Neonatal Sepsis, TORCH and Perinatal Infections MCQs

Pediatrics · 43 free questions with answers & explanations.

1. A neonate born at 36 weeks gestation presents on day 3 with temperature instability, poor feeding, respiratory distress, and bulging anterior fontanelle. CSF shows: WBC 120 cells/mm³ (80% PMN), glucose 18 mg/dL, protein 320 mg/dL, Gram-positive diplococci on Gram stain. The most appropriate antibiotic regimen is:
2. A small-for-gestational-age neonate born to a first-time mother is found on day 1 to have bilateral sensorineural hearing loss, periventricular calcifications on cranial USG, hepatosplenomegaly, petechiae/purpura, and conjugated hyperbilirubinemia. The MOST likely congenital infection and the confirmatory test are:
3. A 28-week premature neonate on day 10 develops abdominal distension, bloody stools, bilious vomiting, and temperature instability. An abdominal X-ray shows pneumatosis intestinalis. Which finding on abdominal X-ray would indicate IMMEDIATE surgical consultation?
4. A neonate born to an HIV-positive mother who received no ART during pregnancy is tested at 6 weeks of age. The HIV DNA PCR is negative. What is the MOST appropriate next step regarding antiretroviral prophylaxis and re-testing?
5. A term neonate born to a mother with a history of genital herpes develops vesicular skin lesions, seizures, and CSF pleocytosis at 10 days of age. The neonate's CSF HSV PCR is positive. What is the MOST appropriate treatment and its duration?
6. A neonate born at 36 weeks is noted to have bilateral sensorineural hearing loss, chorioretinitis, periventricular calcifications on cranial ultrasound, and hepatosplenomegaly at birth. The TORCH screen shows positive IgM for CMV. Which is the MOST appropriate treatment?
7. In early-onset neonatal sepsis (EONS), which organism is the single most common causative pathogen in India and globally?
8. A baby born to a mother with primary rubella at 8 weeks of gestation is examined at birth. Which combination of findings is MOST characteristic of congenital rubella syndrome?
9. A neonate has petechiae, hepatosplenomegaly, and a CSF pleocytosis. CSF PCR is positive for HSV. Which of the following is the recommended treatment duration for neonatal HSV CNS disease?
10. In congenital toxoplasmosis with active chorioretinitis and CNS involvement, which is the standard treatment regimen used in the first year of life?
11. A 3-day-old neonate presents with temperature instability, poor feeding, and abdominal distension. CBC shows WBC 3500/mm3, bands 25%, platelets 68,000/mm3, and CRP 32 mg/L. Blood culture grows Group B Streptococcus (GBS). The most reliable early diagnostic indicator that correctly triggered the workup was:
12. A neonate born at 36 weeks has petechiae, hepatosplenomegaly, jaundice, and chorioretinitis at birth. TORCH workup reveals IgM positive and IgG positive for CMV, and urine CMV-PCR is positive. The treatment of choice to prevent long-term sensorineural hearing loss in this symptomatic congenital CMV case is:
13. A 28-week neonate develops clinical sepsis at day 10. Blood culture grows Candida parapsilosis. The correct initial antifungal agent and the most important concurrent non-pharmacological step is:
14. A neonate born to a mother with primary syphilis during third trimester has a reactive VDRL. On examination: snuffles (bloody nasal discharge), diffuse maculopapular rash involving palms and soles, and hepatosplenomegaly. Bone X-rays show Wimberger's sign. The correct treatment is:
15. A neonate is born to a mother with primary CMV infection at 12 weeks of gestation. The infant is small for gestational age and has hepatosplenomegaly, purpuric rash, and periventricular calcifications on head ultrasound. The most important long-term complication to monitor and counsel about is:
16. A 2-day-old neonate develops poor feeding, temperature instability, and pallor. Blood culture is obtained and empirical antibiotic therapy for early-onset neonatal sepsis (EOS) should cover which organisms primarily?
17. A newborn with congenital toxoplasmosis presents with the classic triad. The three components of the classic clinical triad of congenital toxoplasmosis are:
18. A neonate born to an HBsAg-positive mother should receive which specific combination at birth for optimal prevention of perinatal hepatitis B transmission?
19. A full-term neonate at 36 hours of life has a total bilirubin of 18 mg/dL. The baby is on breastfeeding. Direct Coombs test is negative. Reticulocyte count is normal. The most likely diagnosis and the correct next step is:
20. A neonate born at 32 weeks gestation develops temperature instability, poor feeding and bulging fontanelle at 10 days of life. CSF shows 200 cells/mm3 (90% neutrophils), protein 180 mg/dL, glucose 18 mg/dL with concurrent blood glucose of 60 mg/dL. The most likely causative organism in this late-onset neonatal meningitis is:
21. A neonate presents at birth with microcephaly, periventricular calcifications on CT, hepatosplenomegaly, petechiae, and chorioretinitis. Maternal serology shows primary infection in the first trimester. The most likely TORCH pathogen is:
22. A 36-hour-old neonate born to a GBS-positive mother who received intrapartum penicillin less than 4 hours before delivery develops respiratory distress and hypotension. Blood culture is sent. The IMMEDIATE empirical antibiotic regimen should be:
23. A full-term neonate is diagnosed with congenital toxoplasmosis with evidence of CNS involvement. The treatment of choice for this neonate is:
24. Which criterion BEST differentiates congenital rubella syndrome from other TORCH infections?
25. A neonate born at 36 weeks presents on day 2 with temperature instability, bulging fontanelle, and cerebrospinal fluid showing pleocytosis with gram-positive cocci in chains. Which organism is most likely and what is the drug of choice?
26. A newborn with intrauterine growth restriction is found to have hepatosplenomegaly, thrombocytopenic petechiae, chorioretinitis, and periventricular calcifications on cranial ultrasound. Which TORCH pathogen is the MOST likely cause?
27. An asymptomatic neonate is born to an HBsAg-positive mother. What is the correct prophylactic regimen within the first 12 hours of birth?
28. A 30-week premature neonate on day 10 develops temperature instability, feed intolerance, and CRP of 42 mg/L. Blood culture grows coagulase-negative Staphylococcus. Which of the following best describes the pathogenesis of this organism in late-onset neonatal sepsis?
29. A preterm neonate at 32 weeks develops temperature instability, feed intolerance, and apneic episodes on day 3 of life. Blood culture grows Group B Streptococcus. Which of the following best describes the mechanism of GBS virulence in neonates?
30. A newborn at 36 weeks gestation has petechiae, hepatosplenomegaly, chorioretinitis, and intracranial calcifications distributed diffusely throughout the brain parenchyma. TORCH serology reveals elevated IgM antibodies against CMV. Which finding BEST distinguishes congenital CMV from congenital toxoplasmosis on neuroimaging?
31. A 2-day-old neonate is found to have thrombocytopenia (platelet count 35,000/µL), jaundice, and hepatomegaly. The mother had a flu-like illness at 10 weeks gestation. Which of the following congenital infections is MOST likely and which clinical feature is MOST characteristic of this specific infection?
32. A term newborn presents at 12 hours of life with temperature 39.2°C, irritability, and bulging fontanelle. CSF shows 350 cells/mm3 (90% PMN), glucose 18 mg/dL, protein 280 mg/dL. Gram stain shows gram-negative diplococci. Which organism and what is the recommended antibiotic for this condition?
33. A neonate born to an HIV-positive mother (viral load undetectable at delivery) is to be given ARV prophylaxis. Which prophylaxis regimen is recommended for a LOW-RISK HIV-exposed neonate in India per current NACO guidelines?
34. A neonate born at 32 weeks presents with bulging fontanelle, hepatosplenomegaly, purpuric rash ('blueberry muffin' lesions), and bilateral cataracts at birth. Maternal serology during pregnancy revealed low avidity IgG at 8 weeks. What is the most likely diagnosis?
35. A 2-day-old neonate born to a GBS-positive mother who did not receive intrapartum antibiotic prophylaxis develops respiratory distress, hypotension, and a temperature of 39.2°C. Blood culture grows Group B Streptococcus. What is the treatment of choice?
36. A 3-week-old presents with perioral vesicles, seizures, and CSF pleocytosis with elevated protein. Brain MRI shows hemorrhagic temporal lobe involvement. The mother had no visible genital lesions at delivery. Which investigation would confirm the diagnosis most rapidly?
37. Which TORCH infection is associated with periventricular calcifications, sensorineural hearing loss, microcephaly, and chorioretinitis, and is the most common congenital viral infection worldwide?
38. A neonate born at 34 weeks is noted to have jaundice at 18 hours, hepatosplenomegaly, a maculopapular rash on the palms and soles, snuffles, and pseudoparalysis of one arm. VDRL is reactive 1:32. What is the dose of benzathine penicillin G for confirmed congenital syphilis without CNS involvement?
39. A 3-day-old neonate born to a mother who had chickenpox 2 days before delivery presents with extensive vesicular skin rash, pneumonitis, and encephalitis. What is the most appropriate immediate treatment?
40. A neonate born at 34 weeks gestation is found to have intracranial calcifications on cranial ultrasound, chorioretinitis on ophthalmological examination, and hydrocephalus. CSF shows mild pleocytosis and elevated protein. The TORCH infection MOST likely responsible is:
41. Which of the following is the MOST sensitive and specific neonatal screening test for early-onset bacterial sepsis when the infant appears symptomatic at 12 hours of life?
42. A neonate born to a GBS-positive mother who received intrapartum penicillin 1 hour before delivery now shows signs of respiratory distress at 6 hours of life. What is the recommended initial antibiotic regimen for presumed early-onset GBS sepsis in this neonate?
43. Congenital CMV infection can cause sensorineural hearing loss even in asymptomatic neonates at birth. Which of the following statements about congenital CMV is CORRECT?