Hemorrhagic Disease Of New Born

HEMORRHAGIC DISEASE OF NEW BORN

Q. 1

A newborn infant has multiple hemorrhagic, cutaneous lesions and does not respond to sound stimuli. Head CT scan shows periventricular calcifications. Which of the following infectious agents is the most likely cause of this child’s presentation?

 A

Cytomegalovirus

 B

Herpes simplex

 C

Rubella

 D

Syphilis

Q. 1

A newborn infant has multiple hemorrhagic, cutaneous lesions and does not respond to sound stimuli. Head CT scan shows periventricular calcifications. Which of the following infectious agents is the most likely cause of this child’s presentation?

 A

Cytomegalovirus

 B

Herpes simplex

 C

Rubella

 D

Syphilis

Ans. A

Explanation:

The infectious agents listed are all important causes of congenital disease.

The triad of cutaneous hemorrhages (“blueberry muffin baby”), deafness, and periventricular CNS calcifications suggests congenital CMV infection, the most common cause of intrauterine fetal viral infection. Other manifestations include microcephaly and hepatosplenomegaly.

Neonatal herpes may be congenital, but more commonly is acquired during vaginal delivery. The infection is characterized by vesicles on the skin and mucous membranes, encephalitis, or disseminated disease.

Congenital rubella can cause mental retardation, heart abnormalities, blindness, encephalitis, and motor abnormalities.

Congenital syphilis can cause death in utero, or a variety of problems including abnormal teeth, bones, and central nervous system.


Q. 2

Late onset hemorrhagic disease of newborn is characterized by all of the following features, EXCEPT:

 A

Usually occurs in cow-milk fed babies

 B

Onset occurs at 4-12 week of age

 C

Intracranial hemorrhage can occur

 D

Intramuscular vitamin K prophylaxis at birth has a protective role

Q. 2

Late onset hemorrhagic disease of newborn is characterized by all of the following features, EXCEPT:

 A

Usually occurs in cow-milk fed babies

 B

Onset occurs at 4-12 week of age

 C

Intracranial hemorrhage can occur

 D

Intramuscular vitamin K prophylaxis at birth has a protective role

Ans. A

Explanation:

Late onset hemorrhagic disease of newborn occur in infants at 2 to 12 weeks who are exclusively breast fed, because breast milk contains very low levels of vitamin K.

Ref: William’s Obstetrics, 23rd Edition, Chapter 29; Nelson’s Essentials of Pediatrics, 17th Edition, Pages 606, 607.


Q. 3

Which is abnormal in classic hemorrhagic disease of newborn ?

 A

Platelet count

 B

Thrombin time

 C

Fibrinogen level

 D

APTT

Q. 3

Which is abnormal in classic hemorrhagic disease of newborn ?

 A

Platelet count

 B

Thrombin time

 C

Fibrinogen level

 D

APTT

Ans. B

Explanation:

Thrombin time


Q. 4

Which of the following is not true about late onset Hemorrhagic disease of newborn (HDN)?

 A

Begins between 2-7 days of life

 B

Intracranial hemorrhage is common

 C

Biliary atresia can predispose

 D

Warfarin therapy is associated

Q. 4

Which of the following is not true about late onset Hemorrhagic disease of newborn (HDN)?

 A

Begins between 2-7 days of life

 B

Intracranial hemorrhage is common

 C

Biliary atresia can predispose

 D

Warfarin therapy is associated

Ans. A

Explanation:

Ans. is `a’ i.e., Begins between 2-7 days of life

Hemorrhagic disease of the newborn

o Early onset                                   0-24 hr

o Classical disease            —>          2-7 days

o Late onset                       –>         1-6 months


Q. 5

Feature of hemorrhagic disease of new born is ‑

 A

Prolonged prothrombin time

 B

Defective platelet count

 C

Prolonged bleeding time

 D

Prolonged thrombin time

Q. 5

Feature of hemorrhagic disease of new born is ‑

 A

Prolonged prothrombin time

 B

Defective platelet count

 C

Prolonged bleeding time

 D

Prolonged thrombin time

Ans. A

Explanation:

Ans. is ‘a’ i.e., Prolonged prothrombine time

o Normal new borns are moderately deficient in vitamin K.

o This deficiency increases on 3’d 51h day when, vitamin K level falls further. The serum level of vitamin K starts increasing from 13th to 15th day of life and achieves adult level at 3 months.

o This is normal, and does not produce any bleeding.

o In hemorrhagic disease of the newborn there is delay in achieving the normal vitamin K level. Clinical Features

o Vitamin K deficiency produces severe bleeding.

o Bleeding occurs from umbilical cord stump on 2″d/3rd day after birth.

o Intracranial bleding and large intramuscular hemorrhages may occur.

o Increased prothrombin time and increased partial thromboplastin time.

T/T

o Parenteral vitamin K therapy.


Q. 6

Late onset hemorrhagic disease of newborn is characterized by all of the following features except‑

 A

Usually occurs in cow-milk fed babies

 B

Onset occurs at 4-12 week of age

 C

Intracranial hemorrhage can occur.

 D

Intramuscular vitamin K prophylaxis at birth has a protective role

Q. 6

Late onset hemorrhagic disease of newborn is characterized by all of the following features except‑

 A

Usually occurs in cow-milk fed babies

 B

Onset occurs at 4-12 week of age

 C

Intracranial hemorrhage can occur.

 D

Intramuscular vitamin K prophylaxis at birth has a protective role

Ans. A

Explanation:

Ans. is ‘a’ i.e., Usually occurs in cow-milk fed babies

“Haemorrhagic disease of new born is more common in breast fed infants because breast milk is a poor source of vitamin K”- Nelson

What is haemorrhagic disease of new born

o It is a haemorrhagic disease of new born characterized by bleeding from various sites due to a transient deficiency of vitamin K dependent factors (II, VII, IX & X). .

o Breast milk is a poor source of vitamin K and haemorrhagic manifestation are more common in breast fed infants.


Q. 7

Feature of hemorrhagic disease of new born is‑

 A

Prolonged prothrombin time

 B

Defective platelet count

 C

Prolonged bleeding time

 D

Prolonged thrombin time

Q. 7

Feature of hemorrhagic disease of new born is‑

 A

Prolonged prothrombin time

 B

Defective platelet count

 C

Prolonged bleeding time

 D

Prolonged thrombin time

Ans. A

Explanation:

Answer is A (Prolonged prothrombin time)

Hemorrhagic disease of new born results from a deficiency of vitamin K.

Prothrombin time is the single best laboratory test to detect vitamin K deficiency as vitamin k deficiency may present with isolated prolongation of PT

Laboratory features of vitamin k deficiency (CMDT-2008)

  • Both PT and PTT are prolonged but prolongation of PT is a more sensitive test to detect vitamin K deficiency than PTT

–  The PT is prolonged to a greater extent than PTT

With mild vitamin K deficiency only the PT is defective

  • Fibrinogen level, Thrombin time and platlet count are not affected – CMDT

 


Q. 8

Sign shown in the photograph below occur due to ? 

 A

Subdural hemorrhage.

 B

Hydrocephalus.

 C

Craniotabes.

 D

Dolichocephaly.

Q. 8

Sign shown in the photograph below occur due to ? 

 A

Subdural hemorrhage.

 B

Hydrocephalus.

 C

Craniotabes.

 D

Dolichocephaly.

Ans. B

Explanation:

Ans:B.)Hydrocephalus.

The sign shown in the picture above represents Sun-setting sign.

The sunset eye sign (also known as the setting sun phenomenon) is a clinical phenomenon encountered in infants and young children with raised intracranial pressures (seen in up to 40% of children with obstructive hydrocephalus and 13% of children with shunt dysfunction ). 

It consists of an up-gaze paresis with the eyes appearing driven downward. The lower portion of the pupil may be covered by the lower eyelid, and sclera may be seen between the upper eyelid and the iris.


Q. 9

Case of hemorrhagic disease of newborn bleed on 2nd day‑

 A

2, 7, 9, 10

 B

3, 7, 9, 10

 C

2, 8, 9, 10

 D

2, 5, 9, 10

Q. 9

Case of hemorrhagic disease of newborn bleed on 2nd day‑

 A

2, 7, 9, 10

 B

3, 7, 9, 10

 C

2, 8, 9, 10

 D

2, 5, 9, 10

Ans. A

Explanation:

Ans. is ‘a’ i.e., 2, 7, 9, 10



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