include?
a)Neurologicaldamage
b)Subcutaneousfatnecrosis
c)Pulmonaryhypertension
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d)Hyperglycemiae)Hlpercalcemia
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Neurologicaldamage,'b'i.e.Subcutaneousfat
necrosis&'c'i.e.,Pulmonaryhypertension
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Clinicalfeaturesofhypoxicischemicencephalopathy'oEncephalopathyprogressovertime?
1. Birthto12hoursDecreasedlevelofconsciousness,poortone,
decreasedspontaneousmovement,periodicbreathingor
apnoea,seizures.
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2. 12-24hours-4Moreseizures,Apnoeicspells,jitteriness,weakness.3. After24hoursHypotonia,consciousness,poorfeeding,
brainstemsigns(oculomotor)andpupillarydisturbances.
Hypotoniaisgeneralized,involvesbothlimbsandtrunkandall
musclessimultaneously.
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2.Crouzonsyndromeconsistsof:
a)Maxillaryhypoplasia
b)Syndactyly
c)Hydrocephaly
d)Macrocephaly
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e)MandibularprognathismCorrectAnswer-A:C:E
Ans.is'a'i.e.,Maxillaryhypoplasia,'c'i.e.Hydrocephaly&`e'i.e.
Mandibularprognathism
Crouzonsyndromeisageneticdisordercharacterizedbythe
--- Content provided by FirstRanker.com ---
prematurefusionofcertainskullbones(craniosynostosis).Thisearlyfusionpreventstheskullfromgrowingnormallyand
affectstheshapeoftheheadandface.
ManyfeaturesofCrouzonsyndromeresultfromthepremature
fusionoftheskullbones:
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Wide-set,bulgingeyesandvisionproblemscausedbyshalloweyesockets
Strabismus
Midfacialhypoplasia
Beakednose:Upperairwayobstructiondevelopssecondarytoseptal
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deviation,midnasalabnormalities,choanalabnormalities,andnasopharyngealnarrowing
Underdevelopedupperjaw(Maxillaryhypoplasia)
Dentalproblemsandhearingloss,whichissometimesaccompanied
bynarrowearcanals.
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OpeninginthelipandtheroofofthemouthMandibularprognathism
3.Followingaresignsofgoodattachment
duringbreastfeeding?
a)Baby'smouthiswideopen
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b)Baby'slowerlipisinvertedc)Upperareolaismorevisiblethanlower
d)Baby'schintouchingthebreast
e)Painduringsucking
CorrectAnswer-A:C:D
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Ans.is'a'i.e.,Baby'smouthiswideopen,'c'i.e.,Upperareolaismorevisiblethanlower&'d'i.e.,Baby'schintouchingthebreast
Signsofgoodattachmentare
1. Baby'smouthiswideopen,
2. Mostofthenippleandareolainthemouth,onlyupperareolar
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visible,notthelowerone,3. Baby'schintouchesthebreastand
4. Baby'slowerlipiseverted
4.Allaremetaboliccausesofliverdisease
except
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a)Histiocytosisb)Hemochromatosis
c)Gaucher'sdisease
d)Wilsondisease
e)Galactosemia
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CorrectAnswer-AAns.is'a'i.e.,Histiocytosis
Metabolicliverdiseasescanbeclassifiedinto3categories:
Manifestationsduetohepatocellularnecrosis:
Galactosemia,hereditaryfructoseintolerance,tyrosinemiatype
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I,Wilsondisease,Hemochromatosisandal-antitrypsindeficiency.Cholestaticjaundice:Al-antitrypsindeficiency,Byler'sdisease,
cysticfibrosis,Niemann-Pickdiseaseandsomedisordersof
peroxisomebiogenesis.
Hepatomegaly(disorderswithliverdamage&storagediseases):
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Glycogenstoragediseases,cholesterylesterstoragediseaseand,whenassociatedwithsplenomegaly,lysosomalstoragediseases
(eg:-Gaucherdisease).
5.Trueaboutconstitutionalgrowthdelay-
a)Baselinegrowthhormonedecreased
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b)IGF-flevelsislowforchronologicalagec)Growthdelayonlyoccursafter2-3yearsofage
d)Pubertyspurtisdelayed
e)Finalheightiswithinnormallimits
CorrectAnswer-B:D:E
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Ans.(b)IGF-Ilevelsislowforchronologicalage,(d)Pubertyspurtisdelayed,(e)Finalheightiswithinnormallimits
ConstitutionalGrowthDelay
Thesechildrenarebornwithanormallengthandweightandgrow
normallyforfirst6-12monthsoflife.
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Theirgrowththenshowsadecelerationsothattheheightandweightfallbelowthe3rdcentile.
By3yrofage,normalheightvelocitylsresumedandtheycontinue
togrowjustbelowandparalleltothe3rdcentilewithanormalheight
velocity.
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Theonsetofpubertyandadolescentgrowthspurtlsalsodelayedinthesechildrenbutfinalheightiswithinnormallimits.
Boneageislowerthanchronologicalageandcorrespondstothe
heightage.
Historyofdelayedpubertyanddelayedheightspurtisusually
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presentinoneorbothparents.IGF-1levelstendtobelowerchronologicalagebutwithinthenormal
rangeforboneage
Pubertalgrowthspurtisdelayed.
Growthhormoneresponsestoprovocativetestingtendtobelower
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thaninchildren
6.Featureofpallidbreathholdingspellin
comparisontocyanoticbreathholding
spell:
a)Morecommonthancyanoticbreathholdingspell
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b)Elicitedbypainfulstimulusc)Bradycardiaisprominent
d)Atropineisgiveninrefractorycases
e)None
CorrectAnswer-B:C:D
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Ans.(b)Elicitedbypainfulstimulus.(c)Bradycardiaisprominent,(d)Atropineisgiveninrefractorycases
Breathholdingspells
Breathholdingspellisaparoxysmaleventoccuringin0.1%-5%of
healthychildrenfromtheageof6monthsto6years.
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Thenameforthisbehaviourmaybemisnomerinthatitconnotesprolongedinspiration.Infact,breath-holdingoccursduringexpiration
andisreflexive(notvolitional)innature.
Therearetwomajortypesofbreathholdingspells?
1.Cyanoticform(morecommon):
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Temporarydisappearanceoradecreaseinintensityofthesystolicmurmurisusualasflowacrosstherightventricularoutflowtract
diminishes.
Paroxysmalhypercyanoticattacks(hypoxic,"blue,"or"tet"spells)
areaparticularproblemduringthe1st2yearsoflife.
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Theinfantbecomeshyperpneaandrestless,cyanosisincreases,gaspingrespirationsensue,andsyncopemayfollow.
Mostfrequentlyinmorningoninitiallyawakeningorafterepisodesof
vigorouscrying
2.Pallidform:
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Triggeredbysuddenfrightorpainorfallingwithaminorinjurytothehead
Childmaygaspandgiveabriefcry
Childbecomespale,losesconsciousnessandbecomeslimp
Childmaybecomesweatyandmaystiffenandhaveafewbody
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jerksorlosebladdercontrol.Treatment:
Asubgroupofinfantswithbreathholdingspellshaveirondeficiency
anemia.Irontherapymaytreatnotonlytheanemia,butalsothe
breath-holdingspells.
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Pallidinfantilesyncopemayrespondtoatropinesulfate,whichisusedonanongoingbasisifspellsarefrequent,orintermittentlyif
spellsaresituationallypredictable(suchaswithvenepuncture).
7.Whichofthefollowingfindingisnormalin
infant?
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a)Papilledemaisrareinraisedintracranialpressureb)Floppyinfant
c)Strokingpatellartendonofonesideleadstocontractionon
oppositeside
d)Elbowcrossmidlineifpassivelydonebyexaminer
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e)ParachutereflexCorrectAnswer-A:C:E
Ans.(a)Papilledemaisrareinraised,(c)Strokingpatellar
tendonofonesideleadstocontractiononoppositeside(e)
Parachutereflex
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Inincreasedintracranialtension(ICT),thereisseparationofthecranialsutures,widefontanelsandincreasedheadcircumference.
TheMacewen'sorcrackpotsignindicatesraisedintracranial
pressureaftersuturesandfontanelhaveclosed.
Papilledemaisunusualininfantunlesstheincreaseinintracranial
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pressureisveryrapid.Botulismcausesacuteflaccidparalysisfloppyinfantwhichisnot
anormalfinding.
Thekneejerkinaninfantmayproduceacrossedadductor
response(tappingthepatellartendoninonelegcausescontraction
--- Content provided by FirstRanker.com ---
intheoppositeextremity),which,ifpresent,doesnotbecomeabnormaluntil6-7moofage.
Whentheupperextremityofanormalterminfantispulledgently
acrossthechest,theelbownormallydoesnotquitereachthe
midsternum(scarfsign).Theelbowofahypotoniainfantextends
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beyondthemidlinewithease"Theparachutereflexisdemonstratedbysuspendingthechildbythe
trunkandbysuddenlyproducingforwardflexionasifthechildwere
tofall.Thechildspontaneouslyextendstheupperextremitiesasa
protectivemechanism.Theparachutereflexappearsbeforethe
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onsetofwalking.8.Trueaboutparacetamoltoxicityin
children:
a)HypernatremiaiscommonsideeffectofN-acetylcysteine
b)Liverfailuremayoccurafter3-4days
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c)N-acetylcysteineisverylesseffectiveifgivenafter24hourofparacetamolingestion
d)N-acetylcysteinebegivenorallyorIV
e)Renaldamagealsomayoccur
CorrectAnswer-B:C:D:E
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Ans.b.Liverfailuremayoccurafter3-4days;c.N-acetylcysteineisverylesseffectiveifgivenafter24hourof
paracetamolingestion;d.N-acetylcysteinebegivenorallyorIV;
e.Renaldamagealsomayoccur
Acetaminophenintoxicationlsacommoncauseofacuteliverfailure
--- Content provided by FirstRanker.com ---
inadolescentsandadults.Acetaminophentoxicityresultsfromtheformationofahighly
reactiveintermediatemetabolite,N-acetyl-p-benzoquenoneimine
(NAPQI).
Theacutetoxicdoseofacetaminophenisgenerallyconsideredto
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be>200mg/kglnchildrenyoungerthan12yrofage,asingleingestionof>7.5gisconsideredaminimumtoxicdosein
adolescentsandadults.
Adolescentshaveahigherincidenceoftoxicplasmaconcentration
afteringestionthandochildren,andtheirexposuresareoften
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associatedwithintentionaloverdose.AnIVpreparationofNACLsalsoavailable
N-acetylcysteinecancausenausea&vomitinganddiarrhoeaor
constipation.
Rarely,itcancauserashes,fever,headache,drowsiness,lowblood
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pressureandliverproblems.9.Whichvaccineisrecommendedat2years
ofageaccordingtolatestIAPguidelines:
a)MMR
b)Pneumococcalconjugate
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c)VaricellaRubellad)BoosterofTyphoidConjugateVaccine
e)IPVbooster
CorrectAnswer-D
Ans.(d)BoosterofTyphoidConjugateVaccine
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Recommendedageatwhichthevaccinesshouldbereceivedandtypeofvaccine:
AGE
VACCINE
AtBirth
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HepatitisBDTaP-Diphtheria,Tetanus,Acellular
Pertussis
IVP-InactivatedPoliovaccine
2months
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HepatitisBPneumococcalvaccine
HIB-HaemophilusinfluenzaTypeB
Rotavirusvaccine
DTaP
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IVP4months
Pneumococcalvaccine
HIB
Rotavirusvaccine
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DTaPIVP
HepatitisB
6months
Pneumococcalvaccine
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HIBInfluenzavaccine**
Rotavirusvaccine
MMR-Measles,Mumps,Rubella
12months
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PneumococcalvaccineHepatitisA
DTaP
15months
HIB
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Varicella18months
HepatitisA
2years
BoosterofTyphoidConjugateVaccine
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DTaPMMR
4to6yearsofage
IVP
Varicella
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Tdap11yearsofageto
Meningococcalvaccine
adult
HPV(humanpapillomavaccine)
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10.Maximumrisktofoetusoccurswhen
maternalinfectionwithrubellaoccurs
duringwhichofthefollowingtime:
a)6-12week
b)12-l8week
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c)14-20weekd)20-24week
e)32-36week
CorrectAnswer-A
Ans.(a)6-12week
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Ingeneral,theearlierinpregnancyinfectionoccurs,thegreaterthedamagetothefetus.Maximumdamagetothefetusoccurswhen
infectionisacquiredinthefirsttrimesterofpregnancy.
Duringacuterubellainpregnancy,therateofcongenitalinfectionis
over90%inthe12firstweeksofpregnancy,approximately60%in
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weeks13to17,25%inweeks18to24andthenincreasesagainduringthelastmonthofpregnancy
11.Trueaboutnewborns:
a)Apgarscoreprovideanimmediateestimateofthephysical
conditionofthebaby
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b)APGARscoringisdoneatlminc)APGARscoringat5minhasnoprognosticvalue
d)NormalrespiratoryrateisRRis30-60breaths/min
e)Normalheartrate>100beats/min
CorrectAnswer-A:B:D:E
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Ans.a.Apgarscoreprovideanimmediateestimateofthephysicalconditionofthebaby;b.APGARscoringisdoneatl
min;d.NormalrespiratoryrateisRRis30-60breaths/min;e.
Normalheartrate>100beats/min
APGAR:
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Ababy'sfirsttestQuickassessmentofthenewborn'soverallwell-being
Givenone-minuteafterbirthandfiveminutesafterbirth
Rates5vitalareas
APGARat1min,indicatorsforneonatalresuscitation
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LatertimesAPGARscore(after5minutes)indicatesaboutlongtermneurologicaldamage(notneonatalmortality)
Signs
0
1
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2Heartbeatsper
Absent
Slow(<100)
>100
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minuteRespiratoryeffort
Absent
Slow,irregular
Good,crying
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SomeflexionofMuscletone
Limp
Activemotion
extremities
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NoReflexirritability
Cryorcough
No
Reflexirritability
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response GrimaceCryorcough
Blueor
Bodypink,extremities Completely
Color
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paleblue
pink
12.Trueaboutcephalohematoma:
a)Maximumatbirththenregress
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b)Occursduetoforcepinjurytoperiosteumc)Edematousswellingofsofttissue
d)Localizedcollectionofbloodbelowperiosteum
e)Mayextendacrossthemidlineandacrosssuturelines
CorrectAnswer-B:D
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Ans.(b)Occursduetoforcepinjurytoperiosteum,(d)Localizedcollectionofbloodbelowperiosteum
Cephalohematoma:
Itiscausedbyinjurytotheperiosteumoftheskullduringlaborand
delivery.
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Thisleadstodevelopmentofhemorrhageoveroneorbothparietalboneswithpalpableedgesappreciatedasthebloodreachesthe
limitsoftheperiosteum.
Itisacollectionofbloodlnb/wthepericraniumand.theflat
bone(subperiosteal)oftheskullusuallyunilateraland,overa
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parietalbone13.Highriskinfantare:
a)Birthorder>3
b)Twinning
c)Birthweight<3kg
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d)Failuretogainweightfor3consecutivemonthse)Artificialfeeding
CorrectAnswer-B:C:E
Ans.(b)Twinning,(d)Failuretogainweightfor3consecutive
months,(e)Artificialfeeding
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HighriskinfantriskBirthweightlessthan2.5kg
Twins
Birthorder5ormore
Artificialfeeding
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Weightbelow70%ofexpectedweight(i.eIIandIIIdegreeofmalnutrition)
Failuretogainweightduringthreesuccessivemonths
ChildrenwithPEM,diarrhoeaWorkingmother/oneparent
14.Trueaboutbreastmilkjaundiceis/are:
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a)Appearsafterweekb)Typicallybilirubinlevelisaround10-20ng/d1
c)Phototherapyisuseful
d)Managedconservatively
e)Diaperstainingispresentingfeature
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CorrectAnswer-A:B:C:DAns.(a)Appearsafter1week,(b)Typicallybilirubinlevelis
around10-20ng/d1(c)Phototherapyisuseful,(d)Managed
conservatively
BREASTMILKJAUNDICE:
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Occurslaterinnewbornperiod,withbilirubinlevelpeakingin6thto14thdays.
First,atbirth,thegutissterile,andnormalgutfloratakestimeto
establish.
Breastmilkcontains:
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GlucuronidaseIncreasedeconjugationandenterohepaticrecirculationofbilirubin.
Highepidermalgrowthfactor(EGF)IncreaseBilirubinuptakein
thegut(enterohepaticcirculation)
Second,breast-milkofsomewomencontains3-alpha-20-beta
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pregnanediol.Itinhibitsuridinediphosphoglucuronicacid(UDPGA)glucuronyl
transferaseresponsibleforconjugationandsubsequentexcretionof
bilirubin.
Inthenewbornliver,activityofglucuronyltransferaseisonlyat0.1-
--- Content provided by FirstRanker.com ---
1%ofadultlevels,soconjugationofbilirubinisalreadyreduced.Third,lipoproteinlipaseinbreastmilkproducesincreasedFFAthat
inhibithepaticglucuronyltransferase,whichdecreasesconjugation
ofbilirubin.
TREATMENT:
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Phototherapy:Anynewbornwithatotalserumbilirubingreaterthan359mol/l(21
mg/dL)shouldreceivephototherapy
15.RiskfactorforNeuraltubedefectis/are:
a)Diabeticmother
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b)MTHFRmutationc)Antiepilepticdrugintake
d)Methotrexateintake
e)All
CorrectAnswer-E
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Ans.E.AllA,DiabeticmotherB,MTHFRmutationC,AntiepilepticdrugintakeD,Methotrexateintake
ETIOLOGY:
Teratogens-(hyperthermia,sulphas,antihistaminic,nutrition
deficienciesandanticonvulsantsuse)
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Moststronglytied=carbamazepine,valproicacid(folateantagon)Folatedeficiency
16.Whichofthefollowingis/aretrueabout
atrialseptaldefect(ASD):
a)Ostiumprimumismostcommontype
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b)Surgeryusuallydonebefore3yearc)Secondheartsound-Wideandfixed
d)Softdelayeddiastolicrumbleatleftlowerleftsternalborder
e)None
CorrectAnswer-B:C:D
--- Content provided by FirstRanker.com ---
Ans.(b)Surgeryusuallydonebefore3year,(c)Secondheartsound-Wideandfixed,(d)Softdelayeddiastolicrumble
ClinicalmanifestationsofASD
PatientswithASDaregenerallyasymptomatic.
Mildeffortintoleranceandrespiratorytractinfectionmayoccur.
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CHFisrare.Physicalexamination
Parasternalimpulse
Systolicthrillat2ndleftinterspace.
AccentuationofS,duetoloudtricuspidcomponent.
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WidesplitandfixedS2.Ejectionsystolicmurmuratthesecondandthirdleftinterspaces.
Delayeddiastolicmurmuratthelowerleftsternalborder.
ASDwithmitralstenosisLutembachersyndrome.
Chestx-rayinASD
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Mildtomoderatecardiomegalyarterysegment.Prominentpulmonary
Rightatrialandrightventricularenlargement.
Relativelysmallaorticshadow
Plethoriclungfields.
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17.Achildispresentingfeaturesofrickets
includingchangesonbonesandhas
hypophosphatemia.Whichofthe
followingistrue:
a)ItiscommonlycausedbyXlinkedrecessivedisorder
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b)Normalzoneofprovisionalcalcificationadjacenttothemetaphysisispresent
c)Thereisdefectofmineralizationofmatrix
d)CRFmaybethecause
e)Renaltubuledysfunctionleadstohypophosphatemia
--- Content provided by FirstRanker.com ---
CorrectAnswer-C:EAns.(c)Thereisdefectofmineralizationofmatrix,(e)Renal
tubuledysfunctionleadstohypophosphatemia
X-linked.hypophosphatemicrickets(XLH)inheritedindominant
manner(notrecessive)
--- Content provided by FirstRanker.com ---
Radiologicalchangesarecharacteristicallyseenatmetaphysis.Thefirstchangeislossofnormalzoneofprovisionalcalcification
adjacenttothemetaphysis.
Rickets,adiseaseofgrowingbone,occursinchildrenonlybefore
fusionoftheepiphyses,andisduetounmineralizedmatrixatthe
--- Content provided by FirstRanker.com ---
growthplates.RADIOGRAPHICFINDINGS:
Thickeningandwideningofepiphysis
Cuppingandfrayingofmetaphysis
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Irregularmetaphysealmargins
Flaringofanteriorendsofribs
Ricketicrosary
Bowingofdiaphysis
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18.Corticosteroidsareusefulinwhichofthe
followingpaediatricsdisease:
a)TBmeningitis
b)EndobronchialTB
c)Spinaventosa
--- Content provided by FirstRanker.com ---
d)Acutetuberculouspericardialeffusione)Severemiliarytuberculosis
CorrectAnswer-A:D:E
Ans.(A)TBmeningitis;b.EndobronchialTB;(D)Acute
tuberculouspericardialeffusion;(E)Severemiliary
--- Content provided by FirstRanker.com ---
tuberculosisCorticosteroidsuseinpaediatrics:
Theseareusefulinthetreatmentofsomechildrenwithtuberculosis
disease.
Corticosteroidsdecreasemortalityratesandlong-termneurologic
--- Content provided by FirstRanker.com ---
sequelaeinsomePatientswithtuberculousmeningitisbyreducingvasculitis,inflammation,and,ultimately,intracranialpressure.
Shortcoursesofcorticosteroids:Endobronchialtuberculosisthat
causesrespiratorydistress,localizedemphysema,orsegmental
pulmonarylesions.
--- Content provided by FirstRanker.com ---
Relievesymptomsandconstrictionassociatedwithacutetuberculouspericardialeffusion.
Dramaticimprovementinsymptomsoftuberculouspleuraleffusion
andshiftofthemediastinum.
Severemiliarytuberculosishavedramaticimprovementwith
--- Content provided by FirstRanker.com ---
corticosteroidtherapyiftheinflammatoryreactionissoseverethatalveolocapillaryblockispresent.
19.Eosinophiliainchildrenis/arepresentin:
a)Allergicrhinitis
b)Echinococcosis
--- Content provided by FirstRanker.com ---
c)Rheumatoidarthritisd)Infectiousmononucleosis
e)Wiskott-Aldrichsyndrome
CorrectAnswer-A:B:C:E
Ans.(A)Allergicrhinitis;(B)Echinococcosis;(C)Rheumatoid
--- Content provided by FirstRanker.com ---
arthritis;(E)Wiskott-AldrichsyndromeCommoncausesofeosinophilia:
Acute:
Allergicdisorder:Asthma,atopicdermatitis,urticaria.drug
hypersensitivity,pemphigoid
--- Content provided by FirstRanker.com ---
Parasiticinfestation:Toxocara,ascaris,amebiasis,strongyloidiasis,filarial,toxoplasmosis,trichinosia,schistosomiasis,malaria,scabies
Fungalinfections:Bronchopulmonaryaspergillosis,coccidiomycosis
Malignancy:Hodgkinlymphoma,Tcelllymphoma,acute
myelogenousleukaemia,myeloproliferativesyndrome
--- Content provided by FirstRanker.com ---
HypereosinophilicsyndromeChronic:
Allergicdisorders:Pemphigus,dermatitisherpetiformis
Autoimmunedisorders:Inflammatoryboweldisease,rheumatoid
arthritis,Myeloproliferativesyndrome,hypereosinophilicsyndrome
--- Content provided by FirstRanker.com ---
,Loefflersyndrome.Immunodeficiencysyndromes:HyperIgE,WiskottAldrichsyndrome;
Omennsyndrome;graftversushostreaction
Miscellaneous:Thrombocytopeniawithabsentradii;renalallograft
rejection;Addisondisease
--- Content provided by FirstRanker.com ---
20.Syndromenotassociatedwithchildhood
leukaemia:
a)Edwardsyndrome
b)Fanconisyndrome
c)Diamond-Blackanaemia
--- Content provided by FirstRanker.com ---
d)Patausyndromee)Kostmannsyndrome
CorrectAnswer-A:D
Ans.(A)Edwardsyndrome;(D)Patausyndrome
RiskfactorsforChildhoodLeukemia
--- Content provided by FirstRanker.com ---
DownsyndromeShwachman-Diamondsyndrome
Kostmannsyndrome
Li-Fraumenisyndrome
Fanconisyndrome
--- Content provided by FirstRanker.com ---
Bloomsyndrome.Klinefeltersyndrome
Turnersyndrome
NeurofibromatosistypeI
Ataxia-telangiectasia
--- Content provided by FirstRanker.com ---
SeverecombinedimmunedeficiencyParoxysmalnocturnalhaemoglobinuria
21.AchildhasvitaminDdeficiencyrickets.
Whichofthefollowingis/arecorrect
regardingbiochemicalchanges:
--- Content provided by FirstRanker.com ---
a)Alkalinephosphataseb)serumcalcium
c)parathyroidhormone
d)phosphate
e)25-(OH)D3
--- Content provided by FirstRanker.com ---
CorrectAnswer-A:CAns.(A)Alkalinephosphatase;(C)parathyroidhormone
BIOCHEMICALREACTIONS:
Serumcalcium:normalorlow
Serumphosphate:low
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Alkalinephosphatase:highHypophosphatasiashowslowlevelofalk.phosphatase
PTH:High
Hypophophatemia
22.Trueaboutfetalalcoholsyndrome:
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a)Increasedbirthweightb)Normalfinemotordevelopment
c)Normalsocialskilldevelopment
d)Facialabnormalities
e)Intelligencesubnormal
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CorrectAnswer-D:EAns.(D)Facialabnormalities;(E)Intelligencesubnormal
Fetalalcoholsyndrome
Highlevelofalcoholingestioninpregnancycancausedamageto
fetus,knownasfetalalcoholsyndrome.
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Theharmfuleffectsmaybeduetoalcoholitselforduetooneofitsbreakdownproducts.Someevidencesuggeststhatalcohol
mayimpairplacentaltransferofessentialaminoacidsandzinc,both
necessaryforproteinsynthesis,whichmayaccountforIUGR.
Characteristicsoffetalalcoholsyndromeinclude:?
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IUGR(notlargeproportionatebody)Microcephaly
Congenitalheartdefects(ASD,VSD)
Mentalretardation
FacialabnormalitiesShortpalpebralfissures,epicanthalfolds,
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maxillaryhypoplasia,micrognathia,lowsetears,smoothphiltrum,thinsmoothupperlip.
Minorjointanomalies
Hyperkineticmovements
23.Feature(s)ofcongenitalrubellasyndrome
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include:a)Cataract
b)ASD
c)Deafness
d)Patentductusarteriosus
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e)AlltheaboveCorrectAnswer-A:C:D
Ans.(A)Cataract;(C)Deafness;(D)Patentductusarteriosus
Congenitalrubellasyndrome(CRS)canoccurinadevelopingfetus
ofapregnantwomanwhohascontractedrubella,usuallyinthefirst
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trimester.Triadshows:PDA,cataractanddeafnes
Ifinfectionoccurs0?28daysbeforeconception,theinfanthasa
43%riskofbeingaffected.
Infectionin2ndtrimester?maybedeafnessonly.
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>6wks?nomajorabnormalitiesDiagnosis:Isolationofvirusincellculturesofthroatsamples,urine
orothersecretions.
DetectionofIgMinsingleserumsampleshortlyafterbirth.
PersistenceofRubellaIgGantibodiesserumbeyond1yearor
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risingantibodytitreanytimeduringinfancyinanunvaccinatedchild24.A4.2kgsbabyborntouncontrolled
diabeticmother.Thefollowingcondition
willnotoccurinthebaby:
a)Hypercalcemia
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b)Hypoglycemiac)Hyperbilirubinemia
d)Polycythaemia
e)Cardiovasculardefects
CorrectAnswer-A
--- Content provided by FirstRanker.com ---
Ans.(A)HypercalcemiaNeonatalComplication:
Hypoglycaemia
Respiratorydistresssyndrome
Hyperbilirubinemia
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HypocalcemiaHypomagnesemia.
Polycythemia
Cardiomyopathy
25.Trueaboutcaputsuccedaneum-
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a)Oedematousswellingofscalpb)Marginsareclearlydefined
c)Swellingresolvespontaneouslyafterfewdaysofbirth
d)Swellingremainsforthreemonths
e)Maximumsizeatbirth
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CorrectAnswer-A:C:EAns.(A)Oedematousswellingofscalp;(C)Swellingresolve
spontaneouslyafterfewdaysofbirth;(E)Maximumsizeat
birth
Caputsuccedaneumisadiffuse,sometimesecchymoticedematous
--- Content provided by FirstRanker.com ---
swellingofthesofttissuesofthescalpinvolvingtheareaPresentingduringvertexdelivery.
Itmayextendacrossthemidlineandacrosssuturelines.
Theedemadisappearswithinthelstfewdaysoflife.
Moldingoftheheadandoverridingoftheparietalbonesare
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frequentlyassociatedandbecomemoreevidentaftercaputhasreceded;theydisappearduringthelstweeksoflife
Analogousswelling,discoloration,anddistortionofthefaceareseen
infacePresentations.
26.Achildhasfeverwithrednessofcheek.
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Thecausativeorganismforthisconditionis:
a)Herpesvirus
b)ParvovirusB-19
c)Adenovirus
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d)Rubellae)Roseola
CorrectAnswer-B
Ans.(B)ParvovirusB-19
Exanthemainfectiosum:
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Thecharacteristicrashfirstappearsaserythematousflushingonthefaceinaslappedcheekappearance(redcheek).
ThemostcommonmanifestationofparvovirusB19iserythema
infectiosum,alsoknownasfifthdisease,whichisabenign,self-
limitedexanthematousillnessofchildhood.
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Itwasthe5thinaclassificationschemeofcommonchildhoodexanthems.
Thepreceding4exanthemsweremeasles,scarletfever,rubella,
andFilatov-Dukesdisease(anatypicalscarletfever),withroseola
infantumasthe"sixthdisease
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27.Ingestionofwhichofthefollowingmimics
scurvyinchild:
a)Magnesium
b)Potassiumiodide
c)Arsenic
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d)Irone)Copper
CorrectAnswer-A
Ans.a.Magnesium
Hypermagnesemiaismostprobableanswerbecauseitalsocause
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paralysisHypermagnesemiainhibitsacetylcholinereleaseatthe
neuromuscularjunction,producinghypotonia,hyporeflexia,and
weakness;paralysisoccursathighconcentrations.The
neuromuscular
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28.Inwhichcondition(s),urethralopeningis
neverattipofglanspenis:
a)Epispadias
b)Hypospadias
c)Urethralstricture
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d)Bladderexstrophye)Alloftheabove
CorrectAnswer-A:B:D
Ans.a.Epispadias;b.Hypospadias;d.Bladderexstrophy
Hypospadias
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Acongenitaldisorderoftheurethrawheretheurinaryopeningisnotattheusuallocationontheheadofthepenis.Itisthesecond-most
commonbirthabnormalityofthemalereproductivesystem,affecting
aboutoneofevery250malesatbirth.
EPISPADIAS
--- Content provided by FirstRanker.com ---
Anepispadiasisararetypeofcongenitalmalformationinwhichtheurethraopensonthedorsum(theupperaspect)ofthepenis.Itis
oftenpartoftheconditiontermedEpispadias-exstrophyofthe
bladder.Epispadiasisamildformofbladderexstrophy,andin
severecases,exstrophyandepispadiascoexist.
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29.Whichofthefollowingtrueaboutnew-
born&children:
a)Erythropoietinlevelismoreinpretermthanterm
b)Erythropoietingiventopretermonlyinsomespecialcases
c)ErythropoietingiventoPretermcancausecomplication
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d)a&be)Noneoftheabove
CorrectAnswer-B:C
Ans.(B)Erythropoietingiventopretermonlyinsomespecial
cases;(C)ErythropoietingiventoPretermcancause
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complicationMostinfantswithbirthweightof<1KgRBCtransfusions.Akey
reasonwhythenadirhaemoglobinvaluesofprematureinfantsare
lowerthanthoseofterminfantsistheformergroup'srelatively
diminishedplasmaEPOlevelinresponsetoanaemia.
--- Content provided by FirstRanker.com ---
PreterminfantsexhibitasluggishEPOresponsetofallinghaematocritvalues.
LowplasmaEPOlevelproviderationaletheuseofrecombinant
EPOinthetreatmentofanemiaofprematurity.
ProperdosesofEPOandironeffectivelystimulateneonatal
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erythropoiesis.However,theefficacyofEPOtherapytosubstantiallydiminishtheneedfarRBCtransfusionhasnotbeen
convincinglydemonstrate,particularlyfarsick,extremelypremature
neonates,andrecombinantEPOhasnotbeenwidelyacceptedas
treatmentforanemiaofprematurity.
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lnrarecases,somepreparationsofEPOhavebeenassociatedwiththedevelopmentofanti-EPOantibodiesthatresultinsevereanemia.
30.Macrocephalyisseenin?
a)Soto'ssyndrome
b)GorlinSyndrome
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c)Achondroplasiad)Maternaldiabetes
e)Struge-Webersyndrome
CorrectAnswer-A:B:C:E
Ans.is'a'i.e.,Soto'ssyndrome;'b'i.e.,GorlinSyndrome;'c'
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i.e.,Achondroplasia;&'e'i.e.,Struge-WebersyndromeSyndromes:
Fragile-Xsyndrome
Neuro-cutaneoussyndromes
Tuberoussclerosis
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Sturge-WeberIncreasedCSF:
Hydrocephalus,
Choroidplexuspapilloma.
Bonedisease:
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AchondroplasiaOsteogenesisimperfecta
OsteoPetrosis.
Others:
AVmalformation
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IntracranialhaemorrhageThalassemiamajor
Hypervitaminosis-A
Leadpoisoning
Pseudotumorcerebri
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GalactosemiaCanavan'sleukodystrophy.
Overgrowthsyndromes:
Sotosyndrome(Cerebralgigantism)
Weaversyndrome
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Simpson-Golabi-Behmelsyndrome(bulldogsyndrome)Macrocephaly-Capillarymalformation(M-CMTC)syndrome.
Neuro-cardiofacial-cutaneoussyndromes:
Noonansyndrome
Costellosyndrome
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Gorlinsyndrome(BasalCellNevussyndrome)Cardio-facio-cutaneoussyndrome.
Fragile-xsyndrome&leukodystrophies(Alexanderdisease,
Canavandisease).
31.LargeSkullsizeofnewbornisseenin?
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a)Fetalalcoholsyndromeb)Gestationaldiabetes
c)Turner'ssyndrome
d)Canavan'sleukodystrophy
e)Neurofibromatosis
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CorrectAnswer-D:EAns.is'd'i.e.,Canavan'sleukodystrophy;&'e'i.e.,
Neurofibromatosis
Canavandisease:
Autosomal-recessiveneurologicaldisorderassociatedwith
--- Content provided by FirstRanker.com ---
macrocephalyandspongiformdegenerationofbrain.Thereiseitheralackofdevelopmentorrapidregressionof
psychomotorfunction,lossofsightandopticatrophy,lethargy,
difficultyinsucking,irritability,reducedmotoractivity,hypotonia
followedbyspasticityofthelimbswithcorticospinalsigns,andan
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enlargedhead(macrocephaly).32.ClinicalfeaturesofB-cellALLinchildren
include:
a)Fever
b)Intrauterinedeath
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c)Shockd)Rigormortis
e)Mediastinalenlargement
CorrectAnswer-A:B:C:D
Ans.is'a'i.e.,Fever;'b'i.e.,Intrauterinedeath'c'i.e.,Shock
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&'d'i.e.,RigormortisClinicalmanifestationsofALL:
Symptomsrelatedtodepressionofnormalmarrowfunction.:
Anemia
Neutropenia
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Fatigue,pallorInfection,intermittentlever
Thrombocytopenia
Bleeding,petechiae,ecchymoses,epistaxis.
Bonepainandtenderness
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Generalizedlymphadenopathy,splenomegalyandhepatomegalySymptomsrelatedtocompressionoflargemediastinalvesselsor
airway
CNSmanifestation:
Headache,vomiting,nervepalsies.
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SeriousinfectionsmaycauseSepticshockandlifethreateningbleeding.
Duetoneutropenia,theremaybeinfectiousdiarrhea.
33.Trueaboutheartsounds/murmurinatrial
septaldefect-
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a)WidesplitS,b)Earlydiastolicmurmur
c)Loudshuntmurmur
d)DelayedP2
e)AttenuationofS1
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CorrectAnswer-A:DAns.is'a'i.e.,WidesplitS2&'d'i.e.,DelayedP2
ClinicalmanifestationsofASD
PatientswithASDaregenerallyasymptomatic.
Mildeffortintoleranceandrespiratorytractinfectionmayoccur.
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CHFisrare.Physicalexamination
Parasternalimpulse
Systolicthrillat2ndleftinterspace.
AccentuationofS,duetoloudtricuspidcomponent.
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WidesplitandfixedS2.Ejectionsystolicmurmuratthesecondandthirdleftinterspaces.
Delayeddiastolicmurmuratthelowerleftsternalborder.
ASDwithmitralstenosisLutembachersyndrome.
Chestx-rayinASD
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Mildtomoderatecardiomegalyarterysegment.Prominentpulmonary
Rightatrialandrightventricularenlargement.
Relativelysmallaorticshadow
Plethoriclungfields.
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34.Trueaboutmurmur(s)inPatentDuctus
arteriosus-
a)Delayeddiastolicmurmur
b)Continuousmurmur
c)ReversesplittingofS2
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d)Ejectionsystolicmurmure)Middiastolicmurmur
CorrectAnswer-A:B:C:D
Ans.is'a'i.e.,Delayeddiastolicmurmur;'b'i.e.,Continuous
murmur;'c'i.e.,ReversesplittingofS2;&'d'i.e.,Ejection
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systolicmurmurPressuregradientbetweenaortaandpulmonaryarteryismaintained
throughoutthecardiaccycle(duringsystoleand
diastole)Continuousmurmur,i.e.,murmurstartsinsystoleafter
S1,andreachesapeakatS2.Itthendiminishesandaudibleonlya
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partofdiastole.Largerbloodvolumepassesthroughpulmonarycirculation(blood
fromrightsideofheartplussomebloodfromaorta)Pulmonary
plethorawhichmaycausepulmonaryhypertension.
Increasedflowafterpassingthroughlungreachestheleftatriumand
--- Content provided by FirstRanker.com ---
causesvolumeoverloadLeftatrialdilatationandhypertrophy.Increasedbloodvolumepassesfromleftatriumtoleftventricle
throughmitralvalve,i.e.,increasedflowthroughmitral
valveAccentuationofS1anddelayeddiastolicmurmur.
Leftventriclereceiveslargeramountofbloodthatresultsinvolume
--- Content provided by FirstRanker.com ---
overloadLeftventricleenlargement.Extravolumepassesthroughaorticareacausedelayedclosureof
aorticvalvewhichmaycloseevenafterpulmonaryvalve(normal
pulmonaryvalvescloseafteraorticvalves).Paradoxicalsplittingof
S2,i.e.,A,occursafterP.
--- Content provided by FirstRanker.com ---
LargeleftventricularvolumeejectedintotheaortaresultsindilatationoftheascendingaortaAorticejectionclick.
LargevolumeofbloodpassesthroughnormalaorticvalveAortic
ejectionsystolicmurmur
35.DifferenceinMurmursofPDAandASD
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is/are-a)DelayedP2inPDA
b)WidesplitofS2inPDA
c)AccentuationofS1inASD
d)ContinuousmurmurinPDA
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e)DelayeddiastolicmurmurinASDCorrectAnswer-D
Ans.is'd'i.e.,ContinuousmurmurinPDA
DelayedP2andwidesplitS2arefeatureofASD(notPDA).
ThereiscontinuousmurmurinPDA.
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36.RadiologicalfeaturesofTOFis/are-
a)Cardiomegaly
b)Bootshapedheart
c)Rightsidedaorticarch
d)PulmonaryPlethora
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e)CoeuransabotCorrectAnswer-B:C:E
Ans.is'b'i.e.,Bootshapedheart;'c'i.e.,Rightsidedaortic
arch;&'e'i.e.,Coeuransabot
RadiologicalfeaturesofTOF
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Bootshapedheart(Coeuransabot)Normalheartsize
Oligaemiclungfields
Rightaorticarch(in25%)
37.TrueaboutRETTSyndrome?
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a)Macrocephalyb)Cardiacarrhythmia
c)Seizures
d)Mentalretardation
e)Autisticbehaviour
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CorrectAnswer-B:C:D:EAns.is'b'i.e.,Cardiacarrhythmia,'c'i.e.,Seizures,'d'i.e.,Mental
retardation&'e'i.e.,Autisticbehaviour
Rett'sSyndrome
Thisisthecharacteristicfeatures,thattheybegintoloosetheir
--- Content provided by FirstRanker.com ---
acquiredskills,e.g.,cognitiveandheadgrowthisnormalduringearlyperiodafterwhichthereisanarrestofgrowth.
Acquiredmicrocephaly
Mostchildrendeveloppeculiarsighingrespirationswithintermittent
periodsofapneathatmaybeassociatedwithcyanosisBreath
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holdingspells.AutisticbehaviourImpairedsocialinteraction,languageand
communication.
Generalizedtonic-clonicconvulsionsoccurinthemajority.
Feedingdisorderandpoorweightgain
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38.Congenitaladrenalhyperplasiaisdueto
deficiencyofenzyme?
a)3?-Hydrorysteroiddehydrogenasedeficiency
b)5?reductase
c)l7?-Hydrorylasedeficienry
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d)2l-Hydroxylasedeficiencye)Aromatase
CorrectAnswer-A:C:D
Ans.(a)3?-Hydrorysteroiddehydrogenasedeficiency;(C)l7?-
Hydrorylasedeficienry(d)2l-Hydroxylasedeficiency
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Congenitaladrenalhyperplasia(CAH)GroupofARdisorder
MCadrenaldisorderinchildhood
Mostcommon21-hydroxylasedeficiency
In21a-hyroxylesedeficiency
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Thereisdeficiencyofmineralocorticoids&glucocorticoid.Thisleadstohypoglycemia,hyponatremia
39.CauseoflowerGIbleedinchildrenofage
>2yearofage
a)TB
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b)Meckel'sdiverticulumc)Aspirin
d)Esophagealvarices
e)Itisbleedingfromasitedistaltoligamentoftreitz
CorrectAnswer-A:B:C:E
--- Content provided by FirstRanker.com ---
Ans.is'a'i.e.,TB;"b'i.e.,Meckel'sdiverticulum'c'i.e.,Aspirin;'e'i.e.,Itisbleedingfromasitedistaltoligamentoftreitz
LowerGIbleedingisdefinedasbleedingfromasitedistalto
ligamentoftreitz.
In>2years:
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InfectiouscolitisInflammatoryboweldisease
Tuberculosis
Pseudomembranecolitis
Cowmilkproteinallergy
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Uncommon:Amebiasis,cytomegalovirus,neutropeniccolitisFissure,Arteriovenousmalformation
Polyposissyndrome
Solitaryrectalulcersyndrome
Meckel'sdiverticulum
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RectalvaricesorcolopathyNSAIDS
Haemorrhoids;Coagulopathy
Henochschonleinpurpura
40.Whichofthefollowingis/aretrueabout
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developmentalmilestonesof2yearsoldchild-
a)Canwalkup&downstairswithalternatingfeet
b)Walksupanddownstairs,onestepatatime
c)Ridestricycle
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d)Knowsageandsexe)WeightquadruplesofbirthweightAchildishavingWilson
disease
CorrectAnswer-B:E
Ans.is'b'i.e.,Walksupanddownstairs,onestepatatime;'e'
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i.e.,WeightquadruplesofbirthweightAchildishavingWilsondisease
GROSSMOTORMILESTONES:
Age
Milestone
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3months Neckholding5months Rollsover
6months Sittingsupported
8months Sittingwithoutsupport
9months Standswithsupport
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12months Standswithoutsupport,Walksbutfalls15months Walksalone,Creepsupstairs
18months Runs,exploresdrawers
2years
Walksupstairs(babysteps),Jumps
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3yearsWalksupstairs(alternatefeet),ridestricycle
4years
Hopsononefoot,walksdownstairs(alternatefeet)
FINEMOTORMILESTONES:
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AgeMilestone
4months Bidextrousreach
6months Unidextrousreach
9months Immaturepincergrasp
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12months Maturepincergrasp15months Imitatesscribbling,towerof2blocks
18months Scribbles,towerof3blocks
2years
Towerof6blocks,vertical&circularstroke
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3yearsTowerof9blocks,copiescircle
4years
Copiescross,bridgewithblocks
5years
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Copiestriangle41.Achildispresentedwithmediastinal
mass,swellingofface,dyspnea&stridor,
Nextlineofmanagementis/are
a)Administrationofoxygenwithventimask
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b)Tracheostomyc)Biopsyofmassandfineneedleaspirationcytology
d)Mediastinalradiation
e)Rasburicase
CorrectAnswer-A:B:C
--- Content provided by FirstRanker.com ---
Ans.is.a,i,e.,Administrationofoxygenwithventimask;'b'i.e.,Tracheostomy`c'Biopsyofmassandfineneedleaspiration
cytology
Thisisacaseofsuperiorvena-cavasyndromeorsuperior
mediastinalcompressionsyndrome.
--- Content provided by FirstRanker.com ---
Itisamedicalemergencyandrequiresimmediatediagnosticevaluationandtherapy.
Nextlineofmanagementinthegivenpatientincludes:-
Inclinedpositionifpossible
Oxygenwithventimask
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TracheostomyBiopsyandaspirationcytology
Furosemide
42.Whichofthefollowingstatement(s)is/are
notcorrect-
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a)Kayser-fleischer(KF)ringmaybepresentineyeb)Serumceruloplasminis<20mg/dl
c)Hepaticcopperis>250?g/gdryweightofliver
d)Insymptomaticpatients,the24hrurinarycopperexcretionis
lessthan40?g/day
--- Content provided by FirstRanker.com ---
e)Liverbiopsyisofvaluefordeterminingtheextentandseverityofliverdisease
CorrectAnswer-D
Ans.(d)Insymptomaticpatients,the24hrurinarycopper
excretionislessthan40?g/day
--- Content provided by FirstRanker.com ---
Wilson'sdisease(Hepatolenticulardegeneration)DIAGNOSIS:
Thegoldstandardfordiagnosisisliverbiopsywithquantitative
copperassay->concentrationofcopperinaliverbiopsysample>
200?g/gdryweight.
--- Content provided by FirstRanker.com ---
Othertestsare?1. Serumceruloplasminlevel->low(20mg/dl)
2. KFrings
3. Urinecopperexcretion->increased(>100?g/day)
4. DNAHaplotypeanalysis.
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43.Complication(s)ofH.typeoftracheo-
esophagealfistulais/are
a)Dysphagia
b)Aspirationpneumonia
c)Hematemesis
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d)Paroxysmsofcoughingorcyanosiswithfeedinge)Deathusuallyoccurininfancy
CorrectAnswer-B:D
Ans.b)Aspirationpneumonia;d)Paroxysmsofcoughingor
cyanosiswithfeeding
--- Content provided by FirstRanker.com ---
H-Type{Type-E)TEF:Itaccountsfor4-5%ofallcongenitalTEF'
Commonclinicalfeaturesare:
Recurrentrespiratorysymptom
Paroxysmsofcoughingandcyanosisduringfeeding'
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AspirationduringfeedingwithcyanosisAbdominaldistension.
Dysphagiaisnotpresentbecauseofpatencyofesophagus
Theremaybeassociatedanomalies
VACTERL(vertebral,anorectal,cardiac,tracheal,esophageal,
--- Content provided by FirstRanker.com ---
renal,radial'limb)syndrome44.Trueaboutbenignidiopathicneonatal
seizures
a)Calledas5ddayfits
b)Seizureoftenoccurlaterinlife
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c)Statusepilepticusmayoccurd)Familyhistoryisusuallypresent
e)Morecommoninpreterm
CorrectAnswer-A:C
Ans.is'a'i.e.,Calledas5thdayfits;'c'i.e.,Statusepilepticus
--- Content provided by FirstRanker.com ---
mayoccurBenignNeonatalSeizures(5thdayfits)
Increasinglyrecognizedsyndromecharacterizedbyseizuresinthe
neonatalorinfantileperiod.
2forms:Familialandnonfamilial.
--- Content provided by FirstRanker.com ---
Quitesevere,andstatusepilepticusiscommon.Nonfamilialformischaracterizedby:
Idiopathic,self-Limitedseizureinpreviouslynormalneonates.
Mostcommonlyoccuratday5
Familialseizures:
--- Content provided by FirstRanker.com ---
Mostfrequentlyhavetheironsetduringthefirstweekoflife,butonsetmayoccuraslateasearlyinfancy.
Theseseizuresmayrecurforseveralmonthsbeforeresolving.
Thefamilyhistoryrevealsbenignneonatalseizuresinotherfamily
members.
--- Content provided by FirstRanker.com ---
Prognosisisfavourableinbothsyndrome,butseizuresmayoccasionallyoccurlaterinlifeinthefamilialform.
45.Allaretrueaboutwilmstumorexcept-
a)Painlessabdominalmass
b)Mostlyasymptomatic
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c)Swellingisballotabled)StageI-tumourconfinedtokidney
e)CompletelyexcisionistreatmentofchoiceinstageI&II
CorrectAnswer-E
Ans.(e)CompletelyexcisionistreatmentofchoiceinstageI&
--- Content provided by FirstRanker.com ---
IIPresentationofWilm'stumor:
Asymptomaticabdominalmass(mostcommon)
Abdominelswelling(rcnallump)inwilm'stumorisballottable.
Abdominalpain(30%)
--- Content provided by FirstRanker.com ---
Hypertension(25%)Heamaturia(10-25%)
Fever(20%)
Anorexiaandvomiting
Stages Features
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StageI TumorislimitedtokidenyandcompletelyexcisedTumorbeyondkidney&completelyexcised.Regional
StageII extensionconfinedtoflank
Residualnon-hematogenoustumorconfinedtothe
abdomen.Lymphnodeinvolvementofhilus,periaortic
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chains,orbeyond;diffuseperitonealimplantsoftumor,StageIII tumorextendsbeyondsurgicalmarginsmicroscopicallyor
macroscopically;tumornotcompletelyremovablebecause
oflocalinfiltrationintovitalstructures
oflocalinfiltrationintovitalstructures
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StageDepositsbeyondstageIII(e.g.,lung,liver,bone,brain)
IV
StageV Bilateralrenalinvolvementatdiagnosis.
Treatment-
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1.Fortumourconfinedtorenalcapsule-RadicalnephrectomyfollowedbychemotherapywithantinomycinD
andVincristine
2.Fortumourbeyondrenalcapsule
Nephrectomyfollowedbylocalradiotherapyandchemotherapy
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TheidealtimingofradiotherapyforWilmsTumouraftersurgeryiswithin10days.
3.BilateralWilm'stumour-
Radicalnephrectomyonlargersideoftumourandpartial
nephrectomyonsmallersideoftumour.
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46.A5-month-oldinfanthasmassive
hepatomegaly.Whichofthefollowing
condition(s)presentswithmassive
hepatomegaly
a)TypeIglycogenstoragedisorder
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b)Biliaryatresiac)Gaucher'sdisease
d)Biliarycirrhosis
e)Noneoftheabove
CorrectAnswer-A:D
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Ans.is'a'i.e.,TypeIglycogenstoragedisorder;'d'i.e.,Biliarycirrhosis
Causesofmassivehepatomegaly:
Chroniccongestivehepatomegalyeg..,
VSDwithheartfailure(chronic).
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Cardiomyopathywithcongestiveheartfailure.Constrictivepericarditis.
Chronicextrahepaticcholestasise.g.,congenitalbiliaryatresia.
Malaria,kala-azarforlongduration.
Glycogenstoragedisease
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CongenitalhepaticfibrosisAmoebicliverabscess.
Hepatomaorsecondarymalignantdeposits.
Cystsofliver.
Biliarycirrhosis.
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47.Syndrome(s)relatedtopaediatricbrain
tumors-
a)Tuberoussclerosis
b)Neurofibromatosis-2
c)Cokaynesyndrome
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d)Fanconisyndromee)Turcotsyndrome
CorrectAnswer-A:B:E
Ans.is'a'i.e.,Tuberoussclerosis'b'i.e.,Neurofibromatosis-
2;'e'i.e.,Turcotsyndrome
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FamilialSyndromesAssociatedwithPaediatricBrainTumors:NeurofibromatosistypeI
Neurofibromatosistype2
vonHippel-Lindausyndrome
Tuberoussclerosis
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BilateralretinoblastomaLi-Fraumenisyndrome
Cowdensyndrome
Turcotsyndrome
Gorlinsyndrome
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Nevoidbasalcellcarcinoma48.Commoncauseofdistalsmallintestinal
obstructionininfants/child:
a)Meconiumileus
b)Jejunalatresia
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c)Ilealatresiad)Meckel'sdiverticulum
e)Duodenalatresia
CorrectAnswer-A:B:C:D
Ans.a.Meconiumileu;sb.Jejunalatresia;c.Ilealatresia;d.
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Meckel'sdiverticulumTheprimaryetiologiesofcongenitalsmallbowelobstruction
involves:
Abnormalitiesinanatomicdevelopment(jejunoilealstenosis&
atresia)
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Mucussecretion(meconiumileus)Bowelwallinnervation(long-segmentHirschsprungdisease)
MeckeldiverticulumisthemostcommoncongenitalanomalyofGI
tract
49.Congenitalhyperbilirubinemiais/areseen
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in:a)Prematurity
b)Hypoalbuminaemicstate
c)Hepatitis
d)Sepsis
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e)PolycythemiaCorrectAnswer-A:C:D:E
Ans.a.Prematurity;c.Hepatitis;d.Sepsis;e.Polycythemia
Albuminlessthan3.0mg/dlisriskforhyperbilirubinemia
neurotoxicity
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Twoothergroupsofdisordersareassociatedwithhyperbilirubinemia:
(1)Unconjugatedhyperbilirubinemiaseenin,
Breastmilkjaundice
Bloodgroupincompatibility
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Lucey-DriscollsyndromeCongenitalhypothyroidism
Upperintestinalobstruction
Gilbertdisease
Crigler-Najjarsyndrome
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HereditaryspherocytosisNon-spherocytichemolyticanemia
Drug-inducedhyperbilirubinemia
(2)Conjugatedhyperbilirubinemiapresentin,
Dubin-Johnsonsyndrome
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Rotorsyndrome
Biliaryatresia
Neonatalhepatitis
50.ChildcanSwapsobjectfromonehandto
otherin:
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a)2-3monthb)5-6month
c)6-12Months
d)12-18Months
e)20-24Months
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CorrectAnswer-BAns.b.5-6month
Childcantransferobjectsfromonehandtootherby6-7month
Transferobjectshaniltohanilin5'5months
51.VitaminKdependentcoagulationfactor(s)
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inchildrenis/are:a)Factor2
b)Factor7
c)Factor8
d)Factor9
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e)Factorl0CorrectAnswer-A:D:E
Ans.a.Factor2;b.Factor7;d.Factor9;e.Factorl0
Vit.Kcarboxylatesglutamicacidsoftranslationproductsofvitamin
K-dependentproteins,toproduce?-carboxyglutamate
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FactorII,VII,IX&XareprocoagulantProenzymeswhereasproteinsC&Sareanticoagulantproenzymes
52.Whichofthefollowingcausesneonatal
jaundice:
a)Sicklecellanaemia
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b)?-Thalassemiac)Meningitis
d)G6PDdeficiency
e)Rhincompatibility
CorrectAnswer-B:D:E
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Ans.b.?-Thalassemia;d.G6PDdeficiency;e.Rhincompatibility
ETIOLOGY:
NonConjugated:Haemolytic:
Intrinsiccauses:
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MembraneconditionsSpherocytosis(50%)
Hereditaryelliptocytosis
Systemicconditions
Sepsis
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ArteriovenousmalformationEnzymeconditions
G6PDdeficiency
Pyruvatekinasedeficiency
Globinsynthesisdefect
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SicklecelldiseaseAlpha-thalassemia,e.g.HbHdisease
Extrinsiccauses:
Alloimmunity
Hemolyticdiseaseofthenewborn(ABO)
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RhdiseaseHemolyticdiseaseofthenewborn(anti-Kell)
Hemolyticdiseaseofthenewborn(anti-Rhc)
Otherbloodtypemismatches
Non-hemolyticcauses:
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BreastmilkjaundiceCephalohematoma
Polycythemia
Urinarytractinfection
Sepsis
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HypothyroidismGilbert'ssyndrome
Crigler-Najjarsyndrome
HighGIobstruction
Conjugated:Hepaticcauses:
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InfectionsSepsis
HepatitisA
HepatitisB
TORCHinfectionsverticallytransmittedinfections
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T?Toxoplasmosis/ToxoplasmagondiiO?Otherinfections
R?Rubella
C?Cytomegalovirus
H?Herpessimplexvirus-2orneonatalherpessimplex
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MetabolicGalactosemia
Alpha-1-antitrypsindeficiency
Cysticfibrosis
Dubin-JohnsonSyndrome
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RotorsyndromeDrugs
Totalparenteralnutrition
Idiopathic
Post-hepatic:
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Biliaryatresiaorbileductobstruction
Alagillesyndrome
Choledochalcyst
53.Whichofthefollowingmilestoneis
developedbychildb/w6to9month:
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a)Canpointsomethingwithindexfingerb)Swapsomeobjectfromonepalmtoanother
c)Canholdobjectwiththumb&indexfinger
d)Canvoluntarydropobject
e)Canextendarm
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CorrectAnswer-B:C:DAns.b.Swapsomeobjectfromonepalmtoanother;c.Can
holdobjectwiththumb&indexfinger;d.Canvoluntarydrop
object
6MONTH:
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GrossMotor:Sitsunsupported.
Putsfeetinmouthinsupineposition
Visual-Motor/Problem-Solving:
Unilateralreach.
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UsesrakinggraspLanguage:
Babbles
Social/Adoptive
Recognizesstrangers
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7MONTH:GrossMotor:
Creeps
Language:
Orientstobell((localizedindirectly)
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8MONTH:GrossMotor:
Comestosit.
Crawls
Visual-Motor/Problem-Solving:
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InspectsobjectsLanguage:
"Dada"indiscriminately
Social/Adoptive
Fingerfeeds
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9MONTH:GrossMotor:
Pivotswhensitting.
Pullstostand
Cruises
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Visual-Motor/Problem-Solving:Usespincergrasp
Probeswithforefinger
Holdsbottle,throwsobjects
Language:
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"Mama"indiscriminatelyGestures,wavesbye-bye
Inhibitsto"no"
Social/Adoptive
Startstoexploreenvironment
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Playsgesturegames(eg,pat-a-cake)54.Trueaboutosteumprimumdefect:
a)ItisfoundinASD
b)MorecommonlyassociatedwithASDthanVSD
c)MaybeassociatedwithDownsyndrome
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d)OsteumprimumASDismorecommonthanosteumsecondumASD
e)Alltheabove
CorrectAnswer-A:B:C
Ans.a.ItisfoundinASDb.Morecommonlyassociatedwith
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ASDthanVSDc.MaybeassociatedwithDownsyndromeThemostcommontypeofatrialseptaldefectistheostium
secundumtype.
ChildrenwithDownsyndrome,however,arefrequentlyafflicted
withtheostiumprimumtypeofatrialseptaldefects,whichmaybe
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accompaniedbytricuspidandmitralvalvemalformations.Morecomplexatrioventricularseptaldefectsmayalsooccurinthis
disorder.
Childrenexhibitingtheselesionsshouldbespecificallyevaluatedfor
chromosomalabnormalities.
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Clinically,thelesionsproduceleft-to-rightshuntswithlatecyanosis(aftertherightventriclehypertrophiesinresponsetodevelopinglung
diseasefromtheincreasedbloodflowinthepulmonarysystem).
NeithercysticfibrosisnorGaucherdiseaseisspecifically
associatedwithcardiovasculardefects.
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DissectingaorticaneurysmisassociatedwithMarfansyndrome.55.Vesico-uretericreflexiscommonly
diagnosedby:
a)Micturatingcystography
b)Radioisotoperenography
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c)IVUd)CTscan
e)All
CorrectAnswer-A:B
Ans.a.Micturatingcystography;b.Radioisotoperenography
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TherecommendedradiographicevaluationforVURincludesaVCUG,renal-bladderultrasonographyandnuclearrenalscan
(DMSA).
PerformVCUGandrenal-bladderultrasonographyinanychildwith
documentedUTIbeforeage5years,anychildwithpyelonephritis,
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andanymalechildwithasymptomaticUTI.Arenal-bladderultrasonographymaybeusedtoscreenolder
childrenwithUTI.Ifultrasonographicfindingsareabnormal,conduct
furtherworkupstudieswithVCUGtoruleoutVUR.
Duringtheinitialworkupinapatientwithsuspectedreflux,perform
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thestandardVCUG,whichprovidesclearanatomicdetailandallowsaccurategradingoftherefluxdegree.Byfillingandemptyingthe
bladderseveraltimes(cycling)withthecatheterstillinthebladder,
asdescribedbyLebowitz,theyieldofidentifyingVURisclearly
enhanced.
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Theconventionalcystographyprovidesmoreanatomicalaccuracythannuclearcystography;however,nuclearcystographyis
advantageous(usedwidelytomonitorVUR)becauseoflower
radiationexposureandincreasedsensitivity.
56.TrueaboutTannerstageII:
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a)Penisincreasesinlengthb)Penisincreasesinwidth
c)Scantyhairatbaseofpenis
d)Darkeningofscrotum
e)Moregrowthoccurinboysthangirls
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CorrectAnswer-A:CAns.a.Penisincreasesinlength;c.Scantyhairatbaseof
penis
DEVELOPMENT:
Genitals(male):
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IllustrationoftheTannerscaleformales.
TannerI
testicularvolumelessthan1.5ml;smallpenis(prepubertal;typically
agenineandyounger)
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TannerIItesticularvolumebetween1.6and6ml;skinonscrotumthins,
reddensandenlarges;penislengthunchanged(9?11)
TannerIII
testicularvolumebetween6and12ml;scrotumenlargesfurther;
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penisbeginstolengthen(11?12.5)TannerIV
testicularvolumebetween12and20ml;scrotumenlargesfurther
anddarkens;penisincreasesinlength(12.5?14)
TannerV
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testicularvolumegreaterthan20ml;adultscrotumandpenis(14+)Pubichair(bothmaleandfemale)
TannerI
nopubichairatall(prepubertal)(typicallyage10andyounger)
TannerII
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smallamountoflong,downyhairwithslightpigmentationatthebaseofthepenisandscrotum(males)oronthelabia
majora(females)(10?11.5)
TannerIII
hairbecomesmorecoarseandcurly,andbeginstoextendlaterally
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(11.5?13)TannerIV
adult-likehairquality,extendingacrosspubisbutsparingmedial
thighs(13?15)
TannerV
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hairextendstomedialsurfaceofthethighs(15+57.Pretermbabieshaveincreasedchance
of:
a)Heartdisease
b)Respiratorydistresssyndrome
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c)Necrotisingcolitisd)Meconiumaspirationsyndrome
e)All
CorrectAnswer-A:B:C
Ans.a.Heartdisease;b.Respiratorydistresssyndrome;c.
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NecrotisingcolitisPretermNeonate:
Respiratorysyndrome:Pulmonryoedema,Intra-alveolar
haemorrhage,Idiopathicrespiratorydistresssyndrome&
Bronchopulmonarydysplasia
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Infection:Bronchopneumonia,meningitis&necrotizingenterocolitis.Metabolic(hypoglycemia,hypocalcemia)
Retinopathyofprematurity
Asphxia
Cerebralhaemorrhage
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HypothermiaFetalshock
HeartfailurePrecipitatedbyasphyxiawithrapiddevelopmentof
pulmonaryedema.TheremaybepatentDuctusarteriosus
Jaundice
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Anaemia58.Whichofthefollowingcanpresentswith
cyanosisatbirth:
a)TetralogyofFallot
b)TGA
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c)PDAd)VSD
e)Atrialseptaldefect(ASD)
CorrectAnswer-A:B
Ans.a.TetralogyofFallot;b.TGA
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TOF:Cyanosismaybepresentfrombirthormakeitsappearancesomeyearsafterbirth.
TGA:PatientsofcompleteTGAwithintactventricularseptumare
cyanoticatbirth.
PDA,ASD&VSDareacyanoticcondition
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59.Whichofthefollowingis/aretrue
regardingdevelopmentofchildduring6
to12yr.ofage:
a)Weightincreasesbyl-2kg/yr
b)Headgrowattherateof2-3cm/yr
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c)Growthoccurcontinuouslyd)Growthoccurinspurts
e)Heightincreasesatrateof6-7cm/yr
CorrectAnswer-D:E
Ans.d.Growthoccurinspurts;e.Heightincreasesatrateof6-
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7cm/yrPhysicalDevelopmentDuringMiddleChildhood(6-11yrofage)
Growthduringtheperiodaverages3-3.5kg(7lb)and6-7cm(2.5
in)peryear.
Growthoccursdiscontinuously,in3-6irregularlytimedspurtseach
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year,witheachgrowthspurtlasting,onaverage,8wk.Theheadgrowsonly2-3cmincircumferencethroughouttheentire
period,reflectingaslowingofbraingrowth.
60.TrueaboutAspergersyndrome:
a)Morecommoningirl
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b)Repetitiveactivitypatternc)Subnormalintelligenceisconsistentfeature
d)Severelanguageimpairmentsischaracteristic
e)All
CorrectAnswer-B
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Ans.b.RepetitiveactivitypatternAspergersyndrome:
Itisfourtimesmorelikelytooccurinmalesthaninfemalesand
usuallyisfirstdiagnosedinchildrenbetweentheagesof2and6.
Thecommoncharacteristicsincludeaverageoraboveaverage
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intelligence"Thereisnoclinicallysignificantgeneraldelayinspokenorreceptive
languageorcognitivedevelopment.Self'helpskills,adaptive
behaviour,andcuriosityabouttheenvironmentduringthefirst3
yearsshouldbeatalevelconsistentwithnormalintellectual
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development61.TrueaboutAutisticdisorder:
a)Qualitydecreaseinsocialinteraction
b)Allaffectedchildrenhavesubnormalintelligence
c)TreatmentshouldtargetedtowardSpeechdevelopment
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d)Seenonlyafter3yrofagee)Stereotypedpatternsofbehaviour
CorrectAnswer-A:C:E
Ans.a.Qualitydecreaseinsocialinteraction;c.Treatment
shouldtargetedtowardSpeechdevelopment;e.Stereotyped
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patternsofbehaviourAutisticdisordersarecharacterizedbythetriadofimpaired
socialinteraction,communicationandimagination.Theseare
associatedwithrigidrepetitivepatternofbehaviour.
Theonsetofautisticdisorderalwaysoccursbeforeage3,attwo
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peakperiods.Difficultyinconcentrationandcommunication,
Lesioninfrontalandtemporallobeandcerebellum,
Delayedspeechandlanguagedevelopment,
Problemsinformingsocialrelationshipsinearlychildhood,
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Stereotypedmovements,Poorspeech,
Lackofsocialinteraction,
62.TrueaboutHIVinfectionininfants:
a)Mainlyoccurthroughhorizontaltransmission
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b)HIVDNAPCRpositiveat3monthconfirmsdiagnosisc)PositiveantibodytestforIgGantibodyat3monthconfirm
infectedinfant
d)Passivetransferofmaternalbodygenerallypersistsfor12
month
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e)AllCorrectAnswer-B:D
Ans.b.HIVDNAPCRpositiveat3monthconfirmsdiagnosis;
d.Passivetransferofmaternalbodygenerallypersistsfor12
month
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AllinfantsborntoHIV-infectedmotherstoantibodypositiveatbirthbecauseofpassivetransferofmaternalHIVantibodyacrossthe
placentaduringgestation.
Mostuninfectedinfantslosematernalantibodybetween6and12
monthofageandareknownasseroreverters.
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BecauseasmallproportionofuninfectedinfantscontinuestotestHIVantibodypositiveforupto18monthofage,positiveIgG
antibodytests,includingtherapidtests,cannotbeusedtomakea
definitivediagnosisofHIVinfectionininfantsyoungerthanthisage.
Inanychild>18monthsofage,demonstrationofIgGantibodyto
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HIVbyarepeatedlyreactiveenzymeimmunoassay(EIA)andconfirmatorytest(immunoblotorimmunofluorescenceassay)
establishesthediagnosisofHIVinfection.
Viraldiagnosticassays,suchasHMNAorRNAPC&HIVculture,or
HIVp24antigenimmune-dissociatedp24
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By4-6monthsofage,theIIIVcultureand/orPCRidentifuall
infectedinfants.
63.Commonfeatureofmarfansyndrome&
Homocystinuria:
a)Armspan>Height
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b)Ectopialentisc)Hypermobilityofjoint
d)Mentalretardation
e)Arachnodactyly
CorrectAnswer-B:E
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Ans.b.Ectopialentis;e.ArachnodactylyArachnodactyly:Thisfeaturecanoccuronitsown,withno
underlyinghealthproblems.However,itcanalsobeassociatedwith
certainmedicalconditions.ExamplesincludesMarfansyndrome,
Ehlers-Danlossyndrome,Loeys-Dietzsyndromeand
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homocystinuria.