Neonatology Practice Questions

Q: A term infant is born to a known HIV-positive mother. She has been taking antiretroviral medications for the weeks prior to the delivery of her infant. Routine management of the healthy infant should include which of the following?

A course of zidovudine for the infant. ***A course of zidovudine for the infant*** - This is the standard of care for newborns exposed to HIV prenatally, even if the mother received **antiretroviral therapy (ART)**. - **Zidovudine (AZT)** prophylaxis significantly reduces the risk of **perinatal HIV transmission**. *HIV ELISA on the infant to determine if congenital infection has occurred* - **HIV ELISA** tests detect **maternal antibodies** passed to the infant, which can persist for up to 18 months, leading to **false positive results**. - **HIV DNA PCR** or **RNA assays** are used to diagnose HIV infection in infants. *Admission to the neonatal intensive care unit for close cardiovascular monitoring* - Admission to the **NICU** is generally reserved for **premature** or **symptomatic infants**, or those with specific complications. - A **healthy, term infant** born to an HIV-positive mother on ART does not routinely require NICU admission. *Chest radiographs to evaluate for congenital Pneumocystis carinii* - **Pneumocystis jirovecii pneumonia (PJP)** typically presents in HIV-infected infants between **3 to 6 months of age**, not at birth. - Prophylaxis with **trimethoprim-sulfamethoxazole (TMP-SMX)** is initiated at 4-6 weeks of age for HIV-exposed infants.

Q: Estimation of the blood sugar is relevant in all except –

Baby of hypothyroid mother. ***Baby of hypothyroid mother*** - While maternal hypothyroidism can affect fetal development and lead to various complications, it does not directly cause **neonatal hypoglycemia** or **hyperglycemia**, making routine blood sugar monitoring less critical unless other risk factors are present. - The primary concerns for a baby born to a hypothyroid mother are related to thyroid function itself, such as **congenital hypothyroidism**, not blood glucose dysregulation. *Large for date baby* - **Macrosomic infants**, especially those born to mothers with gestational diabetes, are at increased risk for **hypoglycemia** due to chronic fetal hyperinsulinemia. - Close monitoring of blood glucose levels is essential to prevent neurological damage from sustained low sugar. *Birth asphyxia* - Infants who experience **birth asphyxia** are under significant stress, which can deplete their glycogen stores and impair gluconeogenesis, leading to **hypoglycemia**. - Monitoring blood glucose is a critical component of their post-resuscitation care and management. *Rh Incompatibility* - Severe **Rh incompatibility** can lead to **hydrops fetalis** and other complications, including liver dysfunction and extramedullary hematopoiesis, which can impair glucose regulation. - These infants are at risk for both **hypoglycemia** due to increased metabolic demand and **hyperglycemia** secondary to stress and liver involvement, necessitating blood sugar monitoring.

Q: Which of the following is the most common congenital viral infection?

Cytomegalovirus. ***Cytomegalovirus*** - **Cytomegalovirus (CMV)** is the most prevalent congenital viral infection, with an incidence of 0.2-2% of all live births. - While many infected infants are asymptomatic at birth, up to **10-15% develop neurological sequelae**, such as sensorineural hearing loss, developmental delay, or microcephaly. *Herpes simplex* - **Congenital herpes simplex virus (HSV)** infection is rare, usually acquired during passage through an infected birth canal. - It typically presents with **skin lesions, encephalitis, or disseminated disease** rather than being the most common congenital infection overall. *HIV* - **Perinatal HIV transmission** has significantly decreased due to widespread screening and effective antiretroviral therapy during pregnancy. - While it was a major concern historically, its incidence is now lower than CMV, and it affects the **immune system** primarily. *Rubella* - **Congenital rubella syndrome (CRS)** can lead to severe birth defects, but its incidence has drastically reduced due to the widespread implementation of the **MMR vaccine**. - While devastating, it is no longer the most common congenital viral infection due to successful vaccination programs.

Q: Most common cause of neonatal diarrhea worldwide is:

Rotavirus. ***Rotavirus*** - **Rotavirus** is the **most common cause of severe acute diarrhea in infants and young children worldwide**, including the neonatal period. - It is responsible for significant morbidity and mortality, particularly in **developing countries** with limited access to clean water and sanitation. - The virus causes **watery diarrhea, vomiting, and dehydration**, which can be life-threatening in neonates. - **WHO** recognizes Rotavirus as the leading cause of severe diarrheal disease in children under 5 years globally. - Vaccination programs (Rotavac, Rotarix) have reduced incidence but it remains the predominant pathogen. *E. coli* - **Enteropathogenic E. coli (EPEC)** and **Enterotoxigenic E. coli (ETEC)** are important causes of neonatal diarrhea, especially in resource-limited settings. - EPEC causes diarrhea through attachment and effacement of intestinal mucosa. - ETEC is a major cause of traveler's diarrhea and endemic diarrhea in developing countries. - While significant, E. coli is the **most common bacterial cause** but not the overall most common cause when viruses are included. *Salmonella* - **Salmonella** causes gastroenteritis but is more common in **older infants and children**. - Often associated with **foodborne outbreaks**, fever, and sometimes bloody diarrhea. - Less frequent as a primary cause of neonatal diarrhea compared to Rotavirus or E. coli. *Shigella* - **Shigella** typically causes **dysentery (bloody diarrhea)** and is more common in **children over 6 months**. - Requires a lower infectious dose but is less prevalent in the immediate neonatal period. - Associated with poor hygiene and fecal-oral transmission in older children.

Q: What is the volume of reservoir bag used in neonatal resuscitation?

500 ml. ***500 ml*** - A **500 mL self-inflating bag** is the **standard size** recommended for **neonatal resuscitation** by the Neonatal Resuscitation Program (NRP). - This volume provides an adequate **oxygen reservoir** while allowing controlled delivery of appropriate **tidal volumes (4-6 mL/kg)** for neonates. - The bag volume is larger than the delivered tidal volume to ensure consistent oxygen concentration and effective ventilation without requiring perfect compression technique. *1000 ml* - A **1000 mL bag** is designed for **adult resuscitation** and is unnecessarily large for neonatal use. - While it can be used if neonatal bags are unavailable, the larger size makes it more difficult to achieve consistent, controlled ventilation in neonates. *750 ml* - A **750 mL bag** is sometimes used for older infants or pediatric patients but is larger than the standard neonatal size. - While acceptable, the **500 mL bag** is preferred for term and preterm neonates. *240 ml* - A **240 mL bag** is **too small** to function effectively as a self-inflating bag for neonatal resuscitation. - This volume is insufficient to maintain an adequate **oxygen reservoir** and would compromise the ability to deliver consistent positive pressure ventilation.

Q: Bohn's nodules are

Cystic swellings in neonates. ***Cystic swellings in neonates*** - **Bohn's nodules** are benign, small, white-to-yellow epithelial cysts found on the **buccal and lingual aspects of the alveolar ridges** of newborns. - They are remnants of the dental lamina and typically **resolve spontaneously** within a few weeks or months after birth. *Cysts of gingiva in growing children* - While similar in appearance, **gingival cysts of the newborn** are specifically found on the gingiva, whereas Bohn's nodules often appear on the alveolar ridge, distant from the gingival margin itself. - The term "growing children" is too broad, as Bohn's nodules are exclusively a **neonatal finding**. *Warts on the tongue* - **Warts on the tongue** are typically caused by viral infections (e.g., HPV) and present as papillomatous or verrucous lesions, which are distinct from the smooth, cystic appearance of Bohn's nodules. - Bohn's nodules are found on the alveolar ridges, not directly on the tongue surface. *Cysts associated with soft palate* - Cysts associated with the soft palate would generally include conditions like **palatal cysts of the newborn** (Epstein pearls), which are located on the median palatal raphe. - Bohn's nodules are specifically found on the **alveolar ridges**, not the soft palate.

Q: Most common cause of convulsion on the first day of life in a newborn is:

Perinatal asphyxia. ***Perinatal asphyxia*** - **Perinatal asphyxia** (hypoxic-ischemic encephalopathy) is the most common cause of seizures in the first 24 hours of life in neonates. - The resulting **cerebral injury** from oxygen deprivation and ischemia leads to neuronal excitability and seizure activity. - Accounts for the majority of seizures presenting on day 1 of life, particularly following difficult deliveries or fetal distress. *Hypoglycemia* - While **hypoglycemia** can cause seizures in newborns, it is generally less common than perinatal asphyxia as the primary cause on the very first day. - Seizures due to hypoglycemia often occur in vulnerable infants like those with **diabetic mothers**, intrauterine growth restriction, or those experiencing a sudden drop in glucose. - Usually presents within 2-3 hours after birth in at-risk infants. *Hypocalcemia* - **Early neonatal hypocalcemia** can cause seizures, but typically presents slightly later, usually after 24-48 hours of life. - More common in infants with **low birth weight**, prematurity, birth asphyxia, or those born to diabetic mothers. - Related to immature parathyroid function and increased phosphate load. *Head injury* - **Birth trauma** with intracranial hemorrhage can cause seizures through direct neuronal damage, but is less frequent than perinatal asphyxia as a cause of day 1 seizures. - Risk factors include **difficult instrumental deliveries**, macrosomia, and precipitous labor. - Incidence has decreased significantly with improved obstetric practices.

Q: Most common lesion in fetal toxoplasmosis is -

Chorioretinitis. **Chorioretinitis** - **Chorioretinitis** is the most common and classic ocular manifestation of congenital toxoplasmosis, leading to vision impairment and potential blindness. - The parasite (Toxoplasma gondii) has a predilection for retinal tissue, causing inflammation and scarring. *Encephalitis* - While **encephalitis** (inflammation of the brain) can occur in congenital toxoplasmosis, particularly with intracranial calcifications, it is not the single most common lesion compared to chorioretinitis. - Neurological manifestations are significant but often accompany or are less frequent than ocular involvement. *GI involvement* - **Gastrointestinal involvement** is rare in congenital toxoplasmosis and is not considered a common lesion. - The primary targets of the parasite in congenital infection are the central nervous system and the eyes. *Pulmonary involvement* - **Pulmonary involvement** is also uncommon in congenital toxoplasmosis and is not a typical manifestation. - Severe cases of disseminated toxoplasmosis, particularly in immunocompromised individuals, might show lung involvement, but this is not the most common lesion in fetal infection.

Q: Normal reticulocyte count at birth is

2-6%. ***2-6%*** - At birth, the normal **reticulocyte count** is elevated primarily due to the physiological stress of **adapting to extrauterine life** and increased erythropoiesis. - This higher range reflects the body's need for a rapid turnover of red blood cells to meet oxygen demands after birth. *1-2%* - This range is considered a **normal reticulocyte count** for **older children and adults**, indicating a steady state of red blood cell production. - It does not account for the **physiological erythropoietic surge** observed in healthy neonates. *6-10%* - While higher than adult levels, a range of **6-10%** in a neonate would still be considered unusually high and might suggest **pathological hemolysis** or significant **blood loss**. - Without other supporting clinical signs, this level is typically higher than the **physiological norm**. *30-40%* - A reticulocyte count of **30-40%** at birth is **extremely elevated** and is highly indicative of a severe underlying condition such as **hemolytic disease of the newborn** or significant **neonatal hemorrhage**. - This level is far beyond the **normal physiological response** and requires urgent investigation.

Q: A neonate on routine examination at birth was found to have hepatomegaly. Rest of the examination was essentially unremarkable. On investigations, Anti-HCMV antibodies were found to be positive. What sequelae in later life is the child at risk of?

Sensorineural hearing loss. ***Sensorineural hearing loss*** - **Congenital CMV infection** is the leading cause of non-genetic sensorineural hearing loss (SNHL) in children, affecting a significant proportion of infected neonates. - SNHL can be **progressive, unilateral or bilateral**, and may manifest years after birth, necessitating long-term audiological monitoring. *Intellectual disability* - While CMV can cause **neurological complications** and intellectual disability, these are more common in symptomatic congenital CMV infections with **microcephaly, intracranial calcifications**, or severe neurological impairment at birth. - In a neonate with only hepatomegaly and no overt neurological signs, **SNHL is a more prevalent and specific long-term sequelae** than intellectual disability. *Renal failure* - **Kidney involvement** in congenital CMV is rare and generally not a primary long-term sequela. - Though CMV can rarely cause interstitial nephritis or direct viral cytopathic effects in the kidneys, leading to transient renal dysfunction, it **does not typically lead to progressive renal failure** in later life. *Hepatic fibrosis* - While congenital CMV can cause **hepatitis** and hepatomegaly, significant long-term hepatic fibrosis directly attributable to CMV, leading to liver failure in later life, is **uncommon**. - Most hepatic abnormalities in congenital CMV tend to **resolve spontaneously**, and severe chronic liver disease is rare.

Question 1

A term infant is born to a known HIV-positive mother. She has been taking antiretroviral medications for the weeks prior to the delivery of her infant. Routine management of the healthy infant should include which of the following?

Accepted Answer

A course of zidovudine for the infant

Answer

HIV ELISA on the infant to determine if congenital infection has occurred

Answer

Admission to the neonatal intensive care unit for close cardiovascular monitoring

Answer

Chest radiographs to evaluate for congenital Pneumocystis carinii

Question 2

Estimation of the blood sugar is relevant in all except –

Accepted Answer

Baby of hypothyroid mother

Answer

Large for date baby

Answer

Birth asphyxia

Answer

Rh Incompatibility

Question 3

Which of the following is the most common congenital viral infection?

Accepted Answer

Cytomegalovirus

Answer

Herpes simplex

Answer

HIV

Answer

Rubella

Question 4

Most common cause of neonatal diarrhea worldwide is:

Accepted Answer

Rotavirus

Answer

E. coli

Answer

Salmonella

Answer

Shigella

Question 5

What is the volume of reservoir bag used in neonatal resuscitation?

Accepted Answer

500 ml

Answer

1000 ml

Answer

750 ml

Answer

240 ml

Question 6

Bohn's nodules are

Accepted Answer

Cystic swellings in neonates

Answer

Cysts of gingiva in growing children

Answer

Warts on the tongue

Answer

Cysts associated with soft palate

Question 7

Most common cause of convulsion on the first day of life in a newborn is:

Accepted Answer

Perinatal asphyxia

Answer

Hypoglycemia

Answer

Hypocalcemia

Answer

Head injury

Question 8

Most common lesion in fetal toxoplasmosis is -

Accepted Answer

Chorioretinitis

Answer

Encephalitis

Answer

GI involvement

Answer

Pulmonary involvement

Question 9

Normal reticulocyte count at birth is

Accepted Answer

2-6%

Answer

1-2%

Answer

6-10%

Answer

30-40%

Question 10

A neonate on routine examination at birth was found to have hepatomegaly. Rest of the examination was essentially unremarkable. On investigations, Anti-HCMV antibodies were found to be positive. What sequelae in later life is the child at risk of?

Accepted Answer

Sensorineural hearing loss

Answer

Intellectual disability

Answer

Renal failure

Answer

Hepatic fibrosis

Neonatology — MCQs

Neonatology — MCQs

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