Neonatology — MCQs

Neonatology Indian Medical PG Practice Questions and MCQs

Question 871: Which of the following methods is not recommended for resuscitating a newborn baby with a heart rate less than 60 beats per minute?

A. oxygen therapy
B. tactile stimulation
C. chest compression
D. slapping the back (Correct Answer)

Explanation: ***Slapping the back*** - This method is **contraindicated** and **harmful** for newborn resuscitation as it can cause trauma and does not effectively improve heart rate or ventilation. - Previous practices involving forceful stimulation are now recognized as unsafe and ineffective, with current guidelines emphasizing gentle stimulation or medical interventions. *Chest compression* - **Chest compressions** are indicated when a newborn's heart rate remains below **60 beats per minute** despite adequate ventilation with positive pressure ventilation (PPV). - This intervention helps to circulate oxygenated blood to vital organs and is a critical component of neonatal resuscitation for severe bradycardia. *Oxygen therapy* - **Oxygen therapy** with positive pressure ventilation (PPV) is the **first-line intervention** for newborns with heart rate below 60 bpm after initial steps. - It helps to improve oxygen saturation, support ventilation, and may improve heart rate before chest compressions are needed. *Tactile stimulation* - **Tactile stimulation**, such as gently rubbing the back or flicking the soles of the feet, is an initial step in newborn resuscitation for mild respiratory depression. - However, for a heart rate **below 60 bpm** (as in this question's scenario), tactile stimulation alone is **insufficient** and **not appropriate** - immediate positive pressure ventilation and chest compressions are required instead. - Tactile stimulation is only useful during initial assessment and for mild depression, not for established bradycardia requiring advanced resuscitation.

Question 872: Which viral infection is known to cause a condition resembling erythroblastosis?

A. EBV
B. CMV
C. Parvovirus B19 (Correct Answer)
D. HSV

Explanation: ***Parvovirus B19*** - **Parvovirus B19** has a specific tropism for **erythroid progenitor cells** in the bone marrow. - In the fetus, congenital infection causes **severe anemia** due to destruction of red blood cell precursors, leading to **hydrops fetalis** with massive compensatory erythropoiesis. - This results in circulating **nucleated red blood cells (erythroblasts)**, hepatosplenomegaly from extramedullary hematopoiesis, and severe anemia - a picture closely **resembling erythroblastosis fetalis**. - Unlike the immune-mediated hemolysis in Rh isoimmunization, parvovirus causes direct viral destruction of erythroid precursors with similar clinical manifestations. *CMV* - **Cytomegalovirus (CMV)** is the most common congenital infection and can cause hepatosplenomegaly, jaundice, and thrombocytopenia. - However, CMV typically causes **direct hyperbilirubinemia** from hepatocellular damage rather than the hemolytic anemia pattern seen in erythroblastosis. - While CMV can affect hematopoiesis, it does not characteristically produce the massive erythroblast response and hydrops pattern typical of erythroblastosis fetalis. *EBV* - **Epstein-Barr virus (EBV)** primarily causes **infectious mononucleosis** in older children and adults, with atypical lymphocytosis. - EBV is rare in neonates and does not cause fetal hydrops or an erythroblastosis-like syndrome. - Associated with lymphoproliferative disorders and post-transplant complications rather than fetal anemia. *HSV* - **Herpes simplex virus (HSV)** causes disseminated neonatal infection with encephalitis, hepatitis, and mucocutaneous lesions. - HSV does not have tropism for erythroid precursors and does not cause the anemia, hydrops, or erythroblastosis-like picture. - Typically acquired perinatally rather than causing congenital infection with hematologic manifestations.

Question 873: Chronic lung disease in infancy is defined as

A. Need for supplemental oxygen at 36 weeks postmenstrual age (Correct Answer)
B. Tachypnoea > 50 breaths/ min within 1 week of birth
C. Presence of bilateral infiltrates on chest Xray for 2 weeks
D. Reticulogranular pattern on chest Xray for 6 weeks

Explanation: ***Need for supplemental oxygen at 36 weeks after conception*** - **Chronic lung disease (CLD)**, also known as **bronchopulmonary dysplasia (BPD)**, is defined by the need for **supplemental oxygen** at 36 weeks postmenstrual age (corrected gestational age) or at 56 days postnatal age, whichever comes first, for infants born before 32 weeks gestation. - This definition reflects persistent respiratory morbidity requiring ongoing support, indicative of lung injury and abnormal development. *Tachypnoea > 50 breaths/ min within 1 week of birth* - **Tachypnoea** within the first week of birth can be a symptom of various neonatal respiratory conditions, such as **transient tachypnoea of the newborn (TTN)** or **respiratory distress syndrome (RDS)**, but it is not a defining feature of CLD. - CLD is characterized by a *prolonged* need for respiratory support, not just an acute symptom in the first week. *Presence of bilateral infiltrates on chest Xray for 2 weeks* - **Bilateral infiltrates** on a chest X-ray over two weeks could suggest conditions like **pneumonia** or **ARDS**, but it is not the diagnostic criterion for CLD. - The definition of CLD focuses on the physiological need for oxygen, rather than specific radiographic findings in isolation. *Reticulogranular pattern on chest Xray for 6 weeks* - A **reticulogranular pattern** on chest X-ray is characteristic of **respiratory distress syndrome (RDS)**, typically seen in premature infants due to surfactant deficiency. - While RDS can precede CLD, a **reticulogranular pattern** typically improves with treatment (surfactant therapy, ventilation) and does not persist for 6 weeks as a defining feature of chronic lung disease.

Question 874: Which of the following is NOT a recognized cause of neonatal bradycardia?

A. Hypothermia
B. Head injury
C. Hypoxia
D. BCG Vaccine (Correct Answer)

Explanation: ***BCG Vaccine*** - The **BCG vaccine** (Bacille Calmette-Guérin) is used to prevent tuberculosis and is not a known cause of **neonatal bradycardia**. - While it can cause local reactions or, rarely, disseminated disease in immunocompromised infants, it does not directly affect heart rate. *Hypoxia* - **Hypoxia** is a common and critical cause of **neonatal bradycardia**, as the heart attempts to conserve energy and oxygen in response to insufficient oxygen supply. - Severe or prolonged hypoxia can lead to **myocardial depression** and further compromise cardiac function. *Hypothermia* - **Hypothermia** (low body temperature) can significantly depress the **central nervous system** and **metabolic rate** in neonates. - This physiological response often leads to a decreased heart rate, resulting in **bradycardia**. *Head injury* - **Head injury** in neonates, especially severe forms, can increase **intracranial pressure** and stimulate the **vagal nerve**. - **Vagal stimulation** can lead to a decrease in heart rate, manifesting as **bradycardia**.

Question 875: There is overlapping of skull sutures which can be reduced with gentle pressure. What is the grade of moulding?

A. Grade 1
B. Grade 2 (Correct Answer)
C. Grade 3
D. Grade 4

Explanation: ***Grade 2*** - **Grade 2 moulding** is characterized by overriding of the skull sutures that can be reduced with gentle pressure. This indicates moderate moulding of the fetal head. - This degree of moulding is a common finding during labor and delivery and usually resolves without intervention. *Grade 1* - **Grade 1 moulding** involves the apposition (touching) of the skull bones without actual overlap. - It signifies minimal moulding of the fetal head. *Grade 3* - **Grade 3 moulding** involves significant overlapping of the skull sutures that is fixed and cannot be reduced with gentle pressure. - This indicates severe moulding and may sometimes be associated with increased risk of intracranial complications. *Grade 4* - There is no universally recognized "Grade 4" for fetal head moulding in standard classifications. - Moulding is typically classified up to Grade 3, indicating increasing severity.

Question 876: A newborn presents with subconjunctival hemorrhage. The treatment is

A. No treatment (Correct Answer)
B. Antibiotic eye drops
C. Antibiotic and steroid drops
D. Aspiration

Explanation: ***No treatment*** - **Subconjunctival hemorrhage** in a newborn is typically **benign** and **resolves spontaneously** within **1-2 weeks**. - It is often caused by the trauma of birth and does not require intervention. *Antibiotic eye drops* - These are indicated for **bacterial conjunctivitis** or to prevent bacterial infection, which is not the case here. - Using antibiotics without a bacterial indication is unnecessary and can contribute to **antibiotic resistance**. *Aspiration* - **Aspiration** is an invasive procedure and is **not indicated** for a subconjunctival hemorrhage, which is a collection of blood under the conjunctiva. - It could cause further damage or introduce infection. *Antibiotic and steroid drops* - **Steroid drops** are typically used to reduce **inflammation**, which is not the primary issue in a subconjunctival hemorrhage. - Like plain antibiotic drops, the **antibiotic component** is not necessary in the absence of infection.

Question 877: Which of the following statements about cephalhematoma is correct?

A. It is hemorrhage between the skull and periosteum (Correct Answer)
B. It is hemorrhage within the subcutaneous tissue around the skull
C. It is type of subdural hemorrhage
D. It is subperiosteal bleeding in the skull

Explanation: ***It is hemorrhage between the skull and periosteum*** - A **cephalhematoma** is defined as a collection of blood between the **periosteum** and the underlying **skull bone** (subperiosteal). - Its boundaries are limited by the suture lines because the periosteum is firmly attached at these junctions, preventing blood from crossing. *It is hemorrhage within the subcutaneous tissue around the skull* - This description corresponds to a **caput succedaneum**, which involves **edema and hemorrhage** in the subcutaneous tissue, rather than between the skull and periosteum. - Unlike a cephalhematoma, a **caput succedaneum** can cross suture lines and is typically present at birth. *It is type of subdural hemorrhage* - A **subdural hemorrhage** involves bleeding between the **dura mater** and the **arachnoid mater** within the cranial vault. - This type of hemorrhage is a **neurological emergency** and is distinct from a cephalhematoma, which is an external scalp injury. *It is subperiosteal bleeding in the skull* - While this statement is technically correct (subperiosteal means under the periosteum), the **standard definition** specifically states "between the periosteum and the skull bone." - The distinction is important: **subperiosteal** could theoretically include bleeding within the periosteum itself, whereas the precise location is in the **potential space** between periosteum and bone. - Option A is more precise and is the preferred medical definition.

Question 878: Which test is used to diagnose congenital syphilis in a newborn born to a syphilitic mother?

A. Detection of IgG
B. ZN staining
C. Detection of IgM (Correct Answer)
D. FTA-ABS test

Explanation: ***Detection of IgM*** - The presence of **IgM antibodies** in a newborn suggests active infection because maternal IgM does not cross the placenta. - This indicates the newborn's immune system has produced its own antibodies in response to *Treponema pallidum* infection. *Detection of IgG* - **Maternal IgG antibodies can cross the placenta**, so detecting IgG in a newborn does not differentiate between passive transfer from the mother and active newborn infection. - While total IgG might be elevated due to infection, specific IgM is a more reliable indicator of active congenital syphilis. *ZN staining* - **Ziehl-Neelsen (ZN) staining** is used to identify **acid-fast bacteria**, such as *Mycobacterium tuberculosis*, not spirochetes like *Treponema pallidum*. - *Treponema pallidum* is typically visualized using darkfield microscopy or silver stains due to its thin, helical shape. *FTA-ABS test* - The **Fluorescent Treponemal Antibody Absorption (FTA-ABS)** test detects specific antibodies against *Treponema pallidum* but primarily measures IgG, which can be maternally transferred. - While it confirms exposure, an IgM-specific FTA-ABS would be more definitive for congenital syphilis, but the general FTA-ABS test alone is not sufficient to diagnose active infection in a newborn.

Question 879: Which of the following is not a cause of neonatal anaemia?

A. Subgaleal Hemorrhage
B. Abruptio placentae
C. Wilson's Disease (Correct Answer)
D. Diamond Blackfan syndrome

Explanation: ***Wilson's Disease*** - Wilson's disease is a disorder of **copper metabolism** that typically manifests later in childhood or adolescence with **hepatic**, **neurological**, or **psychiatric symptoms**, not neonatal anemia. - While it can cause hemolytic anemia in older individuals due to copper toxicity, it is not a recognized cause of **neonatal anemia**. *Subgaleal Hemorrhage* - A subgaleal hemorrhage is a significant collection of blood in the **subgaleal space** of the scalp, which can lead to substantial **blood loss** and subsequent **neonatal anemia** due to a large potential space. - This type of hemorrhage is often associated with **vacuum extraction** or other traumatic deliveries. *Abruptio placentae* - **Abruptio placentae** involves the premature separation of the placenta from the uterine wall, leading to **fetal-maternal hemorrhage** and sometimes significant **fetal blood loss**. - This acute blood loss in the fetus can manifest as severe **neonatal anemia** at birth. *Diamond Blackfan syndrome* - **Diamond Blackfan syndrome** is a congenital red cell aplasia characterized by a failure of **red blood cell production** in the bone marrow. - This condition presents with severe **macrocytic anemia** early in infancy, often requiring transfusions.

Question 880: A 45-day-old infant presents with seizures. Examination reveals he is icteric, has bulging fontanelles, and exhibits opisthotonic posture. Which of the following treatments is NOT indicated?

A. Chlorpromazine (Correct Answer)
B. Phenobarbital
C. Phototherapy
D. Exchange Transfusion

Explanation: ***Chlorpromazine*** - Chlorpromazine is an **antipsychotic medication** and is **contraindicated** in infants, especially in the presence of seizures and central nervous system (CNS) dysfunction, due to its potential to **lower the seizure threshold** and cause severe extrapyramidal symptoms. - Its mechanism of action via **dopamine receptor blockade** is not relevant for treating bilirubin encephalopathy or its symptoms. *Phototherapy* - Phototherapy is a primary treatment for **neonatal jaundice** to reduce unconjugated bilirubin levels and prevent neurotoxicity. - While the infant's condition suggests severe hyperbilirubinemia with complications, phototherapy would still be indicated as an initial step or adjunct to further interventions, especially if the bilirubin levels are still rising. *Exchange Transfusion* - Exchange transfusion is a **definitive treatment** for severe hyperbilirubinemia, especially when there are signs of **acute bilirubin encephalopathy (kernicterus)**, as suggested by seizures, bulging fontanelles, and opisthotonus. - It rapidly removes bilirubin from the blood and is crucial to prevent further neurological damage in such critical cases. *Phenobarbital* - Phenobarbital is an **anticonvulsant** used to manage seizures, which are a prominent symptom in this infant. - It can also help to **induce hepatic enzymes** involved in bilirubin metabolism, thereby potentially aiding in the reduction of bilirubin levels in cases of severe hyperbilirubinemia, though its primary role here would be seizure control.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free