Neonatology — MCQs
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Most common site for bone marrow aspiration in neonates is -
Which of the following drugs is most commonly used for cardiovascular support in post-resuscitation care of neonates?
Erythematous blotchy rash is seen on the abdomen, trunk, and face of a 3-day-old child along with yellowish papules. The child appears well. What is the appropriate management?
What is the average weight gain of the neonate per day after the initial weight loss period?
Treatment of choice for symptomatic neonatal hypoglycemia is
What is the most common cause of pneumonia in early onset sepsis in neonates?
Further investigation is essential in a newborn with which of the following conditions?
Which of the following is a common symptom of Hypoxic Ischemic Encephalopathy?
What is the typical lifespan of neonatal red blood cells (RBCs)?
In which condition do symptoms improve with crying?
Neonatology Indian Medical PG Practice Questions and MCQs
Question 881: Most common site for bone marrow aspiration in neonates is -
- A. Anterior superior iliac crest
- B. Posterior superior iliac crest
- C. Sternum
- D. Anteromedial tibia (Correct Answer)
Explanation: ***Anteromedial tibia*** - The **anteromedial tibia** is the preferred site in neonates due to its relatively **large marrow cavity**, superficial location, and reduced risk of vital organ injury. - This site is easily accessible and provides a good yield of marrow cells, making it suitable for diagnostic purposes in newborns. *Anterior superior iliac crest* - While a common site for bone marrow aspiration in older children and adults, the **anterior superior iliac crest** can be more challenging and poses a greater risk in neonates due to their smaller bone structures. - The iliac crest offers less bony prominence and a thinner cortex in neonates, increasing the difficulty of the procedure and potential for sampling error. *Posterior superior iliac crest* - The **posterior superior iliac crest** is another common site in older children and adults but is generally avoided in neonates due to the difficulty in positioning and the risk of damaging vital structures in the vicinity. - It requires prone positioning and offers less superficial bone, making it a less practical and safe choice for neonates compared to the tibia. *Sternum* - **Sternal aspiration** is generally contraindicated in neonates and young children due to the thinness of the sternal bone and proximity to vital structures like the heart and great vessels. - There is a high risk of **perforation** of the sternum and injury to underlying organs, making this site unsafe for bone marrow aspiration in this age group.
Question 882: Which of the following drugs is most commonly used for cardiovascular support in post-resuscitation care of neonates?
- A. Dobutamine
- B. Epinephrine
- C. Sodium Bicarbonate
- D. Dopamine (Correct Answer)
Explanation: ***Dopamine*** - **Dopamine** is often the first-line vasopressor used in neonates for **hypotension** unresponsive to fluid resuscitation, especially in the context of post-resuscitation care, due to its dose-dependent effects on cardiac output and systemic vascular resistance. - It increases **cardiac contractility** and **heart rate** at moderate doses (beta-1 adrenergic effects) and can improve renal blood flow at lower doses. *Sodium Bicarbonate* - **Sodium bicarbonate** is used to correct severe metabolic acidosis but is generally not recommended in the initial stages of neonatal resuscitation or for routine cardiovascular support due to potential adverse effects like rebound acidosis and hypernatremia. - Its use is typically reserved for documented severe metabolic acidosis after adequate ventilation and circulation have been established. *Epinephrine* - **Epinephrine** is primarily used during active cardiorespiratory arrest for its potent vasoconstrictive and inotropic effects, and for sustained **bradycardia** unresponsive to ventilation and chest compressions. - While it has strong cardiovascular effects, it is not the most common drug for *post-resuscitation cardiovascular support* unless there is persistent shock or bradycardia despite dopamine. *Dobutamine* - **Dobutamine** is an inotropic agent primarily used to improve myocardial contractility and cardiac output with less chronotropic effect than dopamine, making it beneficial in conditions with low cardiac output and normal blood pressure. - It is less commonly used as an initial agent for post-resuscitation **hypotension** in neonates compared to dopamine, which also offers systemic vasoconstriction to raise blood pressure.
Question 883: Erythematous blotchy rash is seen on the abdomen, trunk, and face of a 3-day-old child along with yellowish papules. The child appears well. What is the appropriate management?
- A. Topical steroid and antibiotic lotion
- B. Topical steroid cream
- C. Intravenous antibiotics
- D. No treatment (Correct Answer)
Explanation: ***No treatment (Correct Answer)*** The described symptoms—erythematous blotchy rash with yellowish papules on the abdomen, trunk, and face in a well-appearing 3-day-old neonate—are **classic for erythema toxicum neonatorum**. **Key Features:** - **Benign, self-limiting rash** of unknown etiology - Affects **50-70% of term newborns** - Typically appears on **days 2-5** of life - Characterized by **erythematous macules/patches** with overlying **yellowish-white papules/pustules** - Infant appears **well and thriving** - **Resolves spontaneously** within 1-2 weeks without treatment - Histology shows **eosinophils** in pustules **Management:** Reassurance to parents; no medical intervention required. --- *Topical steroid and antibiotic lotion (Incorrect)* This approach is inappropriate because erythema toxicum neonatorum is: - **Not an infection** (no bacterial or fungal cause) - **Not an inflammatory condition** requiring steroids - Misdiagnosis and overtreatment could lead to unnecessary side effects, antibiotic resistance, and mask other conditions --- *Topical steroid cream (Incorrect)* Topical steroids are: - **Unnecessary** for this benign, self-resolving condition - **Potentially harmful** in neonates (can cause skin atrophy, increased absorption) - Provide **no therapeutic benefit** for erythema toxicum neonatorum --- *Intravenous antibiotics (Incorrect)* Systemic antibiotics are: - **Entirely unwarranted** as this is a non-infectious, benign rash - Would represent **gross overtreatment** with significant risks - Contribute to **antibiotic resistance** - Carry risks of adverse reactions, disruption of normal flora, and unnecessary hospitalization **Differentials to consider (but not present here):** - Transient neonatal pustular melanosis (present at birth) - Neonatal acne (appears later, at 2-4 weeks) - Miliaria (smaller, clear vesicles) - Infectious causes (infant appears ill, requires septic workup)
Question 884: What is the average weight gain of the neonate per day after the initial weight loss period?
- A. 5-10 g
- B. 25-30 g (Correct Answer)
- C. 50-60 g
- D. 100-150 g
Explanation: ***25-30 g*** - After the initial physiological weight loss (typically 5-10% of birth weight in the first few days), healthy term neonates should gain approximately **25-30 grams per day**. - This consistent weight gain indicates adequate feeding and healthy development in the first month of life. *5-10 g* - This range is too low for the average daily weight gain after the initial weight loss period. - A gain of only **5-10 g per day** would suggest inadequate feeding or an underlying medical issue. *50-60 g* - This rate of weight gain is typically seen in **older infants** (e.g., 2-3 months of age) or in cases of catch-up growth, not usually in the immediate neonatal period after initial weight loss. - While rapid growth can occur, 50-60 g/day is above the average for a neonate. *100-150 g* - This is an **excessively high** rate of daily weight gain for a neonate. - Such rapid weight gain is not typical and could potentially indicate measurement error or an unusual metabolic state.
Question 885: Treatment of choice for symptomatic neonatal hypoglycemia is
- A. Dextrose normal saline
- B. 5% dextrose
- C. 10% dextrose (Correct Answer)
- D. 25% dextrose
Explanation: ***10% dextrose*** - For **symptomatic neonatal hypoglycemia**, 10% dextrose solution is the **standard initial treatment** with a bolus of 2 mL/kg (200 mg/kg) given IV over 5-10 minutes - This concentration safely and effectively raises blood glucose levels while minimizing the risk of **hyperglycemic rebound** or complications like **osmotic injury** - Followed by continuous infusion to maintain normoglycemia *Dextrose normal saline* - This combination is **not used** for acute hypoglycemia management as the saline component is unnecessary - The glucose concentration would be inadequate for rapid correction of **symptomatic neonatal hypoglycemia** - May lead to excessive fluid administration *5% dextrose* - A **5% dextrose solution** is insufficient to rapidly correct symptomatic neonatal hypoglycemia - Would require much faster infusion rates to deliver adequate glucose, potentially leading to **fluid overload** - May be used for maintenance therapy in asymptomatic cases *25% dextrose* - Too concentrated for routine neonatal use - carries significant risk of **vein sclerosis**, **osmotic injury**, and **rebound hypoglycemia** - Risk of extravasation injury and **hyperglycemia** - Reserved only for extreme cases under close monitoring with careful dilution
Question 886: What is the most common cause of pneumonia in early onset sepsis in neonates?
- A. H influenzae
- B. Coagulase positive staph aureus
- C. Group B streptococcus (Correct Answer)
- D. Listeria
Explanation: ***Group B streptococcus*** - **Group B Streptococcus (GBS)** is the leading cause of **early-onset sepsis** and pneumonia in neonates, typically acquired during passage through the birth canal. - Maternal GBS colonization is a significant risk factor, and GBS can cause **severe respiratory distress** in affected newborns. *H influenzae* - **_Haemophilus influenzae_** is a more common cause of **late-onset sepsis** or pneumonia in infants and children, rather than early-onset neonatal disease. - While it can cause neonatal infections, it is much less frequent than GBS in the early-onset period. *Coagulase positive staph aureus* - **_Staphylococcus aureus_** is a common cause of **nosocomial infections** or late-onset sepsis in neonates, particularly in ventilated or catheterized infants. - It is not the most common pathogen for community-acquired **early-onset neonatal pneumonia**. *Listeria* - **_Listeria monocytogenes_** can cause severe neonatal sepsis and pneumonia, often associated with maternal consumption of contaminated food. - While it is a significant pathogen, it is less common overall than GBS as a cause of early-onset neonatal pneumonia in most regions.
Question 887: Further investigation is essential in a newborn with which of the following conditions?
- A. Vaginal bleed
- B. Subconjunctival hemorrhage
- C. Lens opacity (Correct Answer)
- D. Erythema toxicum
Explanation: ***Lens opacity*** - A **lens opacity** in a newborn suggests congenital **cataracts**, which can lead to permanent vision impairment if not identified and treated early. - **Investigation is essential** to identify underlying causes such as **TORCH infections** (Toxoplasmosis, Rubella, CMV, HSV), **metabolic disorders** (galactosemia, Lowe syndrome), **genetic syndromes**, or **chromosomal abnormalities**. - Early detection and management are crucial to prevent **amblyopia** (lazy eye) and optimize visual development during the **critical period** of visual maturation. - Investigations include: TORCH titers, urine for reducing substances, metabolic screening, and genetic evaluation. *Erythema toxicum* - This is a common, **benign newborn rash** characterized by blotchy red macules and papules with central vesicles or pustules. - It typically resolves spontaneously within days to a few weeks and requires **no specific investigation or treatment**. *Vaginal bleed* - A small amount of **vaginal bleeding** in female newborns is usually due to the temporary withdrawal of maternal hormones (e.g., estrogen) after birth. - This is a **physiologic response** and generally self-resolves, requiring no further investigation unless excessive or prolonged. *Subconjunctival hemorrhage* - This occurs due to the rupture of tiny blood vessels in the eye during the birthing process, often associated with **vaginal delivery**. - It is a **benign condition** that resolves on its own within a couple of weeks and does not affect vision.
Question 888: Which of the following is a common symptom of Hypoxic Ischemic Encephalopathy?
- A. Lower limbs affected more than upper limbs
- B. Seizures (Correct Answer)
- C. Predominant trunk involvement
- D. Proximal muscles affected more than distal muscles
Explanation: ***Seizures*** - **Seizures** are a very common and early symptom of **Hypoxic-Ischemic Encephalopathy (HIE)** due to neuronal injury and dysfunction. - They can manifest in various forms, including tonic, clonic, or multifocal types, and often indicate the severity of brain damage. *Lower limbs affected more than upper limbs* - The pattern of motor impairment in HIE typically involves the **upper limbs more than the lower limbs** due to the specific vulnerability of cortical regions supplying the upper extremities and face. - This is in contrast to conditions like **cerebral palsy from periventricular leukomalacia**, which characteristically affects the lower limbs more. *Predominant trunk involvement* - While HIE can cause widespread neurological dysfunction, **isolated or predominant trunk involvement** is not a characteristic presenting symptom. - Motor deficits usually involve the extremities and cranial nerves, reflecting diffuse or focal brain injury. *Proximal muscles affected more than distal muscles* - The distribution of muscle weakness in HIE does not typically show a clear pattern of **proximal over distal involvement**. - Instead, the motor deficits are often widespread or show predilection for the upper extremities, depending on the extent and location of brain injury.
Question 889: What is the typical lifespan of neonatal red blood cells (RBCs)?
- A. 120-150 days
- B. 150-200 days
- C. 60-90 days (Correct Answer)
- D. 90-120 days
Explanation: ***60-90 days*** - The typical lifespan of **neonatal red blood cells (RBCs)** is **60-90 days**, which is **shorter than adult RBCs** (120 days). - This reduced lifespan is due to **increased membrane fragility**, **higher metabolic rate**, and **immature enzyme systems** in neonatal erythrocytes. - Neonatal RBCs contain more **fetal hemoglobin (HbF)** and have structural differences that contribute to their shorter survival. - This shorter lifespan contributes to the **physiological anemia of infancy** seen in the first few months of life. *90-120 days* - This range represents the typical lifespan of **adult RBCs**, not neonatal RBCs. - Neonatal RBCs have a **demonstrably shorter lifespan** compared to adult erythrocytes. - Confusing adult and neonatal RBC lifespans is a common error in clinical practice. *120-150 days* - This range is **longer than even adult RBC lifespan** (typically 120 days). - This would be **highly atypical** for any normal erythrocyte population. *150-200 days* - This represents an **abnormally prolonged** RBC lifespan not seen in normal physiology. - Such extended survival would suggest **pathological conditions** affecting RBC destruction or measurement error.
Question 890: In which condition do symptoms improve with crying?
- A. Tetralogy of Fallot
- B. Choanal atresia (Correct Answer)
- C. Bronchial asthma
- D. None of the options
Explanation: ***Choanal atresia*** - In **bilateral choanal atresia**, a newborn is unable to breathe through the nose due to a bony or membranous obstruction. Symptoms like **cyanosis** worsen with feeding and improve with crying because crying involves **mouth breathing**, which bypasses the nasal obstruction. - This condition is a **medical emergency** as newborns are obligate nasal breathers, and immediate intervention (e.g., oral airway, surgical repair) is often required. *Tetralogy of Fallot* - This congenital heart defect can lead to **cyanotic spells** (hypercyanotic or "tet" spells), which are characterized by increased cyanosis, tachypnea, and irritability. These spells are often precipitated by activities that increase right-to-left shunting, and **crying can worsen them** rather than improve them due to increased systemic oxygen demand and vascular resistance. - Management often involves positioning (knee-chest) and medications to reduce pulmonary vascular resistance or increase systemic vascular resistance, to alleviate shunting. *Bronchial asthma* - **Crying is a common trigger for asthma attacks** in children, as it can induce bronchoconstriction due to hyperventilation and airway irritation. Symptoms typically worsen with crying, leading to **wheezing, coughing, and shortness of breath**. - Asthma is characterized by **reversible airway obstruction** and airway hyperresponsiveness, and its symptoms do not improve with crying. *None of the options* - This option is incorrect because **choanal atresia** is a condition where symptoms (specifically cyanosis) do improve with crying due to the switch from nasal to mouth breathing.
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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