MCQ OF NEWBORN
ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 1
1) Newborn infants commonly have:-A. Capillary hemangioma on the forehead.B. Posterior cranial fontenalle.C. Metopic sutures.D. Impalpable coronal sutures.E. Skin tag in front of the ear.
Ans:- ABC2) The following should be investigated in five day old baby:-
A. Erythema ToxicumB. Cloudy corneaC. Divarication of rectiiD. Subconjunctival hemorrhageE. Preauricular skin tags
3) During morning rounds in the newborn nursery, you examine a healthy infant who hasblotchy erythematous macules that are 2 to 3 cm in diameter. The macules are scatteredover the trunk, face, and proximal extremities; the palms and soles are spared. Eachmacule has a 1- to 3-mm central vesicle or pustule.Of the following, the MOST likelyadditional finding in this patient is
A. pigmented macules located at sites of resolving pustules B. presence of lesions at birth C. pustules coalescing into bullae D. Wright stain of a smear of the vesicopustular contents revealing a predominance of eosinophils E. Wright stain of a smear of the vesicopustular contents revealing a predominance of polymorphonuclear neutrophils Preferred Response: DThe infant described in the vignette exhibits the classic presentation of erythema toxicumneonatorum. Tiny vesicles or pustules arise from blotchy erythematous macules, withlesions characteristically appearing at 24 to 48 hours after birth. The pustules do not coalesce intobullae. Wright staining of the pustular contents reveals a predominance of eosinophils, notneutrophils. Because the lesions are seen in healthy infants, it has been suggested that this benigncondition be renamed; suggested names include benign neonatal rash or benign erythemaneonatorum.
Transient neonatal pustular melanosis (TNPM) is another well-recognized benign dermaleruption of infancy in which pustular lesions spontaneously resolve into transient pigmentedmacules . TNPM may be present at birth, and examination of pustular contents reveals apredominance of neutrophils.
Infantile acropustulosis is a chronic or recurring benign condition manifested by intenselypruritic pustules on hands and feet. Characteristic papules and pustules may coalesce into bullae.
ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 2
Infantile acropustulosis frequently is confused with scabies infestation. The lesions resolvespontaneously at 1 to 2 years of age.
4) You are examining a newborn who is the product of an uneventful pregnancy, labor, anddelivery. Apgar scores were 9 at both 1 and 5 minutes. Findings on the initial physicalexamination are unremarkable except for the presence of vesicopustules and frecklelikemacules (Item Q33A), some of which have a collarette of surrounding scale. Wright stainof a smear of the vesicopustular contents reveals a predominance of polymorphonuclearneutrophils.Of the following, the MOST likely diagnosis is
A. congenital candidiasis B. erythema toxicum neonatorum C. infantile acropustulosis D. miliaria rubra E. transient neonatal pustular melanosis Preferred Response: ECharacteristic lesions of transient neonatal pustular melanosis (TNPM) may be present at birth asvesicles, pustules, or ruptured vesicles or pustules that have a collarette of surrounding scale.Pigmented macules (Item C33A) often develop at the sites of resolving pustules or vesicles.Primary lesions usually disappear by 5 days of age; the secondary pigmented lesions may remainup to 3 months. TNPM occurs more commonly in African-American infants.Lesions can occur on palms and soles. Pustular contents reveal a predominance of neutrophils onWright stain examination, as reported for the newborn in the vignette. Infants who have congenital cutaneous candidiasis may present with scaling, erythematouspapules and pustules (Item C33B) at birth. Candida albicans can penetrate through the amnion andchorion to cause congenital infections. Scrapings from lesions prepared with potassium hydroxidedocument pseudohyphae (Item C33C) or budding yeast. Term infants who have erythema toxicum neonatorum exhibit vesicopustular lesions (ItemC33D) that usually overlie erythematous macules. Lesions of erythema toxicum rarely are presentat birth, and Wright stain of smears of pustular contents reveals a predominance of eosinophils.
Infantile acropustulosis presents as pustules or vesicles (Item C33E) localized to the handsand feet. It may be present at birth but more commonly develops in the first weeks and monthsafter birth, possibly continuing or recurring throughout infancy and early childhood. Lesions arevery similar to those of infantile scabies infestation. Pustular contents may reveal prominentneutrophils and occasional eosinophils without evidence of the mites, ova, or feces seen inscabies. An absence of hyperpigmentation in resolving lesions and a prolonged or recurringcourse distinguishes infantile acropustulosis from TNPM.
Miliaria rubra (prickly heat or heat rash) is caused by intraepidermal obstruction of the sweatducts. A secondary local inflammatory response is responsible for the erythema (Item C33F)associated with the papules and vesicles. Miliaria rubra occurs later than miliaria crystallina,usually beyond thefirst postnatal week. Hyperpigmented, frecklelike lesions are not expected inmiliaria rubra.
5) The following is true regarding changes in the fetal cardiovascular system after birth:A. There is normally immediate closure of the ductus arteriosus
ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 3
B. Hypoxia-induced vasoconstriction is the mechanism of closure of the ductusarteriosus
C. The ligamentum teres is the remnant of the umbilical veinD. Regression of right ventricular hypertrophy occurs postnatallyE. Inferior vena caval pressure falls after birth
Ans:-CDEOcclusion of the umbilical cord removes this low resistance capillary bed from the circulation;breathing results in a marked decrease in pulmonary vascular resistance, hence there is increasedpulmonary blood flow returning to the left atrium raising the pressure in the left atrium causingthe foramen ovale to close. As pressure in the systemic circulation rises, shunt through the ductusarteriosus reverses. As the pO2 rises, synthesis of bradykinin and prostacyclins is inhibited, thuscausing closure of the ductus arteriosus. The ductus arteriosus can take up to 3 months to close innormal neonates.
6) Neonatal RDS:-A. Seen in most babies of birth weight < 2.5 kg.B. More common in infants of diabetic mothers.C. Associated with prolonged rupture of membrane.D. Less sever in babies of Afro-Caribiean origin than Caucasians.E. Exacerbated by hypothermia.
Ans:-BDE7) The following are causes of generalized hypotonia in 2 days old infants:-
A. PrematurityB. HypothyroidismC. Myotonic dystrophyD. Spinal dysraphyismE. Anterior horn cell disease
Ans:-ACE8) Regarding surfactant:-
A. Production begins at 30 weeksB. It is produced by Type II pneumocytes in the walls of the bronchiC. Testosterone stimulates surfactant productionD. Production is increased during a stressful event like hypothermiaE. Betamathasone given to the mother improves surfactant production in the
premature baby Ans:- E
Surfactant production begins at 20-22 weeks. It is produced by Type II pneumocytes which are inthe walls of the alveoli. The hormones testosterone and insulin inhibit surfactant production;hence hyaline membrane disease is more common in males than females and more common ininfants of diabetic mothers. Surfactant production is suppressed if the baby is hypothermic,hypoxic, acidotic or hypoglycemic.Although dexamethasone is more commonly used, betamethasone has an identical effect on lungmaturation
9) Concerning fetal lung development:-
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A. Type pneumocytes are present at 24 week gestationB. Cuboidal cells are capable of gas transfer in uteroC. There is virtually no smooth muscle in the terminal & respiratory bronchioles at
6 month of ageD. The large airways are formed at 16 week gestationE. Alveoli are completely formed at birth
Ans:-AD10) Congenital CMV infection:-
A. Only 10% of affected pregnancies have resulting long term sequel at birthB. Diagnosis is by viral isolation from the urineC. Hearing loss can develop gradually over the first 5 yearsD. The affected newborn should be treated with ganciclovirE. Intracranial calcifications are seen in a periventricular distribution