1st and 5th minutes were 5 and 8, respectively. His mother is unaware of her immunization status and did not receive any antenatal care. She denies any history of infection, medication use, or alcohol or illicit substance use during pregnancy. Serology for suspected congenital TORCH infection shows the following results: Anti-toxoplasma gondii IgM Negative Anti-toxoplasma gondii IgG Positive Anti-CMV IgM Negative Anti-CMV IgG Positive Anti-Rubella IgM Positive Anti-Rubella IgG Positive Anti-HSV IgM Negative Anti-HSV IgG Negative Which cardiac abnormality would be expected in this infant on echocardiography?

Patent ductus arteriosus. ***Patent ductus arteriosus*** * The clinical presentation with **jaundice**, **petechiae**, **hepatosplenomegaly**, and **positive anti-Rubella IgM and IgG** strongly indicates **congenital rubella syndrome**. A continuous murmur is also characteristic. * **Patent ductus arteriosus (PDA)** is a classic cardiac manifestation of **congenital rubella infection**, along with pulmonary artery hypoplasia. *Pulmonary valve stenosis* * While pulmonary valve stenosis can occur congenitally, it is more commonly associated with conditions like **Noonan syndrome** or isolated defects, not typically **congenital rubella syndrome**. * The continuous murmur described is more consistent with a PDA rather than the typical ejection click and crescendo-decrescendo murmur of pulmonary stenosis. *Atrial septal defect* * An **atrial septal defect (ASD)** is a common congenital heart defect, but it is not specifically or commonly associated with **congenital rubella syndrome**. * ASD typically presents with a **fixed split second heart sound** and usually a systolic murmur, not a continuous murmur. *Atrialization of the right ventricle* * **Atrialization of the right ventricle** is characteristic of **Ebstein's anomaly**, a congenital heart defect affecting the tricuspid valve. * It is not associated with **congenital rubella infection** and presents with different clinical findings, such as cyanosis due to right-to-left shunting.

Q: A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?

Hep B vaccine+ IG. ***Hep B vaccine + IG*** - Neonates born to mothers with **positive hepatitis B surface antigen (HBsAg)** should receive both the **hepatitis B vaccine** and **hepatitis B immune globulin (HBIG)** within **12 hours of birth**. - This combination provides both **passive immunity** (from HBIG) and **active immunity** (from the vaccine) to rapidly protect the newborn from perinatal hepatitis B transmission. *Hep B vaccine only* - Administering only the **hepatitis B vaccine** would provide active immunity, but the **onset of protection is slower**, leaving the neonate vulnerable during the immediate high-risk period of exposure. - While essential for long-term protection, the vaccine alone is **insufficient for immediate post-exposure prophylaxis** in a high-risk scenario. *Only IG* - Administering only **HBIG** provides immediate passive immunity, offering short-term protection, but it **does not confer long-lasting immunity**. - Without the vaccine, the infant would remain susceptible to future HBV infection once the passive antibodies wane, which typically occurs within a few months. *First IG then Hep B vaccine after 1 month* - Delaying the **hepatitis B vaccine** by a month would leave the neonate inadequately protected against subsequent exposure or potential continued viral replication after the HBIG's passive immunity declines. - The goal in this high-risk situation is to initiate **both passive and active immunity as quickly as possible** to maximize protection against perinatal transmission.

Q: A newborn loses maximum heat from:

Head. ***Head*** - Newborns have a **relatively large head surface area** compared to their total body surface area. - The head also has a rich **blood supply** and lacks subcutaneous fat for insulation, contributing to significant heat loss through **convection and radiation**. *Abdomen* - While the abdomen contributes to heat loss, it is covered by clothing and has a more proportionate surface area to mass ratio compared to the head, making it a **less significant site for maximal heat loss**. - Heat loss from the abdomen is not as pronounced as from the head due to its **central location** and typically greater insulation. *Neck* - The neck's surface area is comparably small, and it is often covered or in close proximity to the body, which helps to **reduce heat loss**. - It does not possess the same combination of large surface area and lack of insulating fat as the head. *Palms & soles* - While palms and soles have a high density of **sweat glands** and can contribute to heat loss through evaporation, their **total surface area is relatively small** in a newborn. - These areas are less significant for overall maximal heat loss compared to the head due to their limited size.

Q: Compression ventilation ratio in case of Neonatal CPR:

3:1. ***3:1*** - In **neonatal CPR**, a compression to ventilation ratio of **3 compressions per 1 breath** is recommended. This ratio prioritizes ventilation due to the most common cause of cardiac arrest in neonates being **hypoxia**. - This ratio aims to deliver sufficient oxygen while maintaining adequate cardiac output for the unique physiology of newborns. *30:2* - A 30:2 ratio is generally recommended for **adult CPR** when a single rescuer is present, as adults often have initial cardiac etiologies. - This ratio would provide insufficient ventilations for a neonate whose primary arrest cause is typically respiratory. *100:8* - This ratio is not a standard recommendation for any age group in Cardiopulmonary Resuscitation guidelines. - It would lead to an imbalance, offering a disproportionately high number of compressions relative to ventilations, which is not optimal for neonatal resuscitation. *15:2* - A 15:2 ratio is typically recommended for **pediatric CPR** when two or more rescuers are present. - While closer to the neonatal requirement for ventilation, it still does not provide the immediate and frequent ventilations needed for neonates.

Question 1

A woman delivers a healthy baby with weight 2.2 kg at the time of birth. What measures are to be taken?

1. The baby should be exclusively breast fed for first six months
2. The vaccination with OPV and BCG should be delayed till the baby is 2.5 kg of weight
3. Baby should be kept with mother and kangaroo care to be given

Select the correct answer using the code given below:

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 2

Least chances of perinatal transmission are seen in?

Accepted Answer

HSV

Answer

Rubella

Answer

Hepatitis B

Answer

CMV

Question 3

Which of the following are causes of neonatal seizures?

1. Hypernatremia
2. Hypomagnesemia
3. Hypocalcemia
4. Hyponatremia

Accepted Answer

1, 2, 3, and 4

Answer

2,4 only

Answer

1, 3, 4 only

Answer

1, 2, 3 only

Question 4

Which of the following is a true statement about congenital CMV infection?

Accepted Answer

If mother is IgG positive for CMV prior to conception, the child is less likely to develop severe infection

Answer

About 20-30% of the infections are symptomatic

Answer

Triad of SNHL, periventricular calcification and enamel hypoplasia

Answer

Most children asymptomatic at birth can develop conductive hearing loss later in life

Question 5

One day after delivery, an African American female newborn develops yellow discoloration of the eyes. She was born at term via uncomplicated vaginal delivery and weighed 3.4 kg (7 lb 8 oz). Her mother did not receive prenatal care. Examination shows scleral icterus and mild hepatosplenomegaly. Laboratory studies show:
Hemoglobin 10.7 g/dL
Reticulocytes 3.5%
Maternal blood group O, Rh-negative
Fetal blood group A, Rh-negative
Serum bilirubin, total 6.1 mg/dL
Serum bilirubin, direct 0.4 mg/dL
Which of the following is the most likely cause of this patient's condition?

Accepted Answer

Transfer of Anti-A antibodies

Answer

Binding of Rhesus immune globulins

Answer

Viral infiltration of the bone marrow

Answer

Polymerization of deoxygenated hemoglobin

Question 6

An 18-day-old newborn has difficulty feeding and diarrhea for 2 days. During this period he has vomited after each of his feeds. He was born at 28 weeks' gestation and weighed 1100-g (2-lb 7-oz). His feeds consist of breast milk and cow milk based-formula. He appears lethargic. His temperature is 36.4°C (97.5°F), pulse is 120/min, respirations are 67/min and blood pressure is 70/35 mm Hg. Examination shows diffuse abdominal tenderness; rigidity and guarding are present. Bowel sounds are absent. Test of the stool for occult blood is positive. His hemoglobin concentration is 12.8 g/dL, leukocyte count is 18,000/mm3 and platelet count is 78,000/mm3. An x-ray of the abdomen is shown. Which of the following is the most likely diagnosis?

Accepted Answer

Necrotizing enterocolitis

Answer

Intussusception

Answer

Meckel diverticululum

Answer

Hypertrophic pyloric stenosis

Question 7

A boy born vaginally in the 36th week of gestation to a 19-year-old woman (gravida 3, para 1) is assessed on his 2nd day of life. His vitals include: blood pressure is 85/40 mm Hg, pulse is 161/min, axillary temperature is 36.6°C (98.0°F), and respiratory rate is 44/min. He appears to be lethargic; his skin is jaundiced and slight acrocyanosis with several petechiae is noted. Physical examination reveals nystagmus, muffled heart sounds with a continuous murmur, and hepatosplenomegaly. The boy’s birth weight is 1.93 kg (4.25 lb) and Apgar scores at the 1st and 5th minutes were 5 and 8, respectively. His mother is unaware of her immunization status and did not receive any antenatal care. She denies any history of infection, medication use, or alcohol or illicit substance use during pregnancy. Serology for suspected congenital TORCH infection shows the following results:
Anti-toxoplasma gondii IgM Negative
Anti-toxoplasma gondii IgG Positive
Anti-CMV IgM Negative
Anti-CMV IgG Positive
Anti-Rubella IgM Positive
Anti-Rubella IgG Positive
Anti-HSV IgM Negative
Anti-HSV IgG Negative
Which cardiac abnormality would be expected in this infant on echocardiography?

Accepted Answer

Patent ductus arteriosus

Answer

Pulmonary valve stenosis

Answer

Atrial septal defect

Answer

Atrialization of the right ventricle

Question 8

A patient at 37 weeks' gestation came to the hospital without antenatal check-up and presented with onset of labor. On examination, the mother is Hep B positive. What management should be given to the neonate?

Accepted Answer

Hep B vaccine+ IG

Answer

Hep B vaccine only

Answer

Only IG

Answer

First IG then Hep B vaccine after 1 month

Question 9

A newborn loses maximum heat from:

Accepted Answer

Head

Answer

Abdomen

Answer

Neck

Answer

Palms & soles

Question 10

Compression ventilation ratio in case of Neonatal CPR:

Accepted Answer

3:1

Answer

30:2

Answer

100:8

Answer

15:2

Neonatology — MCQs

Neonatology — MCQs

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