Neonatology Practice Questions

Q: Which of the following is a common symptom of neonatal lupus?

Cutaneous lesion. ***Cutaneous lesion*** - **Cutaneous lesions** are the most common manifestation of neonatal lupus, typically appearing as an **annular erythematous rash** on the face and scalp. - These lesions often develop after exposure to **ultraviolet light** and usually resolve within 6 months as maternal autoantibodies clear from the infant's system. *Thrombocytopenia* - While **hematologic abnormalities** such as thrombocytopenia can occur in neonatal lupus, they are less common than cutaneous lesions. - **Thrombocytopenia** refers to a low platelet count, which can increase the risk of bleeding. *All of the options* - While all listed options (cutaneous lesions, thrombocytopenia, and heart block) can be features of neonatal lupus, **cutaneous lesions** are the most frequently observed symptom. - Choosing "All of the options" would imply equal commonality or presence of all in every case, which is not accurate. *Heart block* - **Congenital heart block** is a serious, but less common and often irreversible, manifestation of neonatal lupus, caused by maternal antibodies attacking the fetal cardiac conduction system. - It usually presents as **bradycardia** and may require a pacemaker, but it is not the most common symptom overall.

Q: What is the threshold for hyperglycemia in neonates?

150 mg/dl. ***150 mg/dl*** - A blood glucose level greater than **150 mg/dL** is the **standard threshold** most commonly taught and used for defining **hyperglycemia** in neonates. - This value is widely accepted in clinical practice and guides decisions regarding **glucose management** and potential **insulin therapy** in this population. - This threshold is particularly relevant for term and late preterm neonates. *125 mg/dl* - While **125 mg/dL** represents an elevated glucose level and some newer guidelines consider this as a threshold (especially >7 mmol/L), it is **not the standard taught threshold** of 150 mg/dL. - For examination purposes, **150 mg/dL** remains the recognized standard definition. *180 mg/dl* - A blood glucose level of **180 mg/dL** indicates **severe hyperglycemia** rather than the initial threshold for defining hyperglycemia. - While some protocols for extremely preterm infants may use higher cutoffs, this exceeds the standard diagnostic threshold. - Intervention is typically initiated well before reaching this level to prevent complications. *100 mg/dl* - A blood glucose level of **100 mg/dL** in a neonate falls within the **normal range**, not hyperglycemia. - This level is desirable for proper brain development and metabolic function. - Normal neonatal glucose ranges from approximately **40-100 mg/dL** in the first days of life.

Q: A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Mild BPD. ***Mild BPD*** - The infant required respiratory support (ventilation and CPAP) for an extended period (5 weeks total, far exceeding the 28-day oxygen requirement for BPD diagnosis). - Being on **room air at 36 weeks post-menstrual age** despite prior prolonged support classifies his condition as mild BPD according to the diagnostic criteria. - For infants born <32 weeks gestation, mild BPD is defined as needing oxygen for ≥28 days but breathing room air at 36 weeks PMA. *Moderate BPD* - Moderate BPD would be diagnosed if the infant still required **less than 30% oxygen (FiO2 0.22-0.29) at 36 weeks post-menstrual age**. - This infant was on room air (FiO2 0.21), indicating less severe lung disease than moderate BPD. *Severe BPD* - Severe BPD involves the ongoing need for **30% or greater oxygen (FiO2 ≥0.30)** and/or positive pressure support (CPAP/ventilator) at 36 weeks post-menstrual age. - This infant did not meet these criteria, as he was on room air without any support. *No BPD* - No BPD would require **less than 28 days of oxygen/respiratory support** during the neonatal period. - This infant required mechanical ventilation for 4 weeks and CPAP for 1 week (total 5 weeks = 35 days), clearly exceeding the 28-day threshold for BPD diagnosis. - Despite being stable on room air at 36 weeks PMA, the prolonged earlier support establishes the diagnosis of BPD (mild severity).

Q: The recommended ambient temperature for NICU is

22-26° C. ***22-26° C*** - Maintaining an ambient temperature of **22-26°C** in the NICU is crucial for preventing **cold stress** in neonates. - This temperature range helps to maintain the baby's **core body temperature**, reducing metabolic demands and ensuring optimal thermal regulation. *20-22° C* - While this might be a comfortable room temperature for adults, it is generally **too cold** for newborns in the NICU. - Temperatures below the recommended range can lead to significant **cold stress**, increasing oxygen consumption and metabolic rate in vulnerable infants. *26-30° C* - This temperature range is generally **too warm** for a NICU environment. - Excessive warmth can lead to **hyperthermia** and sweating, which increases fluid loss and can be detrimental to a neonate's health. *30-35°C* - This temperature is **dangerously high** for neonates in the NICU. - Such high temperatures would significantly increase the risk of **hyperthermia, dehydration**, and other severe complications, compromising the infant's well-being.

Q: What is the primary reason for low glucose levels in premature infants?

Decreased glycogen stores. ***Decreased glycogen stores*** - Premature infants have undeveloped livers, leading to significantly **reduced glycogen reserves** at birth compared to full-term infants. - These limited stores are rapidly depleted within hours after birth, leaving the infant vulnerable to **hypoglycemia** as they cannot maintain glucose homeostasis. *Increased brain to body ratio* - While premature infants do have a relatively **larger brain-to-body ratio**, this primarily increases their glucose utilization, rather than causing low glucose directly. - The increased glucose demand is an exacerbating factor for hypoglycemia, but the fundamental issue remains the lack of available glucose to meet this demand. *Decreased action of pyruvate carboxylase* - **Pyruvate carboxylase** is an enzyme crucial for **gluconeogenesis**, the process of synthesizing glucose from non-carbohydrate precursors. - While immature hepatic enzyme systems in premature infants can contribute to impaired gluconeogenesis, the primary and most immediate reason for initial low glucose levels is the lack of stored glycogen. *None of the options* - Given that a specific and significant reason for low glucose levels in premature infants is clearly identified (decreased glycogen stores), this option is incorrect.

Q: Which of the following statements is true regarding anemia of prematurity?

Low reticulocyte response. ***Low reticulocyte response*** - Anemia of prematurity results from several factors, including a **blunted erythropoietin response** to anemia, **shortened red blood cell lifespan**, and **rapid growth with increased blood volume requirements**. - The combination of these factors leads to **insufficient red blood cell production** by the bone marrow, reflected by a **low reticulocyte count** despite anemia. - This low reticulocyte response is a **key diagnostic feature** distinguishing it from hemolytic anemias. *Hemoglobin level <10 gm/dL* - While premature infants with anemia of prematurity develop low hemoglobin, a specific cutoff of **<10 gm/dL is not universally definitive** for diagnosis. - Hemoglobin nadirs vary based on **gestational age** (more premature = lower nadir) and occur at different postnatal ages. - Transfusion thresholds are determined by **clinical stability and symptoms**, not just a single Hb value. *10 ml/kg packed cell transfusion* - This describes a **treatment intervention**, not a characteristic of the disease itself. - Transfusion volume is typically **10-15 ml/kg** when indicated, but the decision to transfuse depends on gestational age, postnatal age, clinical stability, and symptoms like apnea or bradycardia. - This is **not a defining feature** of anemia of prematurity. *Microcytic hypochromic type* - Anemia of prematurity is typically **normocytic, normochromic**, not microcytic hypochromic. - **Microcytic hypochromic** anemia suggests **iron deficiency**, which is a different condition. - The red cells in anemia of prematurity have **normal size (MCV) and normal hemoglobin content** per cell.

Q: Newborn can be given breast milk after how much time following normal delivery?

1 hour. ***1 hour*** - Initiating breastfeeding **within 1 hour** after a normal vaginal delivery is the **WHO and UNICEF recommended standard** for optimal newborn care. - This practice, often called the **"golden hour"**, allows the newborn to benefit from **colostrum** (rich in antibodies and nutrients), promotes **mother-infant bonding**, and helps stimulate **uterine contractions** to reduce postpartum hemorrhage. - Early initiation within this timeframe supports **successful establishment of breastfeeding** and improves exclusive breastfeeding rates. *Half hour* - While initiating breastfeeding within 30 minutes is **excellent and encouraged**, the standard guideline allows up to 1 hour. - Immediate or very early feeding (within 30 minutes) is ideal when mother and baby are stable, but the flexibility up to 1 hour accommodates immediate postpartum care needs. *2 hours* - Delaying breastfeeding until 2 hours post-delivery **exceeds the recommended window** and can lead to the infant becoming **less alert** and less interested in feeding. - This delay is associated with **lower rates of successful exclusive breastfeeding** and may impact milk supply establishment. *3 hours* - A 3-hour delay in initiating breastfeeding is **significantly beyond recommended guidelines** after a normal, uncomplicated delivery. - Such delays can contribute to **poor latch**, **infant fatigue**, increased **formula supplementation**, and may hinder **long-term breastfeeding success**.

Q: Prophylactic dose of vitamin K given to new born infants at delivery is?

1mg. ***1mg*** - The standard prophylactic dose of **intramuscular (IM) vitamin K** given to newborns at delivery is **1mg**. - This dose is effective in preventing **Vitamin K Deficiency Bleeding (VKDB)**, also known as hemorrhagic disease of the newborn. *5mg* - A 5mg dose of vitamin K is typically reserved for older children or adults with confirmed **vitamin K deficiency** or certain bleeding disorders. - This dose is generally not given prophylactically to healthy newborns due to the risk of potential adverse effects and it being excessive for prophylaxis. *10mg* - A 10mg dose of vitamin K is significantly higher than the recommended prophylactic dose for newborns and is not routinely administered. - Such a high dose could potentially lead to **hemolysis** or other adverse reactions in neonates. *15mg* - A 15mg dose of vitamin K is far beyond the appropriate prophylactic dose for newborns and is not used in this context. - Administering such a large dose would pose significant risks and is unnecessary for preventing **VKDB**.

Q: Congenital varicella infection causes all except:

Macrocephaly. ***Macrocephaly*** - **Macrocephaly** is generally not a direct consequence of congenital varicella infection; rather, **microcephaly** due to brain damage is more commonly observed. - Congenital varicella typically causes destructive lesions leading to tissue loss, not increased head circumference. *Cortical atrophy* - **Cortical atrophy** results from the destructive effects of the virus on the developing brain, leading to **neuronal loss** and reduced brain volume. - This can manifest as **microcephaly**, an indirect but common finding associated with congenital varicella. *Cicatrix* - **Cicatrix** (zig-zag scarring) is a classic dermatological manifestation of congenital varicella, resulting from the virus's impact on developing skin. - These characteristic **skin lesions** are one of the most identifiable features of the syndrome. *Limb hypoplasia* - **Limb hypoplasia**, involving underdeveloped limbs, is a hallmark feature of congenital varicella, often due to **viral damage** to limb buds and associated neural structures. - This can lead to **bone shortening** and muscle atrophy in affected limbs.

Question 1

Which of the following is a common symptom of neonatal lupus?

Accepted Answer

Cutaneous lesion

Answer

All of the options

Answer

Thrombocytopenia

Answer

Heart block

Question 2

What is the threshold for hyperglycemia in neonates?

Accepted Answer

150 mg/dl

Answer

180 mg/dl

Answer

100 mg/dl

Answer

125 mg/dl

Question 3

A baby is born at 27 weeks of gestation and required mechanical ventilation for 4 weeks and CPAP for 1 week. He was maintained on room air subsequently. Based on the new definition of Bronchopulmonary Dysplasia (BPD), and assuming he remained on room air at 36 weeks post-menstrual age, what is the most appropriate classification of his condition?

Accepted Answer

Mild BPD

Answer

Moderate BPD

Answer

Severe BPD

Answer

No BPD

Question 4

The recommended ambient temperature for NICU is

Accepted Answer

22-26° C

Answer

20-22° C

Answer

26-30° C

Answer

30-35° C

Question 5

What is the PRIMARY pathophysiological mechanism underlying the most common cause of neonatal hyperbilirubinemia?

Accepted Answer

Immature liver enzyme

Answer

Inefficient erythropoiesis

Answer

RBC hemolysis

Answer

Decreased bilirubin excretion

Question 6

What is the primary reason for low glucose levels in premature infants?

Accepted Answer

Decreased glycogen stores

Answer

Increased brain to body ratio

Answer

Decreased action of pyruvate carboxylase

Answer

None of the options

Question 7

Which of the following statements is true regarding anemia of prematurity?

Accepted Answer

Low reticulocyte response

Answer

Hemoglobin level <10 gm/dL

Answer

10 ml/kg packed cell transfusion

Answer

Microcytic hypochromic type

Question 8

Newborn can be given breast milk after how much time following normal delivery?

Accepted Answer

1 hour

Answer

Half hour

Answer

2 hours

Answer

3 hours

Question 9

Prophylactic dose of vitamin K given to new born infants at delivery is?

Accepted Answer

1mg

Answer

5mg

Answer

10mg

Answer

15mg

Question 10

Congenital varicella infection causes all except:

Accepted Answer

Macrocephaly

Answer

Cortical atrophy

Answer

Cicatrix

Answer

Limb hypoplasia

Neonatology — MCQs

Neonatology — MCQs

On this page

Practice by Chapter

Want unlimited practice?