A searchable extracted module from Neet_Pediatrics.pdf. Treat explanations as imported source text that still needs clinical editorial review before being mixed into validated learning decks.
All of the following are true about Kernicterus EXCEPT:
A.Kernicterus is due to Unconjugated Hyperbilirubinemia
B.Yellowish staining of Basal Ganglia is seen
C.Prematurity is a risk factor
D.Not associated with increased morbidity
Explanation and source text
Correct answer: D. Not associated with increased morbidity
Not associated with increased morbidity REF: Nelson 171h edition
page 687
KERNICTERUS OR BILIRUBIN ENCEPHALOPATHY:
Kernicterus, or bilirubin encephalopathy, is a neurologic syndrome
resulting from the deposition of unconjugated bilirubin in the basal
ganglia and brainstem nuclei.
The greatest risk associated with hyperbilirubinemia is the
development of kernicterus (bilirubin encephalopathy) at high
indirect serum bilirubin levels.
The level of serum bilirubin associated with kernicterus is dependent
in part on the cause of the jaundice. Kernicterus has developed
when bilirubin levels exceed 30 mg/dL, although the range is wide
(21-50 mg/dL).
Its onset is usually in the 1st wk of life, but it may_be delayed to the
2nd-3rd wk.
Kernicterus develops at lower bilirubin levels in preterm infants and
in the presence of asphyxia, intraventricular hemorrhage, hemolysis,
or drugs that displace bilirubin from albumin. The exact serum
bilirubin level that is harmful for VLBW infants is unclear. Kernicterus
does occur in patients with breast milk jaundice but is very
uncommon.
The surface of the brain is usually pale yellow. On cutting, certain
regions are characteristically stained yellow by unconjugated
bilirubin
Overt neurologic signs have a grave prognosis; 75% or more of such
infants die, and 80% of affected survivors have bilateral
choreoathetosis with involuntary muscle spasms. Mental retardation,
deafness, and spastic quadriplegia are common. Infants at risk
should have screening hearing tests.
Extracted references
Not associated with increased morbidity REF: Nelson 171h edition
Q2Growth and DevelopmentPDF pages 3-4
Definition of childhood is under what age?
A.8 years
B.10 years
C.12 years
D.16 years
Explanation and source text
Correct answer: C. 12 years
12 years REF: Nelson Textbook of Paediatrics 17th edition different
pages
Infancy 0-1 yr
Toddlerhood 1-3 yr
Early childhood (toddlerhood and some
1-4 yr
time afterwards)
Middle Childhood (School Age) 6-12 yr
Preschool 2-5 yr
Adolescence (onset of puberty to
12-20 yr
maturity)
Adulthood (full physical and intellectual 20-21 yr
maturity) onwards
Extracted references
12 years REF: Nelson Textbook of Paediatrics 17th edition different
Q3Infectious DiseasesPDF pages 4-5
A baby has stated to get his first milk teeth. His age is approximately:
A.3 months
B.6 months
C.9 months
D.12 months
Explanation and source text
Correct answer: B. 6 months
Most babies have their first primary (milk) teeth erupt at age 6 month of age and first
secondary teeth erupt at age 6 years.
The teeth in the upper jaw erupt earlier than those in the lower jaw, except for lower central
incisors. The lower central incisors appear, commonly, between the ages of 5 and 8
months. The upper central incisors appear a month later and the lateral incisors usually
within the next three months. The first molar teeth appear around the age of 12-15 months,
preceding the eruption of canine teeth by 6 months, which appear between the age of 18
and 21 months. The second molars are out at the age of 21 to 24 months.
Note: Permanent teeth eruption is in the following order: 1st molar - 6 years; central and
lateral incisors - 6-8 years; canines and premolars - 9-12 years; second molars - 12 years;
third molars - 18 years or later.
Ref: Ghai Essential Pediatrics by O P Ghai, 6th edition, Page 6 ; Nelson Textbook of
Paediatrics 17th edition page 18 & 37
Extracted references
Ref: Ghai Essential Pediatrics by O P Ghai, 6th edition, Page 6 ; Nelson Textbook of
Q4NeonatologyPDF pages 5-6
Which of the following statement is true for physiological jaundice in neonate?
A.Occurs in the first 6 hours of delivery
B.Neurological sequelae are common
C.Best treated by phototherapy
D.Starts on 2nd day of life
Explanation and source text
Correct answer: D. Starts on 2nd day of life
Most neonates develop visible jaundice due to elevation of
unconjugated bilirubin concentration during their first week.
This common condition is called Physiological jaundice.
It lasts for 5 days in term infants & 7 days in preterm infants.
It doesnot require any treatment & disappers spontaneously. In
pathological jaundice clinical jaundice will appear in the first 24hrs of
life.
Ref: Nelson, 18th Edition, Pages 760-761; O P Ghai, 6th Edition,
Pages 170-171.
Extracted references
Ref: Nelson, 18th Edition, Pages 760-761; O P Ghai, 6th Edition,
Q5Infectious DiseasesPDF pages 6-7
Which of the following is not a feature of Juvenile Idiopathic Arthritis?
A.Rheumatoid nodules
B.Spikes of high fever
C.Uveitis
D.Raynaud's phenomenon
Explanation and source text
Correct answer: D. Raynaud's phenomenon
Raynaud's Phenomenon is not mentioned in association with Juvenile Idiopathic Arthritis
(JIA).
Ref: Current Diagnosis and Treatment in Rheumatology, 2nd Edition, Pages 196-197;
Nelson’s Textbook of Pediatrics, 18th Edition, Page 1003; Primer on The Rheumatic
Diseases By John H. Klippel, Page 145
Extracted references
Ref: Current Diagnosis and Treatment in Rheumatology, 2nd Edition, Pages 196-197;
Q6NephrologyPDF pages 7-9
Which one of the following statements is false about Xanthogranulomatous pyelonephritis in children?
A.Often affects those younger than 8 years of age
B.It affects the kidney focally more frequently than diffusely
C.Clinical presentation in children is same as in adults
D.Boys are affected more frequently
Explanation and source text
Correct answer: D. Boys are affected more frequently
It is most frequently affected in females compared to males. It is an
unusual form of chronic pyelonephritis characterized by
granulomatous abscess formation, severe kidney destruction, and a
clinical picture that may resemble renal cell carcinoma and other
inflammatory renal parenchymal diseases.
Xanthogranulomatous pyelonephritis is a form of chronic
pyelonephritis characterised by destruction of renal parenchyma and
the presence of granulomas, abscesses and collection of lipid laden
foamy macrophages (foam cells).
Xanthogranulomatous pvelonephritis in children
* Age of presentation ranges from infancy to 16 years.
* Focal firm being more common in children Appear healthy.
* Those who affected diffusely, present with non-specific
symptoms of chronic infection.
i) Weight loss ii) Fever iii) Lethargy iv)
Failure to thrive
* Proteus is the most common causative organism.
Ref: By James Pattison, David Goldsmith, Barrie Hartley, Fernando
C. Fervenza and Joseph P. Grande (2004), Chapter 6, “Renal
Infections and Structural Abnormalities”, In the book, “A Colour
Handbook of Renal Medicine”, UK, Page 100.
Extracted references
Ref: By James Pattison, David Goldsmith, Barrie Hartley, Fernando
Q7RespiratoryPDF pages 9-10
Which of the following agents is most commonly associated with recurrent meningitis due to CSF leaks?
A.Meningococci
B.Pneumococci
C.Hemophilus Influenza
D.E. Coli
Explanation and source text
Correct answer: B. Pneumococci
Intracranial CSF leaks cause bacterial meningitis, about 80% are caused by S.
Pneumoniae. Other causative organisms are meningococcus, Hemophilus species and
S.aurues.
Ref: Clinical Pediatric Neurology By Ronald B. David, Page 217
Extracted references
Ref: Clinical Pediatric Neurology By Ronald B. David, Page 217
Q8General PediatricsPDF pages 10-11
Which of the following is a marker for neural tube defects?
A.↑Phosphatidylesterase
B.↑Pseudocholinesterase
C.↑Acetylcholinesterase
D.↑Butyrylcholinesterase
Explanation and source text
Correct answer: C. ↑Acetylcholinesterase
Neural tube defects are associated with high levels of
Acetylcholinesterase.
Ref: Genetic disorders and Fetus, 4th Edition, Page 673; Ian
Donald's Practical Obstetric Problem By Renu Misra, 6th Edition,
Page 44
* In intra embryonic life, neural tube is open at both end and freely
communicate with amniotic cavity. Failure of closure of neural tube
results in persistent of this communication. This allows excretion of
following fetal substances into amniotic cavity ?
- Alpha - fetoprotein
- Acetylcholinesterase
* These serve as biochemical markers for NTDs for prenatal
diagnosis.
Extracted references
Ref: Genetic disorders and Fetus, 4th Edition, Page 673; Ian
Q9Growth and DevelopmentPDF pages 11-12
Child draws triangle at what age ?
A.3 years
B.5 years
C.6 years
D.7 years
Explanation and source text
Correct answer: B. 5 years
Ans. is 'b' i.e., 5 years
Age Milestone
12-24 months Tries to scribble spontaneously
2 years Draws a vertical or horizontal line
3 years Draws a circle
4 years Draws a cross (plus sign) and draws a
rectangle
5 years Draws a triangle
Q10Growth and DevelopmentPDF pages 12-13
A child is able to build blocks of 5 Cubes developmental age is -
A.12 months
B.15 months
C.18 months
D.24 months
Explanation and source text
Correct answer: C. 18 months
Ans. is 'c' i.e., 18 month
Bang 2 cube - 8 month
Tower of 2 cubes - 15 month
4 cubes - 18 month
6 cubes - 22 month
Q11General PediatricsPDF pages 13-14
A child is able to say short sentences of 6 words -
A.2 years
B.3 years
C.4 years
D.5 years
Explanation and source text
Correct answer: C. 4 years
Ans. is 'c' i.e., 4 years
o 2 word sentences = 19 month
o 6 word sentences = 48 month
o 10 word sentences = 60 month
Q12Growth and DevelopmentPDF pages 14-15
Delayed dentition is seen in all/except ?
A.Down syndrome
B.Congenital hypothyroidism
C.Rickets
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
Causes of delay in tooth eruption :
1) Impacted teeth 4) Cong
hypothyroidsm
2) Down syndrome 5) Gaucher
Cleidocranial dysplasia 6) Osteo petrosis
Q13General PediatricsPDF pages 15-16
When ICF and ECF of child becomes equal to adult person -
A.1 year
B.2 year
C.3 year
D.4 year
Explanation and source text
Correct answer: A. 1 year
Ans. is 'a' i.e., 1 year
o In fetus, ECF is much larger than ICF.
o By the age of 1 year, ratio of ICF to the ECF volume approaches
adult level.
Q14General PediatricsPDF pages 16-17
Upper segment to lower segment ratio in 3 yr age child is -
A.12
B.1.3
C.1.4
D.1.6
Explanation and source text
Correct answer: B. 1.3
Ans. is 'b' i.e., 1.3
o The lower segment extends from the symphysis pubis to the heels.
o The lower segment grows rapidly after birth as compared to upper
segment giving rise to the gradual reduction in the upper
segment/lower segment ratio with the progression of age.
Age Upper segment : Lower segment ratio
At birth 1.7 : 1.0
3 years 1.3 -1.0
At 7 years 1.0 : 1.0
Thereafter 1.0:1.1
Q15NeonatologyPDF pages 17-18
A newborn baby has a head circumference of 35 ems. at birth, His optimal head circumference will be 43 ems at -
A.4 months of age
B.6 months of age
C.8 months of age
D.12 months of age
Explanation and source text
Correct answer: B. 6 months of age
Ans. is 'b' i.e., 6 months of age
o At 6 month of age head circumference is between 40.0-43.5cm.
Q16Growth and DevelopmentPDF pages 18-19
Vocabulary of 1.5 year old child is -
A.1-10 words
B.10-20 words
C.20-30 words
D.30-40 words
Explanation and source text
Correct answer: B. 10-20 words
Ans. is 'b' i.e., 10-20 words
At 18 months, the child can use 10 words with meaning.
Other milestones asked in the question are achieved in children
older than 18 months :?
Making a tower of 9 cubes - 30 months
Turn pages of book one at a time - 2 years
Ride tricycle - 3 years
Q17Growth and DevelopmentPDF pages 19-21
All of the following are essential features of attention deficit hyperactive disease (ADHD) except -
A.Lack of concentration
B.Impulsivity
C.Mental retardation
D.Hyperactivity
Explanation and source text
Correct answer: C. Mental retardation
Ans. is 'c' i.e., Mental Retardation
Inattentive
This must include at least 6 of the following symptoms of inattention
that must have persisted for at least 6 months to a degree that is
maladaptive and inconsistent with developmental level:
Often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen to what is being said
Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions)
Often has difficulties organizing tasks and activities
Often avoids or strongly dislikes tasks (such as schoolwork or
homework) that require sustained mental effort
Often loses things necessary for tasks or activities (school
assignments, pencils, books, tools, or toys)
Often is easily distracted by extraneous stimuli
Often forgetful in daily activities
Hyperactivity/impulsivity
This must include at least 6 of the following symptoms of
hyperactivity-impulsivity that must have persisted for at least 6
months to a degree that is maladaptive and inconsistent with
developmental level:
Fidgeting with or tapping hands or feet, squirming in seat
Leaving seat in classroom or in other situations in which remaining
seated is expected
Running about or climbing excessively in situations where this
behavior is inappropriate (in adolescents or adults, this may be
limited to subjective feelings of restlessness)
Difficulty playing or engaging in leisure activities quietly
Unable to be or uncomfortable being still for extended periods of
time (may be experienced by others as “on the go” or difficult to
keep up with)
Excessive talking
Blurting out answers to questions before the questions have been
completed
Difficulty waiting in lines or awaiting turn in games or group
situations
Interrupting or intruding on others (for adolescents and adults, may
intrude into or take over what others are doing)
Other
Onset is no later than age 12 years
Symptoms must be present in 2 or more situations, such as school,
work, or home
The disturbance causes clinically significant distress or impairment
in social, academic, or occupational functioning
Disorder does not occur exclusively during the course of
schizophrenia or other psychotic disorder and is not better
accounted for by mood, anxiety, dissociative, personality disorder or
substance intoxication or withdrawal
Q18General PediatricsPDF pages 21-22
Drugs used in ADHD are -
A.Atomoxetine
B.Methylphenidate
C.Dextro-amphetamine
D.All
Explanation and source text
Correct answer: D. All
Ans. is 'a' i.e., Atomoxetine; 'b' i.e., Methylphenidate; 'c' i.e., Dextro-
amphetamine
Some common stimulants used to treat ADHD include:
Adderall (amphetamine)
Ritalin (methylphenidate)
Concerta (methylphenidate)
Focalin (dexmethylphenidate)
Daytrana (methylphenidate patch)
Metadate or Methylin (methylphenidate)
Dexedrine or Dextrostat (dextroamphetamine)
Vyvanse (lisdexamfetamine dimesylate)
Q19Growth and DevelopmentPDF pages 22-23
A 3 year old boy with normal developmental milestones with delayed speech and difficulty in communication and concentration. He is not making friends. Most probable diagnosis is ?
A.Autism
B.ADHD
C.Mental retardation
D.Specific learning disability
Explanation and source text
Correct answer: A. Autism
Ans. is 'A' i.e., Autism
Delayed speech, difficulty in communication and concentration in a 3
year old child suggests the diagnosis of autism.
Autism is characterized by impaired social interaction and
communication, and by restricted and repetitive behavior. These
signs all begin before a child is three years old.
Autism affects information processing in the brain by altering how
nerve cells and their synapses connect and organize
It is one of three recognized disorders in the autism spectrum, the
other two being Asperger syndrome, which lacks delays in cognitive
development and language, and pervasive developmental Disorder-
not otherwise specified (commonly abbreviated as PDD-NOS)
Q20NeurologyPDF pages 23-24
The following are characteristic of autism except -
A.Onset after 6 years of age
B.Repetitive behaviour
C.Delayed language development
D.Severe deficit in social interaction
Explanation and source text
Correct answer: A. Onset after 6 years of age
Ans. is 'a' i.e., Onset after 6 years of age
Autism
Autism is a neurologic disroder characterized by ?
1. Qualitative impairment in social interaction
2. Qualitative impairment in communication.
3. Restricted repetitive and streotyped patterns of behaviour, interests,
and activities.
Onset of symptoms is usually before 3 years of age.
3-5 times more common in boys, but more severe when occurs in
girls.
More common among low socio-economic groups.
Q21General PediatricsPDF pages 24-25
5 year old child bed wetting Rx of choice ?
A.No treatment
B.Imipramin
C.Desmopressin
D.Motivational therapy
Explanation and source text
Correct answer: A. No treatment
Ans. is 'a' i.e., No treatment
o No treatment is given to children below 6 years of age because of
high spontaneous cure rate. o After 6 years treatment include.
t) Behavioral therapy : This is the treatment of choice.
it) Pharmacological treatment : It is used when non-pharmacological
(behavioral) therapy fails. Desmopressin is the drug of choice. Other
drugs used are impramine and oxybutinin.
Q22Growth and DevelopmentPDF pages 25-26
What is thelarche -
A.Pubertal breast enlargement in boys
B.Breast enlargement in pregnancy
C.Hormone related breast enlargement in girls
D.Post hormonal therapy breast enlargement in postmenopausal females
Explanation and source text
Correct answer: C. Hormone related breast enlargement in girls
Ans. is 'c' i.e., Hormone related breast enlargement in girls
Thelarche
o Definition :- Begining of secondary (Post natal) breast
development at onset of puberty in girls.
Tanner stage 2 breast development
Usually after 8 years of age
Because of rising level of estradiol
Breast development during puberty in male termed as
gynaecomastia not thelarche.
Q23General PediatricsPDF pages 26-27
Selenium deficiency is seen in -
A.Keshan disease
B.Wilson disease
C.Acrodermatitis enteropathica
D.None of above
Explanation and source text
Correct answer: A. Keshan disease
Ans. is 'a' i.e., Keshan disease
o Keshan disease ---> Disorder of Se
metabolism
o Wilson's disease ---> Disorder of Cu
metabolism
o Acrodermatitis enteropathica --> Disorder of Zn
metabolism
Q24General PediatricsPDF pages 27-28
Diarrhoea in a child of 12 month, dose of Zinc is ?
A.1 mg / 10 - 14 day
B.10 mg / 10 - 14 day
C.15 mg/ 10- 14 day
D.20 mg / 10 - 14 day
Explanation and source text
Correct answer: D. 20 mg / 10 - 14 day
Ans. is 'd' i.e., 20 mg/10-14 days
According to WHO guidlines
Dose of Zinc
2 month - 6 month = 10 mg / day x 14 days > 6 months = 20 mg/day
x 14 days
Q25NutritionPDF pages 28-29
Phrynoderma is due to ...deficiency-
A.Vitamin D
B.Niacin
C.Vitamin A
D.Essential fatty acid
Explanation and source text
Correct answer: D. Essential fatty acid
Ans. is 'd' i.e., Essential fatty acid
In vitamin 'A' deficiency there is toad like skin also known as
phrynoderma.
o But this is due to associated deficiency of essential fatty acids.
Q26NeonatologyPDF pages 29-31
All of the following are features of prematurity in a neonate, except -
A.No creases on sole
B.Abundant lanugo
C.Thick ear cartilage
D.Empty scrotum
Explanation and source text
Correct answer: C. Thick ear cartilage
Ans. is 'c' i.e., Thick ear cartilage
The ears in a premature neonate are soft and flat with ear cartilage
being deficient and pliant (and not thick)
Features of prematurity in a Neonate :
o Baby is small in size usually less than 47 cm long.
o Head is relatively large, sutures are widely separated and
fontanelle are large
o Face is small and buccal pad of fat is minimal
Skin is thin and pinkish and appears shiny due to generalized
edema.
Skin is covered with abundant lanugo and there is little vernix
caseosa.
Subcutaneous fat is reduced
o The breast nodule is less than 5 mm wide
o The ears are soft and flat with ear cartilage being deficient and
pliant
o Testes are not descended into scrotal sac. (Empty scrotum)
Scrotal sac is poorly pigmented and has less rugosities.
o In females labia majora appears widely separated, exposing the
labia minora and the clitoris.
o Deep creases are not well developed in the sole.
(There may be a single deep crease over the anterior one third of
the sole) o Neonatal reflexes such as Moro, Suckling & Swallowing
are sluggish.
o There is hypotonia with a poor recoil of flexed forearm when
extended.
Q27General PediatricsPDF pages 31-33
A baby is born at 27 weeks of gestation required mechanical ventilation for next 4 weeks & 0 for next 1 week. He 2 maintained at room temperature subsequently. As per new Bronchopulmonary dysplasia definition, he has which of the following ?
A.Mild BPD
B.Moderate BPD
C.Severe BPD
D.No BPD
Explanation and source text
Correct answer: A. Mild BPD
Mild
Supplement O2 (for 28 days) and
< 32 weeks GA Breathing room air at 36 weeks at birth corrected GA
or at discharge (whichever comes first).
. 32 weeks GA Breathing room air by 56 days at birth postnatal age
or at discharge (whichever comes first).
• The baby in question falls in category < 32 weeks gestation age at
birth.
• Simply looking at question, answer seems to be sever BPD as
mechanical ventilation (positive pressure ventilation) has included
only in diagnostic criteria of sever BPD.
• But, This baby was born at 27 weeks of gestation and required
mechanical ventilation for 4 more weeks, i.e. upto 31 weeks
corrected gestational age. After that he maintained at room air.
Thus, at 36 weeks corrected gestaional age, baby is breathing at
Thus, at 36 weeks corrected gestaional age, baby is breathing at
room air —> diagnostic criteria of mild BPD.
Q28NeonatologyPDF pages 33-34
Which of the following is the principal mode of heat exchange in an infant incubator ?
A.Radiation
B.Evaporation
C.Convection
D.Conduction
Explanation and source text
Correct answer: C. Convection
Ans. is 'c' i.e., Convection
"Convection warmed incubators are being routinely used for thermal
regulation of the premature neonate's ambient air" - Ghai 6'/e 154
Q29NephrologyPDF pages 34-35
Dose of i.v. adrenaline in term infant is during neonatal resuscitation -
A.0.1 - 0.3 ml/kg in 1:1000
B.0.3 - 0.5 ml/kg in 1:1000
C.0.1-0.3 ml/kg in 1:10,000
D.0.3 - 0.5 ml/kg in 1:10,000
Explanation and source text
Correct answer: C. 0.1-0.3 ml/kg in 1:10,000
Ans. is c i.e., 0.1-0.3 mUkg in 1:10,000
Dose or adrenlaine ?
0.1 ml/kg to 0.3 inlikg diluted (1: I0,000)
Routs : (1) Intravenous (umbilical vein) or
(2) Endotracheal
Indication ?
HR < 60/min after 30 sec. of positive pressure ventilation & chest
compression
Q30NeonatologyPDF pages 35-36
Causes of conjugated hyperbilirubinemia is ?
A.Rotor syndrome
B.Breast milk jaundice
C.Crigler najjar
D.Gilbert syndrome
Explanation and source text
Correct answer: A. Rotor syndrome
Ans. is 'a' i.e., Rotor syndrome
Conjugated hyperbilirubinemia is seen when ?
i) Impaired secretion of conjugated bilirubin into bile -> Dubin
Johnson syndrome, Rotor syndrome.
ii) Impaired bile flow —> Obstructive jaundice, primary biliary
cirrhosis, Neonatal cholestasis, e.g. Extrahepatic biliary
atresia/neonate idiopathic hepatitis, Choledocal cyst, Sclerosing
cholangitis, Caroli disease, Metabolic (Tyrosinemia, Wolman
disease, Nieman pick disease, Galactosemia, Fructosemia).
Q31NeonatologyPDF pages 36-37
Maximum concentration of dextrose that can be given through peripheral vascular line in neonate -
A.5
B.10
C.12.5
D.25
Explanation and source text
Correct answer: C. 12.5
Ans. is 'c' i.e., 12.5
o Hypoglycemia in neonates is blood sugar < 40 mg/dl
o Common in preteen, IUGR, infant of diabetic mothers
o Treated by breast feed, formula feed & I.V. dextrose solution
In symptomatic hypoglycemia 2 ml/g 10% Dx IV bolus given then
increase dextrose contents of intravenous fluid.
Don't give > 12.5% dextrose infusion through peripheral line
because of risk of thrombophlebitis. (Prefer central line)
Q32NeonatologyPDF pages 37-38
Hyperglycemia in Neonate if blood sugar is above ?
A.150 mg/dl
B.125 mg/dl
C.180 mg/dl
D.100 mg/dl
Explanation and source text
Correct answer: B. 125 mg/dl
Ans. is 'b' i.e., 125 mg/dl
o No established definition of neonatal hyperglycemia and upper
safe limit of blood glucose has been determined
o Various researches has suggested
Whole blood glucose > 125 mg/dl
Plasma glucose > 150 mg/dl
Q33NeurologyPDF pages 38-39
Hypoxic Ischemic encephalopathy true is ?
A.Lower limbs affected more than upper limbs
B.Prox. Muscles > distal muscles
C.Seizure
D.Trunk involved
Explanation and source text
Correct answer: C. Seizure
Ans. is 'c' i.e., Seizure
Clinical features of hvpoxic ischemic encephalopath'
o Encephalopathy progress over time ?
1) Birth to 12 hours —> Decreased level of conciousness, poor
tone, decreased spontaneous movement, periodic breathing or
apnea, seizures.
2) 12-24 hours -4 More seizuers, Apneic spells, jitteriness,
weakness.
3) After 24 hours —> Hypotonia, conciousness, poor feeding,
brainstem signs (oculomotor) and pupillary disturbances.
Q34General PediatricsPDF pages 39-40
Grasp reflex develops by -
A.20 weeks
B.24 weeks
C.28 weeks
D.32 weeks
Explanation and source text
Correct answer: C. 28 weeks
Ans. is 'c' i.e., 28 weeks
Reflex- Age of appearance 32 - Age of disappearance (after birth)
Q35NeonatologyPDF pages 40-41
Which of the following is best for transport of the newborn with maintainance of warm temperature ?
A.Kangaroo Mother Care (KMC)
B.Transport incubator
C.Thermacol box
D.Hot bottle
Explanation and source text
Correct answer: A. Kangaroo Mother Care (KMC)
Ans is 'a' i.e., Kangaroo Mother Care (KMC)
"Preferably mother should accompany and baby can be transported
in KMC position. Even father can provide KMC during transport if
mother can not acompany."
Q36CardiologyPDF pages 41-43
Commonest type of cong. cyanotic heart disease is -
A.ASD
B.SD
C.TOF
D.PDA
Explanation and source text
Correct answer: C. TOF
Ans. is 'c' i.e., TOF
Tetralogy of fallot is the commonest cyanotic congenital heart
disease.
Cyanotic Congenitial heart diseases
o Cyanotic CHDs are Right to Left shunts.
o These are further divided into : ?
1) Cyanotic CHD with decreased pulmonary blood flow.
This group includes TOF, Pulmonary atresia with intact
septum, tricuspid atresia, total anomalous pulmonary venous return
with obstruction.
These lesions have following components : -
a)Obstruction to pulmonary blood flow at tricuspid right ventricular or
pulmonary valve level.
b)A pathway by which systemic venous blood enters the systemic
circulation via a patent foramen ovale or ASD or VSD.
Degree of cyanosis depends on the degree of obstruction to
pulmonary blood flow : -
i) Mild obstruction
Cyanosis is precipitaed by stress, but may be absent at rest.
ii) Severe obstruction
Pulmonary blood flow is dependent on patency of the ductus
arteriosus. When the ductus closes (10-21 days), the neonate
arteriosus. When the ductus closes (10-21 days), the neonate
experience profound hypoxemia, cyanosis and shock.
2) Cyanotic CHD with increased pulmonary blood flow.
This group of lesions is not associated with obstruction to
pulmonary blood flow.
Cyanosis caused by any of the following mechanisms.
i) Abnormal ventricular-arterial connection (e.g., Transposition of
great vessels) In this, aorta arises from rt ventricle, So that systemic
venous blood returning to the right atrium is pumped directly back to
the body, and oxygenated blood returning from lung is pumped back
into the lungs.
ii) Total mixing of systemic venous and pulmonary venous blood
(e.g., total anomalous pulmonary venous return, truncus arteriosus,
a common atrium or ventricle) Deoxygenated systemic venous blood
and oxygenated pulmonary venous blood mix completely in the
heart and, as a result, oxygen saturation is equal in the pulmonary
artery and aorta. If pulmonary blood flow is not obstructed, these
infants have a combination of Cyanosis and heart failure. In
Contrast, if pulmonary stenosis is present, these infants have
cyanosis alone.
Q37CardiologyPDF pages 43-44
ASD is associated with all except ?
A.Infective endocarditis
B.Stroke
C.Arrhythemia
D.Pulmonary hypertension
Explanation and source text
Correct answer: A. Infective endocarditis
Ans. is 'a' i.e., Infective endocarditis
o ASD is usually subtle and not having significant problem except
mild growth disturbance.
o Ostium secundun ASD is M.C. type of ASD.
o Ostium secundum ASD usually associated with mitral valve
prolopse or stenosis (Lutembacher's Syndrome). o Complication
usually develop in 4thclecade and include :
I) Pulmonary hypertension
2) Rt. sided heart failure
3) Stroke
4)Eisenmenger's syndrome
Infective endocarditis is very rare in ASD and not require any
antibiotic prophylaxis.
Q38CardiologyPDF pages 44-45
The following features are true for tetralogy of Fallot, except -
A.Ventricular septal defect
B.Right ventricular hypertrophy
C.Atrial septal defect
D.Pulmonary stenosis
Explanation and source text
Correct answer: C. Atrial septal defect
Ans. is 'c' i.e., ASD
Tetralogy of Fallot
* The classical example of cyanotic patients with pulmonic stenosis
is tetralogy of fallot.
* TOF is the commonest congenital heart disease.
* Constituents of TOF
Ventricular septal defect Overriding or dextroposed aorta
Pulmonic stenosis Right ventricular hypertrophy.
Q39CardiologyPDF pages 45-46
All of the following are characteristic features of Tricuspid Atresia except -
A.Left Axis deviation
B.Right ventricular hypoplasia
C.Pulmonary vascularity is diminished
D.Splitting of S 2
Explanation and source text
Correct answer: D. Splitting of S 2
Ans. is 'd' i.e., Spliting of S
2
Atresia of the tricuspid valve results in the absence of a
communication between the right atrium and right ventricle therefore
the right ventricle is underdeveloped the inflow portion being absent.
The only exit for systemic venous blood coming to the right atrium is
by way ofAtrial Septa! defect. Through this the blood goes to left
atrium from where it enters left ventricle.
A ventricular septal defect provides communication between the left
ventricle and the outflow portion of the right ventricle. The left
ventricle therefore maintain both the systemic as well as the
pulmonary circulation thus there is hypertrophy of the left ventricle
which is reflected by left axis deviation in ECG.
The pulmonary blood flow is dependent on the size of the ventricular
defect, the smaller the VSD, the lesser the pulmonary blood
flow. 90% patients of Triscuspid Atresia have diminished pulmonary
blood flow. o Auscultatory finding in case of Tricuspid Atresia
S -Normal S - Single Murmur grade II to grade III / VI
1 2
Q40CardiologyPDF pages 46-48
True about Ebstein anomaly is?
A.Right ventricular dilatation
B.Right atrial dilatation
C.Left ventricular dilatation
D.Left atrial dilatation
Explanation and source text
Correct answer: B. Right atrial dilatation
Ans. is 'b' i.e., Right atrial dilatation
Ebstein's anomaly
Ebstein anomaly consists of downward displacement of an abnormal
tricuspid valve into the right ventricle. o Normally tricuspid valve has
three leaflets Anterior, posterior and septal.
Fixed end of these leaflets is attached to valve ring in tricuspid area.
In Ebstein anomaly, anterior leaflet is attached to valve ring as
normal, but the other two leaflets (posterior and septal) are
displaced downward and are attached to the wall of left ventricle.
The portion of right ventricle above he tricuspid valve becomes a
part of right atrium —÷ atrialized right ventricle. Hemodynamics
The tricuspid valve anomaly results in obstruction of blood flow as
well as regurgitation of blood from the right ventricle into the right
atrium → Dilatation and hypertrophy of right atrium due to volume
overload.
Blood flows right atrium to left atrium through patent foramen ovale
or ASD → Right to left shunt and cyanosis. Clinical manifestations
1. Cyanosis → Fatigue
2. Dyspnea on exertion → Paroxysmal attacks of tachycardia Signs
3. Cyanosis and clubbing → S., wider split but variable
4. Dominant V wave on JVP. → Right ventricular S3
5. Systolic thrill at the left sternal border → Right atrial S4.
S normal
i
Systolic murmur due to regurgitation at tricuspid valve.
Delayed diastolic murmur due to obstruction at tricuspid valve like
tricuspid stenosis.
Both systolic and diastolic murmur produced at the tricuspid valve
have scratchy character like pericardial friction rib.
Q41General PediatricsPDF pages 48-49
Steroids are given in rheumatic fever when there is-
A.Carditis
B.Chorea
C.Subcutaneous nodules
D.All
Explanation and source text
Correct answer: A. Carditis
Ans. is 'a' i.e., Carditis
Suppressive therapy of RF
o If patient has carditis with CHF —> Steroids
If patients has carditis without CHF —> Steroids or aspirin
(steroids are preferred)
If patient does not have carditis —> Aspirin The
total duration of suppressive therapy is 12 weeks.
Q42CardiologyPDF pages 49-50
In which of the following differential cyanosis found?
A.VSD with reversal of shunt
B.PDA with reversal of shunt
C.ASD with reversal of shunt
D.Tetralogy of Fallot
Explanation and source text
Correct answer: B. PDA with reversal of shunt
Ans. is 'b' i.e., PDA with reversal of shunt
Differential cyanosis
o When one extremity is pink and the other extremity is cyanotic, it is
referred to as differential cyanosis.
Q43General PediatricsPDF pages 50-51
In child, foreign body in lung -
A.Rigid bronchoscopy
B.Chest x-ray
C.Flexible endoscopy
D.Direct laryngoscopy
Explanation and source text
Correct answer: A. Rigid bronchoscopy
Ans. is 'a' i.e., Rigid bronchoscopy
o Treatment of choice is removal of foreign body by rigid
bronchoscope with appropriate antibiotics.
Q44NeonatologyPDF pages 51-52
In which disease, symptoms improve with crying -
A.Tetralogy of fallot
B.Choanal atresia
C.Bronchial asthma
D.All of above
Explanation and source text
Correct answer: B. Choanal atresia
Ans. is 'b' i.e., Choanal atresia
o Bilateral choanal atresia is a very serious life-threatening condition
because the baby is unable to breath directly after birth as neonates
are obligate nasal breathers.
o In some cases, this may present as cyanosis while the baby is
feeding because the oral air passages are blocked by the tongue.
o The cyanosis may improve when the baby cries, as the oral airway
is used at this time.
o These babies may require airway resuscitation soon after birth.
Q45GastroenterologyPDF pages 52-53
3 month infants with abdominal palpable mass & non bilious vomiting -
A.Hypertrophic biliary stenosis
B.Hypertrophic pyloric stenosis
C.Tracheoesophageal fistula
D.Duodenal atresia
Explanation and source text
Correct answer: B. Hypertrophic pyloric stenosis
Ans. is 'b' i.e., Hypertrophic pyloric stenosis
Hypertophic pyloric stenosis
Most common cause of nonbilious vomiting is Hypertrophic pyloric
stenosis.
Male > female.
Vomiting starts with 3 week of age.
Palpable mass is seen in epigastric region.
Visible peristalsis is seen soon after feeding.
Confirmed by USG abdomen.
Contrast study shows :
. Shoulder sign
. Double tract sign.
Treatment surgery = Ramstedt procedure.
Q46General PediatricsPDF pages 53-54
Hirschsprung disease is confirmed by ?
A.Rectal biopsy
B.Per/Rectal examination
C.Rectal manometry
D.X-ray abdomen
Explanation and source text
Correct answer: A. Rectal biopsy
Ans. is 'a' i.e., Rectal biopsy
o Rectal suction biopsy is procedure of choice.
Q47General PediatricsPDF pages 54-56
Skip granulomatous lesions are seen in ?
A.Ulcerative colitis
B.Crohn's disease
C.Whipple's disease
D.Reiter's disease
Explanation and source text
Correct answer: B. Crohn's disease
Ans. is 'b' i.e., Crohn's Disease
Features of CD
In the affected segment, mesentric fat wraps around the bowel
surface —> creeping fat
o The intestinal wall is rubbery and thick, as a consequence of
edema, inflammation, fibrosis, and hypertrophy of the muscularis
propria —> lumen is almost always narrowed --> string sign on
barium meal.
o A classic feature of CD is the sharp demarcation of diseased
bowel segments from adjucent uninvolved bowel. o When multiple
bowel segments are involved, the intervening bowel is normal —>
skip lesions. o There are serpentine linear ulcer along the axis of
bowel.
As the intervening mucosa tends to be relatively spared, the mucosa
acquires a coarsely textured Cobblestone appearance.
o Narrow fissures develop between the folds of the mucosa.
Fissures can penetrate deeply through the bowel wall and leading to
bowel adhesions and serositis. o Further extension of fissures leads
to fistula or sinus tract formation.
o There is transmural inflammation affecting all layers of bowel wall.
Sarcoid like noncaseating granulomas may be present in all tissue
layers.
o Neutrophilic infiltration into the crypts results in formation of crypt
o Neutrophilic infiltration into the crypts results in formation of crypt
abscess.
o Fibrosis of the submucosa, muscularis propria, and mucosa
eventually leads to stricture formation.
There is an increased incidence of cancer of GIT in patients with
long-standing CD, but the risk of cancer in CD is considerably less
than in patients with chronic UC.
Q48HematologyPDF pages 56-57
Most common cause of severe hematemesis in a child is-
A.Portal hypetension
B.Peptic ulcer
C.Mallory weiss syndrome
D.None of the above
Explanation and source text
Correct answer: A. Portal hypetension
Ans. is 'a' i.e., Portal hypertension
"Massive hematemesis in a child is almost always due to variceal
bleeding".
Variceal bleeding is due to portal hypertension.
Q49NeurologyPDF pages 57-58
Chronic constipation in children is seen in all A/E?
A.Hirschspring disease
B.Jejunal polyp
C.Hypothyroidism
D.Stricture
Explanation and source text
Correct answer: B. Jejunal polyp
Ans. is 'b' i.e., Jejunal polyp
Organic causes of constipation are :
i) Intestinal: Hirschprung disease, Anal/rectal stenosis, Anal
fissure, anteriorly displaced anal opening, strictures.
ii) Drugs: Narcotics, vincristine, Psychotropics.
iii) Metabolic/endocrine: Cystic fibrosis, hypothyroidism,
Panhypopituitrism
iv) Neuromuscular: Cerebral palsy, Psychomotor retardation,
spinal cord lesions, Myotonic dystophy, Neuropathy or myopathy of
GIT
v) Other causes: Low fibre diet, Milk protein allergy.
Q50NephrologyPDF pages 58-59
"Potter's syndrome" is associated with -
A.Renal anomalies
B.Severe oligohydramnio's
C.Flattened nose
D.All the above
Explanation and source text
Correct answer: D. All the above
Ans. is 'd' i.e., All of the above
Potter syndrome
Potter syndrome is characterized by -
i) Bilateral renal agenesis
ii) Pulmonary hypoplasia
iii) Potter facies --> widely separated eyes with epicanthic folds,
low set ears, broad compressed flat nose, receding chin.
* This condition is incompatible with life, death occurs shortly after
birth from pulmonary hypoplasia.
* Maternal USG demonstrates -
i) Oligohydramnios ii) Nonvisulization of
bladder iii) Absent kidney
Q51NephrologyPDF pages 59-60
Not true about chronic pyelonephritis in children -
A.Associated with Ureteric reflux
B.Associated with Intrarenal reflux
C.Associated with renal scarring
D.Males are more affected than female
Explanation and source text
Correct answer: D. Males are more affected than female
Ans. is 'd' i.e., Males are more affected than female
o 3 basic forms of UTI - (1) Pyelonephritis (2) Cystitis (3)
Asymptomatic bacteremia
Chronic Pyelonephritis :-
Characterised by renal inflammation & fibrosts induced by recurrent
or persistent renal infection, vesicoureteric reflux or other causes of
UTI.
Progressive renal scarring which leads to end stage renal
diseaes.
In reflex nephropathy, Intrarenal reflex of infected urine induces
renal injury which heals by renal scarring.
Being - straight, short & wide urethra, recurrent UTI is more common
in female, so CPN is also twice as common is female than male.
Q52General PediatricsPDF pages 60-61
Drug of choice for infantile spasm is?
A.Vigabatrin
B.Adrenocorticotropic hormone (ACTH)
C.Ethosuximide
D.Carbamazepine
Explanation and source text
Correct answer: A. Vigabatrin
Ans. 'a' i.e., Vigabatrin
Vigabatrin (drug of choice), ACTH (2nd choice) and
corticosteroids are used for treatment.
Q53NeurologyPDF pages 61-62
Most common cause of neonatal meningitis -
A.Staphylococcus
B.E. coli
C.H. influenze
D.Pneumococcus
Explanation and source text
Correct answer: B. E. coli
Ans. is 'b' i.e., E. coli
"Group B streptococcus followed by E.coli are the two most common
causes of neonatal meningitis".
Most common cause of neonatal meningitis —› Group B
streptococcus (Str. agalactiae) Second most common cause of
neonatal meningitis -- E.coli
Q54NeurologyPDF pages 62-63
The most common cause of meningitis in children aged 5 yrs is-
A.H influnzae
B.N. meningitides
C.Staphylococcus
D.E.coli
Explanation and source text
Correct answer: B. N. meningitides
Ans. is 'b' i.e., N. meningitides
Commonest causes of meningitis
Neonatal - Group B streptococcus most
common, E.coli second most common.
2 months to 3 years • Pneumococci > Meningococci > H.
influenzae
3 years to 20 years Meningococcus
> 20 years • Pneumococci
Q55General PediatricsPDF pages 63-64
Which is MC genetic cause of mental retardation -
A.Tuberous sclerosis
B.Cri-du-chat syndrome
C.Fragile-x-syndrome
D.Angel's syndrome
Explanation and source text
Correct answer: C. Fragile-x-syndrome
Ans. is 'c' i.e., Fragile-X-syndrome
o Down's syndrome is the most common genetic cause of mental
retardation, and fragile-X is second to Down's.
Also know
o Most common inherited cause of mental retardation is fragile-X-
syndrome (because down's syndrome is congenital cause but not
inherited).
Q56General PediatricsPDF pages 64-65
Decorticate child - Flase statement is ?
A.Acute Brain injurys
B.Susthalamic, CT & frontal lobe lesion
C.More dangerous than decerebrate lesion
D.Flexion of arm & extension of lower limb
Explanation and source text
Correct answer: C. More dangerous than decerebrate lesion
Ans. is 'c' i.e., More dangerous than decerebrate lesion
Decortical Posture
o Also known as flexor posturing or Mummy baby
o Arms flexed/bent over chest, hand fisted, leg extended & rotated
inward
o Damage to area in cerebral hemisphere, internal capsule,
thalamus & upper part of brain.
o Decorticate posture is ominous sign of severe brain damage.
Decerebrate posture
o Also known as extensor posturing
o Extension of upper limb & lower limb (ELBOW EXTENDED)
o Indicates brain stem damage (Below level of red nucleus)
o Decerebrate posture is more ominous than decortical posture
Q57NutritionPDF pages 65-67
Which one of the following is the most common tumor associated with type I neurofibromatosis ?
A.Optic nerve glioma
B.Meningioma
C.Acoustic schwannoma
D.Low grade astrocytoma
Explanation and source text
Correct answer: A. Optic nerve glioma
Ans. is 'a' i.e., Optic nerve glioma
Neurofibromatosis type I (Von-Recklinghewsen disease)
o NF-1 is diagnosed when any two of the following seven signs are
present.
1. Six or more cafe-au-lait macules
> 5 mm in prepupertal individuals
> 15 mm in postpubertal individuals
Cafe-au-fait spots are the hallmark of neurofibromatosis
and are present in almost 100% of the patient.
2. Axillary or inguinal freckling
3. Two or more Lisch nodules.
Lisch nodules are hamartomas located within the iris.
4. Two or more neurofibroma or one plexiform neurofibroma.
Typically involve the skin, but may be situated along
peripheral nerves and blood vessels.
They are small, rubbery lesions with a slight purplish
discoloration of the overlying skin.
5. A distinctive osseous lesion.
Sphenoid dysplasia or cortical thinning of long bones.
6. Optic glioma
6. Optic glioma
7. A first degree relative with NF-1
Other findings are : -
Pseudoarthrosis of tibia.
Scoliosis is the most common orthopaedic problem in NF-1,
but is not specific enough to be included as a diagnostic criterian.
Short stature
Q58HematologyPDF pages 67-69
All of the following are features of juvenile CML except -
A.Thrombocytopenia
B.Fetal Hb is increased
C.Philadelphia chromosome is positive
D.Lymphadenopathy
Explanation and source text
Correct answer: C. Philadelphia chromosome is positive
Ans. is 'c' i.e., Philadelphia chromosome is positive
Juvenile CML is mostly seen in children below 2 years of age.
Philadelphia chromosome is negative and leukocyte count is less
than 100'000/mm3.
Features Adult
CML Juvenile CML
Age 10-12
years < 2 years
Bleeding manifestation
Absent Frequent
Thrombocytopenia
Uncommon Frequent
Rash
Absent Frequent
Lymphadenopathy
Rare Frequent
Splenomegaly
Marked Variable
WBC count at diagnosis >
100'000 < 100'000
WBC type
Granulocyte Monocyte
Normoblastic
Unusual Common
HbF
Normal Increased
Immunoglobulins
Normal Increased
Muramidase levels
Normal Increased
Response to Busulphan
Good Poor
Survival 2.5-3
years 9 months
Q59General PediatricsPDF pages 69-70
Commonest tumor of face in chidren is-
A.Rhabdomyosarcoma
B.Sq. cell carcinoma
C.Basal cell carcinoma
D.Mixed parotid tumor
Explanation and source text
Correct answer: A. Rhabdomyosarcoma
Ans. is 'a' i.e., Rhabdomyosarcoma
Rhabdomyosarcoma
o The most common soft tissue sarcoma in children is
rhabdomyosarcoma.
o The common site of involvement are : -
o Head & Neck (25%) 2"d most common Extremities
Genitourinary (22%) —> 2nd most common
Retroperitoneum
Q60General PediatricsPDF pages 70-71
Highest cure rate is of -
A.Wilm's Tumor
B.Retinoblastoma
C.Rhabdomyosarcoma
D.All
Explanation and source text
Correct answer: B. Retinoblastoma
Ans. is 'b' i.e., Retinoblastoma
Tumor
5 years survival rate
Retinoblastoma
97%
Wilms
tumor
88%
Rhabdomyosarcoma
61%
Q61General PediatricsPDF pages 71-72
Most common benign tumours during infancy is-
A.Lymphangioma
B.Hemangioma
C.Cystic hygroma
D.Lipoma
Explanation and source text
Correct answer: B. Hemangioma
Ans. is 'b' i.e., Hemangioma
o Hemangiomas, the most common benign tumors of infancy, occur
in 10% of term infants.
Q62EndocrinologyPDF pages 72-74
Male pseudohermaphroditism is seen in ?
A.5-a reductase deficiency
B.21 hydroxylase deficiency
C.17 hydroxylase deficiency
D.a and c
Explanation and source text
Correct answer: D. a and c
Ans. is 'a' i.e., 5-a reductase deficiency; 'c' i.e., 17 hydroxylase
deficiency
Male pseudohermaphroditism
Genotype is XY
External genitalia are female
Causes of Male Pseudohermaphroditism
A. Defect in testicular differentiation
1. Deletion of short ann Y chromosome 3. Mixed gonadal
dysgenesis (MGD).
2. XY pure gonadal dysgenesis. 4. Dysgenetic
male pseudohennaphroditism (DMP).
B. Defect in testicular hormone synthesis
1. Leydig cell aplasia
2. Inborn error of testosterone biosynthesis
i) 17-alpha hydroxyalse deficiency iv) 3 beta-hydroxy
steroid dehydrogenase deficiency.
ii) 17-20 lyase deficiency v) 20-22
desmolase deficiency
iii) 17-ketosteroid reductase deficiency.
C. Defect in mullerian inhibiting hormone action
D. Defect in androgen action
1. 5-alpha reductase deficiency 4. Reifenstein
syndrome
2. Testicular feminization syndrome 5. Undertermined
etiology
3. Incomplete testicular feminization syndrome
True hermaphroditism
Both ovarian and testicular tissues are present either in the same
(ovotestis) or opposite gonads.
Q63Growth and DevelopmentPDF pages 74-75
Gonads to testes differentiation -
A.SRY gene
B.WNT-4 gene
C.DAX1 gene
D.None
Explanation and source text
Correct answer: A. SRY gene
Ans. is 'a' i.e., SRY gene
o 46 XX chromosome with genetic factor such as DAX1 and
signalling molecule WNT-4 are necessary for development of ovary.
o Y chromosome contains SRY gene which differentiates gonads to
testes.
Q64EndocrinologyPDF pages 75-76
What stimulates the gonads in male at 8 week to secret testosterone -
A.Inhibin from corpus luteum
B.GnRH from hypothalamus of baby
C.Placental HCG
D.All of above
Explanation and source text
Correct answer: C. Placental HCG
Ans. is 'c' i.e., Placental HCG
During embryogenesis, In male embryo, at 6-7 week of gestatin,
secretion of first anti-mullerian hormone (also k/o mullerian inhibiting
substance) causes regression of mullerian duct.
Then at 8-12 week, under influence of Placental HCG, testes started
producing testosterone.
Q65EndocrinologyPDF pages 76-78
Precocious puberty is seen in -
A.Hypothyroidism
B.CNS irridation
C.Mc cune-Albright syndrome
D.All
Explanation and source text
Correct answer: D. All
Ans. is 'a' i.e., Hypothyroidism; 'b' i.e., CNS irradiation; 'c' i.e., Mc
Cune Albright syndrome
Precocious puberty
o Puberty before the age of 8 years in girls or 9 years in boys is
considered precocious puberty. o Menarche before the age of 10
years in girls is also considered as precocious.
o Precocious puberty is of two types
1. Central or true precocious puberty
Results from excessive GnRH, gonadotropins and target sex
hormone elaborated by premature activation of hypothlamic
pituitary-gonadal (HPG) axis.
2. Peripheral or pseudo-precocious puberty
Due to increased sex steroid secretion from either the
adrenal gland or the gonads.
It is independent of HPG axis activation
Causes of Precocious puberty
A. Central precocious puberty
1. Idiopathic : Sporadic or familial.
2. Central nervous system abnormalities
i) Congenital anomalies of CNS: Hypothalamic hamartoma,
hydrocephalus, porencephaly, arachnoid cysts.
ii) Acquired lesions of CNS : Inflammation, granuloma, trauma,
surgery, radiation, chemotherapy.
iii) Tumors of CNS : Pineal tumors, optic glioma, ependymoma,
camiopharyngioma.
iv) Hypothyroidism
B. Peripheral precocious puberty : Isosexual
Girls
1. Ovarian causes : McCune-Albright syndrome, benign follicular
cysts, granulosa-theca cell tumors; Gonadoblastoma
2. Adrenal causes : Feminizing adrenal neoplasia
3. Exogenous estrogen administration
Boys
1. Testis : Leydig cell tumor, adrenal rest tumor, testotoxicosis.
2. Adrenal: CAH (21 or 11-(3 hydroxylase deficiency), virilizing
tumors.
3. hCG secreting tumors : Hepatoma, hepatoblastoma,
choriocarcinoma, chorionepithelioma, teratoma, dysgerminoma.
Exogenous testosterone
C. Heterosexual precocity
1. Girls : Virilization in girls due to virilizing CAH, ovarian or adrenal
neoplasia, polycystic ovarian disease.
2. Boys : Feminization due to estogen producing adrenal tumors,
exogenous estrogen, marijuana smoking.
Note - Hypothyroidism usually causes delayed puberty, but juvenile
hypothyroidism some times can cause precocious puberty.
Q66EndocrinologyPDF pages 78-79
Features of hypothyroidism in infancy include the following except-
A.Premature closure of posterior fontanelle
B.Coarse facies
C.Umbilical hernia
D.Constipation
Explanation and source text
Correct answer: A. Premature closure of posterior fontanelle
Ans. is 'a' i.e., Premature closure of posterior fontanelle
o There is delayed closure of posterior fontanelle.
Q67General PediatricsPDF pages 79-80
The sodium content of ReSoMal (rehydration solution for malnourished children) is -
A.90 mmol/L
B.60 mmol/L
C.45 mmoUL
D.30 mmol/L
Explanation and source text
Correct answer: C. 45 mmoUL
Ans. is 'c' i.e., 45 mmol/L
Q68CardiologyPDF pages 80-81
Turner syndrome is maximally associated with ?
A.Horseshoe kidney
B.Coarctation of aorta
C.VSD
D.ASD
Explanation and source text
Correct answer: B. Coarctation of aorta
Ans. is 'b' i.e., Coarctation of aorta
Among the given options Aortic coarctation is most common.
Turner's syndrome is commonly associated with congenital heart
diseases.
The most common anomaly associated is bicuspid Aortic valves in
one third to one half of the patients (50%).
Other congential anomalies associated with Turner's syndrome —>
Aortic coarctation (30%), Aortic stenosis, Mitral valve prolapse,
Anomalous pulmonary venous drainage.
Q69General PediatricsPDF pages 81-82
Barr body is absent in female having ?
A.46 XX genome
B.45 X0 genome
C.47 XXX
D.All of above
Explanation and source text
Correct answer: B. 45 X0 genome
Ans. is 'b' i.e., 45 X0 genome
Barr body (Sex - chromatin)
o It is a densely staining inactivated condensed 'X' chromosome that
is present in each somatic cells of female.
o It is found in the nucleus.
o It is used as a test of genetic femaleness it is possible to
determine the genetic sex of an individual according as to whether
there is a chromatin mass present on the inner surface of the
nuclear membrane of cells with resting or intermitent nuclei.
Remember following fact and the question will seem very easy.
Chromatid body (Barr body or sex chromatin) is derived from one of
the two X-chromosomes which becomes inactivated.
The numer of Barr bodies is thus one less than the number of X-
chromosomes.
Note -
o Barr body is found in female But -
o Kleinefelter syndrome is male with Barr body.
o Turner syndrome is female without Barr body.
Q70CardiologyPDF pages 82-83
Rubella causes all except
A.Microcephaly
B.VSD
C.Conduction defect
D.All
Explanation and source text
Correct answer: B. VSD
Ans. is 'b' i.e., VSD
Organ of corti : Sensorineural hearing loss (Most common clinical
finding of congenital rubella).
Heart : PDA (Most common CHD in congenital rubella), PS, VSD,
ASD TOF, pulmonary artery hypoplasia.
Eye : Cataract, retinopathy, microphthalmia, myopia, glaucoma.
CNS : Mental retardation, spastic diplegia, microcephaly, seizures,
behavioral disorders.
Other : IDDM, thyroid disorders, inguinal hernia, cryptorchidism,
interstitial pneumonia.
Q71EmergencyPDF pages 83-84
Dengue shock syndrome is characterized by the following except -
A.Hepatomegaly
B.Pleural effusion
C.Thrombocytopenia
D.Decreased haemoglobin
Explanation and source text
Correct answer: D. Decreased haemoglobin
Ans. is 'd' i.e., Decreased hemoglobin
Dengue hemorrhagic fever
Fever Minor or Major hemorrhgic
manifestations
Hepatomegaly Thrombocytopenia 100,000/mm3
Hypoalbuminemia Objective evidence of increased
capillary permeability (hematocrit 20%.)
Pleural effusion (by chest radiograph) [Nelson, 17/e, p 1093]
Criteria for Dengue shock syndrome
It includes those for dengue hemorrhagic fever plus, Hypotension or
narrow pulse.
Q72NeonatologyPDF pages 84-85
Retinopathy of prematurity is commonly predisposed by-
A.Less gestation age
B.Low birth weight
C.O toxicity 2
D.Carbohydrate excess
Explanation and source text
Correct answer: A. Less gestation age
Ans. is 'a' i.e., Less gestation age
Q73General PediatricsPDF pages 85-86
Head control/ neck holding is possible in an infant by: September 2012
A.1 month
B.2 months
C.3 months
D.6 months
Explanation and source text
Correct answer: C. 3 months
Ans. C i.e. 3 months
When a child is tried to pull to sit :-
i) Head lag --> Age is less than 4 weeks
ii) Partial head lag —> 2-3 months
iii) Head (Neck) Control ---> 3 months.
iv) Lifting of head up --> 5 months.
Q74General PediatricsPDF pages 86-87
Nocturnal enuresis may be considered normal upto: March 2005
A.3 years
B.4 years
C.5 years
D.6 years
Explanation and source text
Correct answer: D. 6 years
Ans. D: 6 years
Nocturnal enuresis is normal upto 6 years while its normal upto the
age of 4 years for daytime.
Q75NutritionPDF pages 87-89
Acute malnutrition in a child is clinically assessed by: September 2005
A.Body mass index
B.Weight for age
C.Height for age
D.Weight for height
Explanation and source text
Correct answer: D. Weight for height
Ans. D: Weight for height
An indicator known as weight-for-height is used to determine
whether a child is acutely malnourished or not. The child's weight is
compared to the 'normal' weight for that height.
Based on this information, the World Health Organisation (WHO)
has developed charts known as international standards for expected
growth.
If a child's weight falls within the range considered normal for his/her
height, the child is found to be well-nourished. If the weight is less
than the international standards, the child is considered acutely
malnourished or wasted. WHO has created cut-off points to indicate
the severity of the malnutrition.
If a child's weight-for-height is less than -2 z-scores (or standard
deviations) of normal children, s/he is considered to suffer from
moderate acute malnutrition or wasting.
If the child's weight-for-height is less than -3 z-scores (standard
deviations) of normal children s/he suffers from severe acute
malnutrition and is considered to be severely wasted.
Another measurement used to determine a child's nutritional status
is the mid-upper arm circumference (MUAC) measurement.
is the mid-upper arm circumference (MUAC) measurement.
Because MUAC measurements require a simple, colour-coded
measuring band rather than weighing scales and height boards, they
are often used during crisis situations.
Useful for children between six months and five years of age, a
MUAC measurement of less than 12.5 cm indicates that a child is
suffering from moderate acute malnutrition.
If the MUAC measurement is under 11.0 cm, however, the under-
five child's life may be in danger as he or she is suffering from
severe acute malnutrition.
Although no anthropometric measure is a perfect marker of acute
malnutrition, in the past, there has been a tendency to view W/H
measures as the gold-standard anthropometric measure to diagnose
acute malnutrition in emergencies. Discrepancies between MUAC
and W/H have therefore been explained by MUAC being a poor
indicator of nutritional status.
A third way of diagnosing acute malnutrition is by testing for the
presence of oedema.
Oedema affects a child's appearance, giving him or her a puffy,
swollen look in either lower limbs and feet or face.
It can be detected by small pits or indentations remaining in the
child's lower ankles or feet, after pressing lightly with the thumbs.
The presence of oedema in both feet and lower legs is always
considered a sign of severe acute malnutrition.
Q76CardiologyPDF pages 89-91
All of the following are true for Turners syndrome except: March 2012
A.Height is more than 145 cm
B.Webbing of neck
C.Increased carrying angle
D.Coarctation of aorta may be seen
Explanation and source text
Correct answer: A. Height is more than 145 cm
Ans: A i.e. Height is more than 145
Turner syndrome
Adult stature in Turner syndrome patients is less than 145 cm
Associated congenital defects are common in heart (coarctation of
aorta)
Lymphedema,
Short stature,
Webbed neck,
Low posterior hairline,
Cubitus valgus (increased carrying angle),
Finger deformities,
Short 4th metacarpal,
45 X0 karyotype
Down syndrome
MC trisomy,
Brachycephalic skull,
Hypotonia,
Palpebral fissure slopes upwards,
Marked epicanthic folds,
Brushfield's spots,
Increased nuchal fold thickness,
Iliac index less than 60,
Simian crease (single palmar crease),
MC associated cardiac lesions: VSD
Duodenal atresia, CML & transient myeloproliferative disorders are
seen
May be associated with Alzheimer's dementia,
MC cause of down syndrome: Maternal non-disjunction
Klinefelter syndrome
47 XXY
MC cause of hypergonadotrophic hypogonadism,
Subnormal intelligence
Fragile X syndrome
Large forehead,
Large head,
Macro-orchidism,
Moderately to severely retarded
Q77NutritionPDF pages 91-92
Prophylactic dose of vitamin K given to new born infants at delivery is ?
A.1mg
B.5mg
C.10mg
D.15mg
Explanation and source text
Correct answer: A. 1mg
Ans. is 'a' i.e., 1 mg
Vitamin K Deficiency in Newborns
The symptoms of vitamin K deficiency are due to hemorrhage
Newborns are particularly susceptible to vitamin K deficiency
because of low fat stores, low breast milk levels of vitamin K, sterility
of the infantile intestinal tract, liver immaturity, and poor placental
transport.
Intracranial bleeding, as well as gastrointestinal and skin bleeding,
can occur in vitamin K-deficient infants 17 days after birth.
Thus, vitamin K (1 mg IM) is given prophylactically at the time of
delivery.
Q78Infectious DiseasesPDF pages 92-93
Cat bites in child treatment - false is
A.Cleaning the wound thoroughly
B.Puncture wound most common
C.May require rabies vaccination
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is `d' i.e., All of above
The most common type of injury from cat and rat bites is a puncture
wound. Cat bites often penetrate to deep tissue
Infection is the most common complication of any type of bite
injuries.
Treatment includes cleansing of wound, debridement, wound
culture, tetanus and antirabies immunization, and initiation of
antibiotics.
A moxicillin-clavulanate is an excellent choice for empirical oral
therapy for human and animal bite wounds because of its activity
against most of the strains of bacteria that have been isolated from
infected bite injuries.
Q79Growth and DevelopmentPDF pages 93-94
Most common GI malignancy of childhood
A.Adenocarcinoma
B.Lymphoma
C.Sarcoma
D.carcinoid
Explanation and source text
Correct answer: B. Lymphoma
Ans. is 'b' i.e., Lymphoma
Over all hemangioma is most common Tumor in infant.
Hemangioma is usually benign in Nature.
Leukemia is most common malignancy in pediatric age gyp.
2"' most common is CNS Tumor = Lymphoma is the most common
malignancy of the gastrointestinal tract in children. About 30% of
children with non-Hodgkin lymphoma present with abdominal
tumors.
Q80CardiologyPDF pages 94-95
Swallowing breathing reflex - not seen in fetus for ?
A.14 weeks
B.12 weeks
C.16 weeks
D.Appear in all above period
Explanation and source text
Correct answer: B. 12 weeks
Ans. is 'b' i.e., 12 weeks
Behavioural deveopment in intrauterine life
Muscle contractions first appear around 8 wk, soon followed by
lateral flexion movements.
By 13-14 wk, breathing and swallowing motions appear and tactile
stimulation elicits graceful movements. o The grasp reflex appears
at 17 wk and is well developed by 27 wk.
Eye opening occurs around 26 wk.
During the 3rd trimester, fetuses respond to external stimuli with
heart rate elevation and body movements
Q81Infectious DiseasesPDF pages 95-96
Most common site of extra - pulmonary TB in children is ?
A.Abdominal
B.Genitourinary
C.Lymphnode
D.Congenital
Explanation and source text
Correct answer: C. Lymphnode
Ans. is 'c' i.e., Lymphnode
Most common site of extra pulmonary TB is lymphnode
Most children who develop tuberculosis disease experience
pulmonary manifestations 25 to 35 percent of children have an
extrapulmonary presentation.
The most common extrapulmonary form of tuberculosis is lymphatic
disease accounting for about two thirds of cases of extrapulmonary
tuberculosis. the second most common form is meningeal disease
occurring in 13% of patients
Q82General PediatricsPDF pages 96-97
Characteristics of SMR-2 in boys ?
A.Appearance of pubic hair
B.Appearance of axillary hair
C.Enlargement of scrotum
D.All of above
Explanation and source text
Correct answer: C. Enlargement of scrotum
Ans. is 'c' i.e., Enlargement of scrotum
Scanty & long pubic hair appear at SMR-2. Enlargement of scrotum
is there at SMR-2.
Q83General PediatricsPDF pages 97-98
Pedigree analysis chart?
A.Used for growth monitoring
B.To assess side effect during chemotherapy
C.Used to see gentic transmission
D.To assess developmental delay in infant
Explanation and source text
Correct answer: C. Used to see gentic transmission
Ans. is 'c' i.e., Used to see genetic transmission
Pedigree
Provide graphic depiction of a family structure medical history.
Person providing information is formed as proband.
Special symbol is used for each designation.
Three generation pedigree should be made.
Closer the relationship of proband to the person, greater is change
of shared genetic component.
Q84NephrologyPDF pages 98-99
21-Hydroxylase deficiency - false is ?
A.Most common cause of congenital adrenal hyperlasia
B.Autosomal recessive
C.Femal pseudo hermaphroditism
D.Male pseudo hermephroditism
Explanation and source text
Correct answer: D. Male pseudo hermephroditism
Ans. is 'd' i.e., Male pseudo hermephroditism
Congenital adrenal hvperplasia (CAH)
Group of AR disorder
MC adrenal disorder in childhood
Most common 21-hydroxylase deficiency =There is elevated level of
pregenolone, 17 -OH pergenelone DHEA and decreas level of
progesterone, deoxycortisol,and estradiol so 21 hydroxylase
deficiency causes female pseudohermaphroditism.
Q85General PediatricsPDF pages 99-100
AML best prognosis is seen with ?
A.Acute myelo monocytic leukemia.
B.Acute monocytic leukemia.
C.Acute promyeloblastic lukemia (M.3).
D.Erythro leukemia
Explanation and source text
Correct answer: C. Acute promyeloblastic lukemia (M.3).
Ans. is 'c' i.e., Acute promyeloblastic leukemia (M.3)
Acute promycloblastic leukemia
Also known as M-3
Associated with t(15:17)
DIC, chloromas common
Very responsine to retinoic acid combined with anthracylines.
M.7 (acute megakaryocytic leukemia) mostly seen in down
syndrome.
French-American-British (FAB) Classification of Acute Myelogenous
Leukemia
Q86NutritionPDF pages 100-102
Ideal time to start Iron therapy in a marasamic child with fever and hemoglobin 7 gm% is
A.Immedietly
B.At discharge
C.When fever goes down
D.At any time
Explanation and source text
Correct answer: C. When fever goes down
Ans. is 'c' i.e., When fever goes down
Iron at 3 mg/kg 1 day should started when child gaining weight once
stabilisation phase is over. o The core of the accepted WHO
management protocol is 10 steps in two phases ?
1. Stabilization
2. Rehabilitation.
These 10 essential steps are listed below:
1. Treat/prevent hypoglycemia;
2. Treat/prevent hypothermia;
3. Treat/prevent dehydration;
4. Correct electrolyte imbalance;
5. Treat/prevent infection;
6. Correct micronutrient deficiencies;
7. Start cautious feeding with F-75;
8. Achieve catch-up growth by feeding F-100 after appetite returns;
9. Provide sensory stimulation and emotional support; and
10. Prepare for follow-up after recovery
F-75 is the "starter" formula used during initial management of
malnutrition, beginning as soon as possible and continuing for 2-7
days until the child is stabilized. Severely malnourished children
cannot tolerate normal amounts ofprotein and sodium or high
amounts offat. They may die i f given too much protein or sodium.
They also need glucose, so they must be given a diet that is low in
protein and sodium and high in carbohydrate. F-75 has is specially
mixed to meet the child's needs without overwhelming the body 's
systems in the initial stage of treatment. Use of F-75 prevents
deaths. F-75 contains 75 kcal and 0.9 g protein per 100 ml.
As soon as the child is stabilized on F-75, F-100 is used as a "catch-
up" formula to rebuild wasted tissues. F100 contains more calories
and protein: 100 kcal and 2.9g protein per 100 ml.
Q87EndocrinologyPDF pages 102-104
Most common cardio vascular abnormality in down syndrome is ?
A.VSD
B.Endocardial cushion defect
C.TOF
D.COA
Explanation and source text
Correct answer: B. Endocardial cushion defect
Ans. is 'b' i.e., Endocardial cushion defect
About 40% of down syndrome have CHD.
Endocardial cushion Atrio ventricular septal defect account for 40-
60% of cases.
Other feature in down syndrome.
Hypotonia, flat face, upward and slanted palpebral fissures and
epicanthic folds, speckled irises (Brushfield spot);varying degrees of
mental and growth retardation;dysplasia of the pelvis, cardiac
malformations, and simian crease;short, broad hands, hypoplasia of
middle phalanx of 5th finger, duodenal atresia, and high arched
palate;5% of patients with Down syndrome are the result of a
translocation-t(14q21q), t(15q21q), and t(13q21q)-in which the
phenotype is the same as trisomy 21.
Other feature ?
1. Duodenal atresia
2. Annular pancreas
3. Tracheoesophageal fistula
4. Hirschsprung disease
5. Short stature
6. Short sternum
7. Brachycephaly
8. Delayed fontanel closure
9. Three fontanels
10. Frontal sinus hypoplasia
11. Peripheral joint laxity
12. Atlantoaxial instability (C1-C2 subluxation)
13. Exaggerated space between
14. Mottled skin in infancy
15. Dry coarse skin in adolescence 1st and 2nd toes
Increased Risk for Development of -
Leukemia:AML, ALL
Myelodysplasia
Transient lymphoproliferative syndrome
Celiac disease
Hypothyroidism
Diabetes mellitus
Obesity
Refractive errors
Strabismus
Mitral valve prolapse
Conductive and/or
Obstructive sleep apnea
Epilepsy sensorineural hearing loss
ADHD
Alzheimer disease
Conduct oppositional disorders
Q88RespiratoryPDF pages 104-105
Most common cause of lower respiratory tract infection in 3 year old child is
A.Klebsella
B.H-influenza
C.Streptococcal pneumonia
D.Staphe aureus
Explanation and source text
Correct answer: C. Streptococcal pneumonia
Ans. is 'c' i.e., Streptococcal pneumonia
Most common cause of paediatric pneumonia is respiratory syncytial
virus (RSV). Other viruses causing pneumonia are influenza virus
(2^d most common virus), adenovirus, rhinovirus, and parainfluenza
virus.
Most common bacterial cause of pediatric pneumonia is
streptococus pneumoniae (pneumococcus). Bacteria causing
atypical pneumonia commonly are mycoplasma and chlamydia.
Q89General PediatricsPDF pages 105-106
Non-obstructive hydrocephalus - true is ?
A.Also kin communicating hydrocephalus
B.Due to obliteration of subarachrod cistemae or malfunction of arachnoid villi
C.Dilatation of all 4 ventricle
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
H hy_LQggPllalus is not a specific disease; rather, it represents a
diverse group of conditions that result from impaired circulation and
absorption of CSF or, in the rare circumstance, from increased
production by a choroid plexus papilloma
flyLk.QCSPLlalus resulting from obstruction within the ventricular
system is called obstructive or noncommunicating hydrocephalus
The CSF circulates from the basal cisterns posteriorly through the
cistern system and over the convexities of the cerebral hemispheres.
CSF is absorbed primarily by the arachnoid villi through tight
junctions of their endothelium by the pressure forces that were noted
earlier.
CSF is absorbed to a much lesser extent by the lymphatic channels
directed to the paranasal sinuses, along nerve root sleeves, and by
the choroid plexus itself.
Hydrocephalus resulting from obliteration of the subarachnoid
cisterns or malfunction of the arachnoid villi is called nonobstructive
or communicating hydrocephalus
Q90Growth and DevelopmentPDF pages 106-108
Prader willi syndrome, chromosomal defect?
A.Chromosome 15
B.Chromosome 5
C.Chromosome 10
D.Chromosome 21
Explanation and source text
Correct answer: A. Chromosome 15
Ans. is 'a' i.e., Chromosome 15
Prader-Willi syndrome is a complex genetic condition that affects
many parts of the body.
In infancy, this condition is characterized by weak muscle tone
(hypotonia), feeding difficulties, poor growth, and delayed
development. Beginning in childhood, affected individuals develop
an insatiable appetite, which leads to chronic overeating
(hyperphagia) and obesity.
Some people with Prader-Willi syndrome, particularly those with
obesity, also develop type 2 diabetes mellitus (the most common
form of diabetes).
People with Prader-Willi syndrome typically have mild to moderate
intellectual impairment and learning disabilities. o Behavioral
problems are common, including temper outbursts, stubbornness,
and compulsive behavior such as picking at the skin. Sleep
abnormalities can also occur.
Additional features of this condition include distinctive facial features
such as a narrow forehead, almond-shaped eyes, and a triangular
mouth; short stature; and small hands and feet. Some people with
Prader-Willi syndrome have unusually fair skin and light-colored hair.
Both affected males and affected females have underdeveloped
genitals. Puberty is delayed or incomplete, and most affected
individuals are unable to have children (infertile).
Q91Infectious DiseasesPDF pages 108-109
Minimum interval between 2 live vaccine immunization ?
A.2 weeks
B.4 weeks
C.6 week
D.8 weeks
Explanation and source text
Correct answer: B. 4 weeks
Ans. is 'b' i.e., 4 weeks
Basic principle of immunization
Minimum 4 week interval recommended between 2 live
vaccine administration except OPV and oral typhoid.
Two or more killed vaccine may be administrated simultaneously or
at any given interval
A live and killed vaccine given simultaneously but at different site.
If immunisation status unknown, give age appropriate vaccine
Mixing of vaccine in same syringe not recommended
Live vaccine should be avoided in AIDS,
Q92NephrologyPDF pages 109-110
Fanconi's anemia - false is ?
A.Autosomal recessive
B.Pancytopenia
C.Type I RTA
D.All are true
Explanation and source text
Correct answer: C. Type I RTA
Ans. is 'c' i.e., Type I RTA
Fanconi anemia
Autosomal recessive
Pancytopenia
Hyper pigmentation of trunk, neck, and inlertriginous area.
Growth failure
Fanconi facies (small head, small eyes)
Renal abormality
Proximal RTA (type II RTA)
Renal tubular acidosis 3 types
Distal RTA (type I)
Proximal RTA (type II)
Hyperkalemic RTA (type IV)
Q93General PediatricsPDF pages 110-111
In marasmus wasting is due to ?
A.Prolonge dietery deficiency of calori
B.Prolonge dietery deficiency of protein
C.Excess catabolism of fat & muscle mass to provide energy
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
Marasmus
Prolonge deficiency of calory & protein due to starvation.
Monkey facies- loss of buccal fat.
Baggy pants appearance- loose skin of the buttocks hanging down.
Loss of axillary fat.
Appetite is preserved.
No edema.
Q94NephrologyPDF pages 111-112
A child having H/0 profuse watery diarrhoea not taking oraly and not passed urine since 2 days, what to be given
A.Milk
B.ORS
C.I.V. fluid
D.I.V. antibiotic
Explanation and source text
Correct answer: C. I.V. fluid
Ans. is 'c' i.e., I.V. fluid
Child having history of profuse watery diarrhoea with poor oral intake
and not passed urine since 2 days is suffering from diarrhoea with
dehydration and probably acute renal failure of pre renal types.
Here best choice is intravenous I.V. fluid
If I.V. access not possible, then you can give feed through Ryle's
tube or intra osseous fluid.
Q95NeurologyPDF pages 112-113
Febrile seizure most common - age groups?
A.1 month to 1 year
B.6 month to 5 year
C.6 month to 2 year
D.2 month to 5 year
Explanation and source text
Correct answer: B. 6 month to 5 year
Ans. is 'b' i.e., 6 month to 5 year
Febrile convulsion :-
Commonest provoked seizure
Between 6 months to 5 year
Neurologically normal child
Occurs when temp rise abruptly
Simple benign febrile convulsion
Fits occur within 24 hour of onset of fever.
Duration less than 10 min.
Usually single per febrile episode
Generalised type of convulsion
Atypical febrile seizures
Presence of family history of epilepsy
Neurodevelopmental retardation
Focal neurological deficit.
Q96Growth and DevelopmentPDF pages 113-114
Erythroposis starts in fetal liver during ?
A.2-4 weeks
B.4-6 weeks
C.6-8 weeks
D.8-10 weeks
Explanation and source text
Correct answer: C. 6-8 weeks
Ans. is 'c' i.e., 6-8 weeks
Developmental hematopoiesis occurs in three anatomic stages:?
1. Mesoblastic
2. Hepatic
3. Myeloid
Mesoblastic hematopoiesis occurs in extraembryonic structures,
principally in the yolk sac, and begins between the 10th and 14th
days of gestation.
By 6-8 wk of gestation the liver replaces the yolk sac as the primary
site of blood cell production, and by 10-12 wk extraembryonic
hematopoiesis has essentially ceased.
Hepatic hematopoiesis occurs in the liver throughout the remainder
of gestation, although production begins to diminish during the
second trimester as bone marrow (myeloid) hematopoiesis
increases.
The liver remains the predominant hematopoietic organ through wk
20-24 of gestation
Q97EmergencyPDF pages 114-115
Fluid of choice in child with burn < 24 hour is
A.Fresh frozen plasma
B.Isolye-P
C.Ringer lactate
D.Platlet tranfusion
Explanation and source text
Correct answer: C. Ringer lactate
Ans. is 'c' i.e., Ringer lactate
Fluid resuscitation in burn injury
Parkland formulaa
a. Initial 24 hours: Ringer's lactated (RL) solution 4 ml/kg/% burn
for adults and 3 ml/kg/% burn for children. RL solution is added for
maintenance for children:
a. 4 ml/kg/hour for children weighing 0-10 kg
b. 40 ml/hour +2 ml/hour for children weighing 10-20 kg
c. 60 ml/hour + 1 ml/kg/hour for children weighing 20 kg or higher
This formula recommends no colloid in the initial 24 hours.
b Next 24 hours: Colloids given as 20-60% of calculated plasma
volume. No crystalloids. Glucose in water is added in amounts
required to maintain a urinary output of 0.5-1 ml/hour in adults
and 1 ml/hour in children.
Q98General PediatricsPDF pages 115-116
Antiendomysial antibody is used in screening of ?
A.Myasthenia gravis
B.Auto immune hepatitis
C.Coeliac diseases
D.Graves disease
Explanation and source text
Correct answer: A. Myasthenia gravis
Ans. is 'a' i.e., Coeliac diseases
Coeliac disea.se (CD) is a permanent intolerance of the small
intestine to gluten, characterized by gluten-dependent changes in
villous morphology and/or signs of immunological activation
detectable in the lamina propria of intestinal mucosa.
The presence of serum anti-endomysial antibodies (EMA) is
generally considered to be highly suggestive for CD because of their
high values of sensitivity and specificity.
Other antibodies used for diagnosis
Tissue transglutaminase,
Antigliadin antibodies
Treatment is Gluten-free diet
Q99NephrologyPDF pages 116-117
In congenital adrenal hyperplasia precocious puberty in male is due to ?
A.21 alpha hydroxylase deficiency
B.11(3 hydroxylase deficiency)
C.Both
D.None
Explanation and source text
Correct answer: C. Both
Ans. is 'c' i.e., Both
21 hydroxylase and 3-13-HSD
• Salt losing
• Virilization of female (Female pseudohermaphroditism)
• Precocious puberty in male
Q100Growth and DevelopmentPDF pages 117-118
First sign of puberty in female ?
A.Tanner stage I
B.Tanner stage II
C.Pubic hair
D.Axillary hair
Explanation and source text
Correct answer: B. Tanner stage II
Ans. is `b' i.e., Tanner stage 11
Thelarche- first sign of puberty in Girl around age of 10 year in
Girl
Definition :- Begining of secondary (Post natal) breast development
at onset of puberty in girls.
Tanner stage 2 breast development.
Because of rising level of estradiol
Breast development during puberty in male termed as gynecomastia
not thelarche.
Q101General PediatricsPDF pages 118-119
True about bartter's syndrome are all except ?
A.Hyperkalemic alkalosis
B.Presents in neonate with ototoxicity have bartin gene mutation
C.Decreased K+ assorption from thick descending loop
D.Autosomal recessive
Explanation and source text
Correct answer: A. Hyperkalemic alkalosis
Ans. is 'a' i.e., Hyperkalemic alkalosis
Antibodies in coeliac disease are anti-endomysian, antigliadin and
anti-transglutaminase.
Q102CardiologyPDF pages 119-120
Drug used in congenital heart disease to keep PDA patent
A.PGE i
B.PGE2
C.PGI 2
D.Indomethacin
Explanation and source text
Correct answer: A. PGE i
Ans. is 'a' i.e., PGE,
Prostaglandin El (PGE1) infusion usually effective in keeping the
ductus arteriosus open before surgical intervention to reduce
hypoxemia and acidemia before surgery in ductus dependent lesion
like.
Pulmonary atresia
TOF with severe PS
TOF with pulmonary atresia
Transposition of great arteries with VSD and PS
Indomethacin is used for ductal closure
Q103CardiologyPDF pages 120-121
Figure of 8 in chest X-ray ?
A.Supracardiac TAPVC
B.Tetralogy of fallot
C.TGA
D.None of above
Explanation and source text
Correct answer: A. Supracardiac TAPVC
Ans. is 'a' Supracardiac TAPVC
Tertralogy of fallot—* boot shaped heart
Transposition of great vessel-* egg on side
TPVC (supracardioe) --> snownan or figure of 8 configuration
Q104RespiratoryPDF pages 121-122
False regarding croup is ?
A.Disease include epiglottis, laryngitis, laryngotrachictis
B.Brassy cough is main presenting feature
C.Causes upper airway obstruction
D.All of above
Explanation and source text
Correct answer: C. Causes upper airway obstruction
Ans. is 'c' i.e., Causes upper airway obstruction
Croup is variety of condition which include acute epiglottis, laryngitis,
trachiobronchitis.
Infection of lower respiratory tract.
Brassy cough main presenting feature.
Treatment
Humidified
I.V. fluid
Antibiotics
Nebulisation
Steroid.
Q105Growth and DevelopmentPDF pages 122-123
Most common intra abdominal solid organ tumor in child is ?
A.Neuroblastoma
B.Rhabdomyoblastoma
C.Wilm's tumor
D.Hypernephroma
Explanation and source text
Correct answer: A. Neuroblastoma
Ans. is 'a' i.e., Neuro blastoma
Most common abdominal cancer of childhood.
Most common cancer of infancy.
Most common extracranial solid tumor of childhood (most common
solid tumor of childhood is brain tumor).
Q106Infectious DiseasesPDF pages 123-124
Koplik spot true is ?
A.Pathognomic of measls
B.Present on buccal mucosa opposite P' molar
C.Always present
D.All of above
Explanation and source text
Correct answer: A. Pathognomic of measls
Ans. is 'a' i.e., Pathognomic of measls
Measle
Caused by RNA virus.
Highly contagious droplet spread from secretion of nose and throat 4
day before and 5 days after rash.
Secondary attack rate >90% in contact.
Prodromal phase - characterized by fever, rhinorrhea, conjuctival
congestion and dry hackig cough.
Koplik spots-bluish-gray specks or "grains of sand" on a red base-
develop on the buccal mucosa opposite the second molars
Generally appear 1-2 days before the rash and last 3-5 days
Pathognomonic for measles, but not always present
Rash appears on D4 first behind pinna on neck the spread of face,
thrunk and abdomen.
SSPE is long term complication seen in measls.
Q107General PediatricsPDF pages 124-125
Exchange blood transfusion what is used ?
A.Whole blood
B.EPP
C.Serum
D.Pack cell
Explanation and source text
Correct answer: A. Whole blood
Ans. is 'a' i.e., Whole blood
Exchange transfusion is the process of slowly removing patient
blood and replacing with fresh donor whole blood.
Q108CardiologyPDF pages 125-126
Large PDA leads to ?
A.Endocardial valvulitis
B.Eisenmenger syndrome
C.CHF
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
Patent ductus arteriosus (PDA)
Small PDA may not cause any complication but large defect if
untread may leads to :
Pulmonary hypertension Left to Right shunt leads to too much
circulation of blood in lung which leads to pulmonary hypertension.
Eisenmenger's syndrome - Large standing pulmonary hypertension
leads to permanent lung damage and causes Right to Left shunt.
Endocarditis.
Arrhythmia Enlargement of heart due to PDA increase risk of
arrhythmias
Q109HematologyPDF pages 126-127
ITP false is ?
A.Plattet transfusion should be avoided
B.Anticedent history of febrile illness
C.Overactive immune system
D.Steroid should be avoided
Explanation and source text
Correct answer: D. Steroid should be avoided
Ans. is 'd' i.e., Steroid should be avoided
Idiopathic thrombocytopenic purpura (ITP)
Commonest bleeding disorder presenting in children between 1-7
year of age.
ITP is proposed to be occur due to over active immune response.
Antecedent H/o febrile illness present.
Treatment
Platlet transfusion should be avoided
IVIG or steroid.
Q110NephrologyPDF pages 127-128
Posterior urethral valve - true A/E ?
A.Palpable bladder
B.Hydronephrosis
C.Painful stress incontinence
D.Recurrent UTI
Explanation and source text
Correct answer: C. Painful stress incontinence
Ans. is `c' i.e., Painful stress incontinence
Posterior urethral valve
Most common cause of severe obstructive uropathy in children.
30% of children experienced end stage renal disease/CRF
Dilated prostatic urethra.
Hypertrophy of bladder muscle
Vesicouretic reflux seen in 50% of cases.
Back pressure change:
Hydronephrosis
Distended bladder
Thin urinary stream
Recurent UTI because of urinary stasis
Q111NeonatologyPDF pages 128-129
In infant, bone marrow biopsy is done from ?
A.Sternum
B.Iliac crest
C.Tibia
D.All of above
Explanation and source text
Correct answer: C. Tibia
Ans. is 'c' i.e., Tibia
Sternum : —>
Hematopoitically active
Site in cooperative patient like adult
Ilium :
Apprehesive patient
Useful in older children & adult
Tibia :
Useful in newborn & infant and children below 2 year of age.
Q112General PediatricsPDF pages 129-130
Most common malignancy in children is ?
A.ALL
B.AML
C.Neuroblastoma
D.Wilm's tumor
Explanation and source text
Correct answer: A. ALL
Ans. is 'a' i.e., ALL
Leukemia is most common malignancy in pediatric age group. o
Leukemia / lymphoma = 40% (ALL is more common than AML)
CNS Tumor= 30%
Embryonal & Sarcoma =10%
2nd most common is CNS Tumor (30%)
Q113Growth and DevelopmentPDF pages 130-131
Alopecia thin brittle nail, sparse hair with thin enamel diagnosis is ?
A.Ectodermal dysplasia
B.Alopecia aerata
C.Alopica congenita
D.None of above
Explanation and source text
Correct answer: A. Ectodermal dysplasia
Ans. is 'a' i.e., Ectodermal dysplasia
Ectodermal dysplasia
Group of syndrome
All derived from ectodemal structure
Abnormalities of two or more ectodermal structure such as
Hair
Teeth
Nail
Sweat gland
Cranio facial structure
Digit
Q114General PediatricsPDF pages 131-132
Most common ASD is ?
A.Ostium primum
B.Patent foramen ovale
C.Ostium secondum
D.Sinus venosus
Explanation and source text
Correct answer: C. Ostium secondum
Ans. is 'c' i.e., Osteum secondum
ASD can occur in any portion of atrial septum -
Secundum
Primum
Sinus venosus
Absent atrial septum (leads to single atrium)
Ostium secondum defect
Defect in region of fossa ovalis
Most common form of ASD
Q115CardiologyPDF pages 132-133
Most common ASD in down syndrome is ?
A.Ostium primum
B.Ostium secundum
C.Absent atrial septum
D.Sinus venosus
Explanation and source text
Correct answer: A. Ostium primum
Ans. is 'a' i.e., Ostium primum
About 40% children with down syndrome have congenital heart
disease.
Endocardial cushion defect (ASD with ostium primum) account for
40-60% of cases.
Q116General PediatricsPDF pages 133-134
Sitting without support is appear at which month
A.5 month
B.6 month
C.7 month
D.8 month
Explanation and source text
Correct answer: B. 6 month
Ans. is 'b' i.e., 6 month
3 month Neck holding
5 month Roll over
6 month Sits in tripod position
8 month Sitting without support
9 month Stand with support
Q117General PediatricsPDF pages 134-135
Weight of child is 70% of normal according to IAP classification, categorised in ?
A.Mild
B.Moderate
C.Severe
D.Normal
Explanation and source text
Correct answer: B. Moderate
Ans. is `b' i.e., Moderate
Q118NeurologyPDF pages 135-137
Influenza vaccine cause ?
A.Local swelling
B.Fever
C.Itching
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
Mild problems following inactivated flu vaccine:
Soreness, redness, or swelling where the shot was given
Hoarseness
Sore, red or itchy eyes
Cough
Fever
Aches
Headache
Itching
Fatigue
If these problems occur, they usually begin soon after the shot and
last 1 or 2 days.
Moderate problems following inactivated flu vaccine:
Young children who get inactivated flu vaccine and pneumococcal
vaccine (PCV13) at the same time may be at increased risk for
seizures caused by fever. Ask your doctor for more information. Tell
your doctor if a child who is getting flu vaccine has ever had a
seizure.
Problems that could happen after any vaccine:
Brief fainting spells can happen after any medical procedure,
including vaccination. Sitting or lying down for about 15 minutes can
help prevent fainting, and injuries caused by a fall. Tell your doctor if
you feel dizzy, or have vision changes or ringing in the ears.
Severe shoulder pain and reduced range of motion in the arm where
a shot was given can happen, very rarely, after a vaccination.
Severe allergic reactions from a vaccine are very rare, estimated at
less than 1 in a million doses. If one were to occur, it would usually
be within a few minutes to a few hours after the vaccination.
Q119General PediatricsPDF pages 137-138
Hair an syndrome is consists of ?
A.Hyperandrogenism
B.Acanthosis nigricans
C.Insulin resistance
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
HAIR-AN syndrome consists of hyperandrogenism (HA), insulin
resistance (IR), and acanthosis nigricans (AN).
It is a subset of polycystic ovary syndrome
Q120NephrologyPDF pages 138-139
Renal tubuler acidosis with ABG value pH = 7.24 P0 =80; PaCO = 36 Na = 131; 2 2 HCO = 14 C1= 90; BE = -13 Glucose = 3 135 above ABG picture suggest ?
A.Metabolic acidosis
B.Respiratory acidosis
C.Respiratory alkalosis
D.Metabolic alkalosis
Explanation and source text
Correct answer: A. Metabolic acidosis
Ans. is 'a' i.e., Metabolic acidosis
The given values have low pH, and low HCo - Indicate metabolic
2
acidosis
PCO in lower normal range (normal value 35-45 mm/hg)
2
Q121General PediatricsPDF pages 139-140
Grimace with APGAR score -
A.0
B.1
C.2
D.3
Explanation and source text
Correct answer: B. 1
Ans. is `b i.e., 1
Q122CardiologyPDF pages 140-141
PDA true is all except ?
A.More common in preterm baby
B.Left to right shunt
C.Acyanotic congenital heart disease
D.More common in term baby
Explanation and source text
Correct answer: D. More common in term baby
Ans. is 'd i.e., More common in term baby
During fetal life, most of the pulmonary arterial blood is shunted
through the ductus arteriosus into the aorta .
Functional closure of the ductus normally occurs soon after birth, but
if the ductus remains patent when pulmonary vascular resistance
falls, aortic blood is shunted into the pulmonary artery.
The aortic end of the ductus is just distal to the origin of the left
subclavian artery, and the ductus enters the pulmonary artery at its
bifurcation
Female patients with PDA outnumber males 2 : 1.
PDA is also associated with maternal rubella infection during early
pregnancy.
It is a common problem in premature infants, where it can cause
severe hemodynamic derangements and several major sequelae
Q123NephrologyPDF pages 141-142
Most common presentation of wilm's tumor ?
A.Hematuria
B.Asymptomatic abdominal mass
C.Abdominal pain
D.Headache
Explanation and source text
Correct answer: B. Asymptomatic abdominal mass
Ans. is `b' i.e., Asymptomatic abdominal mass
Wilm's tumor (Nephroblastoma)
Most common malignant tumor of kidney.
80% of tumor present below 5 year of age.
Presention :?
Asymptomatic abdominal mass (M.C.).
Haematuria (10-25%).
Hypertension (25%).
Abdominal pain (30%).
Fever (20%).
Q124EndocrinologyPDF pages 142-143
Confirmation of male intersex by?
A.USG abdomen
B.Genetic testing
C.Hormonal study
D.All of above
Explanation and source text
Correct answer: B. Genetic testing
Ans. is 'b' i.e., Genetic testing
Intersex :(DSD)
Discrepancy between morphology of gonads and that of extemal
genitalia
Now Disorder of Sex development (DSD) is preferred instead of
intersex
Distinctly not defined as male or female
Intersex trait not always manitest at both
Some as not aware of intersex and it is confirned by Genetic testing
Most common is virilisation of female 46 XX DSD.
46 XX DSD -
Phenotype is xx & gonads are ovary but external genitalia is virilised.
(due to lack of antimullerian hormone (AMH))
Most common is congenital adrenal hyper plasia (CAH)
Most commonly 21 a hydroxylase & 11[3 - Hydroxylase deficiency.
Q125RespiratoryPDF pages 143-145
Post term baby with tachypnea - commonest cause?
A.Transient tachypnea of newborn
B.Meconium aspiration syndrome
C.Hyaline membrane disease
D.Infection
Explanation and source text
Correct answer: B. Meconium aspiration syndrome
Ans. is 'b' i.e., meconium aspiration syndrome
Transient Tachypnea of the Newborn
Transient tachypnea of the newborn is the most common cause of
neonatal respiratory distress, constituting more than 40 percent of
cases.1
A benign condition, it occurs when residual pulmonary fluid remains
in fetal lung tissue after delivery o Respiratory Distress Syndrome
Respiratory distress syndrome of the newborn, also called hyaline
membrane disease, is the most common cause of respiratory
distress in premature infants
Immature type II alveolar cells produce less surfactant, causing an
increase in alveolar surface tension and a decrease in compliant
Meconium Aspiration Syndrome
Meconium-stained amniotic fluid occurs in approximately 15 percent
of deliveries, causing meconium aspiration syndrome in the infant in
10 to 15 percent of those cases, typically in term and post-term
infants
Infection
Bacterial infection is another possible cause of neonatal respiratory
distress.
Common pathogens include group B streptococci (GBS),
Staphylococcus aureus, Streptococcus pneumoniae, and gram-
negative enteric rods.
Pneumonia and sepsis have various manifestations, including the
typical signs of distress as well as temperature instability
Q126General PediatricsPDF pages 145-146
Major criteria for rheumatic fever - AJE
A.Carditis
B.Arthralgia
C.Erythema marginatum
D.Subcutaneous nodule
Explanation and source text
Correct answer: B. Arthralgia
Ans. is 'b' i.e., Arthralgia
Jone's criteria
Major criteria are : Carditis, arthritis, subcutaneous natule, chorea,
and erythema marginatum
Q127General PediatricsPDF pages 146-147
0.9% NaCI contains True as?
A.0.9 gm of Nacl in 1000 ml of fluid
B.77 meg of sodium is 1000 ml of fluid
C.154 meg of chloride in 1000 ml of fluid
D.30 meg of sodium in 1000 ml of fluid.
Explanation and source text
Correct answer: C. 154 meg of chloride in 1000 ml of fluid
Ans. is 'c' i.e., 154 meq of chloride in 1000 ml of fluid
Nomal saline (Isotonic saline)
Contains - 9 gms of Nacl in 1000 ml of fluid
154 meq/sodium in 1000 ml of fluid
154 meq Chloride in 1000 ml of fluid
Q128Growth and DevelopmentPDF pages 147-148
Handedness develops by age of?
A.2 years
B.3 years
C.4 years
D.5 years
Explanation and source text
Correct answer: B. 3 years
Ans. is 'b' i.e., 3 year
Handedness is usually established by the 3rd yr. Frustration may
result from attempts to change children's hand preference.
Variations in fine motor development reflect both individual
proclivities and different opportunities for learning. Children who are
seldom allowed to use crayons, for example, develop a mature
pencil grasp later
Q129NephrologyPDF pages 148-149
Drug used in neonatal resuscitation
A.Adrenaline
B.Soda bi carbonate
C.Naloxone
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
Drug used during neonatal resuscitation
Epinephrine./Adrenalin
NS or RL
Naloxone
Sodium-by-carbonate
Q130Growth and DevelopmentPDF pages 149-150
Delayed puberty in female?
A.No breast budding in 10 years
B.Menarche > 16 year
C.menarche > 1 year of brean budding
D.FSH
Explanation and source text
Correct answer: B. Menarche > 16 year
Ans. is 'b' i.e., Menarche > 16 year
Delayed Puberty
More common in boy than girl
Most common cause in constitutional delay
Girls-Delayed puberty is defined as
Lack of secondary sexual character by age of 17 years
Absence of menarche by age of 16 year
5 year after pubertal onset.
Boys-Lack of pubertal changes by the age of 14 years.
Q131NeonatologyPDF pages 150-151
Reye syndrome false is?
A.Associated with salicylate ingestion
B.Hepatomegaly
C.Jaundice
D.Hypoglycemia
Explanation and source text
Correct answer: C. Jaundice
Ans. is 'c' i.e., Jaundice
Reve syndrome
Detrimental effects to many organs, especially the brain and liver, as
well as causing low blood sugar and increase ammonia level.
Secondary Mitochondria hepatopathy
H/o viral injection (Influenza, varicella) & salicylate interactions.
Higher mortality rate.
The disease causes fatty liver with minimal inflammation and
cerebral edema (swelling of the brain).
Jaundice is not usually present. With raised enzyme with normal
bilirubin.
Children of ages 4 to 12 are most commonly afflicted.
Early diagnosis is vital; although most children recover with
supportive therapy, it may lead to severe brain injury and death
Q132GastroenterologyPDF pages 151-152
3 year old child come in ER with H/o vomiting, loose watey motion for 3 days. on examination, child was drowsy, sunken eye. Hypothermia and skin pinch take time to revert back, diagnosis?
A.No dehydration
B.Mild dehydration
C.Some dehydration
D.Severe dehydration
Explanation and source text
Correct answer: D. Severe dehydration
Ans. is 'd' i.e., Severe dehydration
A child with severe dehydration will have at least two of the following
four signs : sensorium is abnormally sleepy or lethargic, sunken
eyes, drinking poorly or not at all, and a very slow skin pinch.
A child with some signs of dehydration will have two of the following
: restlessness or irritability, sunken eyes, drinking eagerly or slow
skin pinch.
A child with either one or none of these signs is classified as having
no signs of dehydration.
Q133CardiologyPDF pages 152-153
In duschene the knee jerk ?
A.Exaggerrated
B.Decrease
C.May be normal initially lateron increase
D.May be normal initially lateron decrease
Explanation and source text
Correct answer: D. May be normal initially lateron decrease
Ans. is 'd' i.e., May be normal initially lateron decrease
Duchenne and Becker's muscular dystrophy.
X-like recessive So expression of gene is essentially confirmed
in males.
Females are affected only if X-chromosome carrying the normal
allele is lost or inactivated
Becker is milder form with late onset and slow progression.
In duchenni, onset is early with deloyed misection.
Pseudohypertrophy of calf muscle, glutei, deltiod,
Gower sign may positive at age of 3 year.
Cardiac involvement started at 10 year of age.
Deep tendon reflexes remain normal or are decreased in
patients with DMD.
Ankle jerks are relatively preserved until the terminal stages,
while the knee jerk reflex is less brisk than the ankles by age
six, but is eventually lost.
Histopathology shows diffuse degeneration & regeneration of
muscle fibre.
Serum CPX are markedly high.
Q134NephrologyPDF pages 153-154
Intra uterine hydronephrosis of 32-34 weeks-management?
A.Intrauterine drainage
B.Wait until 3 weeks
C.Immediate delivery
D.Require serial USG and other associated anomalies
Explanation and source text
Correct answer: D. Require serial USG and other associated anomalies
Ans. is `d' i.e., Require serial USG and other associated anomalies
Antenatal hydronephrosis (ANH) is transient and resolves by the
third trimester in almost one-half cases.
The presence of oligohydramnios and additional renal or extrarenal
anomalies suggests significant pathology. o All patients with ANH
should undergo postnatal ultrasonography
The intensity of subsequent evaluation depends on anteroposterior
diameter (APD) of the renal pelvis and/or Society for Fetal Urology
(SFU) grading.
Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-
4 should be screened for upper or lower urinary tract obstruction and
vesicoureteric reflux.
Surgery is considered in patients with increasing renal pelvic APD
and/or an obstructed renogram with differential renal function <35-
40% or its subsequent decline.
Q135General PediatricsPDF pages 154-155
Child knows his/her sex by age of?
A.2 year
B.3 year
C.4 year
D.5 year
Explanation and source text
Correct answer: B. 3 year
Ans. is 'b' i.e., 3 year
Rides tricycle
Stands momentarily on one
foot.
Draws a circle
Can dress or undress
himself completely
Builds tower of 10 cubes
Knows his age and sex.
Repeat a sentence of 6
syllables
Has a vocabulary of 250
words.
Counts 3 objects correctly.
Can withhold and
postpone bowel
movement.
Q136Growth and DevelopmentPDF pages 155-156
True about SLE is?
A.Autoimmune disease
B.Childhood SLE had poor prognosis than adult SLE
C.Presence of ANA
D.All are true
Explanation and source text
Correct answer: D. All are true
Ans. is 'd' i.e., All are true
SLE (sytemic lupus Erythematosus)
Autoimmune disorder
Inflammation of blood vessel
Childhood SLE had poor pnognosis than adult SLE
Hall mark of SLE is presence of antinuclean antibody (ANA)
More common in female.
Malar rash in pathognomic of SLE
Non - erosive arthritis
Nephritis
Encephalopathy
Pleuritis / Pericarditis
Cytopenia
Q137NutritionPDF pages 156-157
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
Explanation and source text
Correct answer: A. 2, 7, 9, 10
Ans. is 'a' i.e., 2, 7, 9, 10
Hemorrhagic disease of newborn is due to deficiency of Vitamin K
dependent factors —> II, VII, IX and X.
Q138General PediatricsPDF pages 157-158
8 year old child with hematuria in 5 days after throat infection?
A.Post streptococcal nephropathy
B.Ig A nephropathy
C.Nephrotic syndrome
D.can be a or b
Explanation and source text
Correct answer: B. Ig A nephropathy
Ans. is 'b'i.e., Ig A Nephnopathy
IgA nephropathy
Predominant deposition of IgA in glomeruli.
RECURRENT episode of gross rematuria that also precipitation by
URTI in last 2-5 days.
PSGN
Acute GN following infection by group A - -hemolytic streptococci.
Common in school age children. o Streptococcal infection usually of
throat (4 or 12 strain) or skin (strain 49) by 1-4 week prior to AGN.
Edema, oliguria, hypertension, ARF, hematurea of abrupt onset.
Q139HematologyPDF pages 158-159
Hemophilia X-linked?
A.Hemophilia A
B.Hemophilia B
C.Hemophilia C
D.Both A & B
Explanation and source text
Correct answer: D. Both A & B
Ans. is 'D' i.e., Both a & b
Hemophilia A (also known as classic hemophilia or factor VIII
deficiency) and hemophilia B (also known as Christmas disease or
factor IX deficiency) are inherited in an X-linked recessive pattern.
Haemophilia C is caused by a deficiency of coagulation factor XI and
is distinguished from haemophilia A and B by the fact it does not
lead to bleeding into the joints. Furthermore, it has autosomal
recessive inheritance
Q140NutritionPDF pages 159-160
Kwashiorkor not true is?
A.Apathy
B.Flaky paint dermatosis
C.Increased transaminase
D.Voracious appetit
Explanation and source text
Correct answer: D. Voracious appetit
Ans. is 'd' i.e., Voracious appetite
There is decreased appetite in kwasiorkor (not varacious appetite).
Kwashiorkar
Kwashiorkar represents the uncompensated phase of PEM.
It is characterized by classical 'triad' of edema (Due to
hypoalbuminemia), markedly retarded growth, and psychomotor
(mental) changes
Q141EndocrinologyPDF pages 160-162
Most common cardiac defect in Turner syndrome
A.Coartaction of aorta
B.VSD
C.ASD
D.TOF
Explanation and source text
Correct answer: A. Coartaction of aorta
Ans. is 'a' i.e., Coartaction of aorta
Disorders Associated with Turner Syndrome
Short stature
Congenital lymphedema
Horseshoe kidney
Patella dislocation
Increased carrying angle of elbow
Madelung deformity (chondrodysplasia of distal radial epiphysis)
Congenital hip dislocation
Scoliosis
Widespread nipples
Shield chest
Redundant nuchal skin (in utero cystic hygroma)
Low posterior hairline
Coarctation of aorta
Bicuspid aortic valve
Cardiac conduction abnormalities
Hypoplastic left heart syndrome
Gonadal dysgenesis (infertility, primary amenorrhea)
Gonadoblastoma (if Y chromosome material present)
Learning disabilities (nonverbal perceptual motor and visuospatial
skills) [in 70%]
Developmental delay (in 10%)
Social awkwardness
Hypothyroidism (acquired in 15-30%)
Type 2 diabetes mellitus (insulin resistance)
Strabismus
Cataract
Red-green colorblindness (as in males)
Recurrent otitis media
Sensorineural hearing loss
Inflammatory bowel disease
Celiac disease
Q142General PediatricsPDF pages 162-163
In HSP gross hematurea is seen in what % of children?
A.5 - 10%
B.10 - 20%
C.20 - 30%
D.30 - 40%
Explanation and source text
Correct answer: C. 20 - 30%
Ans. is 'c' i.e., 20 - 30%
Henoch-schonlein_purpura (HSP)
Small vessel vasculitis
Purpuric rash
Arthritis
Abdominal pain
Glomerulonephritis
Gross hematuria is seen in 20-30% of cases
Q143NutritionPDF pages 163-165
Child has lesion on buttocks since 2 year spreading peripherally with central scarring non symptomatic diagnosis?
A.Erythema annular cetrifugam
B.Erythema migrains
C.Erythema marginatum
D.Erythema Gyratum
Explanation and source text
Correct answer: A. Erythema annular cetrifugam
Ans. is 'a' i.e., Erythema annulase cetrifugam
Erythema annulare centrifugum : an asymptomatic or pruritic
eruption of variable duration. The eruption may be associated with
an underlying disease (eg, infection, malignancy, sarcoidosis, other
systemic illness)
The eruption begins as erythematous papules that spread
peripherally while clearing centrally. These lesions enlarge at a rate
of approximately 2-5 mm/d to produce annular, arcuate, figurate,
circinate, or polycyclic plaques
Lesions demonstrate a predilection for the thighs and the legs, but
they may occur on the upper extremities, the trunk, or the face. The
palms and the soles are spared.
Erythema migrans: These lesions are typically less numerous, less
circinate in configuration, and often accompanied by a history of a
tick bite.
Erythema gyratum repens: EAC can be distinguished from this
condition by its slower rate of spread and by its less bizarre
configuration. Also, erythema gyratum repens is almost always
associated with an underlying malignancy.
Erythema marginatum rheumaticum: This is a nonscaling gyrate
erythema that by definition is found in association with rheumatic
fever (10-18% of patients with rheumatic fever).
Q144RespiratoryPDF pages 165-167
Infant has fever, one episode of febrile convulsions admitted for observation, fever than subsided and followed by rash on abdomen & chest, maculopapular erythematous-what is the cause?
A.Chickenpox
B.Measles
C.Typhoid
D.Dengue
Explanation and source text
Correct answer: A. Chickenpox
Ans. is 'a' i.e., Chickenpox
In this question, infant had develop rash on first day offever &
distribution of rash is in favour of chickenpox, or varicella.
Mnemonic for Day of appearance of rash in a febrile patient is
Very Sick Person Must Take Double Tablets
Very - Varicella (day 1)
Sick - Scarlet fever (day 2)
Person - Pox-small pox (day 3)
Must - Measles (day 4)
Take - Typhus (day 5)
Double - Dengue (day 6)
Tablets - Typhoid (day 7)
Chicken pox (Varicella ):
Caused by virus
Child develop fever with rash
Rash are macular, maculo-papular, vesicular (pleomorphic)
Distribution is usually centripetal
Complication include - more seen in immunocompromised child.
a. Mild thrombocytopenia
b. Hematurea
c. GI Bledding
d. Encephalitis
e. Pneumonia
Q145General PediatricsPDF pages 167-168
7 year old boy is ill and has fever. what is the caloric requirement?
A.1200 kcal/d
B.1500 kcal/d
C.1900 kcal/d
D.2200 kcal/d
Explanation and source text
Correct answer: C. 1900 kcal/d
Ans. is 'c' i.e., 1900 kcal/day
Children
6 year 7 -> 1690
9 year -> 1950
Q146Growth and DevelopmentPDF pages 168-170
Boy power school preference no spoken at school, normal speech at other place, IQ assessment normal diagnosis is?
A.Selective mutism
B.ADHD
C.Autism
D.Dyslexia
Explanation and source text
Correct answer: A. Selective mutism
Ans. is 'a' i.e., Selective mutism
Autism typically diagnosed before 36 month of age.
Autism is a neurodevelopmental disorder of unknown etiology, but
with a strong genetic basis.
It develops and is typically diagnosed before 36 mo of age.
It is characterized by a behavioral phenotype that includes
qualitative impairment in the areas of language development or
communication skills, social interactions and reciprocity, and
imagination and play.
Selective mutism is defined as a failure to speak in specific social
situations, despite speaking in other situations; it is typically a
symptom of an underlying anxiety disorder. Children with selective
mutism can speak normally in certain settings, such as within their
home or when they are alone with their parents, but do not speak in
other social settings, such as at school or at other places outside
their home.
Attention-deficit/hyperactivity disorder (ADHD) is the most common
neurobehavioral disorder of childhood, 1 of the most prevalent
chronic health conditions affecting school-aged children.
ADHD is characterized by:
Inattention, including increased distractibility and difficulty sustaining
attention.
Poor impulse control and decreased self-inhibitory capacity
Motor overactivity and motor restlessness.
Dyslexia is characterized by an unexpected difficulty in reading in
children and adults who otherwise possess the intelligence,
motivation, and opportunities to learn considered necessary for
accurate and fluent reading. Dyslexia is the most common and most
comprehensively studied of the learning disabilities
Q147RespiratoryPDF pages 170-172
Kangaroo mother care - False is?
A.Can also be given by father
B.Especially for low birth weight body
C.Effective thermal control
D.All of above
Explanation and source text
Correct answer: A. Can also be given by father
Ans.:A.)Can also be given by father
KANGAROO MOTHER CARE
• KMC is care of preterm or LBW infants by placing skin-to-skin
contact with the mother
• Position: vertical position between the mother's breasts and under
her clothes
• The position is maintained until the infant no longer tolerates it
(indicated by sweating or baby refuses to stay in KMC position)
• Kangaroo nutrition: exclusive breast feeding
• Continuous KMC is an alternative to minimal care in an incubator
for infants who have already overcome major problems while
adapting to extra-uterine life
Able to suck and swallow properly
Thriving in neutral thermal environment
• Intermittent KMC (atleast 1-2 hour) when continuous KMC is not
possible
• All mothers can provide KMC irrespective of age, parity, education,
culture or religion
• Initiated in a facility and continued at home
Clinical benefits
• Significantly increases milk production in mothers
• Increases exclusive breast feeding rates
• Reduces incidence of respiratory tract and nosocomial infection
• Better cardiorespiratory stability
• Fewer apneic episodes
• Improved weight gain
• Improves thermal protection in infants and there is a reduced
chance of hypothermia
• Improves emotional bonding between the infant and mothers
• Reduces the duration of hospital stay
• Improved survival in low resource setting
Criteria for eligibility for KMC
• Indicated in all stable LBW babies
• Very sick babies needing special care should be cared for under
radiant warmer initially. KMC should be started after the baby is
hemodynamically stable
• Short KMC sessions can be initiated during recovery with ongoing
medical treatment
• KMC can be provided while the baby is being fed via orogastric
tube or on oxygen therapy
• BW > 1800g: generally stable at birth and KMC initiated soon after
birth
• BW 1200 — 1799 g: many babies have significant neonatal
problems. It might take a few days to start KMC
• BW < 1200g: it might take days to weeks before initiating KMC
When to stop KMC
• When the baby attains a weight of 2500g and a gestation of 37
weeks
• A baby who upon being put in kangaroo position, tends to wriggle
out, pull limbs out or cries, is not in need of KMC any more
Q148HematologyPDF pages 172-173
Child having long history of hemoglobin 5 gm% next step?
A.Blood transfusion
B.CBC,reti count with periphesal smear.
C.Start Iron
D.Hb elechophoresis
Explanation and source text
Correct answer: B. CBC,reti count with periphesal smear.
Ans. is 'b' i.e., CBC,reti count with peripheral smear
In above question, if child is stable, then no need to give blood
transfusion.
Before starting Iron, we have to rule out types of anemia as Iron is
indicated only in nutritioral anemia.
Hb ele ctrophoresis is indicated if there is featuer of hemolytic
anemia (thalassemia) so over all our next step is complete
hemogram with manual peripheral smear examination. (obtion b).
Q149NutritionPDF pages 173-174
3 year old child with normal height for age, abnormal weight for age and abnormal weight for height, what It is not be?
A.Acute malnutrition
B.Chronic Malnutrition
C.Acute on chronic
D.None of above
Explanation and source text
Correct answer: B. Chronic Malnutrition
Ans. is 'b' i.e., Chronic malnutrition
For this purpose wasting and stunting are measured :-
i) Wasting (deficit in weight for height) 4 Acute malnutrition.
ii) Stunting (deficit in height for age) - Chronic malnutrition.
iii) Wasting and stunting - Acute on chronic malnutrition.
Q150EndocrinologyPDF pages 174-175
Hypergonadotropic hypogonadism is sean in all except?
A.Turner syndrome
B.Down syndrome
C.Klinefelter syndrome
D.Swyer's syndrome
Explanation and source text
Correct answer: B. Down syndrome
Ans. is 'b' i.e., Down syndrome
Hypergonadotropic hypogonadism
Also K/a primary or peripheral hypogonadism.
Characterised by hypogonadism due to an impaired response of the
gonads to the gonadotropin, FSH and LH.
In turn a lack of sex steroid production and elevated gonadotropin
level.
Causes :
Chromosomal abnormalitis
Turner's syndrome
Klinefelter syndrome
Swyer's syndrome
Enzyme defect
17 , hydroxylase
17, 20 lyase deficiency
Q151NephrologyPDF pages 175-176
Turner syndrome - karyotyping is?
A.45, X0
B.46 X0
C.47 XXX
D.Trisomy 21
Explanation and source text
Correct answer: A. 45, X0
Ans. is 'a' i.e., 45 XO
45X0
Lymphadema of dorsum of hand & fat
Loose skin fold at nape of neck
Short stature
Short Neck (with webbing of neck)
Anomalies ear
Broad shield like chest with widely spaced small nipple
Renal anomalies (Horse-shoe, souble or cleft renal pelvis)
Coart of aorta
Q152NephrologyPDF pages 176-177
Not a finding in potter syndrome?
A.Bilateral renal agenesis
B.Polyhydromnios
C.Pulmonary Hyperplasia
D.Flat chain
Explanation and source text
Correct answer: B. Polyhydromnios
Ans. is 'b' i.e., Poly hydromnios
Potter syndrome
Bilateral renal agenesis is incompatible with extrauterine life and is
termed Potter syndrome.
Death occurs shortly after birth from pulmonary hypoplasia.
The newborn has a characteristic facial appearance, termed Potter
facies. The eyes are widely separated withepicanthic folds, the ears
are low set, the nose is broad and compressed flat, the chin is
receding, and there arelimb anomalies.
Bilateral renal agenesis should be suspected when maternal
ultrasonography demonstrates oligohydramnios,nonvisualization of
the bladder, and absent kidneys.
Q153NeurologyPDF pages 177-178
Drug used for absence seizure?
A.Lamotrigine
B.Carbamazepine
C.Phenytoin
D.Vigabatrine
Explanation and source text
Correct answer: A. Lamotrigine
Ans. is 'a' i.e., Lamotrigine
Drug of choice for absence seizures is Valproate (Previously it was
ethosuxamide). Other drugs used are lamotrigine and clonazepam.
Q154CardiologyPDF pages 178-179
Most common cause of acquired heart disease in children
A.Acute rheuamatic fever
B.Kawasaki
C.Takayasu
D.Diabetes
Explanation and source text
Correct answer: A. Acute rheuamatic fever
Ans. is 'a' i.e., Acute Rheumatic fever
Acute rheumatic fever
Most common cause of acquired heart disease in children.
Caused by group A f3 hemolytic streptococci
Usually seen in school going children
Jones criteria = very impotrant
Mitral valve most common followed by aortic valve
In acute phase - MR seen
In RI-ID MS seen
Q155NeonatologyPDF pages 179-180
Mildly elevated bilirubin, normal liver enzymes are seen in?
A.Malaria
B.Thalassemia
C.G-6 PD deficie
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
Mildly elevated bilirubin especially indirect and normal liver enzyme
seen in hemolytic anemia.
In above question all causes hemolytic anemia.
Q156NeonatologyPDF pages 180-181
Single umblical artery is associated with?
A.NTD
B.Hydrops fetalis
C.Congenital heart disease
D.In utero death
Explanation and source text
Correct answer: C. Congenital heart disease
Ans. is `c'i.e., Congenital heart disease
Approximately 30% of infants with a single umbilical artery have
congenital abnormalities.
Trisomy 18 is one of the more frequent abnormalities.
The most common congenital anomalies in chromosomally normal
fetuses and neonates were.
Genitourinary (6.48%)
Cardiovascular (6.25%)
Musculoskeletal (5.44%).
Q157EndocrinologyPDF pages 181-182
Hypocalcemia in a child may be associated with
A.Digeorge syndrome
B.Hypo parathyroidism
C.Magnesium deficiency
D.All of above
Explanation and source text
Correct answer: D. All of above
Ans. is 'd' i.e., All of above
Causes of hypocakemia
Hypo parathyroidism
Digeorge syndrome
PTH receptor defect (pseudo hypoparathyroidism)
Magnesium dificiency
Exogenous organic phosphate excess
Vit D difeciency
Q158NephrologyPDF pages 182-183
Female hermaphrodite is?
A.Female sexual characterstic with testes
B.Male sexual charaterstic with ovary
C.XY
D.Female sexual characteristic with both testes & ovary
Explanation and source text
Correct answer: B. Male sexual charaterstic with ovary
Ans. is 'b' i.e., Male sexual characteristc with ovary
Female pseudo hermaphroditism
Have internal genitalia female type
Katy() type XX
Masculinisation of external genitalia
Most common - CAN
Congenital adrenal hyperplasia
M-C. 21 hydroxylase deficiency
Other cause excess maternal androgen due to - o Maternal ovarian
tumor.
Maternal drug intake
Treatment
Hormonal therapy
Q159NeonatologyPDF pages 183-184
Baby '0* positive, blood group, mother Rh negative, cord bilirubin 7 mg%, conjugated I now treatment is?
A.Nothing
B.Stop breast feeding for 48 hours
C.Continue breast feeding and phototherapy
D.Stop breast feed and prepare for exchange blood transfusion
Explanation and source text
Correct answer: D. Stop breast feed and prepare for exchange blood transfusion
Ans. is 'd' i.e., Stop breast tad and prepare for exchange blood
transfusion
· In hemolytic disease, immediate exchange
transfusion indication :
bilirubin is > 4.5 mg/dl and Hb < 11 gm%
a) Cord
b) Bilirubin rising > 1 mg/dl/hour despite phototherapy
c) Hb level 11-13 gm/dl and bilirubin rising more than 0.5 mg/dl/hour
d) Bilirubin is rising inspite of phototherapy
Q160NephrologyPDF pages 184-186
3 days old newborn with unknown inborn error of metabolism, hyperammonemia in blood.
A.Maple syrup urine disease
B.Urea cycle enzyme dificiency
C.Organic acidurea
D.Phenyl ketonuria
Explanation and source text
Correct answer: B. Urea cycle enzyme dificiency
Ans. is 'b' i.e., Urea cycle enzyme deficiency
Urea cycle enzyme defect
Catabolism of amino acid leads to free ammonia which is highly
toxic
Free ammonia is converted into urea by group of 5 enzyme
Newborn is usually asymphomatic but leter on become symptomatic
after giving protein
Treatment is dietery protein restriction
MSUD (maple syrup urine disease)
Defective decorboxglation of branch chain amino acid (leucine,
Isoleuvine, valine)
Autosomal recessine
Smell of maple syrup in urine.
Phenyl ketonuria
Autosomal recessive
Deficiency of phenylalanine hydroxylase.
Defect in conversion of phenylalanine to tyrosine.
This leads to increase level of phenylalanine.
This increase phenlylalanine converted into phenylpyruvate and
phenyl acetate.
This phenyl acetate gives mousy or musty odour in urine/body.
Other point to remember?
Sweaty feat odour -Isovaleric academia
In Alkaptanuria - Urine become darkish brown when exposed to air
while purplish brown in porphyria.
Smoky sweat - MSUD
Mousy or Musty - Phenylketonuria
Boiled cabbage - Tyrosinemia
Q161General PediatricsPDF pages 186-187
10 month old child can not perform?
A.Standing with support
B.Pincer group
C.Walking with suppor
D.Two words with meaning
Explanation and source text
Correct answer: D. Two words with meaning
Ans. is 'd' i.e., Two words with meaning
o A child can transfer the objects from one hand to another by 5-7
months.
o A child can build a tower of 6 cubes by 21 months
o A child can pull himself up by the age of 10 months.
o A child makes a simple sentence first time by the age of 2 years.
o Pincer grasp develops by 9 months.
Q162NeurologyPDF pages 187-188
Child comes with blood sugar 32 mg/dl with convulsions Treatment is?
A.5% dextrose 2 ml/kg
B.10% dextrose 2 ml/kg bolus
C.10% dextrose 4 ml/kg
D.5% Dextrose 4 ml/kg
Explanation and source text
Correct answer: C. 10% dextrose 4 ml/kg
Ans. is 'c' i.e., 10% Dextrose 4 ml/kg
Symtomatic Hypoglycemia (<40mg/d1) should be managed with
10% IV Dextrose.
In seizures, dose of 10% dextrose is 4 ml/kg.
Q163RespiratoryPDF pages 188-189
Omalizumab True statement is?
A.Anti-IgE
B.Used as add on therapy in moderate to severe asthma prophylaxis
C.Givn subcutaneously
D.All o above
Explanation and source text
Correct answer: D. All o above
Ans. is 'd' i.e., All of above
Anti-IgE (Omalizumab).
Omalizumab is a humanized monoclonal antibody that binds IgE,
thereby preventing its binding to the high-affinity IgE receptor and
blocking IgE-mediated allergic responses and inflammation.
approved for patients >12 yr old with moderate to severe asthma,
It is given every 2-4 wk subcutaneously based on body weight and
serum IgE levels.
Its clinical efficacy as an "add-on" therapy for patients with moderate
to severe allergic asthma It is generally well tolerated, although local
injection site reactions can occur
Q164HematologyPDF pages 189-190
Pigmentation and growth retardation is seen in?
A.Zinc deficiency
B.Riboflavin deficiency
C.Niacin deficiency
D.Vit A deficiency
Explanation and source text
Correct answer: A. Zinc deficiency
Ans. is 'a' i.e., Zinc dificiency
Dwarfism (growth retardation)
Diarrhea
Dermatitis
Hepatosplenomegaly
Iron deficiency anemia
Acrodermatitis enteropathica
Hyperpigmentation
Q165General PediatricsPDF pages 190-191
Not included in modified Jones criteria?
A.Polyarthalgia
B.Carditis
C.Chorea
D.Erythema marginatum
Explanation and source text
Correct answer: A. Polyarthalgia
Ans. is 'a' i.e., Polyarthalgia
All the given options are included in modified Jones criteria. Carditis,
chorea and erythema marginatum are major criteria. Only
polyarthralgia (arthralgia) is minor criterian.
Q166NutritionPDF pages 191-192
True about foremilk & hind milk?
A.Foremilk has fat
B.Hind milk relieve hunger
C.Fore milk relieve hunger
D.Hind milk is rich in protein
Explanation and source text
Correct answer: B. Hind milk relieve hunger
Ans. is 'b' i.e., Hind milk relive hunger
The foremilk (the milk "in front"); is produced at the beginning of
each feeding. It contains water, vitamins, and protein and relieve
thurst.
The hindmilk ; is pushed out latter, it is heavier, richer in lipid and
satisfy hunger.
Q167General PediatricsPDF pages 192-193
13 year old female having sudden onset high grade fever with delirium. CT. finding s/o involvement of limbic system & medial temporal lobe - Dx is
A.Subarachnoid hemorrhage
B.Herpes simplex encephalitis
C.Pyomeningitis
D.Cerebral malaria
Explanation and source text
Correct answer: B. Herpes simplex encephalitis
Ans. is 'b' i.e., Herpes simplex encephalitis
Herpes simplex encephalitis
Acute necrotising infection involving frontal, temporal lobe & limbic
system.
Feature Non specific - fever, headache, nuchal rigidity. convulsion,
altered sensorium.
Confirmed by CSF examin & radio imaging.
Treatment supportive and Acyclovir
Q168General PediatricsPDF pages 193-194
Height of child acquire 100 cm in?
A.2.5 year
B.3.5 year
C.4.5 year
D.5.5 year
Explanation and source text
Correct answer: C. 4.5 year
Ans. is 'c' i.e., 4.5 year
1 Year- 75 cm
2 Year- 90 cm
4 1/2 Year- 100 cm
Q169Growth and DevelopmentPDF pages 194-195
mental retardation can be proved if delayed milestones and slow or retarded growth seen upto which age (in year)?
A.12
B.16
C.18
D.20
Explanation and source text
Correct answer: C. 18
Ans. is 'c' i.e., 18 year
a) Significantly sub-average intellectual functioning:an IQ score
of 70 or below on an individually administered IQ test (for infants, a
clinical judgment of significantly sub-average intellectual
functioning).
Q170Infectious DiseasesPDF pages 195-196
Most common organ involved in congenital Tb is?
A.Liver
B.Pancreas
C.Kidney
D.Lung
Explanation and source text
Correct answer: A. Liver
Ans. is 'a' i.e., Liver
Congenital tuberculosis
Although it is rare as mother having tuberculosis primarily present
with infertility.
Tuberculous bacilli sometimes pass throgh umblical vein and may
develop focus in liver (hepatic complex).
When neonate aspirate amniotic fluid containing bacilli then develop
GI tuberculosis or lung infection.
Neonate usually present as respiratory distress,
hepatosplenomegaly lymphadenopathy.
Overall liver is most commonly involved in congenital tuberculosis
Q171Infectious DiseasesPDF pages 196-197
Bivalent meningococcal vaccine is ?
A.A Y
B.A C
C.C y
D.A W-I35
Explanation and source text
Correct answer: B. A C
Ans. is 'b' i.e., A C
Two type of meningococcal vaccine develop
Unconjugated polysaccharide vaccine.
Conjugated group C vaccine.
Polysaccharide vaccines
Internationally marketed meningococcal polysaccharide vaccines
are o Bivalent (A and C),
Trivalent (A, C and W-135)
Tetravalent (A, C, Y and W-135).
The vaccines are purified, heat-stable, lyophilized capsular
polysaccharides from meningococci of the respective serogroups.
A protective antibody response occurs within 10 days of vaccination.
In schoolchildren and adults, one dose of these polysaccharide
vaccines appears to provide protection for at least 3 years, but in
children under 4 years of age the levels of specific antibodies
decline rapidly after 2-3 years.
Q172NeonatologyPDF pages 197-198
Apnea of prematurity ?
A.> 10 sec
B.> 15 sec
C.20 sec
D.> 30 sec
Explanation and source text
Correct answer: C. 20 sec
Ans. is 'c' i.e., 20 sec
Apnea of prematurity defined as sudden stoppage of breathing that
lasts for 20 sec or is associated with bradycardia or cyanosis.
Apnea of prematurity should be differentiated from periodic
breathing which is normal phenomenon is preterm neonate
Q173General PediatricsPDF pages 198-199
Down syndrome - all are seen except -
A.t (14; 21)
B.t (11: 14)
C.Trisomy 21
D.t (15: 21)
Explanation and source text
Correct answer: B. t (11: 14)
Ans. is 'b' i.e., t (11: 14)
In 95% of cases of Down syndrome-trisomy of 21:-
Extra chromosome is of maternal in origin.
I% have mosaic with some all have 46 chromosome.
4% have robertsonian translocation.
t (13 : 21)
t (14 : 21)
t (15 : 21)
Very rarely long arm of chromosome 21 is triplicate (Partial trisomy).
Q174Growth and DevelopmentPDF pages 199-201
Bidextrous grip is seen at what age?
A.4 months
B.5 months
C.6 months
D.7 months
Explanation and source text
Correct answer: A. 4 months
Ans. A. 4 months
FINE MOTOR MILESTONES:
Age Milestone
4 months Bidextrous reach
6 months Unidextrous reach
9 months Immature pincer grasp
12monthsMature pincer grasp
Imitates scribbling, tower of 2
15months
blocks
18monthsScribbles, tower of 3 blocks
Tower of 6 blocks, vertical &
2 years
circular stroke
3 years Tower of 9 blocks, copies circle
4 years Copies cross, bridge with blocks
5 years Copies triangle
Q175RespiratoryPDF pages 201-202
Which vaccine to be given every year ?
A.Hepatitis A
B.Hepatitis B
C.Influenza
D.Chicken pox
Explanation and source text
Correct answer: C. Influenza
Ans. C. Influenza
Influenza (Flu): The flu vaccine is recommended every year for
children 6 months and older:
Kids younger than 9 who get the flu vaccine for the first time (or who
have only had one dose before July 2017) will get it in two separate
doses at least a month apart.
Those younger than 9 who have had at least two doses of flu
vaccine previously (in the same or different seasons) will only need
one dose.
Kids older than 9 only need one dose.
The vaccine is given by injection with a needle (the flu shot) or by
nasal spray. The flu shot is preferred for children of all ages because
it has been shown to be safe and effective. Although the nasal spray
was not used in recent years, a changed version of it is now
recommended (for the 2018–2019 flu season) for kids who may
otherwise not get a flu shot. The nasal spray is only for healthy
people ages 2 through 49. People with weakened immune systems
or some health conditions (such as asthma) and pregnant women
should not get the nasal spray vaccine.
Q176RespiratoryPDF pages 202-204
APGAR score 3 at 1 minute indicates:
A.Mildly depressed
B.Further resuscitation not needed
C.Severely depressed
D.Normal
Explanation and source text
Correct answer: C. Severely depressed
Ans. C. Severely depressed
APGAR CRITERIA:
Component
Score of
Score of 1 Score of 2 of
0
backronym
blue at no cyanosis
blue or
extremities body and
Skin color pale all Appearance
body pink extremities
over
(acrocyanosis) pink
< 100 beats per > 100 beats
Pulse rate absent Pulse
minute per minute
no grimace on
Reflex
response suction or cry on
irritability Grimace
to aggressive stimulation
grimace
stimulationstimulation
flexed arms
and legs that
Activity none some flexion Activity
resist
extension
Respiratory weak, irregular, strong, robust
absent Respiration
effort gasping cry
INTERPRETATION:
The test is generally done at 1 and 5 minutes after birth and may be
repeated later if the score is and remains low.
Scores 7 and above are generally normal
Score 4 to 6, fairly low
Score:3 and below are generally regarded as critically low and
cause for immediate resuscitative efforts.
Q177NutritionPDF pages 204-206
Severe acute malnutrition as per WHO criteria-
A.Weight for age less than median plus – 2 SD
B.Weight for height less than median plus 2 SD
C.Weight for age less than median plus 3 SD
D.Weight for height less than median minus -3SD
Explanation and source text
Correct answer: D. Weight for height less than median minus -3SD
Ans. D.Weight for height less than median minus -3SD
Severe acute malnutrition is defined by a very low weight for height
(below -3z scores of the median WHO growth standards), by visible
severe wasting, or by the presence of nutritional oedema.
World Health Organization (WHO) classification of nutritional status
of infants and children:
Nutritional status Age: birth to 5 years
Weight-for-length/height or BMI-for-age >3
Obese
standard deviations (SD) of the median
Weight-for-length/height or BMI-for-age >2 SD
Overweight
and ≤3 SD of the median
Moderately
Weight-for-age
underweight
Severely
Weight-for-age
underweight
Weight-for-length/height or BMI-for-age ≤–2 SD
Moderate acute
and ≥–3 SD of the median, or mid-upper arm
malnutrition
circumference ≥115 mm and
Severe acute
Weight-for-length/height or BMI-for-age
malnutrition
Moderately stunted
Moderately stunted
Length/height-for-age ≤–2 SD and ≥–3 SD of
(moderate chronic
the median
malnutrition)
Severely stunted
(severe chronic Length/height-for-age
malnutrition)
Weight-for-length/height ≤–2 SD and ≥–3 SD of
Moderately wasted
the median
Severely wasted Weight-for-length/height
Q178CardiologyPDF pages 206-207
Where to look for pre-ductal O2 saturation in PDA in a 3 minute born infant?
A.Fetal left Upper limb
B.Fetal left lower limb
C.Fetal right Upper limb
D.Fetal right lower limb
Explanation and source text
Correct answer: C. Fetal right Upper limb
Ans. C. Fetal right Upper limb
A simpler way to detect this right-to-left shunting is to use two pulse
oximeters and measure preductal and postductal SpO2. In one
study it was found that arterial saturation in the right arm (preductal)
of at least 3%above the lower limb (postductal) is evidence of right-
to-left ductal shunting.
Q179General PediatricsPDF pages 207-209
True about Fragile X syndrome is-
A.Triple nucleotide CAG Sequence mutation
B.10% Female carriers mentally retarded
C.Males have IQ 20-40
D.Gain of function mutation
Explanation and source text
Correct answer: C. Males have IQ 20-40
Ans. C. Males have IQ 20-40
Fragile X Syndrome
Fragile X syndrome is associated with a fragile site on chromosome
X (Xq 29.3)
Triple nucleotide CGG Sequence mutation
About 20% of women who are carriers for the fragile X premutation
are affected by fragile X-related primary ovarian insufficiency.
Individuals with FXS may present anywhere on a continuum from
learning disabilities in the context of a normal intelligence quotient
(IQ) to severe intellectual disability, with an average IQ of 40 in
males who have complete silencing of the FMR1 gene.
Fragile sites are regions of chromosomes that show a tendency to
separation breakage or attenuation tinder particular growth
conditions.
Inheritance
Inheritance does not follow the usual Mendelian single gene patterns
It is due to Allelic expansion.
Clinical Manifestations :
The main clinical manifestations are :
1. Mental Retardation
In fact it is the commonest cause of mental retardation in males.
2. Macroorchidism.
3. Characteristic facial appearance with :
Long face
Large prominent ears
Prominent Jaw
Q180NeurologyPDF pages 209-210
True about RETT Syndrome –
A.Macrocephaly
B.Cardiac arrhythmia
C.Seizures
D.Mental retardation e) Autistic behaviour
Explanation and source text
Correct answer: B. Cardiac arrhythmia
:C:D:E
Ans. is'b'i.e., Cardiac arrhythmia,'c'i.e., Seizures,'d'i.e., Mental
retardation &'e'i.e., Autistic behaviour
Rett's Syndrome
This is the characteristic features, that they begin to loose their
acquired skills, e.g., cognitive and head growth is normal during
early period after which there is an arrest of growth.
Acquired microcephaly
Most children develop peculiar sighing respirations with intermittent
periods of apnea that may be associated with cyanosis → Breath
holding spells.
Autistic behaviour → Impaired social interaction, language and
communication.
Generalized tonic-clonic convulsions occur in the majority.
Feeding disorder and poor weight gain
Q181Growth and DevelopmentPDF pages 210-211
True about Asperger syndrome:
A.More common in girl
B.Repetitive activity pattern
C.Subnormal intelligence is consistent feature
D.Severe language impairments is characteristic e) All
Explanation and source text
Correct answer: B. Repetitive activity pattern
Ans. b. Repetitive activity pattern
Asperger syndrome:
It is four times more likely to occur in males than in females and
usually is first diagnosed in children between the ages of 2 and 6.
The common characteristics include average or above average
intelligence"
There is no clinically significant general delay in spoken or receptive
language or cognitive development. Self' help skills, adaptive
behaviour, and curiosity about the environment during the first 3
years should be at a level consistent with normal intellectual
development
Q182General PediatricsPDF pages 211-212
Which of the following is present in a XY child but not in a XX child ?
A.Epoophoron
B.Paroophoron
C.Cowper's glands
D.Gartner's duct
Explanation and source text
Correct answer: C. Cowper's glands
Answer- C. Cowper's glands
Bulbourethral gland (Cowper's gland) are found in males (XY) and
are homologous to Bartholin's gland in females (XX).
[Ref : "Differentiation of the urogenital sinus in males". Embryology]
Extracted references
[Ref : "Differentiation of the urogenital sinus in males". Embryology]
Q183General PediatricsPDF pages 212-213
Therepeutic phlebotomy is not done in which of the following conditions ?
A.CML
B.Polycythemia vera
C.Hemochromatosis
D.Porphyria cutanea tarda
Explanation and source text
Correct answer: A. CML
Answer- A. CML
Indications for therepeutic phlebotomy-
Polycythemia vera
Hemochromatosis
Secondary polycythemia
Porphyria cutanea tarda
[Ref Current applications of therapeutic phlebotomy Tarek Bou Assi
and Elizabeth Baz. Blood Transfus. 2014 Jan; 12(Suppl 1): s75-s83]
Extracted references
[Ref Current applications of therapeutic phlebotomy Tarek Bou Assi
Q184General PediatricsPDF pages 213-214
What is the IQ of a borderline deficiency?
A.70 - 80
B.50 - 69
C.20 - 49
D.0 - 20
Explanation and source text
Correct answer: A. 70 - 80
Answer- A. 70 - 80
IQ Range IQ Classification
70 and BelowExtremely Low
71 -79 Borderline
80 -89 Low Average
90 -110 Average
111 -120 Bright
121 -130 Very Bright
131 and OverExtremely Bright
Q185Growth and DevelopmentPDF pages 214-215
Which is false about development milestones at 6 months of age?
A.Watching self in mirror
B.Sitting in tripod position
C.Pincer grasp
D.Monosyllable sounds
Explanation and source text
Correct answer: A. Watching self in mirror
Answer- A. Watching self in mirror
Milestones at 6 months of age
In prone position lifts his head and greater part of his chest while
supporting weight on extended arms.
Produces monosyllable sounds like da, ma.
Enjoys watching his own image in the mirror.
Binocular vision develops (between 3-6 months).
Purposeful movements in space (6-8 months).
Sits in tripod position.
Q186General PediatricsPDF pages 215-216
At what age child begins to use past and present tense
A.1 Years
B.2 Years
C.18 Months
D.30 Months
Explanation and source text
Correct answer: D. 30 Months
Answer- D. 30 Months
Begin to identify objects from a group by their function and parts (ie.
"which one has wheels", "which one can we eat")
Begin to use verbs with "ing" endings (i.e. "eating");
Early concepts such as "big, little" are identified;
Child will use "no, not" and answer "where" questions
Q187General PediatricsPDF pages 216-217
Reduced osmolarity ORS does not contain which of the following ion -
A.Sodium
B.Potassium
C.Lactate
D.Citrate
Explanation and source text
Correct answer: C. Lactate
Answer- C. Lactate
Table 1: Composition of standard and reduced osmolarity ORS
solutions
ORS → StandardReduced Osmolarity
Contents↓ mEq/L mEq/L
Glucose 111 75
Sodium 90 75
Choride 80 65
Potassium20 20
Citrate 10 10
Osmoarity 311 245
30 mmol/l of bicarbonate instead of 10 mmol/l of citrate
Q188NeonatologyPDF pages 217-218
Most common site for bone marrow aspiration in neonates is -
A.Anterior superior iliac crest
B.Posterior superior iliac crest
C.Sternum
D.Anteromedial tibia
Explanation and source text
Correct answer: D. Anteromedial tibia
Answer- D. Anteromedial tibia
Preferred site for bone marrow aspiration in children - Posterior
superior iliac crest.
In children < 18 month of age → Anteromedial tibia is preferred.
Q189Growth and DevelopmentPDF pages 218-219
Milestones at 1 year of age are all except
A.Playing a simple ball game
B.Using 2 words that are meaningful
C.Spontaneous scribbling
D.Walking upstairs 1 step at a time
Explanation and source text
Correct answer: D. Walking upstairs 1 step at a time
Answer- D. Walking upstairs 1 step at a time
Tries to remove his coat and attempts to wear his socks or shoes
without success.
Does mimicry.
Plays a simple ball game
Can use 2 words with meaning
Tries to build a Tower of 2 cubes
Tries to scribble spontaneously (between 12-24 months).
Q190General PediatricsPDF pages 219-220
Floor of nasal cavity in children is made of -
A.Palatine bone and vomer
B.Sphenoid and ethmoid
C.Nasal bone and maxilla
D.Palatine bone and maxilla
Explanation and source text
Correct answer: D. Palatine bone and maxilla
Answer- D. Palatine bone and maxilla
"The floor of the nasal cavities, which also form the roof of the
mouth, is made up by the bones of the hard palate: the horizontal
plate of the palatine bone posteriorly and the palatine process of the
maxilla anteriorly."
[Ref Moore, Keith L; Dailey, Arthur F. (1999). Clinically Oriented
Anatomy. Lippincott Williams er Wilkins.]
Extracted references
[Ref Moore, Keith L; Dailey, Arthur F. (1999). Clinically Oriented
Q191Growth and DevelopmentPDF pages 220-221
Stranger anxiety develops at
A.3 months
B.4 months
C.7 months
D.11 months
Explanation and source text
Correct answer: C. 7 months
Answer- C. 7 months
Milestones at month
Holds the objects with crude grasp from palm (palmar grasp)
Pivots
Shows strangers anxiety
Resists if a toy is pulled from his hand.
Babbles
Q192EndocrinologyPDF pages 221-222
Consanguinous marriages increase risk of diseases -
A.Autosomal dominant disease
B.Autosomal recessive disease
C.X linked dominant diseases
D.Environmental diseases
Explanation and source text
Correct answer: B. Autosomal recessive disease
Answer- B. Autosomal recessive disease
Increases risk of - autosomal recessive disease
No change in risk of - autosomal dominant, X linked recessive (if
neither parent affected)
Not Proven - complex late onset diseases like diabetes,
schizophrenia, cardiovascular diseases
Q193NeonatologyPDF pages 222-223
What is the average weight gain of the neonate per day
A.5-10 g
B.25-30 g
C.50-60g
D.100-150g
Explanation and source text
Correct answer: B. 25-30 g
Answer- B. 25-30 g
They gain weight at a rate of approximately 25 to 30 gm per day for
the first 3 months of life. Thereafter they gain about 400 gm of
weight every month for the remaining part of first year.
[Ref Ghai 7th/e p. 6]
Extracted references
[Ref Ghai 7th/e p. 6]
Q194Infectious DiseasesPDF pages 223-224
Japanese encephalitis vaccine in routine schedule is given in how many doses -
A.Two doses 1 month apart with a booster after 1-2 years if needed
B.Single dose vaccine
C.Three doses 1 month apart followed by a booster if needed
D.Three doses with the second dose 1 month and 3' dose 6 months after the first dose
Explanation and source text
Correct answer: A. Two doses 1 month apart with a booster after 1-2 years if needed
Answer- A. Two doses 1 month apart with a booster after 1-2
years if needed
A Vero cell-derived, inactivated and alum-adjuvanted JE vaccine
based on the SA 14-14-2 strain is used. The primary two doses are
administered 4 weeks apart. A booster dose is recommended 1-2
years after the primary immunization
Q195NeonatologyPDF pages 224-225
Newborn loses how much weight in first week?
A.5 -10%
B.1-2%
C.10-20%
D.None
Explanation and source text
Correct answer: A. 5 -10%
Answer- A. 5 -10%
The average birth weight of neonates is about 3 Kg.
During first few days after birth, the newborn loses extracellular fluid
equivalent to about 10% of the body weight.
Q196GastroenterologyPDF pages 225-226
In acute diarrhea following is used to decrease duration and severity -
A.Zn
B.Mg
C.Fe
D.Ca
Explanation and source text
Correct answer: A. Zn
Answer- A. Zn
Recent studies suggest that administration of zinc along with new
low osmolarity oral rehydration solutions / salts (ORS), can reduce
the duration and severity of diarrheal episodes for up to three
months.
[Ref Sachdev HP, Mittal NK, Yadav HS. Oral zinc supplementation
in persistent diarrhea in infants. Ann Trop Paediatr. 1990;10:63-9.]
Answer- C. 50-55%
" The cardiac silhouette occupies 50-55% of the chest width.
Cardiomegaly is present when the cardiothoracic (CT) ratio is more
than 55%."
Q198General PediatricsPDF pages 227-228
Eyelid papules and hoarse cry in a child is suggestive of -
A.Congenital syphilis
B.Croup
C.Lipoid proteinosis
D.Acrodermatitis enterohepatica
Explanation and source text
Correct answer: C. Lipoid proteinosis
Answer- C. Lipoid proteinosis
Lipoid proteinosis also known as hyalinosis cutis et mucosa or
Urbach-Weithe disease is a rare autosomal recessive disorder.
characterized clinically by a myriad signs and symptoms that include
hoarseness of the voice, beaded eyelid papules (Moniliform
blepharosis), yellowish-white mucocutaneous infiltrates, and atrophic
pock-like scars.
Q199NeonatologyPDF pages 228-229
The fetal circulation changes to normal circulation at birth with
A.Closure of patent ductus arteriosus
B.Closure of ductus venosus
C.Increased activity of right Ventricle
D.Opening of fossa Ovalis
Explanation and source text
Correct answer: A. Closure of patent ductus arteriosus
Answer- A. Closure of patent ductus arteriosus
The increase in the concentration of oxygen in the blood leads to a
decrease in prostaglandins, causing closure of the ductus arteriosus.
These closures prevent blood from bypassing pulmonary circulation,
and therefore allow the neonate's blood to become oxygenated in
the newly operational lungs.
Q200NeonatologyPDF pages 229-230
Most common cause of pneumonia in early onset sepsis a neonate is
A.Pnemococcus
B.S. Pyogens
C.E Coli
D.S. Aureus
Explanation and source text
Correct answer: C. E Coli
Answer- C. E Coli
Early onset sepsis
It is caused by organisms prevalent in the genital tract or in the labor
room and maternity operation theatre.
In the west it is mostly caused by group B streptococcus and E.coli.
In our country it is mostly due to gram negative organisms-E.coli,
ldebsiella and enterobactor sp.
Q201NeonatologyPDF pages 230-231
Test done to diagnose syphilis in newborn if mother is syphilitic -
A.Syphilis Capita M test
B.Detection of IgG
C.ZN staining
D.Fluoroescent antigen test
Explanation and source text
Correct answer: A. Syphilis Capita M test
Answer- A. Syphilis Capita M test
The tests to detect IgM are -
1. FTA-ABS (19S IgM FTA-ABS).
2. Syphilis Capita M test.
Q202General PediatricsPDF pages 231-232
Inotropic support for severely dehydrated child with dopamine is done at what rate -
A.0.1-0-5 microgram/kg/min
B.1-5 microgram/kg/min
C.1-5 mg/kg/min
D.10-15 mg/kg/min
Explanation and source text
Correct answer: B. 1-5 microgram/kg/min
Answer- B. 1-5 microgram/kg/min
In high doses, it acts on alpha-adrenergic receptors to increase
systemic vascular resistance and raise blood pressure.
1-5 mcg/kg/min IV, increased to 5-20 mcg/kg/min; not to exceed 50
mcg/kg/min.
Q203NephrologyPDF pages 232-233
Neonatal resuscitation - which of the following drugs is used ?
A.Dopamine
B.Sodium Bicarbonate
C.Noradrenaline
D.Dobutamine
Explanation and source text
Correct answer: B. Sodium Bicarbonate
Answer- B. Sodium Bicarbonate
Important drugs used for neonatal resuscitation are
Epinephrine (adrenaline),
Normal saline or ringer lactate,
Naloxone and
Soda bicarbonate.
Q204EmergencyPDF pages 233-234
Which of the following is correct about shock in child?
A.Tachycardia is a very sensitive indicator of depletion of intravascular volume
B.Mottling of extremities is seen in early shock
C.Confusion, stupor and coma are early signs
D.Respiratory rate is more sensitive than heart rate as an indicator of early shock
Explanation and source text
Correct answer: A. Tachycardia is a very sensitive indicator of depletion of intravascular volume
Answer- A. Tachycardia is a very sensitive indicator of
depletion of intravascular volume
Hypovolemic shock in children may have following stages : -
i) Early compensated
Immediately after hypovolemia, body tries to maintain the BP to
maintain adequate perfusion to vital organs through a compensatory
mechanisms.
An increase in heart rate (Tachycardia) is the earliest and most
sensitive indicator for intravascular volume reduction
ii) Late uncompensated
If shock state continues or the compensatory mechanisms are not
enough to maintain the metabolic needs of the tissue, the shock,
goes into uncompensated phase.
Q205NeurologyPDF pages 234-235
When does crying stop in cyanotic spells ?
A.Forced Expiration
B.Forced inspiration
C.Mid inspiration
D.Crying is continuous
Explanation and source text
Correct answer: A. Forced Expiration
Answer- A. Forced Expiration
Cyanotic form (cyanotic spells)
This is more common and is provoked in response to frustration and
anger precipitated by upsetting or scolding infant/child.
Cyanotic spells are due to central sympathetic overactivity.
Clinical features include generalized cyanosis, apnea, forced
expiration(crying stops) , opisthotonus, shrill cry and bradycardia.
Seizures may occur due to cerebral hypoxia, but antiepileptics are
not required.
The only treatment is support and reassurance to parents
Q206GastroenterologyPDF pages 235-236
Abdominal pain in Henoch Schonlein purpura is due to -
A.Mucosal erosions and swelling of the GI mucosa
B.Gastrointestinal hemorrhage
C.Volvulus
D.Associated pancreatic inflammation
Explanation and source text
Correct answer: A. Mucosal erosions and swelling of the GI mucosa
Answer- A. Mucosal erosions and swelling of the GI mucosa
The second most frequent symptom of Henoch-SchOnlein purpura
is abdominal pain, which occurs in up to 65 percent of cases. The
most common complaint is colicky abdominal pain, which may be
severe and associated with vomiting.
Endoscopic evaluation often shows mucosal erosions and swelling.
Q207NeurologyPDF pages 236-237
Treatment of choice for symptomatic neonatal hypoglycemia is
A.Dextrose normal saline
B.5% dextrose
C.10% dextrose
D.25% dextrose
Explanation and source text
Correct answer: C. 10% dextrose
Answer- C. 10% dextrose
Symptomatic or asymptomatic with blood glucose < 20 mg/dl
Bolus 10% dextrose 2 ml/kg is given IV. Followed by continuous
infusion of 6 mg/kg/minute. If normoglycemia is not achieved within
24 hours, glucocorticoids (prednisone or hydrocortisone) should be
administered. For intractable hypoglycemia, glucagon, epinephrine
or diazoxide can be given.
In hypoglycemic seizures, dose of 10% dextrose is 4 ml/kg
Q208Infectious DiseasesPDF pages 237-238
ALL of the following are causes of neonatal bradycardia except
A.Hypoxia
B.Hypothermia
C.Head injury
D.BCG Vaccine
Explanation and source text
Correct answer: D. BCG Vaccine
Answer- D. BCG Vaccine
Neonatal bradycardia is defined as a decrease in heart by 30 bpm
from baseline. Regarding neonatal resuscitation, bradycardia is
concerning when the heart rate is less than 100 bpm.
Q209NephrologyPDF pages 238-239
Investigation of choice for CONFIRMING Henoch Schonlein purpura is -
A.Serum IgA levels
B.CRP levels
C.Renal Biopsy
D.DTPA
Explanation and source text
Correct answer: C. Renal Biopsy
Amswer= C. Renal Biopsy
Biopsy of the kidney may be performed both to establish the
diagnosis or to assess the severity of already suspected kidney
disease.
Q210NephrologyPDF pages 239-240
Which of the following is not a cause of neonatal anaemia?
A.Subgaleal Hemorrhage
B.Abruptio placentae
C.Diamond Blackfan syndeome
D.Wilson's Disease
Explanation and source text
Correct answer: D. Wilson's Disease
Answer- D. Wilson's Disease
Internal hemorrhage such as intracranial hemorrhage, subgaleal
hemorrhage, cephalohematoma, adrenal hemorrhage, subcapsular
hematoma of liver or ruptured viscus
Obstetrical causes: placental abruption, placenta previa, trauma to
placenta or umbilical cord during delivery and rupture of anomalous
placental vessels
Twin-twin transfusion
RBC destruction
RBC production
Q211NephrologyPDF pages 240-241
Autosomal recessive Polycystic kidneys - all are true except -
A.Seen in adults
B.Defective gene is PKHD1
C.Both kidneys show innumerable cysts
D.USG shows salt and pepper appearance
Explanation and source text
Correct answer: A. Seen in adults
Amswer- A. Seen in adults
Childhood polycystic kidney disease has autosomal recessive
inheritance, therefore it is also known as autosomal recessive
polycystic kidney disease.
Defective gene is the PKHD1 (Polycystic Kidney and Hepatic
Disease1) which codes for a protein fibrocystin
Both kidneys are markedly enlarged and show innumerable cysts
radiating from medulla the cortex.
MRI of kidney shows radially arranged fusiform dilated collecting
ducts.
Prenatal USG shows a salt and pepper appearance of kidney.
Q212RespiratoryPDF pages 241-242
3 month old child with indrawing chest with respitratory rate 52/min classified as
A.SIRS
B.Respiratory distress
C.Tachypnoea
D.ARDS
Explanation and source text
Correct answer: B. Respiratory distress
Answer- B. Respiratory distress
Tachypnea (fast breathing) : Fast breathing is defined as :-
1. Less than 2 months of age -› 60 breaths per minute
2. Child aged 2 months upto 12 months - 50 breaths per minute
3. Child aged 12 months upto 5 years -> 40breathsperminute
Q213NeurologyPDF pages 242-243
45 day old infant presents with seizures. Examination reveals he is icteric, having bulging fontanelles and opisthotonic posture. Treatment is all except
A.Phototherapy
B.Exchange Transfusion
C.Phenobarbitone
D.Chlorpromazine
Explanation and source text
Correct answer: D. Chlorpromazine
Answer- D. Chlorpromazine
Chlorpromazine is not used in hyperbilirubinemia.
Treatment of hyperbilirubinemia includes
1. Pharmacological tharapy: Barbiturates (phenobarbitone),
metallloporphyrins (Tin/Sn and Zinc/Zn)
2. Phototherapy
3. Exchange tronsfusion
Q214CardiologyPDF pages 243-244
Most common site for opening of TAPVC is -
A.Supracardiac
B.Cardiac
C.Infracardiac
D.Multiple
Explanation and source text
Correct answer: A. Supracardiac
Answer- A. Supracardiac
Type I (Supra Cardiac) TAPVC Most common 45%
Type II (Cardiac level) TAPVC - 25%
Type III (Infra Cardiac) TAPVC - 25%
Type IV (Multiple level) TAPVC 4 5%
Q215General PediatricsPDF pages 244-245
Chronic lung disease in a infancy is defined as
A.Need for supplemental oxygen at 36 weeks after conception
B.Tachypnoea > 50 breaths/ min within 1 week of birth
C.Presence of bilateral infiltrates on chest Xray for 2 weeks
D.Reticulogranular pattern on chest Xray for 6 weeks
Explanation and source text
Correct answer: A. Need for supplemental oxygen at 36 weeks after conception
Answer- A. Need for supplemental oxygen at 36 weeks after
conception
Chronic lung disease of infancy was formerly called
bronchopulmonary dysplasia.
Bronchopulmonary dysplasia is usually defined as a need for
supplemental oxygen at 36 weeks after conception.
Bronchopulmonary dysplasia is usually defined as a need for
supplemental oxygen at 36 weeks after conception. BPD is usually
defined as a need for supplemental oxygen at 36 wk after
conception.
BPD is a result of lung injury in infants requiring mechanical
ventilation and supplemental oxygen.
Q216General PediatricsPDF pages 245-246
Most common antigen involved in erythroblastosis fetalis is
A.C antigen in Rh group
B.D antigen in Rh group
C.E antigen in Rh group
D.Duffy antigen
Explanation and source text
Correct answer: B. D antigen in Rh group
Answer- B. D antigen in Rh group
RBC antigens are capable of eliciting an antibody response,
significant disease is associated primarily D antigen of Rh group and
with ABO incompatibility
Q217NeonatologyPDF pages 246-247
Eryhtematous blotchy rash is seen on the abdomen, trunk and face of a 3 day old child along with yellowish papules. However the child feels well. What is the management ?
A.Steroid and antibiotic lotion
B.No treatment
C.Steroid cream
D.Urgent intravenous antibiotics
Explanation and source text
Correct answer: B. No treatment
Answer- B. No treatment
Erythema toxicum neonatorum is a benign self-limited eruption
occurring primarily in healthy newborns in the early neonatal period.
It is characterized by Erythematous papules on trunk & face. They
appear on 2nd & 3rd day and disappear spontaneously.
Q218NeonatologyPDF pages 247-248
Further investigation is essential in a newborn with which condition?
A.Erythema toxicum
B.Vaginal bleed
C.Subconjunctival hemorrhage
D.Lens opacity
Explanation and source text
Correct answer: D. Lens opacity
Answer- D. Lens opacity
The problems are
1. Milia
2. Erythema toxicum
3. Stork bites
4. Peeling of skin
5. Subconjuctival hemorrhages
6. Breast engorgment
7. Epstein pearl
8. Pre-deciduous (natal teeth)
9. Vaginalbleeding
10. Vaginalmucoiddischarge
11. Hymenaltags
12. Physiologicalphymosis
13. Mongolian spots
Q219NeonatologyPDF pages 248-249
A newborn presents with subconjunctival hemorrhage. The treatment is
A.No treatment
B.Antibiotic eye drops
C.Aspitation
D.Antibiotic and steroid drops
Explanation and source text
Correct answer: A. No treatment
Answer- A. No treatment
Subconjunctival hemorrhage in newborn is a normal phenomenom
which disappears spontaneously.
Q220NeonatologyPDF pages 249-250
What is the shape of caecum in the newborn ?
A.Ovoid
B.Trapezoid
C.Globular
D.Conical
Explanation and source text
Correct answer: D. Conical
Answer- D. Conical
The shape of the caecum in an infant is conical with the appendix
borne at the base of the cone.
Q221HematologyPDF pages 250-251
Most common complication of Meckel's Diverticulum lit children
A.Abdominal pain
B.Peptic ulcers
C.Intestinal obstruction
D.Painless Rectal bleeding
Explanation and source text
Correct answer: D. Painless Rectal bleeding
Answer- D. Painless Rectal bleeding
Most comnmon presentation of Meckel's Diverticulum in children is
painless rectal Bleeding.
[Ref Alemayehu H, Hall M, Desai AA, St Peter SD, Snyder CL.
Demographic disparities of children presenting with symptomatic
Meckel's diverticulum in children's hospitals. Pediatric Surgery
International. 2014 Jun 30. 6:649-653]
Extracted references
[Ref Alemayehu H, Hall M, Desai AA, St Peter SD, Snyder CL.
Q222General PediatricsPDF pages 251-252
Which of the following is a X linked metabolic disorder?
A.Fabry's disease
B.Sandoff s disease
C.Pompe disease
D.Gaucher disease
Explanation and source text
Correct answer: A. Fabry's disease
Answer- A. Fabry's disease
All lysosomal disorders are `autosomal recessive' except for
Hunter's syndrome and Fabry's disease, which are X-linked
recessive. Thus Hunter's syndrome and Fabry's disease affect only
male.
Q223Growth and DevelopmentPDF pages 252-253
Testes are not palpable in
A.SRY deletion
B.DAX 1 deletion
C.WNT- 4 gene mutation
D.RSPO-1 gene mutation
Explanation and source text
Correct answer: A. SRY deletion
Answer- A. SRY deletion
SRY gene is involved in development of male gonds (testes) from
primitive (bipotential gonads).
DAX-1, WNT-4 and RSPO1 genes are involved in development of
female gonads (ovary).
Q224General PediatricsPDF pages 253-254
What is the maintainance fluid requirement in a 6 kg child ?
A.240 ml/day
B.600 ml/day
C.300 ml/day
D.1200 ml/day
Explanation and source text
Correct answer: B. 600 ml/day
Answer- B. 600 ml/day
Fluid Requirements in: Infants and Children
HOLLIDAY - SEGAR METHOD
100ml/kg
First 10 kgl Na+3
(4ml/kg/hr)
1000ml + 50ml/kg for each Kg>10kg
10-20kg K+2
(40ml/hr+2ml/kg/hr(wt-10kg)
1500ml + 20ml/kg for each Kg>20kg
>20kg Cl-2
(60ml/hr + 1ml/kg/hr(wt-20 kg)
Q225General PediatricsPDF pages 254-255
Kwashiorkor- Triad includes all except -
A.Psychomotor changes
B.Hypoglycemia
C.Edema
D.Growth retardation
Explanation and source text
Correct answer: B. Hypoglycemia
Answer- B. Hypoglycemia
Classical triad of kwashiorkor is markedly retarded growth,
psychomotor (mental) changes and edema.
Q226GastroenterologyPDF pages 255-256
Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is
A.ORS solution
B.breast feeding
C.Start 10% dextrose
D.Start Ringer's lactate
Explanation and source text
Correct answer: D. Start Ringer's lactate
Answer- D. Start Ringer's lactate
This is a case of severe dehydration.
Severe Dehydration
Start IV fluids immediately
Best IV fluid solution is Ringer lactate
Normal saline can be used
Dextrose is not effective
100 ml/kg is to be given as shown below:
AGE FIRST THEN
<12 months 30 nil/kg in I hours70 ml/kg 5 hours
12 months to 5 yrs.30 minutes 21/2 hrs
Q227GastroenterologyPDF pages 256-257
1 year old child with multiple episodes of diarrhea presents with sunken dry eyes, depressed fontanelles, very slow skin pinch. The amount of fluid to be given in the first 6 hours is
A.600 ml
B.900 ml
C.1200 ml
D.1500 ml
Explanation and source text
Correct answer: B. 900 ml
Answer- B. 900 ml
The approximate weight of a 1 year old child is 9kg (ie thrice the
birth weight)
The description of dehydration given above is consistent with severe
dehydration. T
Q228NephrologyPDF pages 257-258
A 6 year old child presents with an abdominal mass, fever, bone pain and IVC thrombosis , the diagnosis could be -
A.Wilm's tumour
B.Neuroblastoma
C.Langerhans cell Histiocytosis
D.Gastric lymphoma
Explanation and source text
Correct answer: B. Neuroblastoma
Amswer- B. Neuroblastoma
Renal vein invasion is more characteristic of neuroblastoma (it is
rare in wilms tumor).
Q229General PediatricsPDF pages 258-259
What is the first line treatment of a 4 year old child presenting with intussusception ?
A.Conservative management with wait and watch policy
B.Immediate attempt to reduction using barium edema
C.Surgical correction
D.Exploratory laparotomy with resection of the affected segment
Explanation and source text
Correct answer: B. Immediate attempt to reduction using barium edema
Answer- B. Immediate attempt to reduction using barium edema
Correction of intussusception by barium enema is the initial
management of choice. If it fails, surgical correction is done.
Q230General PediatricsPDF pages 259-260
Hutchison's Triad is seen in
A.Congenital Syphilis
B.Tertiary syphilis
C.Secondary Syphilis
D.Primary syphilis
Explanation and source text
Correct answer: A. Congenital Syphilis
Answer- A. Congenital Syphilis
Hutchinson's triad is a common pattern of presentation of Congenital
syphilis.
It consists of three phenomena :
1. Interstitial keratitis,
2. Hutchinson incisor,
3. Eighth nerve deafness
Q231Growth and DevelopmentPDF pages 260-261
A 8 year old child presents with a mass in the lumbar region with abdominal pain with excruciating bone pain. Possible diagnosis is -
A.Neuroblastoma
B.Wilm's Tumour
C.Lymphoma
D.Angiomyolipoma
Explanation and source text
Correct answer: A. Neuroblastoma
Amswer- A. Neuroblastoma
This is a case of neuroblastoma that has metastatized
Metastasis is present in 60-70% at the time of diagnosis.
Commonest site of metastasis is skeletal system and neuroblastoma
is the most common childhood malignancy metastasizes to bone.
Q232General PediatricsPDF pages 261-262
Triad of normal pressure hydrocephalus includes all except -
A.Dementia
B.Gait disturbance
C.Urinary incontinence
D.Browache
Explanation and source text
Correct answer: D. Browache
Answer- D. Browache
Triad of normal pressure hydrocephalus/Adam's triad/Hakim's
triad
Dementia
Gait disturbance
Urinary incontinece (wet, wacky and wobbly)
Q233HematologyPDF pages 262-263
True about cephalhematoma is -
A.It is hemorrhage between the skull and periosteum
B.It is hemorrhage within the subcutaneous tissue around the skull
C.It is type of subdural hemorrhage
D.It is extraperiosteal bleeding in the skull
Explanation and source text
Correct answer: A. It is hemorrhage between the skull and periosteum
Amswer- A. It is hemorrhage between the skull and periosteum
Cephalhematoma is subperiosteal bleeding, i.e. between skull bone
and periosteum.
Q234General PediatricsPDF pages 263-264
Medulloblatoma arises exclusively from the cells of
A.Immature embryonal cells
B.Ependymal cells
C.Neurons
D.Spindle shaped cells
Explanation and source text
Correct answer: A. Immature embryonal cells
Answer- A. Immature embryonal cells
Medulloblastoma is the most common PNET (primitive
neuroectodermal tumor) located in posterior cranial fossa.
[Ref Hinz, Chris; Hesser, Deneen. Focusing On Brain Tumors:
Medulloblastoma. American Brain Tumor Association]
Extracted references
[Ref Hinz, Chris; Hesser, Deneen. Focusing On Brain Tumors:
Q235General PediatricsPDF pages 264-265
Which of the following is not true about encephalocoele?
A.It is a neural tube defect
B.Common in the frontal region
C.Can be associated with hydrocephalus
D.It is protrusion of neural tissue through a defect
Explanation and source text
Correct answer: A. It is a neural tube defect
Answer- A. It is a neural tube defect
Perinatal asphyxia, more appropriately known as hypoxic-ischemic
encephalopathy (HIE), is characterized by clinical and laboratory
evidence of acute or subacute brain injury due to asphyxia. The
primary causes of this condition are systemic hypoxemia and/or
reduced cerebral blood flow (CBF)
Q236General PediatricsPDF pages 265-266
Most common conotruncal anomaly
A.TGA
B.Tetralogy of fallot
C.Truncus arteriosus
D.Double oulet right ventricle
Explanation and source text
Correct answer: A. TGA
Answer- A. TGA
Conotruncal defects are abnormalities of outflow tract septation or
ectomesenchymal tissue migration abnormalities.
Most common conotructal defect is transposition of great arteries
(TGA).
Q237General PediatricsPDF pages 266-267
Meconium can passed upto → days in healthy bady -
A.1
B.3
C.5
D.7
Explanation and source text
Correct answer: B. 3
Answer- B. 3
Meconium is passed within → 24 hours of birth.
Meconium stools are passed → upto 3 days.
Transition stools are passed → zith & 5th days.
Regular milk stools are passed → After 5 days.
Q238CardiologyPDF pages 267-268
Fallot physiology includes all except
A.TOF
B.Eisenmenger complex
C.TGA
D.Tricuspid atresia
Explanation and source text
Correct answer: B. Eisenmenger complex
Answer- B. Eisenmenger complex
These includes
1. TOF
2. Single ventricle with PS
3. TGA with VSD & PS
4. Corrected TGA with VSD & PS
5. TA
6. Double outlet right ventricle with PS
Q239General PediatricsPDF pages 268-269
Pulmonary plethora is seen with - all except
A.TGA
B.Hypoplastic left heart syndrome
C.Ebstein anomalis
D.Double outlet right ventricle
Explanation and source text
Correct answer: C. Ebstein anomalis
Answer- C. Ebstein anomalis
Pulmonary oligamia
TOF
TA
Ebstein's anomaly
Pulmonary atresia
Q240Infectious DiseasesPDF pages 269-270
Child with rash- wrong is
A.Typhus - day 5
B.Varicella - day 1
C.Typhoid - day 5
D.Measles - day 4
Explanation and source text
Correct answer: C. Typhoid - day 5
Answer- C. Typhoid - day 5
Very Sick Person Must Take Double Tablets
Very Varicella (day 1)
Sick Scarlet fever (day 2)
Person Pox-small pox (day 3)
Must Measles (day 4)
Take Typhus (day 5)
Double Dengue (day 6)
Tablets Typhoid (day 7)
Q241RespiratoryPDF pages 270-271
What is recurrence of febrile seizure -
A.10-20%
B.20-30%
C.30-50%
D.50-70%
Explanation and source text
Correct answer: C. 30-50%
Answer- C. 30-50%
Recurrent febrile seizures occur in 30-50% of cases.
More than 90% of febrile seizures are generalized.
Acute respiratory illness are most commonly associated with febrile
seizures.
Q242NeonatologyPDF pages 271-272
In neonate, intra muscular injection given at -
A.Deltoid
B.Gluteal
C.Thigh
D.Abdomen
Explanation and source text
Correct answer: C. Thigh
Answer- C. Thigh
Anterolateral aspect of thigh because of lack of important blood
vessel & nerve is preferred site upto 12 month of age.
Q243General PediatricsPDF pages 272-273
Sitting in Tripod position at which month ?
A.5 months
B.6 months
C.8 months
D.9 months
Explanation and source text
Correct answer: B. 6 months
Answer- B. 6 months
6 Month → Sit with support, sits in tripod position
8 Month → Sit without support
9 Month → Stand with support
12 Month → Stand without support Walk with support
15 Month → Walk alone, creep upstair
Q244NeonatologyPDF pages 273-274
Weight of newborn quadruplets by -
A.9 months
B.12 months
C.2 year
D.3 years
Explanation and source text
Correct answer: C. 2 year
Answer- C. 2 year
Triple- 1 yr
Four times- 2 yrs
Five times- 3 yrs
Q245NeonatologyPDF pages 274-275
From 6 weeks to 12 weeks... Infant weight increases at rate of -
A.30 g/d
B.40 g/d
C.50 g/d
D.60 g/d
Explanation and source text
Correct answer: A. 30 g/d
Answer- A. 30 g/d
Average weight of New born baby is 3 kg.
Newborn loses extracellular fluid about 10% of body weight and start
gaining weight and become equal to birth weight at day 10 of life.
Subsequently, they gain weight at a rate of approximately 25 to 30
gm per day for the first 3 month of life.
Q246General PediatricsPDF pages 275-276
Arm span and height become same at what age (year) -
A.9
B.11
C.13
D.15
Explanation and source text
Correct answer: B. 11
Answer- B. 11
In under-5 children , arm span is 1 to 2 cm smaller than body length.
During 10-12 years of age , arm span = height.
In adults arm span is more in adults by 2 cm.
Abnormally large arm span is seen in patients with : (1)
Arachnodactyly (Marfan syndrome) (2) Eunuchoidism (3)
Klinefelter's Syndrome (4) Coarctation of aorta.
Q247GastroenterologyPDF pages 276-277
In protein deficiency all are seen except -
A.Flaky paint like skin
B.Glossitis
C.Nail change
D.Cherry like skin
Explanation and source text
Correct answer: D. Cherry like skin
Answer- D. Cherry like skin
redness on the skin, brittle nails, thin hair
Glossitis
Risk of infections
Fatty liver
Protein deficiency may leave its mark on the skin, hair and nails.
Q248General PediatricsPDF pages 277-278
In a child having diarrhoea with perianal moist crust. The diagnosis is -
A.Acrodermatitis enteropathica
B.Riboflavin dificiency
C.Pellagra
D.None of above
Explanation and source text
Correct answer: A. Acrodermatitis enteropathica
Answer- A' Acrodermatitis enteropathica
Acrodermatitis enteropathica is a rare autosomal recessive disorder
caused by an inability to absorb sufficient Zinc from the diet.
Associated manifestations :- Chronic diarrhoea, stomatitis, glossitis,
Paronychia, Nail dystrophy, Growth retardation, irritability, delayed
wound healing, Bacterial & candidal infection.
Q249NutritionPDF pages 278-279
Vitamin B6 is used in treatment of -
A.Homocystinuria
B.Xanthourenic aciduria
C.Cystathionuria
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Vit B6 dependent convulsion.
Vit B6 responsive anemia.
Xanthurenic acidmia
Cystathioninuria
Homocystinuria
Q250CardiologyPDF pages 279-280
Prostaglandin analogue used in PDA is -
A.Anaprastone
B.Misoprost
C.Danaprostone
D.PGE-2
Explanation and source text
Correct answer: B. Misoprost
Answer- B. Misoprost
Prostaglandin inhibitor such as indomethacin and special form of
ibuprofen are used for duct closure in preterm.
PGE-1 used to keep open duct are Alprostadil or misoprostol.
Q251CardiologyPDF pages 280-281
Drug used to keep PDA open -
A.PGE1
B.PGI2
C.PGE
D.PGH2
Explanation and source text
Correct answer: A. PGE1
Answer- A. PGE1
Prostaglandin nt 1fbe,; infusion usually efective in keeping the
ductus arteriosus open before surgical intervention to reduce
hypoxemia and acidemia before surgery in ductus dependent lesion
like.
Q252CardiologyPDF pages 281-282
WPW syndrome is associated with -
A.Ebstein anomaly
B.TOF
C.VSD
D.TAPVC
Explanation and source text
Correct answer: A. Ebstein anomaly
Answer- A. Ebstein anomaly
Wolff-Parkinson-White syndrome (WPW) is one of several disorders
of the conduction system of the heart that are commonly referred to
as pre-excitation syndromes.
People with WPW may have more than one accessory pathway
seen in individuals with Ebstein's anomaly.
Q253CardiologyPDF pages 282-283
Most common syndrome associated with A-V canal defect -
A.Down syndrome
B.Klinfilter syndrome
C.Turner syndrome
D.Marfan syndrome
Explanation and source text
Correct answer: A. Down syndrome
Answer- A. Down syndrome
It is also called as atrioventricular canal defect (AVCD) or
endocardial cushion defect.
It covers a spectrum of congenital heart malformation characterized
by contiguous atrial and ventricular septal defects with markedly
abnormal AV valve.
AVSD may be :-
1. Incomplete AVSD: It is the simplest form and nothing else but
ostrium primum type of ASD in which there is a common
atrioventricular junction but separate valvular orifices for right and
left ventricles. It is more common in Down syndrome.
2. Complete AVSD : There is a common atriventricular junction and
single common valvular orifice.
Q254NeurologyPDF pages 283-284
% of children with simple febrile seizure developing epilepsy is -
A.1-2 %
B.2-5 %
C.5-10 %
D.10-15 %
Explanation and source text
Correct answer: A. 1-2 %
Answer- A. 1-2 %
Between 2% to 7% of all children with febrile seizures develop
epilepsy if followed upto the age of 25 years. Risk depends on type
of febrile seizure :
1. Simple febrile seizures 4 2% of all children with simple febrile
seizures.
2. Complex febrile seizures - 6-8% of all children with complex febrile
seizures.
Q255NeurologyPDF pages 284-285
Common deformity in chiari H malformation is -
A.Syringomyelia
B.Meningo myelocele
C.Hydrocephalus
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Chiari malformation is divided into :
1. Type I : Produce symptoms during adolescence or adulthood is
usually not associated with hydrocephalus. The deformity consists of
displacement of cerebellar tonsils into the cervical canal.
2. Type II : It is characterized by progressive hydrocephalus with a
myelomeningocele in newborns. There is a failure of pontine flexure
during embryogenensis, which results in elongation of 4th ventricle;
kinking of brainstem and breaking of quadrigeminal plate (tectum);
along with displacement of inferior vermis, pons and medulla into
cervical canal. This causes widening of cervical canal
(syringomyelia).
3. Type III : Usually associated with occipital encephalocele and
causes abundant neurological deficit.
4. Type IV : Characterised by lack of cerebeller development and
usually not compatable with life.
Q256RespiratoryPDF pages 285-286
A child of less than one year with asthma treatment -
A.MDI with Spacer
B.MDI with Mask
C.MDI with Spacer with Mask
D.MPI with mask
Explanation and source text
Correct answer: C. MDI with Spacer with Mask
Answer- C. MDI with Spacer with Mask
MDI alone require better press and breath co-ordination so used
above 12 years of age.
MDI with spacer overcome breath co-ordination so used above 4
years of age.
MDI with spacer with mask can be used successfully in children
below 4 years of age.
Q257RespiratoryPDF pages 286-287
Treatment of bronchiolitis includes all except -
A.Macrolides
B.Humid oxygen
C.Bronchodilator
D.All of above
Explanation and source text
Correct answer: A. Macrolides
Answer- A. Macrolides
Bronchiolitis is predominantly a viral disease.
1. RSV (most common)
2. Parainfluenza virus 3, 1, 2
3. Adenovirus
4. Influenza virus
5. Mycoplasma pneumoniae
Treatment is mainly symptomatic which includes humid atmosphere,
bronchodilators (n-agonist, ipratromium, epinephrine nebulized) and
antipyretics. Though antibiotics have no role, ribavarin, when
indicated, is the antiviral agent of choice.
Q258General PediatricsPDF pages 287-288
Most common pulmonary tumor in children is -
A.Carcinoid
B.Small cell carcinoma
C.Adeno carcinoma
D.Squamous cell carcinoma
Explanation and source text
Correct answer: A. Carcinoid
Answer- A. Carcinoid
The most common tumor types are carcinoid , inflammatory
myofibroblastic tumor , and pleuropulmonary blastoma
Rare pediatric lung tumors including small cell carcinoma,
adenocarcinoma, and pulmonary capillary hemangiomatosis were
also seen.
Q259HematologyPDF pages 288-289
Most common cause of per rectal bleeding in infant is -
A.Anal fissure
B.Rectal polyp
C.Intussusception
D.Hypertension
Explanation and source text
Correct answer: A. Anal fissure
Answer- A. Anal fissure
Anal fissures are the most common cause of rectal bleeding in
infants and children.
Q260General PediatricsPDF pages 289-290
Most common anomaly of upper urogenital tract is -
A.Uretero pelvic junction stenosis
B.Ectopic uretheral opening
C.Ureterocele
D.Ectopic ureter
Explanation and source text
Correct answer: A. Uretero pelvic junction stenosis
Answer- A. Uretero pelvic junction stenosis
Most common cause of urinary tract obstruction in children -
Posterior urethral valves.
Most common cause of lower urinary tract obstruction in children ->
Posterior urethral valves.
Most common cause of upper urinary tract obstruction in children 4
PUJ obstruction.
Q261NephrologyPDF pages 290-291
Features of cystinuria are
A.Impaired proximal tubular reabsorption of cystine
B.Autosomal recessive
C.Recurrent renal stone
D.All of the above
Explanation and source text
Correct answer: D. All of the above
Answer- D. All of the above
Cystinuria
Biochemical Defect: An autosomal recessive disorder that results
in the formation of a defective amino acid transporter in the renal
tubule and intestinal epithelial cells.
Pathophysiology: The amino acid transporter is responsible for
transporting cystine, ornithine, lysine, and arginine. Defective tubular
reabsorption of these amino acids in the kidneys results in increased
cysteine in the urine, which can precipitate and cause kidney stones.
Clinical Manifestations: Cysteine kidney stones presenting with
severe, intermittent flank pain and hematuria.
Lab findings: Increased urinary excretion of cystine, ornithine,
arginine, and lysine on urine amino acid chromatography; hematuria
and cysteine crystals (hexagonal) on the cooling of acidified urine
sediment.
Imaging: Radiopaque kidney stones on CT scan. The most specific
test is the cyanide–nitroprusside test
Treatment: Low-methionine diet; increased fluid intake;
acetazolamide to alkalinize the urine. If this fails then patients are
usually started on chelating therapy with penicillamine.
Q262General PediatricsPDF pages 291-292
Second degree consanguineous marriage, baby with diarrhoea, perianal diaper area redness -
A.Lactose intolerance
B.Shigella diarrhoea
C.Salmonella
D.Fungal
Explanation and source text
Correct answer: A. Lactose intolerance
Answer- A. Lactose intolerance
In Lactose intolerance, there is deficiency of enzyme lactase.
So No natural breakdown of lactose - a carbohydrate present in milk.
This causes diarrhoea.
Stool contains reducing sugar which causes perianal excoriation.
Q263NephrologyPDF pages 292-293
On USG a mass was found in abdomen which was displacing the kidney laterally in 1 year old child -
A.Neuroblastoma
B.Nephroblastoma
C.RCC
D.All of the above
Explanation and source text
Correct answer: A. Neuroblastoma
Answer- A. Neuroblastoma
The commonest intra-abdominal tumor in first two years of life
Neuroblastoma
Q264NephrologyPDF pages 293-295
Drugs used in ALL in child are all except -
A.Methotrexate
B.Vincristine
C.Vinblastine
D.Cyclophosphamids
Explanation and source text
Correct answer: C. Vinblastine
Answer- C. Vinblastine
Treatment of ALL is divided into 4 stages. The total duration of
treatment ranges between 2 and 2% years.
1. Induction of remission
Induction therapy is used to attain remision, i.e., to eradicate the
leukemic cells from bone marrow.
Drugs used are 4 Vincristine, Prednisolone, L - Asparginase,
Anthracycline. Duration of therapy is 4-6 weeks..
2. CNS therapy
Most children with leukemia have subclinical CNS involvement at the
time of diagnosis. Moreover, CNS acts as a sanctuary site where
leukemic cells are protected from systemic chemotherapy because
of blood brain barrier. So, treatment to keep leukemia cells from
spreading to the CNS is often started with induction.
Treatment include 4 Intrathecal methotrexate plus cranial radiation.
3. Intensification
If the patient goes into remission, the next step is to intensify the
therapy for a short period.
Drugs used are 4 Methotrexate, L - Asparginase,
Epipodophyllotoxin, Cyclophosphamide, Cytarabine.
4. Maintenance therapy
After consolidation, the patient is generally put on a maintenance
therapy to maintaine the remission state and prevent relapse.
Drugs used are 4 6-mercaptopurine, Methotrexate, Prednisolone,
Vincristine. Duration of maintenace therapy is 2-2.5 years.
Q265General PediatricsPDF pages 295-296
34 week primigravida punjabi khatri comes with history of consanguineous marriage, with history of repeated blood transfusion to her sibling since 8 months of age. The first diagnostic test is -
A.HPLC
B.Blood smear
C.Bone marrow
D.Hb electrophoresis
Explanation and source text
Correct answer: B. Blood smear
Answer- B. Blood smear
Type of hemoglobin is detected by Hb electrophoresis.
In this case, Hb electrophoresis of the woman should be done. If she
comes positive for abnormal hemoglobin, she should be counselled
about termination of pregnancy.
Q266General PediatricsPDF pages 296-297
3 beta hydroxysteroid dehydrogenase deficiency causes increase production of -
A.DHEA
B.Progesterone
C.Deoxycortisol
D.Estradiol
Explanation and source text
Correct answer: A. DHEA
Answer- A. DHEA
There is elevated level of pregenolone, 17a-OH pergenelone DHEA
and decreas level of progesterone, deoxycortisol and estradiol.
Q267General PediatricsPDF pages 297-298
2-5 year old child with DM, target HbA, C is -
A.< 8 %
B.< 7 %
C.< 9 %
D.< 6 %
Explanation and source text
Correct answer: C. < 9 %
Answer- C. < 9 %
In children below 5 year of age, target HBA1C is 7.5 - 9%.
Q268General PediatricsPDF pages 298-299
Prenatal diagnosis of Down Syndrome is by -
A.Karyo typing
B.Triple test
C.Fetal ultrasonography
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Following methods are used :
1. Triple test : It includes (i) Unconjugated estrogen (estriol) :
decreased; (ii) Maternal serum alpha-feto protein (MSAFP):
decreased; and (iii) hCG : increased (Note : All these three markers
are decreased in Edward syndrome)
2. New markers : These are (i) Increased inhibin A in maternal blood;
and (ii) Decreased PAPA (pregnancy associated plasma protein).
3. USG : It shows : (i) Increased nuchal translucency (increased nuchal
fold thickness) in first trimester; (ii) Ductus venous flow reversed;
and (iii) Nasal bone hypoplasia.
4. Karyotyping : It can be done by chorionic villus sampling at 10-12
weeks or aminocentesis at 16-18 weeks.
Q269Infectious DiseasesPDF pages 299-300
5 year old child develop fever and rash on first day and rash disappear, after few days develop child develop ataxia. Most probable diagnosis is -
A.Measles
B.Fifth disease
C.Chicken pox
D.Rocky mountain spotted fever
Explanation and source text
Correct answer: A. Measles
Answer- A. Measles
Information :
1. Rash on 1st day
2. Complication like ataxia
3. Diagnosis is chicken pox.
Q270GastroenterologyPDF pages 300-301
MC symptom of AIDS in infant is -
A.GI infection
B.Persistent cough
C.Failure to thrive
D.Lymphadenopathy
Explanation and source text
Correct answer: A. GI infection
Answer- A. GI infection
Features in older children -
Growth failure
Fever
Diarrhea
Secondary infection
Q271NeonatologyPDF pages 301-302
Baby borne to patient suspected of chlamydial infection sample to be taken for diagnosis -
A.Conjunctival
B.Urethral
C.Urine sample
D.Blood
Explanation and source text
Correct answer: A. Conjunctival
Answer- A. Conjunctival
About 70% of baby born to positive chlamydal infection develop
conjuctivitis at day 5 of life so sample taken for diagnosis is
conjuctival.
Chlamydal infection is most common cause of conjuctivitis in
newborn.
Chlamydal infection causes watering dischange form eye (unlike
purulent dischange in Gonococcal).
[Ref Debbie-Metal Newborn & Infant Nursing Review (NAINR 2004)]
Answer- B. CCF
Peroxisomal disorder.
Defective enzyme - phytonoyl CoA oxidase.
Clinical feature includes
1. Impaired vision (retinitis pigmentosa).
2. Icthyosis
3. Peripheral neuropathy.
4. Ataxia
Q273NeurologyPDF pages 303-304
Young child with laughing spells. Diagnosis -
A.Hypothalamic hamartoma
B.Tetralogy of fallot
C.Nitrous oxide poisoning
D.None of the above
Explanation and source text
Correct answer: A. Hypothalamic hamartoma
Answer- A. Hypothalamic hamartoma
Laughing spills (also know as Gelastic seizure)
Gelastic seizures are epileptic events characterized by bouts of
laughter. Laughter-like vocalization is usually combined with facial
contraction in the form of a smile. Autonomic features such as
flushing, tachycardia, and altered respiration are widely recognized.
Gelastic seizures have been associated classically to hypothalamic
hamartomas.
Q274General PediatricsPDF pages 304-305
Thirteen pair of Ribs are seen in ?
A.Down syndrome
B.Holt oram
C.Turner
D.Fibrous dysplasia
Explanation and source text
Correct answer: A. Down syndrome
Answer- A. Down syndrome
7 pair Trisomy 21, cleidocranial dysplasia
11 pair Trisomy 18,21
13 pair Trisomy 21
14 pair VATER Syndrome
[Ref Abnormal number of fetal ribs in USG by Liat Gindes et.al.]
Extracted references
[Ref Abnormal number of fetal ribs in USG by Liat Gindes et.al.]
Q275Growth and DevelopmentPDF pages 305-306
What is the age of the child who draws a circle and builds tower of 7 cubes?
A.1 year
B.2 years
C.21/2 years
D.3 years
Explanation and source text
Correct answer: D. 3 years
Answer- D. 3 years
Age Milestone Age Number of
cubes of tower
12-24 Tries to scribble 12 months 2
spontaneously 3
months
2 years Draws a vertical or 15 months 4
horizontal line
3 years Draws a circle 18 months 6
4 years Draws a cross (plus 21 months 7
sign) and draws a 24 months
rectangle
5 years Draws a triangle 30 months 9
36 months 10
Q276Growth and DevelopmentPDF pages 306-307
By what age is the milestone of climbing steps with alternate feet achieved?
A.2 years
B.3 years
C.4 years
D.5 years
Explanation and source text
Correct answer: B. 3 years
Answer- B. 3 years
Walk independently- 1 year
unwell, climbing upstairs and going downstairs with one step at a
time- 2 years
Ride tricycle; climbing upstairs with alternate feet- 3 years
Hopping; going downstairs with alternate feet- 4 years
Skipping- 5 years
Q277General PediatricsPDF pages 307-308
Mature finger grip comes at what age?
A.5 months
B.7 months
C.9 months
D.1 year
Explanation and source text
Correct answer: C. 9 months
Answer- C. 9 months
6 months → Drops one object when another is offered
7 months → Transfers object & unidextrous approach
9 months → -p Pincer grasp
12 — 13 months → Casting appear, mouthing disappear
15 months → Feeds himself with cup, slight spillage
Q278General PediatricsPDF pages 308-309
Social smile is attained at what age?
A.2 months
B.5 months
C.9 months
D.1 year
Explanation and source text
Correct answer: A. 2 months
Answer- A. 2 months
Social smile develops at 2 months.
Q279Growth and DevelopmentPDF pages 309-310
Arrange the following milestones in the correct order of their attainment I. Build tower of 4 cubes II. Make simple sentences III. Drawing a circle IV. Drawing a rectangle
A.II → III → IV → I
B.I → II → III → IV
C.II → I → III → IV
D.I → II → IV → III
Explanation and source text
Correct answer: B. I → II → III → IV
Answer- B. I → II → III → IV
The age of attainment of the milestones is :-
Builds a tower of 4 cubes →18 months
Makes simple sentences → 2 years
Drawing a circle → 3 years
Drawing a rectangle → 4 years
Q280NeonatologyPDF pages 310-311
By what age can a newborn recognize mother?
A.2 months
B.3 months
C.6 months
D.7 months
Explanation and source text
Correct answer: B. 3 months
Answer- B. 3 months
Head control
Starts cooing
Recognizes mother
Can follow an object upto 180°
On pulling the child to sit, head lags partially (between 2-3 months).
After 3 months head control develops.
Q281General PediatricsPDF pages 311-312
Which of the following can be done by an 18 months old baby?
A.Making tower of 9 cubes
B.Can use 10 words with meaning
C.Ride tricycle
D.Turn pages of book one at a time
Explanation and source text
Correct answer: B. Can use 10 words with meaning
Answer- B. Can use 10 words with meaning
At 18 months, the child can use 10 words with meaning.
Q282General PediatricsPDF pages 312-313
A child of 5 years can use sentences of around how many words?
A.6 words
B.10 words
C.100 words
D.250 words
Explanation and source text
Correct answer: B. 10 words
Answer- B. 10 words
Although a child has a vocabulary of 250 words at 3 years, the child
can use sentence of 10 words at 5 years.
Q283Growth and DevelopmentPDF pages 313-314
Milestones achieved by a 10 months old child are all except -
A.Pincer grasp
B.Waving bye - bye
C.Standing without support
D.Plays a peek - a - boo game
Explanation and source text
Correct answer: C. Standing without support
Answer- C. Standing without support
Baby stands without support by 1 year of age.
Pincer grasp → 9 months
Waving bye - bye → 9 months
Plays a peek - a - boo game → 10 months
Q284General PediatricsPDF pages 314-315
What is the age of a child who can identify 4 colours and draw a triangle?
A.21/2 years
B.3 years
C.4 years
D.5 years
Explanation and source text
Correct answer: D. 5 years
Answer- D. 5 years
A child learns to draw a triangle at the age of 5 years.
Identification of four colours is attained at the age of 4 years.
Q285General PediatricsPDF pages 315-316
Weight of an infant doubles by what age?
A.6 months
B.1 year
C.2 years
D.3 years
Explanation and source text
Correct answer: C. 2 years
Answer- C. 2 years
Weight of an infant doubles by 5 months and quadruples by 2 years
of age.
Q286General PediatricsPDF pages 316-317
Growth of head circumference in 1st 3 months of life is by
A.2 cm
B.3 cm
C.5 cm
D.10 cm
Explanation and source text
Correct answer: C. 5 cm
Answer- C. 5 cm
Head circumference is measured from the occipital protuberance to
the supraorbital ridge of forehead which is the maximum occipito
frontal diameter of skull. The head circumference in utero grows by
0.5 cm in first 2 weeks, 0.75 cm in 3rd week and after that 1
cm/week till birth.
Q287Growth and DevelopmentPDF pages 317-318
Delayed eruption is failure of teeth to appear by
A.6 months
B.13 months
C.25 months
D.37 months
Explanation and source text
Correct answer: B. 13 months
Answer- B. 13 months
Delayed eruption is usually considered when there are no teeth by
approximately 13 months of age (mean + 3 SD).
Common causes of delayed eruption of teeth include :-
Idiopathic (Most common).
Hypothyroid
Hypoparathyroid
Familial
Q288NutritionPDF pages 318-319
Breast milk protects from infections as it contains all of the following except:
A.IgE
B.Lactoferrin
C.Bifidus factor
D.PABA
Explanation and source text
Correct answer: A. IgE
Answer- A. IgE
Breast milk contains several antiinfective factors
1. Antibodies -3 secretory IgA, IgM
2. Lysozyme
3. Antistaphylococcal factor
4. Specific inhibitory substances against viral infections.
5. Lactoferrin → Inhibits growth of E. coli.
6. Bile stimulated lipase → kills entamoeba histolytica and Giardia
lamblia.
7. Bifidus factor → Inhibits growth of E. coli
8. Para-amino-benzoic acid (PABA) → Provides protection against
malaria ix) Phagocytic macrophages and lymphoid cells
Q289GastroenterologyPDF pages 319-320
Which of the following is true regarding premature milk as compared to mature milk?
A.Less lactose
B.Less iron
C.Less immunoglobulins
D.Less sodium
Explanation and source text
Correct answer: A. Less lactose
Answer- A. Less lactose
Preterm milk
The milk of mother who delivers prematurely differs from the milk of
a mother who delivers at term.
Preterm milk contains : Less lactose (in comparison to term milk).
Contains more protein S, sodium, iron, immunoglobins and calories
as they are needed by the preterm baby.
Q290NutritionPDF pages 320-321
All of the following are true regarding breast milk as compared to cow's milk except
A.Contains more lactose
B.More amount of proteins
C.Less amount of fat content
D.Minerals and salts is less
Explanation and source text
Correct answer: B. More amount of proteins
Answer- B. More amount of proteins
In comparison to cow milk, human milk contains less amount of :
Proteins (1 gm/ 100 ml), salts (sodium, chloride, potassium), fat (3.4
gm/100 ml), and minerals (calcium, phosphate) & more : Lactose
(7g/100 ml or 7%).
Q291NutritionPDF pages 321-322
Which of the following is the best reference for growth monitoring in children?
A.ICMR
B.NCHS
C.Boston
D.IAP
Explanation and source text
Correct answer: B. NCHS
Answer- B. NCHS
WHO reference values (NCHS standards)
These are most commonly used and best available reference values
for international use.
These values are based on the data assembled by United States
National Centre for Health Statistics (NCHS).
Classification of PEM is based on these standards
Extracted references
WHO reference values (NCHS standards)
These are most commonly used and best available reference values
Q292General PediatricsPDF pages 322-323
Kwashiorkar is due to deficiency of
A.Calories
B.Minerals
C.Vitamins
D.Zinc
Explanation and source text
Correct answer: A. Calories
Answer- A. Calories
Marasmus and kwashiorkor are due to deficiency of proteins and
calories.
It is characterized by classical 'triad' of edema (Due to
hypoalbuminemia), markedly retarded growth and psychomotor
(mental) changes.
Q293NutritionPDF pages 323-324
Features of marasmus are all except :
A.Absence of anasarca
B.Increased appetite
C.Excessive catabolism of adipose tissue and muscle protein
D.Uncompensated phase of PEM
Explanation and source text
Correct answer: D. Uncompensated phase of PEM
Answer- D. Uncompensated phase of PEM
It is due to prolong deficiency of calories and proteins. Thus there is
exessive catabolism of adipose tissue and muscle protein.
It is characterized by gross wasting of muscle and subcutaneous
tissues resulting in emaciation and marked stunting.
Child may show voracious appetite.
Marasmus represents the compensated phase of PEM.
Q294NutritionPDF pages 324-325
All of the following are causes of pseudoparalysis except
A.Osteomyelitis
B.Scurvy
C.Septic arthritis
D.Polio
Explanation and source text
Correct answer: D. Polio
Answer- D. Polio
Causes of pseudoparalysis
1. Scurvy (vitamin C deficiency)
2. Osteomyelitis
3. Septic (arthritis)
4. Congenital syphilis
Q295Growth and DevelopmentPDF pages 325-326
Which of the following can lead to regression of developmental milestones
A.Rett's syndrome
B.Autism
C.Neuromuscular diseases
D.All of the above
Explanation and source text
Correct answer: D. All of the above
Answer- D. All of the above
The hallmark of many degenerative disorders is neurological
regression.
Loss of only language skills – autism – suspected.
Regression of both language and motor milestones → Rett's
syndrome.
Q296General PediatricsPDF pages 326-327
All of the following are features of Rett's syndrome except
A.Microcephaly
B.Regression of milestones
C.Cardia arrhythmias
D.Focal Convulsions
Explanation and source text
Correct answer: D. Focal Convulsions
Answer- D. Focal Convulsions
This is the characteristic features, that they begin to loose their
acquired skills, e.g., cognitive and head growth is normal during
early period after which there is an arrest of growth.
Acquired microcephaly (Decleration of head growth due to
significantly reduced brain weight).
Most children develop peculiar sighing respirations with intermittent
periods of apnea that may be associated with cyanosis -4 Breath
holding spells.
Q297NeurologyPDF pages 327-328
Child while playing has sudden loss of consciousness and appears pale. There is no significant medical history and the child was otherwise healthy. Which of the following is the most probable diagnosis?
A.Attention deficit hyperkinetic disorder
B.Breath holding spell
C.Autism
D.Rett's syndrome
Explanation and source text
Correct answer: B. Breath holding spell
Answer- B. Breath holding spell
Pallid form (Pallid spells)
These are initiated by painful experience, e.g falling and striking the
head.
Pallid spells are due to excessive central parasympethetic activity.
Clinical features include pallor, apnea, loss of consciousness,
hypotonia, seizures and bradycarda.
Treatment includes support and reassurance of parents. Atropine
may be used in refractory cases
Q298EndocrinologyPDF pages 328-329
Infantile body proportion in adults is seen in all except-
A.Achondroplasia
B.Hypothyroidism
C.Klinefelter's syndrome
D.Cretinism
Explanation and source text
Correct answer: C. Klinefelter's syndrome
Answer- C. Klinefelter's syndrome
Infantile type body porportion
Achondroplasia
Juvenile myxedema (hypothyroidism)
Cretinism
Q299Growth and DevelopmentPDF pages 329-330
If chronological age > skeletal age with normal growth velocity, then the final height that is expected to be achieved is
A.Normal
B.Less because of small bones
C.More than expected
D.Less because of epiphyseal closure due to accelerated growth velocity
Explanation and source text
Correct answer: A. Normal
Answer- A. Normal
If the growth velocity is normal but the chronological age is more
than the bone age, then the diagnosis is Constitutional delay in
growth.
Constitutional delay in growth
It is the most common cause of short stature in mid childhood period
but the ultimate height is normal.
Their birth weight and height are normal. Strong family history of
parents having short stature in childhood with delay in onset of
puberty is usually present.
Q300EndocrinologyPDF pages 330-331
Which of the following about hormone levels in a malnourished child is true?
A.Increased insulin levels
B.Decreased cortisol levels
C.Increased growth hormone
D.All of the above
Explanation and source text
Correct answer: C. Increased growth hormone
Answer- C. Increased growth hormone
changes in PEM
Decreased insulin levels
Increased cortisol
Increased growth hormone
Q301RespiratoryPDF pages 331-332
A 9 month old child with respiratory rate 53/min and presence of cough is classified as :
A.SIRS
B.Respiratory distress
C.Tachypnoea
D.ARDS
Explanation and source text
Correct answer: C. Tachypnoea
Answer- C. Tachypnoea
Tachypnea (fast breathing) : Fast breathing is defined as:
1. less than 2 months of age -> 60 breaths per minute
2. Child aged 2 months upto 12 months - 50 breaths per minute
3. Child aged 12 months upto 5 years - 40 breaths per minute
Q302NeonatologyPDF pages 332-333
A newborn after prolonged labour is not breathing well and after 30 seconds of receiving 100% oxygen by bag and mask, heart rate is 88 beats per min, what is the next step in management?
A.Discontinue oxygen and ventilation
B.Discontinue oxygen, continue ventilation
C.Continue oxygen and ventilation
D.Start chest compressions
Explanation and source text
Correct answer: C. Continue oxygen and ventilation
Answer- C. Continue oxygen and ventilation
After the infant has received 30 seconds of ventilation with
100% oxygen by bag and mask, evaluation of heart rate should
be done -
HR >100 → Discontinue ventilation if spontaneous respiration is
present.
HR 60 to 100 → Continue ventilation
Below 60 → Continue ventilation + chest compressions
After 30 seconds of chest compressions, the heart rate is
checked.
HR < 60 → Continue chest compression and bag & mask ventilation
+ initiate medications.
HR > 60 → Discontinue chest compression but continue bag &
mask ventilation until the heart rate is above 100.
[Ref: O.P.Ghai 7th/e p. 98]
Extracted references
[Ref: O.P.Ghai 7th/e p. 98]
Q303NeonatologyPDF pages 333-334
How are chest compressions given in a newborn?
A.Using palm on the lower third of sternum
B.Using two fingers on the middle third of sternum
C.Using the two thumbs on the lower third of sternum
D.Using three fingers on the lower third of sternum
Explanation and source text
Correct answer: C. Using the two thumbs on the lower third of sternum
Answer- C. Using the two thumbs on the lower third of sternum
Two - finger technique
The tips of the middle finger and either the index finger or ring finger
of one hand are used to compress the sternum.
The other hand is used to support the infant's back, unless the infant
is on a very firm surface.
Q304General PediatricsPDF pages 334-335
Asymmetric tonic neck reflex disappears at what age?
A.2 months
B.3 months
C.6 months
D.8 months
Explanation and source text
Correct answer: C. 6 months
Answer- C. 6 months
Assymmetic tonic neck- wks of gestation 4-6 → 6-7 months
Q305General PediatricsPDF pages 335-336
True about tonic neck reflex is
A.Extension of arm on ipsilateral side, flexion on contralateral side
B.Extension of arm on contralateral side, flexion on ipsilateral side
C.Extension of arms on both sides
D.Flexion of arms on both sides
Explanation and source text
Correct answer: A. Extension of arm on ipsilateral side, flexion on contralateral side
Answer- A. Extension of arm on ipsilateral side, flexion on
contralateral side
The tonic neck reflex is produced by manually rotating the infant's
head to 1 side and observing for the characteristic fencing posture
(extension of the arm on the side to which the face is rotated and
flexion of the contralateral arm).
An obligatory tonic neck response, in which the infant becomes
"stuck" in the fencing posture, is always abnormal and implies a
CNS disorder.
Q306General PediatricsPDF pages 336-337
Closure of patent ductus arteriosus is stimulated by?
A.Prostaglandin F2a
B.Cycloxygenase
C.Increase in 02 tension at birth
D.Hypercarbia
Explanation and source text
Correct answer: C. Increase in 02 tension at birth
Answer- C. Increase in 02 tension at birth
The mechanism producing the initial constriction of ductus arteriosus
is not completely understood, but the increase in arterial 02 tension
plays an important role.
One more factor which helps in closure of the ductus arteriosus is
the decrease in concentration of prostaglandins at the time of birth.
Q307NeonatologyPDF pages 337-338
False about PDA is
A.More common in females
B.Anatomical closure takes 21 hours after birth
C.PGE maintains patency of ductus
D.Dilatation of ascending aorta
Explanation and source text
Correct answer: B. Anatomical closure takes 21 hours after birth
Answer- B. Anatomical closure takes 21 hours after birth
Patent ductus arteriosus is a communication between the pulmonary
artery and aorta.
'Functional closure' takes place within 15 hours of birth. 'Anatomic
closure' of ductus arteriosus occurs 10-21 days after birth.
Prostaglandins maintain the patency of ductus.
The persistence of function of ductus arteriosus beyond 24 hours
after birth is considered as PDA in term neonate, i.e. if functional
closure does not take place in 24 hours after birth, it is considered
as PDA.
Q308CardiologyPDF pages 338-339
Which of the following is not seen in patent ductus arteriosus?
A.Left atrial hypertrophy
B.Left ventricular enlargement
C.Continuous murmur
D.Attenuated SI
Explanation and source text
Correct answer: D. Attenuated SI
Answer- D. Attenuated SI
Increased flow after passing through lung reaches the left atrium and
causes volume overload → Left atrial dilatation and hypertrophy.
Increased blood volume passes from left atrium to left ventricle
through mitral valve, i.e., increased flow through mitral
valve → Accentuation of S1 and delayed diastolic murmur.
Left ventricle receives larger amount of blood that results in volume
overload → Left ventricle enlargement.
Q309CardiologyPDF pages 339-340
Which of the following congenital anomalies leads to heart failure at birth?
A.Total anomalous pulmonary venous connection
B.Transposition of great arteries
C.Pulmonary atresia
D.Coarctation of aorta
Explanation and source text
Correct answer: C. Pulmonary atresia
Answer- C. Pulmonary atresia
Timing of CHF in congenital heart diseases- Pulmonary, mitral and
aortic atresias
Hypoplastic left and right heart syndromes, transposition and
malposition of great ate ries.
Q310CardiologyPDF pages 340-341
Most important prognostic marker of tetralogy of fallot
A.VSD
B.Pulmonary stenosis
C.Overriding of aorta
D.Right ventricular hypertrophy
Explanation and source text
Correct answer: B. Pulmonary stenosis
Answer- B. Pulmonary stenosis
Tetrology of fallot has 4 components:
1. Obstruction to right ventricular outflow (pulmonary stenosis),
2. A mal-alignment type of ventricular septa] defect (VSD),
3. Dextro position of the aorta so that it overrides the ventricular
septum, and
4. Right ventricular hypertrophy
[Ref Nelson 20th le p. 2211]
Extracted references
[Ref Nelson 20th le p. 2211]
Q311EndocrinologyPDF pages 341-342
Microcephaly is common in children of mothers with all except
Answer- C. 50 ml
Day 1 5 - 7 ml. Size of cherry
Day 3 22 - 27 ml. Size of walnut
One week 45 - 60 ml. Size of an apricot
One month 80 - 150 ml. Size of a large egg
Q313NeonatologyPDF pages 343-344
Colour of stools in breastfed new born is -
A.Red
B.Green
C.Black
D.Golden
Explanation and source text
Correct answer: D. Golden
Answer- D. Golden
Colour of stools in neonate
Meconium (first stool) is passed within 24 hours. After that
meconium stools (black tarry) can be passed upto 3 days.
On 4th-5th days transitional stools (greenish) are passed. After 5
days regular milk stools (golden yellow) are passed.
There is golden discoloration of stool.
Q314General PediatricsPDF pages 344-345
Trigonocephaly is due to premature closure of which suture?
A.Sagittal suture
B.Metopic suture
C.Lambdoid suture
D.Coronal suture
Explanation and source text
Correct answer: B. Metopic suture
Answer- B. Metopic suture
Trigonocephal- Metopic suture
Keel shaped forehead
Hypotelorism
Abnormalities of forebrain
Q315NephrologyPDF pages 345-346
Which of the following is not a feature of Minimal change disease?
A.Hypertension
B.Edema
C.Proteinuria
D.Responsive to steroid therapy
Explanation and source text
Correct answer: A. Hypertension
Answer- A. Hypertension
Minimal Change Disease is the most common cause of Nephrotic
syndrome in children.
Edema and Selective proteinuria are features of nephrotic
syndrome. Fever may be present on account of increased
susceptibility to infection.
Minimal change disease prsents with insidious onset of nephrotic
syndrome in children below 6 years of age.
Hypertension is not a feature of nephrotic syndrome and is rare in
Minimal change disease.
Hematuria (a finding of nephritic syndrome) is also rare.
Q316General PediatricsPDF pages 346-347
What is the rate of CSF formation in children?
A.0.3 ml/min
B.1 ml/min
C.3 ml/min
D.20 ml/min
Explanation and source text
Correct answer: A. 0.3 ml/min
Answer- A. 0.3 ml/min
The rate of CSF formation in children and adults is :-
0.3 to 0.4 ml/min OR
18 to 20 ml/hour
Q317General PediatricsPDF pages 347-348
Most common cause of cranial irradiation in children is
A.Small cell lung Ca
B.ALL
C.AML
D.Craniopharyngioma
Explanation and source text
Correct answer: B. ALL
Answer- B. ALL
ALL and small cell lung Ca are two major indications for cranial
irradiation, even prophylactically to prevent brain metastasis.
In children, ALL is the most common cause.
Q318HematologyPDF pages 348-349
Which of the following is not a feature of physiological anaemia of infancy?
A.Term infant hemoglobin 7 gm%
B.Preterm infant hemoglobin 7 gm%
C.Term infant hemoglobin 9 gm%
D.Preterm infant hemoglobin 9 gm%
Explanation and source text
Correct answer: A. Term infant hemoglobin 7 gm%
Answer- A. Term infant hemoglobin 7 gm%
Physiologic Anemia of Infancy
1. Hemoglobin drops to low point at age 6 to 8 weeks
2. Erythropoietin nadir drops Hemoglobin
3. Term Infants: Hemoglobin drops to 9-11 g/dl
4. Preterm Infants: Hemoglobin drops to 7-9 g/dl
[Ref Anemia in infancy, pediatric in review American academy of
pediatrics 2012]
Extracted references
[Ref Anemia in infancy, pediatric in review American academy of
Q319HematologyPDF pages 349-350
Mean hemoglobin in a 1 year old child is
A.18.5 g/dl
B.16.5 g/d1
C.14 g/c11
D.12 g/dl
Explanation and source text
Correct answer: D. 12 g/dl
Answer- D. 12 g/dl
Hb level
Prevalence (%)
(g/L)
Age Mild anemia Moderate to Severe
N MeamSE
(mo) (Hb<110 g/L) anemia (Hb<80 g/L)
0-5 56 9.8 0.2178.1 5.2
6-11 88 10.08 0.1775.3 5.8
12-23 12810.04 0.2163.3 11.9
24-60 25110.18 0.1368.3 8.1
Totel 52310.09 0.0969.3 8.3
Hb, hemoglobin
a. Means and frequencies are weighted.
Q320NephrologyPDF pages 350-351
Amino acid metabolism is implicated in which disease?
A.Maple syrup urine disease
B.Reye's syndrome
C.Von Gierke's disease
D.McArdle's disease
Explanation and source text
Correct answer: A. Maple syrup urine disease
Answer- A. Maple syrup urine disease
It is due to deficiency of enzyme that catalyzes the second reaction
in these amino acids metabolism i.e. branched chain-a keto acid
dehydrogenase which catalyses decarboxylation of branched chain
amino acids.
Q321NeonatologyPDF pages 351-352
A 3 months old child was started on supplemental foods alongwith breastmilk. The child was fed with fruit pulp and sweetened cereals. Soon the child developed bloating of abdomen, vomiting, lethargy, irritability. On investigation, there was hyperbilirunemia and elevated transaminase levels. The child is suffering from which of the following enzyme deficiencies?
A.Fructokinase
B.Aldolase B
C.Gal actokinase
D.Galactose - 1 - phosphate uridyl transferase
Explanation and source text
Correct answer: B. Aldolase B
Answer- B. Aldolase B
Symptoms occur when foods or formulas containing these sugars
are introduced into the diet.
Clinical manifestations resemble galactosemia and include jaundice,
hepatomegaly, vomiting, lethargy, irritability, and convulsions.
Laboratory findings include a prolonged clotting time, hypo-
albuminemia, elevation of bilirubin and transaminase levels, and
proximal tubular dysfunction.
Q322NeonatologyPDF pages 352-353
All are true about sacrococcygeal teratoma except
A.Not associated with increased serum markers
B.In most cases is not visible externally
C.If associated with hydrops, should be resected antenatally
D.Most common tumor of fetus
Explanation and source text
Correct answer: B. In most cases is not visible externally
Answer- B. In most cases is not visible externally
Ureters may be partially obstructed resulting in hydro-ureter and
hydronephrosis.
Sacrococcygeal Teratoma (SCT) is the most common neoplasm in
the fetus and newborn
Most common tumor in fetus and neonate sacrococcygeal teratoma
Most common tumor in infancy neuroblastoma.
They are not associated with elevated markers unless malignancy is
present.
Sacrococcygeal teratoma with hydrops :- Treatment - Inutero
resection or catheter directed vessel obliteration
Q323RespiratoryPDF pages 353-354
Most common sign of LRTI [Lower respiratory tract infection] in children is
A.Chest indrawing
B.Tachypnea
C.Nasal flaring
D.Failure to feed well
Explanation and source text
Correct answer: B. Tachypnea
Answer- B. Tachypnea
Tachypnea is the most consistent manifestation of pneumonia.
Pneumonia is an inflammation of the parenchyma of lungs, and
mostly caused by bacterial or viral infection.
Most common cause of paediatric pneumonia is respiratory syncytial
virus (RSV). Other viruses causing pneumonia are influenza virus
(2"° most common virus), adenovirus, rhinovirus, and parainfluenza
virus.
Q324NephrologyPDF pages 354-355
Which of the following is not a sign of severe dehydration?
A.Tachycardia
B.Anuria
C.Increased thirst
D.Delayed capillary refill [>3 sec]
Explanation and source text
Correct answer: C. Increased thirst
Answer- C. Increased thirst
Peripheral pulses either rapid and
weak or absent
Decreased blood pressure
No urine output
Very sunken eyes and fontanel
No tears
Parched mucous membrane
Delayed elasticity (poor skin turgor)
Very delayed capillary refill (> 3 sec)
Cold and mottled
Limp
Depressed consciousness
Q325NephrologyPDF pages 355-356
What is the grade of dehydration if a child demonstrates excessive thirst and decreased urine output?
A.No dehydration
B.Mild dehydration
C.Moderate dehydration
D.Severe dehydration
Explanation and source text
Correct answer: B. Mild dehydration
Answer- B. Mild dehydration
Normal or increased pulse
Decreased urine output
Thirsty
Normal physical findings
Q326Infectious DiseasesPDF pages 356-357
Which of the following cannot be used to detect HIV status in early infancy?
A.DNA - PCR
B.HIV culture
C.ELISA
D.P - 24 antigen assay
Explanation and source text
Correct answer: C. ELISA
Answer- C. ELISA
ELISA or Western blot test are not as reliable in young infants.
In older infants (> 6 months), detection of anti-HIV IgA antibodies by
ELISA is diagnostic.
In children (> 18 months) demonstration of anti-HIV IgG antibodies
by ELISA is used.
Q327CardiologyPDF pages 357-358
Teratology is a study of
A.Congenital heart defect
B.Congenital abnormalities
C.Wounds and injuries
D.None of the above
Explanation and source text
Correct answer: B. Congenital abnormalities
Answer- B. Congenital abnormalities
Study of Congenital heart defects is a part of the broad spectrum of
congenital abnormalities, the study of which is known as Teratology
Q328EndocrinologyPDF pages 358-359
Russell silver syndrome is associated with which of the following?
A.Autosomal inheritance
B.X - linked inheritance
C.Sporadic gene mutation
D.Uniparental disomy
Explanation and source text
Correct answer: D. Uniparental disomy
Answer- D. Uniparental disomy
Angelman syndrome
Prader Willi syndrome
Pseudohypoparathyroidism Ib
Transient neonatal diabetes mellitus
Beckwith - Wiedemann syndrome
Russell silver syndrome
Wang syndrome
Temple syndrome
Q329EndocrinologyPDF pages 359-360
Which of the following is not a feature of Down's syndrome?
A.Hypotonia
B.Infections
C.Female infertility
D.Early onset Alzheimer's disease
Explanation and source text
Correct answer: C. Female infertility
Answer- C. Female infertility
GIT :- Anal atresia, Duodenal atresia, Hirschsprung disease, annular
pancreas.
Increased incidence of leukemia (1%). Leukemias common are ALL
(most common), AML (M7-AML) transient myeloproliferative
disorders, and Juvenil CML.
Others : Early onset of Alzheimer's disease, Decreased immunity
with recurrent infections, obesity, DM, Hypothyroidism (most
common endocrine abnormality).
Q330NutritionPDF pages 360-361
Which of the following is not a feature of Turner's syndrome?
A.Cubitus valgus
B.Cryptorchidism
C.Short fourth metacarpal
D.Shield chest
Explanation and source text
Correct answer: B. Cryptorchidism
Answer- B. Cryptorchidism
Clinical features in adolescents are short stature, webbed neck, low
posterior hair line, widely spaced nipples with broad chest (shield
chest), hypertelorism, epicanthus, slanted palpebral fissure, ptosis,
micrognathia, cubitus valgus (increared carrying angle),
sensorineural hearing loss, short fourth metacarpal, hypothyroidism,
streak ovaries, and sexual infantilism. Turner syndrome is the most
important cause of primary amenorrhea.
Q331General PediatricsPDF pages 361-362
Which of the following is true regarding Turner's syndrome?
A.Cubitus valgus
B.Autosomal dominant
C.Monosomy of chromosome 12
D.Sensorineural hearing loss
Explanation and source text
Correct answer: A. Cubitus valgus
Answer- A. Cubitus valgus
Turner syndrome is a monosomy of sex chromosome (not
autosomal dominant). Cubitus valgus is a feature of Turner
syndrome. SNHL is not a feature.
Q332EmergencyPDF pages 362-363
Most common cause of shock in child
A.Septic shock
B.Hypovolemic shock
C.Cardiogenic shock
D.Anaphylactic shock
Explanation and source text
Correct answer: B. Hypovolemic shock
Answer- B. Hypovolemic shock
Hypovolemia is the most common cause of shock in children.
The 2nd most common cause - Septic or distributive shock .
3rd most common - Cardiogenic shock
Q333General PediatricsPDF pages 363-364
Which is the prognostic scoring system for head injury in children?
A.CCS
B.AUDIT
C.Injury severity score
D.Pediatric Trauma Score
Explanation and source text
Correct answer: A. CCS
Answer- A. CCS
Table 1: Children Coma Score (CC S) < 2 years"
Ocular Response
4 Pursuit
3 Extra ocular muscles intact reactive pupils
2 Fixed pupils and EOM impaired
1 Fixed pupils and EOM paralyzed
Verbal response
3 Cries
2 Spontaneous respiration
1 Apneic
Motor responses
4 Flexes and extends
3 Withdraws from painful stimuli
2 Hypertonic
1 Flaccid
Total Max. Score 11
Total Min Score
Q334General PediatricsPDF pages 364-365
Which of the following is a criteria for clinical Stage II of AIDS in children?
Answer- B. Posterior fontanelle
Posterior fontanelle
Posterior fontanelle generally closes by 2-4 months after birth.
Posterior fontanelle usually closes by the age of 1-4 months. But
sometime it may be ossified (closes) at birth. Thus, it is the best
answer among the given choices.
Q336Growth and DevelopmentPDF pages 366-367
Harlequin skin change is seen due to mutation of which gene?
A.ABCA 12
B.FAD
C.Keratin 1
D.ALOXE 3
Explanation and source text
Correct answer: A. ABCA 12
Answer- A. ABCA 12
Harlequin ichthyosis (HI) is caused by mutations in the ABCAl2
gene.
Mutation in the gene leads to defective lipid transport and ABCAl2
activity is required for the generation of long-chain ceramides that
are essential for the development of the normal skin barrier. It is
inherited by autosomal recessive mode of inheritance.
Q337General PediatricsPDF pages 367-368
Ritter disease is a disease caused by -
A.Infection
B.Autoimmune
C.Genetic
D.Metabolic disorder
Explanation and source text
Correct answer: A. Infection
Answer- A. Infection
Staphylococcal scalded skin syndrome is caused predominantly by
phage group 2 staphylococci, particularly strains 71 and 55, which
are present at localized sites of infection.
Q338General PediatricsPDF pages 368-369
Pink color in the IMNCI chart is suggestive of
A.Normal zone of weight for age
B.Undernutrition (Upto - 2SD)
C.Severely underweight zone (Upto - 3SD)
D.Very severely undernourished (Upto - 5SD)
Explanation and source text
Correct answer: C. Severely underweight zone (Upto - 3SD)
Answer- C. Severely underweight zone (Upto - 3SD)
Green - Normal zone of weight for age
Yellow - Undernutrition (upto - 2SD)
Pink - Severely underweight zone (upto - 3 SD)
Q339Growth and DevelopmentPDF pages 369-370
5DHT is necessary for development of which of the following?
A.External genitalia
B.Internal genitalia
C.Mullerian structures
D.Wollfian structures
Explanation and source text
Correct answer: A. External genitalia
Answer- A. External genitalia
Virilization of the wolffian duct is caused by the action of
testosterone itself.
Masculinization of the urogenital sinus and external genitals
depends on the action of DHT (Dehydrotestosterone) during the
critical period of fetal masculinization.
Q340General PediatricsPDF pages 370-371
Prevalence of omphalocele at birth is
A.1 in 100 live births
B.1 in 2000 live births
C.1 in 4000 live births
D.1 in 10,000 live births
Explanation and source text
Correct answer: C. 1 in 4000 live births
Answer- C. 1 in 4000 live births
Incidence of omphalocele at 11 - 14 weeks gestation - 1 in 1100
pregnancies.
Prevalence at birth - 1 in 4000 - 6000 live births.
This indicates sudden mortality most likely due to in utero fetal
demise from associated chromosomal anomalies as well as elective
termination after the diagnosis
Q341General PediatricsPDF pages 371-372
Pectus excavatum is
A.Protrusion of sternum
B.Sternal depression
C.Sternal cleft
D.Lateral displacement of sternum
Explanation and source text
Correct answer: B. Sternal depression
Answer- B. Sternal depression
Pectus excavatum (funnel chest) is midline narrowing of thoracic
cavity due to sternal depression.
May occur in isolation or may be associated with a connective tissue
disorder, Marfan or Ehlers-Danlos syndrome. Secondary to chronic
lung disease, neuromuscular disease, or trauma.
Q342Growth and DevelopmentPDF pages 372-373
A child aged 7 years has how many teeth
A.15
B.20
C.26
D.32
Explanation and source text
Correct answer: C. 26
Answer- C. 26
Permanent teeth that appear :
1st molars :- 4
Central incisors :- 2
Temporary teeth :- 20 (since molars are superadded permanent
teeth and central incisors are replaced).
So in all 26 teeth ( Range 24 to 26) - at 7 years of age.
Q343General PediatricsPDF pages 373-374
Child starts monosyllables speech in which age
A.4 months
B.6 months
C.8 months
D.10 months
Explanation and source text
Correct answer: B. 6 months
Answer- B. 6 months
3 months- Starts cooing
6 months- Produces monosyllable sounds like da, ma
9 months- Produces bisyllable sound like baba, mania
Q344General PediatricsPDF pages 374-375
Nocturnal enuresis best t/t is
A.Positive reinforcement
B.Punishment
C.Bed alarm
D.Desmopressin
Explanation and source text
Correct answer: A. Positive reinforcement
Answer- A. Positive reinforcement
Consistent dry bed training with positive reinforcement has a
success rate of 85% and bed and pad alarm systems have a
success rate of approximately 75% with relapse rate that are lower
than those with pharmacotherapy.
Q345NeonatologyPDF pages 375-376
Neonatal lupus -
A.Heart block
B.Thrombocytopenia
C.Cutaneous lesion
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Neonatal lupus
Age of onset newborn to 6 month
Skin lesion include :
Annular erythematous scaly plaque.
Seen on sun exposed = head, neck
May be associated with heart block/thrombocytopenia
Diagnosed by:
ANA
Anti RO antibodies
Q346Growth and DevelopmentPDF pages 376-377
In Precocious puberty age limit of girls is-
A.8 year
B.10 year
C.9 year
D.11 year
Explanation and source text
Correct answer: A. 8 year
Answer- A. 8 year
Precocious puberty in a girl is the appearance of any of the
secondary sexual characteristics before the age of 8 years or the
occurrence of menarche before the age of 10 years.
Precocious puberty in boys is the onset of secondary sexual
characteristics before the age of nine years.
Q347General PediatricsPDF pages 377-378
Malnourished child minimum weight gain
A.5 gm/kg/day
B.10 gm/kg/day
C.15 gm/kg/day
D.20 gm/kg/day
Explanation and source text
Correct answer: A. 5 gm/kg/day
Answer- A. 5 gm/kg/day
In malnourish child if there
> 10 gm/kg/day = good weight gain
5-10 gm/kg/day = moderate weight gain
< 5 gm/kg/day = poor weight gain
Q348General PediatricsPDF pages 378-379
CPR with 2 candidate is done at rate of (in infant) -
A.15 : 2
B.30 : 2
C.1 : 3
D.1 : 5
Explanation and source text
Correct answer: A. 15 : 2
Answer- A. 15 : 2
In infant children with two resuscitator = 15 : 2
In adult with two resuscitator - 30 : 2
In single resuscitator chest compresion ventilation ratio in all age
group i.e. Infant, children & adult = 30 :
Q349NeonatologyPDF pages 379-380
Preterm baby have
A.Continue extramedullary hematopoesis
B.Greater risk of hypothermia
C.Greater risk of hypoglycemia
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Preterm baby (< 37 week of gestation). Have high risk for
RDS (HMD)
Broncho pulmonary dysplasia (BPD)
PDA
Anemia (early & late)
IVH
Sepsis
NEC
Jaundice
Hypoglycemia, hypokalemia, hypothermia
IVH
ROP (Retinopathy of prematurity).
Q350NutritionPDF pages 380-381
Pica refers to -
A.Ice sucking
B.Thumb sucking
C.Foreign object being put in the mouth
D.None of above
Explanation and source text
Correct answer: C. Foreign object being put in the mouth
Answer- C. Foreign object being put in the mouth
Pica involves repeated or chronic ingestion of non-nutritive
substances, which include plaster, charcoal, clay, wool, ashes, paint
& earth.
Q351General PediatricsPDF pages 381-382
Low glucose level in premature
A.Increased brain to body ratio
B.Decreased glycogen stores
C.Decreased action of pyruvate carboxylase
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Hypoglycemia is common in pretem & IUGR babies b/c all three
reason
1. Increased brain to body ratio.
2. Decrease action of pyruvate carboxylase.
3. Decrease glycogen store.
Q352General PediatricsPDF pages 382-383
Temperature of NICU is
A.20-22° C
B.22-26° C
C.26-30° C
D.30-35°C
Explanation and source text
Correct answer: B. 22-26° C
Answer- B. 22-26° C
Standards for NICU thermal invornment
Specify 72-76° F (22-26° C) as acceptable range for air temperature.
Q353RespiratoryPDF pages 383-384
GBS in a child treatment -
A.IV Ig
B.Ventilation
C.Plasmapharesis
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Treatment of Guillain-barre syndrome -
Self limited in majority of cases.
Intravenous immunoglobin shows good response.
Plasma pharesis - Removal of autoantibodies.
Assisted ventilation - If patient had respiratory muscle paralysis.
Physiotherapy.
Q354NeonatologyPDF pages 384-385
Anemia of prematurity - True is
A.Marginal reticulocytosis
B.<10 gm criteria (Hb level)
C.10 ml/kg packed cell
D.Microcytic hypo chromic type
Explanation and source text
Correct answer: B. <10 gm criteria (Hb level)
Answer- B. <10 gm criteria (Hb level)
Normocytic, normochromic, hyporegenerative anemia with EPO
level.
AOP usually resolve spontaneously within 3-6 months.
Aetiology
1. RBC production ( Reti. count)
2. RBC life span
3. Blood loss
Low hemoglobin (below 10 gm%)
Reticulocyte count is low.
Treatment :
Require blood transfusion if needed.
Observe if neonate is asymptomatic.
Answer- B. 5-10 ml/min
A) Exchange transfusion
For term infant = 80-160 ml/kg
For pre term = 100-200 ml/kg
B) Top-up transfusion
Desired Hb (glds) - actual hb x kg x 3 (usually 10-20 ml/kg).
Rate of transfusion 5-10 ml/min.
Q357Infectious DiseasesPDF pages 387-388
TB in children, most common is -
A.Abscess
B.Consolidation
C.Hilar adenopathy
D.CNS tuberculosis
Explanation and source text
Correct answer: C. Hilar adenopathy
Answer- C. Hilar adenopathy
"Most common form of primary TB in children is pulmonary TB. This
could be in the form of hilar lymphadenopathy with or without lung
parenchymal involvement".
Q358CardiologyPDF pages 388-389
In children, CHF (congestion heart failure) is diagnosed by
A.Raised JVP
B.Pedal edema
C.Tender hepatomegaly
D.Basal crepts
Explanation and source text
Correct answer: C. Tender hepatomegaly
Answer- C. Tender hepatomegaly
Heart failure in infants & children results some degree of
hepatemegaly which is usually tender & sometimes splenomegaly.
Peripheral edema is age dependent :
In infants, edema usually eye & over flank.
Older childern & adolescent shows both periorbital edema & pedal
edema and occurs late.
Answer- C. Atopic dermatitis
Simian crease
Single transverse palmer crease
Resembles non-human-simian so known as simian crease.
It is seen in :
1. Down syndrome
2. Fetal alcohol syndrome
3. Cri-du chat syndrome (Chr. 5)
4. Klinefelter (XXY)
5. Noonan (Chr. 12)
6. Patau (Chr. 13)
7. Edward (Chr. 18)
Q361NeurologyPDF pages 391-392
Treatment of simple febrile convulsion is based on
A.Control of fever
B.Rectal diazepam
C.CSF finding
D.Blood reports
Explanation and source text
Correct answer: A. Control of fever
Answer- A. Control of fever
Prompt reduction of temperature by hydrotherapy (sponging) and
antipyretics (paracetamole, ibuprofen) is the most important
measure. If seizures lasts for more than 5 minutes, diazepam (rectal
or IV) is the anticonvulsant of choice. Phenobarbitone is an
alternative
Q362General PediatricsPDF pages 392-393
Rehydration therapy in a 2 year old severely dehydrated child is -
A.30 ml/kg in 1 hour, 70 ml in 5 hours
B.30 ml/kg in 30 min, 70 ml/kg in 2'/2 hours
C.20 ml/kg in 30 min, 80 ml/kg in 2'/2
D.75 ml/kg in 4 hours
Explanation and source text
Correct answer: B. 30 ml/kg in 30 min, 70 ml/kg in 2'/2 hours
Answer- B. 30 ml/kg in 30 min, 70 ml/kg in 2'/2 hours
12 Month - 5 year 30 ml/Kg in 30 min 70 ml/Kg in 2.30 hour
Q363NeurologyPDF pages 393-394
What is correct about febrile seizures
A.Normal EEG
B.Focal deficits
C.Repeated seizure
D.Abnormal EEG
Explanation and source text
Correct answer: A. Normal EEG
Answer- A. Normal EEG
Spontaneous remmission occurs with no postictal neurological
deficit and EEG changes few days after the seizure is normal.
Recurrent febrile seizures occur in 30-50% of cases.
More than 90% of febrile seizures are generalized.
Acute respiratory illness are most commonly associated with febrile
seizures.
Q364NeonatologyPDF pages 394-395
Cause of neonatal hyperbilirubinemia ?
A.Inefficient erythropoiesis
B.RBC hemolysis
C.Immature liver enzyme
D.All of above
Explanation and source text
Correct answer: D. All of above
Answer- D. All of above
Impaired bile flow → Obstructive jaundice, primary biliary cirrhosis,
Neonatal cholestasis, e.g. Extrahepatic biliary atresia/neonate
idiopathic hepatitis, Choledocal cyst, Sclerosing cholangitis, Caroli
disease, Metabolic (Tyrosinemia, Wolman disease, Nieman pick
disease, Galactosemia, Fructosemia).
Q365EmergencyPDF pages 395-396
Dosage of intravenous fluid for 2 month old child in diarrhoea with severe dehydration -
A.100 ml/Kg in 6 hour
B.50 ml/Kg in 6 hour
C.75 ml/Kg in 6 hour
D.80 ml/Kg in 6 hour
Explanation and source text
Correct answer: A. 100 ml/Kg in 6 hour
Answer- A. 100 ml/Kg in 6 hour
So total fluid to be given 100 ml/Kg in 6 hour.
Q366CardiologyPDF pages 396-397
In Diapragmatic Hernia. Most common anomaly is seen in
A.Cardiovascular anomalies
B.Urinary tract
C.Craniofacial anomaly
D.Skull anomaly
Explanation and source text
Correct answer: A. Cardiovascular anomalies
Answer- A. Cardiovascular anomalies
Diaphragmatic Hernia is defined as a communication between
abdominal & thoracic cavities with or without abdominal contents in
thorax.
Females are affected more than males.
More common on left side and is posterolateral.
Associated anomalies may be seen 30% of cases CNS lesions,
esophageal atresia, omphalocele and CVS lesions. Most cases are
sporadic.
Cardiac anomalis is MC anomalis.
Q367EndocrinologyPDF pages 397-398
Causes of mental retardation in congenital hypothyroidism is -
A.Decrease cerebral growth
B.Decrease myelination of CNS neuron
C.Decrease growth hormone by pitutary glands
D.Decreae production of neurotransmitters
Explanation and source text
Correct answer: A. Decrease cerebral growth
Answer- A. Decrease cerebral growth
is 'a' i.e., Decrease cerebral growth [Ref : Ghai 7h/e p. 481; Jornal of
Americal Physiological Review]
Thyroid hormone has major effect on brain in utero & neonatal
period, deficiency cause diminsh axonal growth, dendritic
arborisation, delay proliferation & migration of granule cell so it
decrease cerebral growth.
Extracted references
is 'a' i.e., Decrease cerebral growth [Ref : Ghai 7h/e p. 481; Jornal of
Q368NephrologyPDF pages 398-399
Mousy urine in a child due to defect in phenylalamine to
A.Tyrosine
B.Homogentisic acid
C.Phenyl acetate
D.Phenylpyruvate
Explanation and source text
Correct answer: A. Tyrosine
Answer- A. Tyrosine
Phenylketonuria:
Autosomal recessive
Deficiency of phenylalanine hydroxylase.
Defect in conversion of phenylalanine to tyrosine.
This leads to increase level of phenylalanine.
This increase phenlylalanine converted into phenylpyruvate and
phenyl acetate.
This phenyl acetate gives mousy or musty odour in urine/body.
Q369General PediatricsPDF pages 399-400
Most common site of extramedullary relapse of ALL in 6 year old is
A.Testes
B.Liver
C.Lung
D.None
Explanation and source text
Correct answer: A. Testes
Answer- A. Testes
The common sites of relapse of ALL after complete remission are :
Bone marrow (mc), CNS (2 mc) and testis.
Q370General PediatricsPDF pages 400-401
Male pseudohermaphrodism most common cause -
A.Congenital adrenal hyperplasia
B.Adrenocortical tumor
C.Chromosomal abnormalities
D.Cytogenetic abnormalities
Explanation and source text
Correct answer: D. Cytogenetic abnormalities
Answer- D. Cytogenetic abnormalities
Most common cause of female pseudohermaphroditism - CAH due
to 21 hydroxylase deficiency.
Most common cause of male pseudohermaphroditism - Gonadal
dysgenesis and defect in androgen action.
Q371HematologyPDF pages 401-402
Enzyme used as treatment for sickle cell anemia
A.Chymotrypsin
B.Glucose 6-phosphatase
C.Trypsin
D.None of above
Explanation and source text
Correct answer: A. Chymotrypsin
Answer- A. Chymotrypsin
Chymotrypsis used in Sickle cell disease.
Q372NephrologyPDF pages 402-403
XX baby presenting with penis & scrotum cause -
A.High level of testosterone in maternal blood
B.Klinfilter syndrome
C.Turner syndrome
D.None of above
Explanation and source text
Correct answer: A. High level of testosterone in maternal blood
Answer- A. High level of testosterone in maternal blood
This is a case of female pseudohermaphroditism i.e. XX karyotype
with virilized external genitalia.
Maternal androgen (testosterone) is the cause of this.
Female pseudohermaphroditism
Genotype is XX. Internal gonad is ovary but external genitalia are
virilized (male differentiation).
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase
deficiency is the commonest cause.
Other causes are maternal virilizing tumor
(arrhenoblastoma),maternal androgen administration, CAH due to
11-beta hydroxylase deficiency, fetal placental aromatase
deficiency, and WNT-4 gene mutation.
Q373General PediatricsPDF pages 403-404
Which of the fontanelle is the last to close?
A.Anterolateral
B.Anterior
C.Lateral
D.Occipital
Explanation and source text
Correct answer: B. Anterior
Ans. B. Anterior
The posterior fontanelle normally closes 2 to 3 months after birth
The sphenoidal fontanelle is the next to close around 6 months after
birth
The mastoid fontanelle closes next from 6 to 18 months after birth;
The anterior fontanelle is generally the last to close between 18–24
months.
Q374General PediatricsPDF pages 404-405
Which enzyme deficiency causesLesch– Nyhan syndrome ?
Correct answer: A. Hypoxanthine-guanine phosphoribosyltransferase (HGPRT)
Ans. A.Hypoxanthine-guanine phosphoribosyltransferase
(HGPRT)
Lesch–Nyhan syndrome (LNS), also known as juvenile gout, is a
rare inherited disorder caused by a deficiency of the enzyme
hypoxanthine-guanine phosphoribosyltransferase (HGPRT),
produced by mutations in the HPRT gene located on the X
chromosome
Q375Infectious DiseasesPDF pages 405-406
Which vaccine is not include in indradhanush mission?
A.Tuberculosis
B.Measles
C.Japanese Encephalitis
D.Diphtheria
Explanation and source text
Correct answer: C. Japanese Encephalitis
Ans. C. Japanese Encephalitis
The Mission Indradhanush, depicting seven colours of the
rainbow, targets to immunize all children against seven vaccine
preventable diseases namely:
Diphtheria
Pertussis
Tetanus
Childhood Tuberculosis
Polio
Hepatitis B
Measles.
Q376General PediatricsPDF pages 406-407
Which among the following is the Most common cause for neonatal blindness?
A.Neisseria gonorrhoeae
B.Chlamydia trachomatis
C.Klebsiella
D.Enterobacter
Explanation and source text
Correct answer: A. Neisseria gonorrhoeae
Ans. A. Neisseria gonorrhoeae
Ophthalmia neonatorum (ON) is defined as a purulent conjunctivitis
occurring during the first four weeks of life.
The two most common causative agents are Neisseria gonorrhoeae
and Chlamydia trachomatis, the former being of more concern here
because of its propensity to cause blindness.
Q377General PediatricsPDF pages 407-408
True hermaphroditism karyotype:
A.45 X0 streaked gonads
B.46 XX Ovotestis
C.47 XY+9
D.47 XX
Explanation and source text
Correct answer: B. 46 XX Ovotestis
Ans. B.46XX Ovotestis
True hermaphrodite or ovotesticular disorder of sexual differentiation
(OVO-DSD) is one of the rarest variety of all inter sex anomalies.
In about 90% of cases, patients have 46 XX karyotype.
Rarely, 46 XY/46 XX mosaicism may occur.
Q378CardiologyPDF pages 408-410
When can one diagnose acute respiratory distress in a child ?
A.Within 7 days of known clinical insult
B.Respiratory failure not fully explained
C.Left ventricular dysfunction
D.All of the above
Explanation and source text
Correct answer: D. All of the above
Ans: D. All of the above
Pediatric Critical Care Medicine 2015
Exclude patients with 1:m11-natal related lung
Age
disease
Iiming Within 7 days of known clinical Insult
origin of Respiratory failure not fully explained by cardiac failure
Edema or fluid overload Chest
Chest imaging findings of new infiltrate(siconsigent with acute
Imaging pulmonary
Non invasive mechanicallovas i ve mechanical
ventilation ventilation-
PARRS (No severity
Mild Moderate Severe
gratification)
OxygenationFull face-mask bi-level
EK 01 < O1 t16
ventilation or
4501c8 16 CiSt
CPAP z5 crn HA a
Ss09.c7.517.5 OSI 1233
PF ratios 300
<12.31
SF ratio 5 2E4 I
Specia- l Populations
tandard Criteria above for age, timing, origin of edema
Cyanotic
Cyanotic and chest imaging with an acute deterioration In
Heart oxygenation not explained by underlying cardiac
Disease disease.
standard Criteria above for age, timing, and origin of
Chronic
edema with chest imaging consistent with new infiltrate
Lung
and acute deterioration in oxygenation from
Disease
baseline which meet oxygenation criteria above_
Standard Criteria for age, timing and origin of edema
Left with chest imaging changes consistent with new
Ventricular infiltrate and acute deterioration in oxygenation which
dysfunction meet criteria above not explained by left ventricular
dysfunction.
Q379NeonatologyPDF pages 410-412
New born baby with heart rate less than 60 beats per minute can be resuscitated by all except
A.chest compression
B.oxygen therapy
C.tactile stimulation
D.slapping the back
Explanation and source text
Correct answer: D. slapping the back
Ans: D.slapping the back
The first three s are indicated while slapping the back is not
recommended in a newborn who has
Heart rate less than 60 beats per minute.
Q380EndocrinologyPDF pages 412-413
Which condition is associated with Congenital adrenal hypoplasia?
A.Male pseudohermaphroditism
B.Female pseudohermaphroditism
C.True pseudohermaphroditism
D.Sequential pseudohermaphroditism
Explanation and source text
Correct answer: B. Female pseudohermaphroditism
Answer - B -
Congenital Adrenal Hyperplasia:
This is the most common cause of androgenic excess in fetuses with
female pseudohermaphroditism.
The hyperplastic glands synthesize defective enzymes that cause
impaired cortisol synthesis.
This leads to excessive pituitary ACTH the secretion of the fetal
adrenal glands with secretion of large amounts of cortisol
precursors, including androgenic prehormones.
These prehormones, for example, androstenedione, are converted
to testosterone in fetal extra-adrenal tissues.
Q381EmergencyPDF pages 413-415
1 yr child weighing 6 kg is suffering from Acute Gastroenteritis along with signs of sunken eyes & skin pinch going back to normal very rapidly. What will be your management?
A.RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours
B.RL INFUSION 180 ml in the first hour followed by 420 ml in the next 5 hours
C.RL INFUSION 180 ML IN the first hour followed by 480 ml in the next 5 hours
D.RL INFUSION 240 ml in the first hour followed by 360 ml in the next 5 hours
Explanation and source text
Correct answer: B. RL INFUSION 180 ml in the first hour followed by 420 ml in the next 5 hours
Ans. B.RL INFUSION 180 ml in the first hour followed by 420 ml
in the next 5 hours
Severe dehydration constitutes a medical emergency requiring
immediate resuscitation with intravenous fluids.
Intravenous access should be obtained, and patients should be
administered a bolus of 20-30 mL/kg lactated Ringer's (LR) or
normal saline (NS).
If pulse, perfusion, and/or mental status do not improve, a second
bolus should be administered.
After this, the patient should be given an infusion of 70 mL/kg LR or
NS over 5 hours (children < 12 months) or 2.5 hours (older children).
If no peripheral veins are available, an intraosseous line should be
placed. Serum electrolytes, bicarbonate, urea/creatinine, and
placed. Serum electrolytes, bicarbonate, urea/creatinine, and
glucose levels should be sent.
Q382NutritionPDF pages 415-417
Which parameter conclusively rules out malnutrition?
A.Edema
B.Lean body mass
C.Skinfold thickness
D.Normal ECF volume
Explanation and source text
Correct answer: B. Lean body mass
Ans. B. Lean body mass
Measuring weight and height is the most common way of assessing
malnutrition in a given population. Such use of measurements of
dimensions of the human body is known as anthropometry.
Anthropometry is a widely used, inexpensive and noninvasive
measure of the general nutritional status of an individual or a
population group. The three commonly used anthropometric indices
are :
- Weight-for-Age {WFA).
- Length-for-Age or Height-For-Age (HFA).
- Weight-for-Length or Weight-for-Height {WFH).
PEM reduces growth in children
Energy expenditure in excess of consumption leads to metabolizing
nutrition reserves in the form of stored body fat.
Lean body mass in the form of muscle and even organ tissue will
also be consumed if PEM persists. it serves as a reliable indicator
for PEM
Weight loss accompanies the initial stages of inadequate energy
intake but, if prolonged, is followed by wasting, called in its severe
clinical form, marasmus.
In children, PEM delays or permanently stunts growth and increases
morbidity and mortality.
Ref. Park PSM ed. 24th Page no. 677
Extracted references
Ref. Park PSM ed. 24th Page no. 677
Q383GastroenterologyPDF pages 417-419
A 2 years baby with 6.7 kg, Hb%- 6 mg/dl total protein 3mg/dL, low albumin with distended stomach but no proteinuria. What will be the diagnosis?
A.Marasmus
B.Kwashiorkor
C.Indian childhood cirrhosis
D.None
Explanation and source text
Correct answer: B. Kwashiorkor
Ans. B. Kwashiorkor
Kwashiorkor is a form of severe acute malnutrition (SAM)
characterized by edema and apathy.
Edema is most likely to appear first on the feet and then in the lower
legs. It can develop into generalized edema affecting the hands,
arms, and face.
Moon face
Skin changes include depigmentation of skin, dermatoses, dark,
cracked peeling patches (flaky paint dermatosis) with pale skin
underneath that is easily infected.
Hair is sparse, easily pulled out, and may turn reddish.
Flag sign: alternating bands of hypopigmented and normal
pigmented areas on the hair strand
The liver is often enlarged with fat (fatty Liver).
The children are miserable and apathetic and often refuse to eat.
Muscle wasting and growth failure are seen.
Villous atrophy of small intestine and diarrhea.
Nelson Textbook of Pediatrics 20th Edition Page:301
Q384RespiratoryPDF pages 419-420
In RDS in a child, which cells are found defective?
A.Type 1 pneumocytes
B.Type 2 pneumocytes
C.Bronchial epithelium
D.None
Explanation and source text
Correct answer: B. Type 2 pneumocytes
Ans. B. Type 2 pneumocytes
Type I cells form the alveolar wall while the Type II cells synthesize
and secrete surfactant DPCC.
The defect in the biosynthesis of Dipalmitoylphosphatidylcholine
(DPPC), also known as dipalmitoyl lecithin leads to Respiratory
distress syndrome.
Ref. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880575/
Ans. B. Biliverdin
Fetal bowel contents consist of various products of secretion, such
as glycerophospholipids from the lung, desquamated fetal cells,
lanugo, scalp hair, and vernix. It also contains undigested debris
from the swallowed amnionic fluid. The dark greenish-black is
caused by pigments, especially biliverdin.
Ref. Williams Obstetrics Ed. 24th Page no. 141
Extracted references
Ref. Williams Obstetrics Ed. 24th Page no. 141
Q386NeonatologyPDF page 421
A term baby on breastfeeding with bilirubin 14mg/dL which of the following is true?
A.Exchange transfusion
B.Continue to breastfeed
C.Phototherapy
D.None
Explanation and source text
Correct answer: B. Continue to breastfeed
Ans. B. Continue to breastfeed
Compared with formula-fed newborns, breastfed infants are three to
six times more likely to experience moderate jaundice (total serum
bilirubin level above 12 mg per dL) or severe jaundice (total serum
bilirubin level above 15 mg per dL.
In a breastfed newborn with early-onset hyperbilirubinemia, the
frequency of feedings needs to be increased to more than 10 per
day. If the infant has a decline in weight gain, delayed stooling, and
continued poor caloric intake, formula supplementation may be
necessary, but breastfeeding should be continued to maintain breast
milk production.
Phototherapy usually not recommended when the total serum
bilirubin level is below 15 mg per dL.
Ref: https://www.aafp.org/afp/2002/0215/p599.html