Neonatology Practice Questions

Q: A poverty-stricken mother suffering from active tuberculosis delivers a baby. Which one of the following would be the most appropriate advice in her case?

Breast feeding and isoniazid administration. ***Breast feeding and isoniazid administration*** - **Breastfeeding** is safe and encouraged for infants of mothers with active tuberculosis, as the benefits of breast milk (nutrition, antibodies) outweigh the minimal risk of TB transmission through milk. - **Isoniazid (INH) chemoprophylaxis** for the infant provides additional protection in high-risk exposure settings, particularly when the mother has active pulmonary TB and close contact is inevitable. - This approach represents a conservative strategy prioritizing immediate chemoprophylaxis in a poverty-stricken setting where follow-up may be challenging. *Breast feeding and BCG immunization* - **Breastfeeding** is beneficial and appropriate. - **BCG immunization** at birth is the current standard recommendation per WHO and IAP guidelines for infants born to TB-positive mothers. - However, in settings with very high exposure risk and uncertain follow-up, some protocols additionally recommend INH prophylaxis, making the first option more comprehensive for this specific scenario. *Expressed breast milk and BCG immunization* - Expressing breast milk offers no significant additional protection against TB transmission compared to direct breastfeeding. - Direct breastfeeding has additional benefits for mother-infant bonding and is not contraindicated in maternal TB. - While **BCG immunization** is appropriate, this option unnecessarily complicates feeding. *Stop feeds and isoniazid administration* - **Stopping breastfeeding** is not indicated and would deprive the infant of essential nutrition and passive immunity. - Breastfeeding is not contraindicated in maternal tuberculosis. - While **isoniazid administration** may be appropriate, cessation of feeding is an incorrect recommendation.

Q: Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:

Withhold breast feeding. ***Withhold breast feeding*** - For mothers with **drug-sensitive tuberculosis**, breastfeeding is **strongly encouraged** by WHO and CDC guidelines as the benefits far outweigh any theoretical risks. - Tuberculosis is **not transmitted through breast milk**, and the nutritional and immunological benefits of breastfeeding are crucial for the newborn. - With appropriate maternal treatment and **INH prophylaxis** for the baby, breastfeeding poses no significant risk and should **never be withheld**. *Administer INH to the baby* - **Isoniazid (INH) prophylaxis** for 6 months is the standard of care for newborns exposed to maternal tuberculosis. - This protects the infant from potential infection via respiratory droplets while the mother is receiving treatment. - After completing prophylaxis, BCG vaccination is given if tuberculosis is excluded. *Separate the baby from mother immediately* - **Immediate routine separation** is generally not recommended for drug-sensitive TB if the mother has been on appropriate treatment for at least 2 weeks and is clinically improving. - **Rooming-in is encouraged** with respiratory hygiene measures (mask wearing, hand hygiene, covering mouth when coughing). - Separation may be considered only for untreated or inadequately treated mothers, or those with multi-drug resistant TB. *Ask mother to ensure proper disposal of sputum* - **Proper sputum disposal** and adherence to respiratory hygiene are essential infection control measures. - This reduces environmental contamination and protects healthcare workers, family members, and the newborn from infectious aerosols. - This is a standard precaution for all tuberculosis patients regardless of drug sensitivity.

Q: A blood specimen for neonatal thyroid screening is obtained on:

48 hours after birth. ***48 hours after birth*** - Neonatal thyroid screening is optimally performed at **48-72 hours** after birth, with **48 hours** being the most practical timing in current practice. - This timing balances two important factors: avoiding the **physiological TSH surge** that occurs in the first 24 hours, while ensuring screening occurs **before early hospital discharge**. - According to **IAP (Indian Academy of Pediatrics)** and international guidelines, screening at 48 hours allows accurate detection of congenital hypothyroidism while being realistic for modern obstetric practices where most mothers are discharged within 48 hours. - The **thyroid-stimulating hormone (TSH)** levels have normalized sufficiently by 48 hours to minimize false-positive results. *Cord blood* - Cord blood is not used for routine neonatal thyroid screening because **maternal thyroid hormones** (T4 and T3) cross the placenta and can mask congenital hypothyroidism in the newborn. - It does not reflect the newborn's **independent thyroid function**, which is essential for identifying congenital disorders. *24 hours after birth* - Drawing blood at 24 hours is generally **too early** for optimal thyroid screening, as the **postnatal TSH surge** is still significant. - This timing would result in a higher rate of **false-positive results**, leading to unnecessary follow-up tests and parental anxiety. - However, if discharge occurs before 48 hours, screening at 24 hours is preferable to missing screening entirely. *72 hours after birth* - While 72 hours was traditionally recommended for thyroid screening, it is **no longer practical** in the era of early hospital discharge. - Most mothers and babies are discharged within **48 hours**, making 72-hour screening logistically difficult and risking missed screening. - Current guidelines recommend **48-72 hours OR at discharge, whichever is earlier**, making 48 hours the most optimal single timepoint.

Q: The lesions seen on this infant's face are usually associated with?

Congenital rubella. ***Congenital rubella*** - The image likely displays a **"blueberry muffin" rash**, which is a classic sign of congenital rubella syndrome due to **dermal erythropoiesis**. - Infants with congenital rubella also commonly present with other severe anomalies such as **cataracts**, **heart defects** (e.g., patent ductus arteriosus), and **sensorineural hearing loss**. *Acquired rubella* - This is a milder disease in older children and adults, characterized by a **maculopapular rash** that originates on the face and spreads downwards. - It does not typically cause the severe, disseminated cutaneous lesions or systemic congenital abnormalities seen in the infant. *Rubeola* - Also known as measles, rubeola presents with a fierce maculopapular rash, **Koplik spots** in the mouth, and symptoms of cough, coryza, and conjunctivitis. - The rash is not characteristically described as "blueberry muffin" and it is not associated with congenital deformities from maternal infection. *Syphilis* - Congenital syphilis can cause a variety of skin lesions, including a **bullous rash** or a copper-colored maculopapular rash, but not typically the "blueberry muffin" purpuric lesions. - Other manifestations of congenital syphilis include **bone abnormalities**, **hepatosplenomegaly**, and **rhinitis** (snuffles).

Q: Which one of the following life-threatening congenital anomalies in the newborn presents with polyhydramnios, aspiration pneumonia, excessive salivation and difficulty in passing a nasogastric tube?

Tracheo-esophageal fistula. ***Tracheo-esophageal fistula*** - This condition presents with **polyhydramnios** due to the fetus being unable to swallow amniotic fluid, **excessive salivation** from accumulated secretions in the blind-ending esophageal pouch, and difficulty passing a **nasogastric tube** because of the esophageal obstruction. - **Aspiration pneumonia** is a common complication as saliva and gastric contents can be aspirated into the lungs through the fistula. *Choanal atresia* - Characterized by **blocked nasal passages**, leading to **cyclical cyanosis** relieved by crying, but not typically associated with polyhydramnios or excessive salivation in this manner. - While it can cause respiratory distress, it does not involve esophageal obstruction or directly cause aspiration pneumonia from swallowed fluids. *Gastroschisis* - This is an **abdominal wall defect** where intestines protrude outside the body, unrelated to swallowing difficulties, polyhydramnios caused by inability to swallow, or excessive salivation. - It does not involve difficulty in passing a nasogastric tube or directly cause aspiration pneumonia. *Diaphragmatic hernia* - Involves **abdominal contents herniating into the chest cavity**, leading to **pulmonary hypoplasia** and respiratory distress. - It does not explain polyhydramnios due to impaired swallowing, excessive salivation, or the characteristic inability to pass a nasogastric tube.

Q: Jitteriness can be distinguished from seizures by all of the following except -

Frequency of movement. ***Frequency of movement*** - Both **seizures** and **jitteriness** can present with frequent, repetitive movements. The frequency alone is not a reliable distinguishing factor between the two. - The **quality and pattern** of the movements, rather than just their frequency, are more indicative for differentiation. *Sensitivity to stimulus* - **Jitteriness** is typically sensitive to external stimuli such as touch, loud noises, or light, which can exacerbate or stop the movements. - **Seizures**, particularly generalized tonic-clonic seizures, are generally not influenced by external stimuli once they have begun. *Abnormality of Gaze* - **Seizures** often involve an **abnormal gaze**, such as sustained ocular deviation or nystagmus, which is a key clinical sign. - In contrast, **jitteriness** rarely presents with significant or sustained abnormalities of gaze; the infant's eyes usually remain responsive and can follow objects. *Autonomic disturbance* - **Seizures** are frequently accompanied by **autonomic disturbances**, including changes in heart rate, blood pressure, temperature, apnea, or skin color changes (e.g., cyanosis). - **Jitteriness** typically lacks these prominent autonomic signs, with vital signs generally remaining stable.

Q: Late metabolic acidosis is seen in-

Preterm baby getting cow milk. ***Preterm baby getting cow milk*** - **Preterm infants** have immature kidneys with reduced ability to excrete **acidic metabolites**. - **Cow milk-based formulas** have a higher protein and mineral content, leading to a greater **acid load** which can exacerbate the metabolic acidosis in preterm infants. *Term infant given formula feed* - Term infants generally have more mature renal function capable of handling the **acid load** from formula feeding. - While formula feeding can contribute to a higher renal solute load than breast milk, it rarely results in **late metabolic acidosis** in otherwise healthy term infants. *Long term breast feeding* - **Breast milk** has a lower protein content and a more balanced mineral composition, resulting in a significantly lower **renal solute load** and acid load compared to formula. - It is protective against metabolic acidosis and is the preferred feeding method for infants. *None of the options* - This option is incorrect because **preterm infants fed cow milk-based formula** are indeed at risk for late metabolic acidosis due to their immature kidneys and the higher acid load from the formula.

Q: A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Antiepileptic of choice shall be:

Phenobarbitone. ***Phenobarbitone*** - **Phenobarbitone** is the **first-line antiepileptic drug** recommended for neonatal seizures due to its established efficacy and safety profile in this population. - It acts primarily by **potentiating GABAA receptor-mediated chloride currents**, leading to central nervous system depression and seizure control. *Lorazepam* - While **benzodiazepines** like lorazepam can be used for acute seizure cessation, especially status epilepticus, they are generally **not the first-line choice for maintenance therapy** due to potential sedation and respiratory depression in neonates. - Its short duration of action and risk of rebound seizures make it less suitable as a sole agent for ongoing seizure control. *Levetiracetam* - **Levetiracetam** is an increasingly common antiepileptic in neonates, but its long-term efficacy and safety, particularly regarding neurodevelopmental outcomes, are **still under investigation** compared to phenobarbitone. - While it may be used as a second-line agent or in specific situations, it is **not universally considered the first-line drug of choice** for neonatal seizures. *Phenytoin* - **Phenytoin** is typically considered a **second-line or third-line antiepileptic** for neonatal seizures, primarily used if phenobarbitone is ineffective. - Its use is limited by potential side effects such as **cardiac arrhythmias, hypotension, and infiltration at the injection site**, which can be particularly concerning in premature infants.

Question 1

A poverty-stricken mother suffering from active tuberculosis delivers a baby. Which one of the following would be the most appropriate advice in her case?

Accepted Answer

Breast feeding and isoniazid administration

Answer

Breast feeding and BCG immunization

Answer

Expressed breast milk and BCG immunization

Answer

Stop feeds and isoniazid administration

Question 2

Basanti, a 29-year-old female from Bihar, presents with drug-sensitive tuberculosis. She delivers a baby. All of the following are indicated except:

Accepted Answer

Withhold breast feeding

Answer

Administer INH to the baby

Answer

Separate the baby from mother immediately

Answer

Ask mother to ensure proper disposal of sputum

Question 3

Symptomatic neonatal CNS involvement is most commonly seen in which group of congenital intrauterine infections?

Accepted Answer

CMV and toxoplasmosis

Answer

Rubella and toxoplasmosis

Answer

CMV and syphilis

Answer

Rubella and HSV

Question 4

A 32-year-old woman with diabetes mellitus delivers a child after 38 weeks of gestation. Which of the following is the most likely abnormality that might be encountered in this child at birth?

Accepted Answer

Hypoglycemia

Answer

Cataracts

Answer

Hyperbilirubinemia

Answer

Low birth weight

Question 5

A blood specimen for neonatal thyroid screening is obtained on:

Accepted Answer

48 hours after birth

Answer

Cord blood

Answer

24 hours after birth

Answer

72 hours after birth

Question 6

The lesions seen on this infant's face are usually associated with?

Accepted Answer

Congenital rubella

Answer

Acquired rubella

Answer

Rubeola

Answer

Syphilis

Question 7

Which one of the following life-threatening congenital anomalies in the newborn presents with polyhydramnios, aspiration pneumonia, excessive salivation and difficulty in passing a nasogastric tube?

Accepted Answer

Tracheo-esophageal fistula

Answer

Choanal atresia

Answer

Gastroschisis

Answer

Diaphragmatic hernia

Question 8

Jitteriness can be distinguished from seizures by all of the following except -

Accepted Answer

Frequency of movement

Answer

Sensitivity to stimulus

Answer

Abnormality of Gaze

Answer

Autonomic disturbance

Question 9

Late metabolic acidosis is seen in-

Accepted Answer

Preterm baby getting cow milk

Answer

Term infant given formula feed

Answer

Long term breast feeding

Answer

None of the options

Question 10

A preterm infant with poor respiration at birth starts throwing seizures at 10 hours after birth. Antiepileptic of choice shall be:

Accepted Answer

Phenobarbitone

Answer

Lorazepam

Answer

Levetiracetam

Answer

Phenytoin

Neonatology — MCQs

Neonatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?