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Neonatology MCQs

Major causes of neonatal mortality include all of the following except:


(a) Respiratory distress syndrome
(b) Congenital malformations
(c) Asphyxia
(d) Sepsis
(e) Sudden infant death syndrome
All of the statements regarding prenatal steroids are true EXCEPT
(a) They cause 50% reduction in respiratory distress syndrome and intraventricular haemorrage
(b) It is advised to mothers at risk of preterm delivery at 24-34 weeks of gestation
(c) It can be safely administered to mothers with hypertension and diabetes
(d) It can be given even in presence of chorioamnionitis clinically
3.
Which nutrient supplementation may decrease the incidence of broncho-pulmonary
dysplasia?
(a) Vitamin A
(b) Vitamin C
(c)

Polyunsaturated fatty acids

(d) Vitamin E

4. The number of births is 4050, 50 still birth, 50 died in 7 days, 150 died within 28 days, what
is the NMR
(a)50

(b)61.72
(c)12.5
( d)49.4
5. Pondreal index of baby of of 2000gm and 50 cm
a)1.6
b)2.2
c)2.6
d)1.0

6. Child with phocomelia anomaly due to drug taken by mother


a) Tetracycline
b) Thalidomide
c) Valproate
d) Lithium

7. Which is a true statement?


(a) Folic acid supplementation will prevent all types of neural tube defects
(b) The dose is 400 microgram per day if there is no prior history of NTD
(c) Dose is 10 mg per day if there is prior or family history of NTD
(d) It should be initiated immediately after diagnosis of pregnancy.

8. Fetal alcohol syndrome is characterized by all except


A. Microcephaly
B. Low intelligence
C. Large propotionate body
D. Septal defects of heart

9. All of the following are features of postneonatal mortality except:


(a) Death between age 28 days and 1 yr

(b) Caused in part by sudden infant death syndrome


(c) Caused in part by bronchopulmonary dysplasia
(d) Caused in part by premature rupture of membranes
(e) Caused in part by trauma
10. Oligohydramnios is associated with all of the following except:
(a) Esophageal atresia
(b) Pulmonary hypoplasia
(c) Potter syndrome
(d) Posterior urethral valves
(e) Skeletal contractures
11. Fetal tachycardia may be caused by all of the following except:
(a) Maternal lupus erythematosus
(b) Maternal fever
(c) Prematurity
(d) Fetal anemia
(e) Fetal supraventricular tachycardia
12. All are associated with large anterior fontanelle in a newborn EXCEPT
(a) Achondroplasia
(b) Osteogenesis imperfecta
(c) Hypothyroidism
(d) Pyknodysostosis
(e) Tay-Sachs disease

13. All are causes of natal teeth EXCEPT


(a) Ellis van Creveld syndrome
(b) Hallermann-Streiff syndrome
(c) Athyrotic hypothyroidism
(d) Pierre-Robin syndrome
14. Epsteins pearls are seen
(a) Median palatal raphe
(b) Vagina
(c) Buccal mucosa
(d) Iris
15. A newborn 60 seconds after birth has the following g features. Heart rate 110/minute, central
cyanosis, slow and irregular respiratory effort, flaccid, no reflex irritability. What is the Apgar
score?
(a) 1
(b) 3
(c) 5
(d) 7
16. Which is included in APGAR score
A Colour,
B Bilirubin,
C blood group,
D Respiratoty rate
17. The best description of the Apgar score is that it:

(a) Accurately predicts who will develop cerebral palsy


(b) Assesses neonates in need of resuscitation
(c) Accurately predicts a low umbilical cord pH
(d) Is unaffected by maternal opiate pain relief
(e) Accurately predicts neonates who will die in the neonatal period
18. Which maternal condition do not have an adverse fetal outcome?
(a) Idiopathic thrombocytopenic purpura
(b) Myotonic dystrophy
(c) SLE
(d) Phenyl ketonuria
(e) None of the above
19. The following factors contribute to hypothermia in pretem babies except
(a) Decreased subcutaneous fat and brown fat
(b) Large surface area in relation to body weight
(c) Less oxygen consumption
(d) Increased muscular activity
20. Baby born at 33 weeks / 1.5 kg, clinically stable, should be started on?
A. Nil oral and IV fluids
B. Oral nasogastric tube / alternate oral route
C. IV fluids and oral feeding
D. TPN
21. All of the following are features of prematurity in a neonate EXCEPT
(a) No creases on sole
(b) Abundant lanugo

(c) Thick ear cartilage


(d) Empy scrotum
(e) Palm cannot be approximated to forearm
22. Preterm babies needs nutritional supplements apart from breast milk except
(a) Calcium
(b) Phosphorus
(c) Iron
(d) Potassium
23. All are associated complications of prematurity except
(a) IVH
(b) PDA
(c) NEC
(d) HMD
(e) SAH
24. All of the statements are true about cephalhaematoma EXCEPT
(a) Limited to the surface of one cranial bone
(b) Never seen immediately after birth
(c) Collection is beneath galea aponeurotica
(d) May require phototherapy
25. A 5-day-old, large-for-gestational-age, 4,500-g boy has a bilirubin level of 21 mg/dL. There is
no anemia or polycythemia, but on examination he has a large cephalohematoma. The next
therapeutic activity should be to:
(a) Aspirate the hematoma

(b) Perform an incision and drainage of the hematoma


(c) Undertake prophylactic blood transfer
(d) Administer phototherapy
(e) Perform exchange transfusion

26. Late sequelae of intracranial hemorrhage in a baby include


a) Cerebral palsy
b) Mental retardation
c) Behaviour disorder
d) All of the above

27. Most common sequelae due to periventricular Leukomalacia


A. Splastic Diplegia
B. Splastic quadriplegia
C. Mental retardation
D. Seizures

28. A 12-day-old, large-for-gestational-age infant is noted to have Erb palsy. You should do all of
the following except:
(a) Refer for immediate neuroplasty
(b) Refer for physical therapy
(c) Reassure the family
(d) Determine if the clavicle is fractured
(e) Look for additional nerve involvement (phrenic)
29. A 1.5 kg child born at 32 weeks through LSCS, presents with moderate respiratory difficulty.
Which of the following is the appropriate management

A. CPAP
B. Mechanical ventilation
C. Warm oxygen
D. Surfactant and ventilation

30. A 30-min-old term 3.4-kg baby, born after a spontaneous vaginal delivery, is noted to have
acrocyanosis. The most important next step is:
(a) Perform a sepsis evaluation
(b) Perform a CBC followed by a sepsis work-up if neutropenia is found
(c) Keep the infant warm
(d) Begin oxygen administration
(e) Hold oral feedings until the acrocyanosis resolves
31. A newborn female child, weight 3.5kg, delivered by uncomplicated delivery, developed
respiratory distress immediately after birth. On chest x-ray ground glass appearance was seen.
Baby put on mechanical ventilation and was given surfactant but condition of baby deteriorated
and increasing hypoxemia was present. A full term female sibling died within a week with
similar complaint. ECHO is normal. Usual cultures are negative. Your diagnosis is:
a. Total anomalous pulmonary venous connection
b. Meconium aspiration syndrome
c. Neonatal pulmonary alveolar proteinosis
d. Disseminated HSV infection
32. True about transient tachypnoea of newborn is
(a) Air bronchogram seen
(b) Common in preterm infants
(c) Interlobar fissure effusion
(d) Respiratory distress resolve spontaneously in 6-10 days

33. Chest X-ray in a newborn with respiratory distress showing multiple air containing lesions in
left hemithorax and mediastinal shift suggests

(a) Diaphragmatic hernia


(b) congenital lobar emphysema
(c) Pneumatoceles
(d) Congenital lung cyst
34. A 3.5-kg female born following repeat cesarean section is noted by the nurses to be grunting
at 10 min of age. You come to see the baby and note that the grunting has stopped, the respiratory
rate is 36/min, the pulse oximetry reading is 99%, and the child looks vigorous. The most
appropriate next step is to:
(a) Perform a sepsis evaluation
(b) Obtain a chest film
(c) Observe, and if grunting returns, admit to the normal newborn nursery
(d) Begin surfactant therapy
(e) Begin nasal continuous positive airway pressure
35. A term female is born by spontaneous vaginal delivery to a primiparous woman who received
two doses of meperidine 30 min and 2 hr prior to an abrupt delivery. The baby is apneic and limp.
The most important, immediate management is to:
(a) Administer naloxone in the umbilical vein
(b) Perform bag-mask ventilation
(c) Administer naloxone in the endotracheal tube
(d) Begin chest compressions
(e) Obtain a cord pH
36. A term infant has not passed meconium for 48 hours. He presents with distension of abdomen
and emesis since one day. Next most appropriate investigation would be:
a. Genetic testing for cystic fibrosis
b. Manometry
c. Lower bowel contrast enema
d. Oesophagoscopy

37. In congenital hypertrophic pyloric stenosis, all statements are true EXCEPT
a. Conjugated hyperbilirubinaemia may be seen
b. Hypokalaemia is due to vomiting
c. Blood pH is high and urinary pH is low.
d. first born males are commonly affected

38. A 3 day old infant presents with vomiting, rapidly distending abdomen and signs of shock.
The vomitus is bile stained. Most likely diagnosis is
.
a) Meconium ileus
b) Mid gut volvulus
c) Achalasia
d) Duodenal atresia

39. All of the following are feature of necrotising enterocolitis except

a) Increased bowel sounds


b) Bilious vomiting
c) Blood in stool
d) Abdominal distention

40. A term baby girl has two episodes of bile-stained emesis at 24 hr after birth. There is a history
of excessive amniotic fluid volume. The most appropriate diagnostic test is:
(a) Blood culture
(b) Barium swallow and upper gastrointestinal tract x-ray series

(c) Barium enema


(d) CT scan
(e) Head ultrasound study
41. A 50 hour old fullterm breast fed newborn boy with 3100gm birth weight presents with
clinically evident jaundice. Physical examination is otherwise normal. The total bilirubin is
11gram per deciliter with a direct bilirubin of 0.4 mg/dL. What would be the correct treatment?
(a) Continue breast feeds and review after 48 hours
(b) Stop breast feeds and review after 24 hours
(c) Continue breast feeds and start blue light phototherapy
(d) Arrange for a double volume exchange transfusion
42. Which is a wrong statement regarding physiologic jaundice in a newborn?
(a) Do not occur in first 24 hours of life
(b) Do not require phototherapy
(c) Occurs in about 10% of newborns
(d) Unconjugated hyperbilirubinaemia

43. A 32 weeks premature infant 900 gram birth weight, at 72 hours of birth has got a serum
bilirubin of 13 mg%. the treatment of choice is
(a) Exchange transfusion
(b) Phototherapy
(c) Wait and watch policy
(d) Pharmacologic therapy
44. A 16 day old child presents in an OPD with gradually progressive jaundice from D2 and
acholic stools. On blood biochemistry a Serum Bilirubin of 16mg % is found with a direct

component of 14mg %. The most important investigation for making a diagnosis is


a) TORCH
b) Biliary scintiscan with imidoacetic acid
c) Phytate scan
d) Serum GGT levels
45. Which mechanism is responsible for maximum reduction in serum bilirubin with
phototherapy?
(a) Photo oxidation
(b) Photo isomerisation
(c) Structural isomerisation
(d) Conjugation
46. the following statements regarding exchange transfusion are true EXCEPT
(a) this is the most effective way to bring down serum bilirubin
(b) double volume exchange transfusion is usually performed for neonatal hyperbilirubinemia
(c)prior administration of albumin as infusion 1-2 hour prior to the procedure makes it more
effective
(d) it is done through a peripheral vein
47. Commonest organism to produce early neonatal sepsis in India is
A) Group B Streptococcus
B) E. coli
C) Staphylococcus
D) Pseudomonas
48. A 2 days old child is presented to the neonatal ICU with fever and regurgitation of feeds. CSF
examination shows WBCs 30/mm3 (60% polys ), RBCs 500/mm3, Protein 100mg %, Sugar 40mg
%. The most probable diagnosis is
(a) Pyogenic meningitis

(b) Traumatic L.P.


(c) Tubercular meningitis
(d) Normal CSF

49. A 5 days old child presents with fever, seizures, refusal to feed and features of meningeal
irritation . His CSF examination shows Protein 300mg %, Sugar 10mg %, WBC 5000 / mm3. The
most probable causative organism is

(a) Tubercular
(b) Mycoplasma
(c) Listeria monocytogenes
(d) Leptospira
50. 'C' in C reactive protein stands for:
A. Capsular polysaccharide in pneumococcus
B. Concanavalin-a
C. Calretinin
D. Cellular
51. Mother to baby transmission of HIV can be minimised by all except?
A. Zidovudine
B. Vitamin A
C. Vaginal delivery
D. Avoidance of breast feeding
Most common type of seizures in neonates are:
a. Clonic
b. Tonic
c. Subtle
d. Myoclonic
Which vitamin deficiency is responsible for neonatal seizure?
A. Pyridoxine
B. Vitamin C

C. Thiamine
D. Cobalamin
54. Infant of diabetic mother with weight 3.8 kg presented with seizures after 16 hours of birth.
What is the cause?
A. Hypoglycemia
B. Hypocalemia
C. Birth asphyxia
D. Intraventricular hemorrhage

55. A 1-day-old infant born to a diabetic mother is noted to have tremors of all extremities while
awake. They disappear during sleep and are not associated with eye movements. The glucose and
calcium levels are normal. The most likely diagnosis is:
(a) Hypoglycemia
(b) Kernicterus
(c) Renal vein thrombosis
(d) Caudal regression syndrome
(e) Jitteriness

56. A 3 day child vomits everytime he is breastfed, has a distended abdomen, diarrhoea, in urine
the benedicts test is positive, what is the substance in urine?
a) sucrose
(b) glucose
(c) galactose
(d) lactose
57. A 3 week old male infant was brought in a state of dehydration and shock. Examination
revealed hyper pigmentation over the body with normal external genitalia. Blood tests revealed
hypoglycemia, Na - 124 mEq/L and K - 7 mEq/L. What is the probable diagnosis ?
A. Congenital adrenal hyperplasia
B. Adrenal haemorrhage and shock
C. Acute gastroenteritis with dehydration
D. sepsis

58. Hypotension in a newborn suggests all of the following except:


(a) Fetal-maternal hemorrhage
(b) Hypoplastic left heart syndrome
(c) Adrenogenital syndrome
(d) Tension pneumothorax
(e) Jaundice
59. The test to distinguish mother and baby Hb?
a) Kleihaur-Betke test
b)Apt and Downey test
c)shake test
d)benzidine test
60. All are true regarding haemorrhagic disease of newborn EXCEPT
(a) Usually occurs in babies on artificial feeds
(b) Occurs usually after 24 hours of birth
(c) Intracranial haemorrhage can occur
(d) Intramuscular injection of vitamin K at birth has got a protective role.
61. The appropriate approach to a female neonate presenting with vaginal bleeding on 5th day of
life
(a) Administration of vitamin K
(b) Investigate for coagulation disorder or thrombocytopenia
(c) No specific therapy, but examine for evidence of bleeding from other sites
(d) USG abdomen to rule out uterine malformation

62. Large doses of vitamin K administered to a newborn may result in

(a) Prolonged hyperbilirubinaemia


(b) Bulging of fontanelles
(c) Hypoprothrombinaemia
(d) Haemolytic anaemia
63. Stork bite lesion is seen in
(a) Sturge-Weber syndrome
(b) Klippel-Feil syndrome
(c) Blue rubber bleb nevus syndrome
(d) Craniofacial nevus
64. Most common newborn rash that presents at 24-48 hours of life
(a) Erythema Toxicum
(b) Milia
(c) Transient neonatal pustular melanosis
(d) Hemangioma
65. Major malformations and chromosomal anomalies are common with
A. Gastroschisis
B. Omphalocele
C. Spina Bifida
D. Cleft Palate
66. Child brought to casualty with reports of violent shaking by parents. Most likely injury is?
A. Long bone fracture
B. Ruptured spleen
C. Subdural hematoma
D. Skull bone fracture

67. Bilateral and multiple retinal hemorrhages, presenting in the 6th week of life in a lethargic
neonate without any other physical findings, are most likely due to:

(a) Birth trauma


(b) Nuchal cord
(c) Vacuum extraction
(d) Being large for gestational age
(e) Child abuse

68. Rectosigmoid index is useful in the diagnosis of


a) Diverticulosis

(a)
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