Neonatology Practice Questions

Q: Congenital Rubella syndrome may have the following clinical features, except

Hydrocephalus. ***Hydrocephalus*** - **Hydrocephalus** is generally *not* a characteristic feature of **congenital rubella syndrome (CRS)**. - While many devastating neurological developmental abnormalities can occur in utero, **hydrocephalus** specifically is not one of them. - CRS is associated with **microcephaly** (small brain), not hydrocephalus (enlarged ventricles). *Microcephaly* - **Microcephaly**, or an abnormally small head, is a common neurological sequel of **congenital rubella syndrome** due to brain damage. - The rubella virus can interfere with cell proliferation during fetal development, leading to **poor brain growth**. *Neonatal hepatitis* - **Neonatal hepatitis** can occur as part of the systemic manifestations of **congenital rubella syndrome**, resulting in **jaundice** and **liver dysfunction**. - The rubella virus can infect various organs, including the liver, causing inflammation and damage. *Congenital cataract* - **Congenital cataracts** are a classic ocular manifestation of **congenital rubella syndrome**, often leading to significant visual impairment. - The rubella virus can directly infect the developing lens, causing opacification. - Cataracts are part of the classic triad of CRS along with **cardiac defects** and **deafness**.

Q: A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:

HSV II. ***HSV II*** - **Herpes simplex virus type 2 (HSV-2)** is the most common cause of **neonatal herpes**, presenting with neurological manifestations like encephalitis and characteristic vesicular skin lesions. - Transmission usually occurs during **vaginal delivery** from a mother with genital herpes, leading to widespread infection in the neonate. *Meningococci* - While *Neisseria meningitidis* can cause **meningitis** and **septicemia** in neonates, it does not typically produce vesicular skin lesions. - Its infections are more commonly associated with a **petechial or purpuric rash**, not vesicles. *Streptococci* - **Group B Streptococcus (GBS)** is a leading cause of **neonatal sepsis and meningitis**, but it does not cause vesicular skin lesions. - GBS typically presents with non-specific signs of sepsis or meningitis in neonates. *HSV I* - Although **herpes simplex virus type 1 (HSV-1)** can cause neonatal herpes, **HSV-2 remains the predominant cause** of vertically transmitted neonatal infection with encephalitis and disseminated disease. - HSV-1 is more commonly associated with **oral herpes (cold sores)** in older children and adults, though its incidence in neonatal infection is increasing.

Q: A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?

Obstruction in the circulation of the cerebrospinal fluid. ***Obstruction in the circulation of the cerebrospinal fluid*** - **Non-communicating hydrocephalus**, by definition, is caused by an **obstruction within the ventricular system** that prevents CSF from reaching the subarachnoid space. - In a newborn, common causes of such obstruction include **aqueductal stenosis** or malformations like **Dandy-Walker syndrome**. *Disturbances in the resorption of cerebrospinal fluid* - This typically leads to **communicating hydrocephalus**, where CSF can flow freely within the ventricles but is not adequately absorbed into the venous system. - Examples include **arachnoid granulations** dysfunction or **post-meningitic scarring**. *Excess production of cerebrospinal fluid* - This is a very rare cause of hydrocephalus, usually associated with conditions like a **choroid plexus papilloma**. - This would lead to a **communicating hydrocephalus** as the obstruction is not within the ventricular system itself. *Increased size of the head* - An **increased head size (macrocephaly)** is a *symptom* or *sign* of hydrocephalus in an infant, not a cause. - The elevated intracranial pressure from the accumulated CSF leads to the expansion of the skull bones before the sutures fuse.

Q: To assess thyroid profile of a newborn, which of the following is mandatory?

Measure both TSH and T4. ***Measure both TSH and T4*** - **Newborn screening** for congenital hypothyroidism typically involves measuring both **TSH** (thyroid-stimulating hormone) and **T4** (thyroxine). - Elevated TSH levels indicate **primary hypothyroidism**, where the thyroid gland is underactive, while low T4 levels confirm the reduced thyroid hormone production. *Measure T3 only* - **T3 (triiodothyronine)** is generally not the primary screening test for congenital hypothyroidism in newborns. - While T3 is an active form of thyroid hormone, its levels can be influenced by various factors and are less reliable than TSH and T4 for initial screening. *Measure TSH only* - Measuring only **TSH** can detect primary hypothyroidism, but it doesn't provide a complete picture of thyroid function. - In cases of **central (secondary or tertiary) hypothyroidism**, TSH levels might be normal or low, while T4 levels are reduced, which would be missed if only TSH were measured. *Measure T4 only* - Measuring only **T4** can help identify low thyroid hormone levels, but it doesn't differentiate between primary and central hypothyroidism. - To properly assess the cause of low T4, **TSH levels** are crucial to determine if the problem lies within the thyroid gland itself or higher up in the pituitary/hypothalamic axis.

Q: Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?

None of the above. ***None of the above*** - All listed interventions—**endotracheal tube intubation**, **chest compressions**, and **adrenaline administration**—are standard components of neonatal resuscitation when the heart rate remains below 60 beats/min despite initial steps. - This question asks which is *NOT* included, implying that all options are, in fact, appropriate interventions in this critical scenario. *Endotracheal tube intubation* - This is a critical step in **securing the airway** and ensuring effective positive pressure ventilation when other methods fail or prolonged mechanical ventilation is anticipated. - It's indicated if the heart rate remains below 60 bpm despite adequate bag-mask ventilation and chest compressions. *Chest compression* - **Chest compressions** are initiated when the heart rate is less than 60 bpm *after* 30 seconds of effective positive pressure ventilation. - They are used in conjunction with positive pressure ventilation to improve cardiac output and myocardial perfusion. *Adrenaline* - **Adrenaline** is administered if the heart rate remains below 60 bpm *despite* adequate ventilation and chest compressions. - It acts as a potent **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility.

Q: A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?

No active treatment required. ***No active treatment required*** - A total serum bilirubin of **14 mg/dL** on day 5 in an otherwise well, exclusively breastfed term neonate (birth weight 2700g, which is >2500g) falls within the **physiologic jaundice range** and below thresholds for intervention. - This level is considered **normal for breastfed infants** at this age and does not warrant medical intervention as per current guidelines. *Stop breastfeeding for 2 days* - This intervention, known as **breast milk jaundice interruption**, is usually reserved for higher bilirubin levels or if there is concern for significant breast milk jaundice, which is not indicated here. - Temporarily stopping breastfeeding can disrupt the establishment of breastfeeding and is generally discouraged unless strictly necessary. *Phototherapy* - **Phototherapy** is indicated for bilirubin levels typically >15-18 mg/dL in a healthy term neonate on day 5, depending on risk factors, which this infant does not meet. - It works by converting unconjugated bilirubin into water-soluble isomers that can be excreted more easily. *Exchange transfusion* - **Exchange transfusion** is reserved for severe hyperbilirubinemia, usually with bilirubin levels approaching or exceeding 20-25 mg/dL, especially if there are signs of **acute bilirubin encephalopathy**. - This level is far below the threshold for such an invasive procedure.

Q: Which among the following is NOT part of the classic clinical triad of necrotizing enterocolitis?

Metabolic acidosis. ***Metabolic acidosis*** - Metabolic acidosis is **not** part of the classic clinical triad of necrotizing enterocolitis, though it is a common laboratory finding in severe cases. - The **classic triad of NEC** consists of: **abdominal distension**, **bloody stools**, and **pneumatosis intestinalis** on radiography. - Metabolic acidosis occurs as a consequence of intestinal ischemia and sepsis but is not included in the defining triad. *Abdominal distension* - **Abdominal distension** is a cardinal clinical feature and part of the classic triad. - Results from intestinal inflammation, ileus, and gas accumulation. *Bloody stools* - **Bloody stools** (grossly bloody or occult blood positive) are part of the classic triad. - Reflect mucosal injury and intestinal necrosis. *Pneumatosis intestinalis* - **Pneumatosis intestinalis** (intramural gas on abdominal X-ray) is the pathognomonic radiological finding in the classic triad. - Indicates gas-forming bacterial invasion of the damaged intestinal wall.

Question 1

A newborn presents with petechiae, skin lesions, hematuria, and a platelet count of 22,000/L. This is most likely caused by:

Accepted Answer

Congenital CMV infection

Answer

Congenital rubella infection

Answer

Both CMV and rubella infection

Answer

Premature infants

Question 2

Congenital Rubella syndrome may have the following clinical features, except

Accepted Answer

Hydrocephalus

Answer

Microcephaly

Answer

Neonatal hepatitis

Answer

Congenital cataract

Question 3

A neonate who is febrile, presents with features of encephalitis. On examination, the baby is found to have vesicular skin lesions. Most probable causative organism is:

Accepted Answer

HSV II

Answer

Meningococci

Answer

Streptococci

Answer

HSV I

Question 4

A 5-day-old infant is diagnosed with a non-communicating hydrocephalus. Which of the following is most likely to lead to such a condition?

Accepted Answer

Obstruction in the circulation of the cerebrospinal fluid

Answer

Disturbances in the resorption of cerebrospinal fluid

Answer

Excess production of cerebrospinal fluid

Answer

Increased size of the head

Question 5

To assess thyroid profile of a newborn, which of the following is mandatory?

Accepted Answer

Measure both TSH and T4

Answer

Measure T3 only

Answer

Measure TSH only

Answer

Measure T4 only

Question 6

Which of the following is NOT included in the resuscitation of a neonate with HR < 60/min?

Accepted Answer

None of the above

Answer

Endotracheal tube intubation

Answer

Chest compression

Answer

Adrenaline

Question 7

Which of the following is most specific for congenital Rubella syndrome?

Accepted Answer

Triad of CRS are cataract, cardiac defects, sensorineural deafness

Answer

Blueberry muffin rash is seen

Answer

Infection is most serious in the first trimester of pregnancy

Answer

Virus can be isolated up to 12 months after birth

Question 8

A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?

Accepted Answer

No active treatment required

Answer

Stop breastfeeding for 2 days

Answer

Phototherapy

Answer

Exchange transfusion

Question 9

Which among the following is NOT part of the classic clinical triad of necrotizing enterocolitis?

Accepted Answer

Metabolic acidosis

Answer

Bloody stools

Answer

Pneumatosis intestinalis

Answer

Abdominal distension

Question 10

A newborn presents with snuffles, hepatosplenomegaly, and osteochondritis. Mother's VDRL is 1:32. Most appropriate initial investigation is:

Accepted Answer

Quantitative VDRL of newborn

Answer

Dark field microscopy of nasal discharge

Answer

CSF examination

Answer

X-ray long bones

Neonatology — MCQs

Neonatology — MCQs

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