Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 861: Meconium can be passed up to how many days in a healthy baby?

A. 2 (Correct Answer)
B. 3
C. 5
D. 7

Explanation: ***2*** - Most healthy term infants pass **meconium** within the first 24 hours of life (90-95%). - Passage of meconium up to **48 hours (2 days)** can still occur in healthy term infants. - **Failure to pass meconium by 48 hours** warrants investigation for potential underlying conditions such as **Hirschsprung disease**, meconium plug syndrome, or intestinal obstruction. - This is the accepted standard in pediatric practice for initiating evaluation. *3* - Waiting **72 hours (3 days)** before investigating delayed meconium passage is not recommended. - By 3 days, the delay is considered **abnormal** and should have already prompted medical evaluation. - Most guidelines recommend investigation by **48 hours**, not 72 hours. *5* - A delay in meconium passage for **5 days** represents a significant abnormality requiring urgent evaluation. - Such delays are typically associated with conditions like **Hirschsprung disease**, intestinal atresia, or other causes of obstruction. - This duration would never be considered normal in a healthy baby. *7* - A delay of **7 days** would be a severe abnormality indicating serious underlying pathology. - This would require urgent medical and likely surgical intervention. - Complete failure to pass meconium for this duration strongly suggests **intestinal obstruction or severe motility disorder**.

Question 862: Which of the following statements about Kangaroo Mother Care is false?

A. Can also be provided by the father.
B. It is only applicable to mothers. (Correct Answer)
C. It is especially beneficial for low birth weight infants.
D. It provides effective thermal control.

Explanation: ***It is only applicable to mothers.*** - This statement is false because **Kangaroo Mother Care (KMC)** involves skin-to-skin contact, which can be provided by any adult caregiver, including the **father** or other family members, not exclusively the mother. - The benefits of KMC, such as **thermal regulation**, improved **bonding**, and **breastfeeding promotion**, are achieved regardless of whether the mother or another caregiver provides the contact. *Can also be provided by the father.* - This statement is true; **fathers** are increasingly recognized as important caregivers in providing **KMC**, offering similar benefits as when provided by the mother. - Involving fathers can enhance **parental bonding** and share the caregiving responsibilities for the infant, especially for **low birth weight** or **premature infants**. *It is especially beneficial for low birth weight infants.* - This statement is true; **KMC** is particularly recommended for **low birth weight (LBW)** infants, especially those weighing under 2500 grams, as it has been shown to reduce mortality and improve their health outcomes. - It helps stabilize **cardiorespiratory function**, promotes **weight gain**, and facilitates **exclusive breastfeeding** in these vulnerable infants. *It provides effective thermal control.* - This statement is true; **KMC** involves direct **skin-to-skin contact**, which helps regulate the infant's body temperature, preventing both **hypothermia** and **hyperthermia** more effectively than conventional incubators in some settings. - The caregiver's body acts as a **human incubator**, providing a stable and appropriate thermal environment for the infant.

Question 863: Post term baby with tachypnea - commonest cause?

A. Transient tachypnea of newborn
B. Meconium aspiration syndrome (Correct Answer)
C. Hyaline membrane disease
D. Infection

Explanation: ***Meconium aspiration syndrome*** - Post-term infants are at increased risk of **meconium staining of amniotic fluid** and subsequent **meconium aspiration**, leading to respiratory distress. - Meconium in the lungs causes **airway obstruction**, chemical pneumonitis, and surfactant inactivation, resulting in tachypnea and hypoxemia. *Transient tachypnea of newborn* - This condition is more common in **term or late preterm infants delivered by C-section**, rather than post-term. - It is caused by **delayed reabsorption of fetal lung fluid**, leading to mild respiratory distress that typically resolves within 24-48 hours. *Hyaline membrane disease* - Also known as **respiratory distress syndrome**, this condition primarily affects **preterm infants** due to **surfactant deficiency**. - It would be highly unusual in a post-term infant, as surfactant production is mature by term or post-term. *Infection* - While infection (e.g., **neonatal sepsis**, pneumonia) can cause tachypnea in any newborn, it is **not the commonest cause of respiratory distress specifically in a post-term baby** with tachypnea. - Infection would typically be accompanied by other signs like fever/hypothermia, poor feeding, lethargy, or signs of systemic illness.

Question 864: The most common bone fractured during birth is

A. Clavicle (Correct Answer)
B. Scapula
C. Radius
D. Humerus

Explanation: ***Clavicle*** - The **clavicle** is the most common bone fractured during birth due to the stresses applied during delivery, especially in cases of shoulder dystocia. - Its relatively superficial location and slender shaft make it vulnerable to fracture as it may get compressed or stretched against the maternal pelvis. *Scapula* - Fractures of the **scapula** are extremely rare in newborns due to its protected position and broad, flat structure. - It would require a significant, unusual force to fracture the scapula during birth. *Radius* - While long bone fractures can occur, a **radial fracture** is less common than a clavicle fracture during birth. - Fractures of the radius typically occur from direct trauma or hyperextension injuries, rather than the compressive forces seen during normal birth. *Humerus* - Fractures of the **humerus** are less common than clavicle fractures but can occur, particularly in difficult deliveries or when excessive force is applied during extraction. - However, the clavicle remains the most frequently fractured bone overall in neonates during birth.

Question 865: Which drug is primarily used in neonatal resuscitation?

A. Sodium bicarbonate
B. Adrenaline (Correct Answer)
C. Naloxone
D. Atropine

Explanation: ***Adrenaline*** - **Adrenaline (epinephrine)** is the primary drug used in neonatal resuscitation when **bradycardia** (heart rate <60 bpm) persists despite adequate ventilation and chest compressions. - It acts as a **vasopressor** and **cardiac stimulant**, increasing heart rate and contractility. - Administered intravenously or via endotracheal tube at a dose of **0.01-0.03 mg/kg**. *Sodium bicarbonate* - **Sodium bicarbonate** is rarely used in neonatal resuscitation due to concerns about potential side effects like **intracranial hemorrhage** and paradoxical intracellular acidosis. - Its use is generally reserved for prolonged resuscitation with documented **metabolic acidosis**. - Not recommended for routine use in the delivery room. *Naloxone* - **Naloxone** is an opioid antagonist used to reverse severe **respiratory depression** caused by maternal opioid administration shortly before delivery. - It is not indicated for primary resuscitation efforts in the absence of opioid exposure, and ventilation remains the priority. - Current NRP guidelines emphasize **ventilation over naloxone** administration. *Atropine* - **Atropine** is no longer recommended in neonatal resuscitation protocols. - It was previously considered for bradycardia but has been removed from **NRP guidelines** due to lack of evidence for efficacy. - **Adrenaline** has replaced atropine as the drug of choice for persistent bradycardia.

Question 866: Which of the following APGAR score ranges indicates that a newborn is 'at risk'?

A. 7-10
B. 4-6 (Correct Answer)
C. Above 8
D. 0-3

Explanation: ***4-6*** - This range indicates **moderate depression** or some difficulty adapting to extrauterine life, representing the newborn **"at risk"** category. - Newborns with this score require **intervention** such as stimulation, oxygen administration, or assisted ventilation. - This is the classic definition of an "at risk" newborn who needs close monitoring and support but is not in critical condition. *7-10* - An APGAR score in this range indicates that the newborn is **healthy** or has minimal adaptations to extrauterine life, and is **NOT considered "at risk"**. - Scores of 7, 8, 9, or 10 at both 1 and 5 minutes are typical for **normal newborns**. - These babies require routine care without special interventions. *0-3* - This range indicates **severe asphyxia** or critical depression, where the newborn is in **life-threatening condition**. - This is beyond "at risk" - these babies require **immediate resuscitation** and are in critical danger. - A score of 0-3 at 5 minutes is associated with significantly increased neonatal mortality and risk of neurological damage. *Above 8* - This range (9-10) overlaps with the 7-10 category and indicates an **excellent, healthy newborn**. - Scores of 9 and 10 show no signs of depression and represent optimal adaptation to extrauterine life. - These newborns are definitely **NOT at risk**.

Question 867: In a term baby who is 72 hours old, breastfeeding well, and has a bilirubin level of 14 mg/dL, which of the following statements is true?

A. Exchange transfusion
B. Continue to breastfeed (Correct Answer)
C. Phototherapy
D. None of the options

Explanation: ***Continue to breastfeed*** - A bilirubin level of **14 mg/dL at 72 hours of age** in a healthy, full-term, breastfeeding baby is usually within the range considered **physiological jaundice** and does not warrant stopping breastfeeding. - **Breastfeeding should continue** regardless of jaundice management, as interruption can cause a **decrease in milk supply** and may worsen jaundice by reducing bilirubin excretion through stool. - Continued breastfeeding (8-12 times per day) helps promote bilirubin clearance. *Exchange transfusion* - This is an **invasive procedure** reserved for very high bilirubin levels (typically **>20-25 mg/dL** in full-term infants depending on age and risk factors) or in cases of **acute bilirubin encephalopathy**. - A bilirubin level of 14 mg/dL is **well below the threshold** for exchange transfusion in a healthy term infant. *Phototherapy* - According to **AAP guidelines**, phototherapy thresholds are age-dependent: - At **72 hours of age**, phototherapy is typically considered at bilirubin levels **>15-18 mg/dL** in low-risk term infants. - At 14 mg/dL, **close monitoring** with repeat bilirubin measurement is appropriate, but phototherapy is generally **not yet indicated** for a healthy term infant without risk factors. *None of the options* - This option is incorrect because **continuing to breastfeed** is the appropriate and evidence-based management for this clinical scenario. - The other interventions (exchange transfusion, phototherapy) are **not indicated** at this bilirubin level and age in a healthy term infant.

Question 868: Cause of greenish-black stool in a neonate -

A. Breakdown product of hemoglobin metabolism
B. First intestinal discharge in newborns (Correct Answer)
C. Urinary pigment found in normal excretion
D. Hepatic pigment involved in bile production

Explanation: ***First intestinal discharge in newborns*** - The greenish-black stool in a neonate is characteristic of **meconium**, which is the first intestinal discharge. - Meconium is composed of materials ingested during the fetal period, including **vernix caseosa**, fine hair (lanugo), **intestinal epithelial cells**, mucus, and biliary secretions. *Breakdown product of hemoglobin metabolism* - While hemoglobin breakdown products (like **bilirubin**) contribute to the color of stool, this option is too general and doesn't specify the unique nature of **meconium**. - Bilirubin is primarily responsible for the yellow color of later infant stools, not the initial greenish-black of meconium. *Urinary pigment found in normal excretion* - **Urinary pigments** (like urochrome) are responsible for the color of urine, not stool. - This option refers to a completely different bodily excretion system. *Hepatic pigment involved in bile production* - This option likely refers to **bilirubin**, which is a hepatic pigment involved in bile production and contributes to stool color. - However, it doesn't fully capture the complex composition and unique appearance of **meconium** as the *first* stool.

Question 869: Which among the following is the most common infectious cause of neonatal blindness?

A. Klebsiella
B. Enterobacter
C. Chlamydia trachomatis (Correct Answer)
D. Neisseria gonorrhoeae

Explanation: ***Chlamydia trachomatis*** - This is the **most common infectious cause of neonatal blindness** due to its high prevalence as the leading cause of neonatal conjunctivitis (50-60% of cases). - Although Chlamydia causes less severe conjunctivitis than Neisseria gonorrhoeae, its **much higher incidence** means it accounts for more **total cases of blindness** worldwide, especially in areas with limited healthcare access. - Infection occurs during passage through the birth canal of an infected mother, manifesting as **mucopurulent discharge** 5-14 days post-delivery. - Untreated cases can lead to **corneal scarring and blindness**, though this is preventable with timely antibiotic therapy. *Klebsiella* - While Klebsiella can cause neonatal infections, including sepsis and meningitis, it is **not a primary or common cause of neonatal blindness.** - **Ocular involvement** is rare and usually secondary to severe systemic infection rather than direct transmission during birth. *Enterobacter* - Similar to Klebsiella, **Enterobacter species** can cause **neonatal sepsis** and other infections, but they are not a leading cause of neonatal blindness. - **Ophthalmic manifestations** are uncommon and not characteristic of direct infectious blindness in newborns. *Neisseria gonorrhoeae* - This causes **severe hyperacute conjunctivitis** (ophthalmia neonatorum) within the first 5 days of life with high risk of rapid corneal ulceration and perforation. - While **more severe per case** than Chlamydia, gonococcal ophthalmia is **much less common** due to widespread maternal screening, prophylactic eye drops (erythromycin/tetracycline), and lower overall prevalence. - Therefore, despite its severity, it accounts for fewer total cases of neonatal blindness than Chlamydia.

Question 870: Which of the following is a classic triad of congenital rubella syndrome?

A. Patent ductus arteriosus, cataracts, and deafness (Correct Answer)
B. Hepatosplenomegaly, mental retardation, and deafness
C. Chorioretinitis, multiorgan failure, and pneumonitis
D. None of the options

Explanation: ***Patent ductus arteriosus, cataracts, and deafness*** - This is the **classic triad** of congenital rubella syndrome, reflecting the damage caused by the rubella virus to the developing fetus's **heart, eyes, and ears**. - **Patent ductus arteriosus** is a common cardiac defect, **cataracts** affect vision, and **sensorineural deafness** is a prevalent auditory defect. *Hepatosplenomegaly, intellectual disability, and deafness* - While **deafness** is part of the rubella triad, **hepatosplenomegaly** and **intellectual disability** are more common features of other congenital infections like **cytomegalovirus (CMV)**, not the classic rubella triad. - **Intellectual disability** can occur with severe rubella, but it's not considered a core component of the classic diagnostic triad. *Chorioretinitis, multiorgan failure, and pneumonitis* - **Chorioretinitis** is a hallmark of congenital toxoplasmosis and CMV infection, not typically seen with congenital rubella. - **Multiorgan failure** and **pneumonitis** are severe, non-specific complications that can occur with various congenital infections but are not part of rubella's classic presentation. *None of the options* - This option is incorrect as the first option accurately describes the **classic triad of congenital rubella syndrome**.

Practice by Chapter

Neonatal Resuscitation

Practice Questions

Care of the Normal Newborn

Practice Questions

Prematurity and Low Birth Weight

Practice Questions

Respiratory Distress Syndrome

Practice Questions

Neonatal Jaundice

Practice Questions

Neonatal Sepsis

Practice Questions

Necrotizing Enterocolitis

Practice Questions

Intraventricular Hemorrhage

Practice Questions

Persistent Pulmonary Hypertension

Practice Questions

Perinatal Asphyxia

Practice Questions

Neonatal Seizures

Practice Questions

Congenital Anomalies

Practice Questions

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