Neonatology: hypoxic ischaemic encephalopathy staging: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatology: hypoxic ischaemic encephalopathy staging

Sample item

A term newborn with perinatal asphyxia is examined at 12 hours. He is lethargic with decreased tone and a weak suck, has bradycardia, constricted pupils and has had two seizures. Which Sarnat stage is this?

AStage 2, moderate encephalopathyBStage 0, no encephalopathyCStage 3, severe encephalopathyDStage 1, mild encephalopathy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Stage 2, moderate encephalopathy

Sarnat stage 1 is hyperalert with sympathetic overactivity such as dilated pupils and tachycardia. Stage 2 is lethargy, hypotonia, weak suck, parasympathetic features such as bradycardia and miosis, and seizures. Stage 3 is stupor or coma with flaccidity and absent reflexes, and carries the worst outcome.

Option by option

A. Stage 2, moderate encephalopathy (correct)
Correct. Lethargy with seizures, miosis and bradycardia fits moderate encephalopathy.
B. Stage 0, no encephalopathy
Stage 0 is a normal examination, which does not fit this baby.
C. Stage 3, severe encephalopathy
Stage 3 shows stupor, flaccidity and absent suck and primitive reflexes.
D. Stage 1, mild encephalopathy
Stage 1 shows a hyperalert baby with dilated pupils and no seizures.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Stage 2, moderate encephalopathy. Sarnat stage 1 is hyperalert with sympathetic overactivity such as dilated pupils and tachycardia.

Why is "Stage 0, no encephalopathy" not the answer?

Stage 0 is a normal examination, which does not fit this baby.

Why is "Stage 3, severe encephalopathy" not the answer?

Stage 3 shows stupor, flaccidity and absent suck and primitive reflexes.

Why is "Stage 1, mild encephalopathy" not the answer?

Stage 1 shows a hyperalert baby with dilated pupils and no seizures.

What concept does this question test?

It tests Neonatology: hypoxic ischaemic encephalopathy staging in Pediatrics. Stage 2 is lethargy, hypotonia, weak suck, parasympathetic features such as bradycardia and miosis, and seizures. Stage 3 is stupor or coma with flaccidity and absent reflexes, and carries the worst outcome.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatology: hypoxic ischaemic encephalopathy staging?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.