Q-1. Most common candidal species infecting neonates from caregiver’s hand:
a) C. tropicalis
b) C. parapsilosis
c) C. glabrata
d) C. albicans
Answer: C. parapsilosis
Explanation:
In the surgical ICU, C albicans accounts for about 50% of infections, C glabrata for about 25%, and a mixture of other species for the remainder.
In the neonatal ICU, C albicans accounts for approximately two thirds of infections and C parapsilosis for the remaining third.
Molecular epidemiology shows that the infecting strains of C albicans also colonize the mother’s vaginal mucosa.
The strains of C parapsilosis that infect infants are those found on the hands of healthcare workers in the neonatal ICU.
Q-2. In neonate with Erb’s palsy, Moro reflex is
a) Absent
b) Symmetrical
c) Exaggerated
d) Asymmetrical
Answer: Absent
Explanation:
Erb’s palsy is caused by damage to the brachial plexus during delivery of the neonate. This is mostly limited to the 5th and 6th cervical nerves.
Presentation:
Infant is unable to abduct the arm from the shoulder, rotate the arm externally from the shoulder, and supinate the forearm. This results in the classic ‘porter’s tip’ or ‘waiter’s tip’ appearance.
Clinical signs:
Characteristic position – adduction and internal rotation of the arm with forearm pronated
Forearm extension normal
Biceps reflex absent
Moro reflex absent on affected side that is asymmetrical
Sensory impairment on outer aspect of arm (unusual)
Power of the forearm is normal (if impaired, suggests injury to lower part of plexus)
Hand-grasp normal unless lower part of plexus is also damaged
Q-3. Not a part of Kangaroo mother care
a) Skin to skin contact
b) Early discharge
c) Free nutritional supplements
d) Exclusive breastfeeding (?)
Answer: Free nutritional supplements
Explanation:
Kangaroo mother care (KMC) includes thermal care through continuous skin-to-skin contact, support for exclusive breastfeeding or other appropriate feeding, early discharge from hospital and early recognition/response to illness.
Individual component of kangaroo mother care:
Kangaroo position or skin to skin contact
Kangaroo nutrition or exclusive breastfeeding or other appropriate feeding
Kangaroo support
Kangaroo discharge
Q-4. 4 years old girl presents with severe vomiting after viral fever of 6 days. She develops cerebral edema later on. What would be the liver biopsy findings?
a) Centri-zonal hemorrhagic necrosis
b) Marked micro-vesicular steatosis
c) Ring granuloma
d) NASH (Nonalcoholic Steato-hepatitis)
Answer: Marked micro-vesicular steatosis
Explanation:
Reye syndrome, an extremely rare but serious illness that can affect the brain and liver, occurs most commonly in children recovering from a viral infection.
The signs and symptoms of Reye syndrome are almost always preceded by a viral illness, such as an upper respiratory tract infection (a cold, the flu, etc.) and a diarrheal illness.
Reye syndrome can occur from 1 day to 2 weeks after a viral infection.
Symptoms include: frequent vomiting, lethargy or sleepiness, irritability or aggressive behavior
In the later stages, a child may exhibit irrational behavior, confusion, severe muscle weakness, seizures, and loss of consciousness. There is usually no fever.
Liver biopsy:
The major histopathological finding is diffuse micro-vesicular steatosis. In the typical case the hepatocytes are swollen and packed with multiple small vacuoles.
Q-5. A 7-year old boy presents with a right-sided hemangioma and left-sided focal seizures. The most likely diagnosis is –
a) Neurofibromatosis
b) Sturge-Weber disease
c) Hemangioma
d) None
Answer: Sturge-Weber disease
Explanation:
Sturge-Weber syndrome is a neuro-cutaneous disorder with angiomas that involve the lepto-meninges and the skin of the face, typically in the ophthalmic (V1) and maxillary (V2) distributions of the trigeminal nerve.
In the majority of cases the naevus (Port-wine stain- facial cutaneous venous dilation) is unilateral and ipsi-lateral to the intracranial abnormality.
The most common clinical manifestation is with childhood seizures that are often refractory to medical therapy.