Ear and audiology: confirming congenital CMV: practice question

A ENT 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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ENT · Ear and audiology: confirming congenital CMV

Sample item

A two-week-old baby who failed the hearing screen has petechiae, hepatosplenomegaly and periventricular calcifications on cranial ultrasound. Which test best confirms congenital infection with the most likely agent?

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

The answer and the reasoning

D. Urine or saliva PCR for cytomegalovirus within the first three weeks of life

Congenital cytomegalovirus is the commonest non-genetic cause of congenital sensorineural hearing loss and classically causes periventricular calcification. Congenital infection must be confirmed on a specimen taken within the first three weeks, since later positivity may be postnatal. PCR on urine or saliva is used because IgG in a newborn may be maternal.

Option by option

  • A. Blood culture for Gram-negative bacteria

    Bacterial culture would not detect the viral cause suggested by the calcifications.

  • B. Toxoplasma IgM from the cord blood alone

    Toxoplasmosis causes diffuse calcification and IgM alone is unreliable in this setting.

  • C. Neonatal serum cytomegalovirus IgG titre alone

    Neonatal IgG can be of maternal origin and does not prove infection.

  • D. Urine or saliva PCR for cytomegalovirus within the first three weeks of life (correct)

    Correct. Viral detection in urine or saliva in the first three weeks confirms a congenital infection.

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 ENT question

What is the answer to this ENT question?

The best answer is D, Urine or saliva PCR for cytomegalovirus within the first three weeks of life. Congenital cytomegalovirus is the commonest non-genetic cause of congenital sensorineural hearing loss and classically causes periventricular calcification.

Why is "Blood culture for Gram-negative bacteria" not the answer?

Bacterial culture would not detect the viral cause suggested by the calcifications.

Why is "Toxoplasma IgM from the cord blood alone" not the answer?

Toxoplasmosis causes diffuse calcification and IgM alone is unreliable in this setting.

Why is "Neonatal serum cytomegalovirus IgG titre alone" not the answer?

Neonatal IgG can be of maternal origin and does not prove infection.

What concept does this question test?

It tests Ear and audiology: confirming congenital CMV in ENT. Congenital infection must be confirmed on a specimen taken within the first three weeks, since later positivity may be postnatal. PCR on urine or saliva is used because IgG in a newborn may be maternal.

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 Ear and audiology: confirming congenital CMV?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT 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.