Neonatology: chronic bilirubin encephalopathy: 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: chronic bilirubin encephalopathy

Sample item

A 4-year-old who had very high unconjugated bilirubin as a newborn now has athetoid movements, high-frequency sensorineural deafness and limited upward gaze. Which brain region is preferentially damaged?

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

The answer and the reasoning

C. Globus pallidus and subthalamic nucleus

Unconjugated bilirubin stains and damages the basal ganglia, especially the globus pallidus and subthalamic nucleus, along with brainstem auditory and oculomotor nuclei. The chronic picture is athetoid cerebral palsy, sensorineural deafness, upward gaze palsy and enamel hypoplasia. Prevention depends on timely phototherapy and exchange transfusion.

Option by option

  • A. Parasagittal watershed cortex

    Watershed cortical injury follows hypotension and gives spastic quadriparesis.

  • B. Periventricular white matter

    Periventricular white matter injury produces spastic diplegia in preterm infants.

  • C. Globus pallidus and subthalamic nucleus (correct)

    Correct. Bilirubin deposits in the globus pallidus and subthalamic nucleus, giving athetosis.

  • D. Cerebellar Purkinje cell layer

    Purkinje cell loss is not the typical site and would give ataxia, not athetosis with deafness.

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.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, Globus pallidus and subthalamic nucleus. Unconjugated bilirubin stains and damages the basal ganglia, especially the globus pallidus and subthalamic nucleus, along with brainstem auditory and oculomotor nuclei.

Why is "Parasagittal watershed cortex" not the answer?

Watershed cortical injury follows hypotension and gives spastic quadriparesis.

Why is "Periventricular white matter" not the answer?

Periventricular white matter injury produces spastic diplegia in preterm infants.

Why is "Cerebellar Purkinje cell layer" not the answer?

Purkinje cell loss is not the typical site and would give ataxia, not athetosis with deafness.

What concept does this question test?

It tests Neonatology: chronic bilirubin encephalopathy in Pediatrics. The chronic picture is athetoid cerebral palsy, sensorineural deafness, upward gaze palsy and enamel hypoplasia. Prevention depends on timely phototherapy and exchange transfusion.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: chronic bilirubin encephalopathy?

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.