Download Neet PG Pediatrics MCQs Question Bank
Thesurfaceofthebrainisusuallypaleyellow.Oncutting,certainregionsarecharacteristicallystainedyellowbyunconjugatedbilirubinOvertneurologicsignshaveagraveprognosis;75%ormoreofsuchinfantsdie,and80%ofaffectedsurvivorshavebilateralchoreoathetosiswithinvoluntarymusclespasms.Mentalretardation,deafness,andspasticquadriplegiaarecommon.Infantsatriskshouldhavescreeninghearingtests.
2.Definitionofchildhoodisunderwhatage? a)8years b)10years c)12years d)16years CorrectAnswer-C12yearsREF:NelsonTextbookofPaediatrics17theditiondifferentpages Infancy 0-1yr Toddlerhood 1-3yr Earlychildhood(toddlerhoodandsome 1-4yr timeafterwards)MiddleChildhood(SchoolAge) 6-12yr Preschool 2-5yr Adolescence(onsetofpubertyto 12-20yr maturity)Adulthood(fullphysicalandintellectual 20-21yr maturity) onwards
3.Ababyhasstatedtogethisfirstmilkteeth.Hisageisapproximately: a)3months b)6months c)9months d)12months CorrectAnswer-BMostbabieshavetheirfirstprimary(milk)teetheruptatage6monthofageandfirstsecondaryteetheruptatage6years. Theteethintheupperjaweruptearlierthanthoseinthelowerjaw,exceptforlowercentralincisors.Thelowercentralincisorsappear,commonly,betweentheagesof5and8months.Theuppercentralincisorsappearamonthlaterandthelateralincisorsusuallywithinthenextthreemonths.Thefirstmolarteethappeararoundtheageof12-15months,precedingtheeruptionofcanineteethby6months,whichappearbetweentheageof18and21months.Thesecondmolarsareoutattheageof21to24months. Note:Permanentteetheruptionisinthefollowingorder:1stmolar-6years;centralandlateralincisors-6-8years;caninesandpremolars-9-12years;secondmolars-12years;thirdmolars-18yearsorlater. Ref:GhaiEssentialPediatricsbyOPGhai,6thedition,Page6;NelsonTextbookofPaediatrics17theditionpage18&37
4.Whichofthefollowingstatementistrueforphysiologicaljaundiceinneonate? a)Occursinthefirst6hoursofdelivery b)Neurologicalsequelaearecommon c)Besttreatedbyphototherapy d)Startson2nddayoflife CorrectAnswer-DMostneonatesdevelopvisiblejaundiceduetoelevationofunconjugatedbilirubinconcentrationduringtheirfirstweek.ThiscommonconditioniscalledPhysiologicaljaundice.Itlastsfor5daysinterminfants&7daysinpreterminfants.Itdoesnotrequireanytreatment&disappersspontaneously.Inpathologicaljaundiceclinicaljaundicewillappearinthefirst24hrsoflife.Ref:Nelson,18thEdition,Pages760-761;OPGhai,6thEdition,Pages170-171.
5.WhichofthefollowingisnotafeatureofJuvenileIdiopathicArthritis? a)Rheumatoidnodules b)Spikesofhighfever c)Uveitis d)Raynaud'sphenomenon CorrectAnswer-DRaynaud'sPhenomenonisnotmentionedinassociationwithJuvenileIdiopathicArthritis(JIA). Ref:CurrentDiagnosisandTreatmentinRheumatology,2ndEdition,Pages196-197;Nelson'sTextbookofPediatrics,18thEdition,Page1003;PrimeronTheRheumaticDiseasesByJohnH.Klippel,Page145
6.WhichoneofthefollowingstatementsisfalseaboutXanthogranulomatous pyelonephritisinchildren? a)Oftenaffectsthoseyoungerthan8yearsofage b)Itaffectsthekidneyfocallymorefrequentlythandiffusely c)Clinicalpresentationinchildrenissameasinadults d)Boysareaffectedmorefrequently CorrectAnswer-DItismostfrequentlyaffectedinfemalescomparedtomales.Itisanunusualformofchronicpyelonephritischaracterizedbygranulomatousabscessformation,severekidneydestruction,andaclinicalpicturethatmayresemblerenalcellcarcinomaandotherinflammatoryrenalparenchymaldiseases.Xanthogranulomatouspyelonephritisisaformofchronicpyelonephritischaracterisedbydestructionofrenalparenchymaandthepresenceofgranulomas,abscessesandcollectionoflipidladenfoamymacrophages(foamcells).Xanthogranulomatouspvelonephritisinchildren*Ageofpresentationrangesfrominfancyto16years.*FocalfirmbeingmorecommoninchildrenAppearhealthy.*Thosewhoaffecteddiffusely,presentwithnon-specificsymptomsofchronicinfection.i)Weightlossii)Feveriii)Lethargyiv)Failuretothrive
*Proteusisthemostcommoncausativeorganism.Ref:ByJamesPattison,DavidGoldsmith,BarrieHartley,FernandoC.FervenzaandJosephP.Grande(2004),Chapter6,"RenalInfectionsandStructuralAbnormalities",Inthebook,"AColourHandbookofRenalMedicine",UK,Page100.
7.Whichofthefollowingagentsismostcommonlyassociatedwithrecurrent meningitisduetoCSFleaks? a)Meningococci b)Pneumococci c)HemophilusInfluenza d)E.Coli CorrectAnswer-BIntracranialCSFleakscausebacterialmeningitis,about80%arecausedbyS.Pneumoniae.Othercausativeorganismsaremeningococcus,HemophilusspeciesandS.aurues.Ref:ClinicalPediatricNeurologyByRonaldB.David,Page217
8.Whichofthefollowingisamarkerforneuraltubedefects? a)Phosphatidylesterase b)Pseudocholinesterase c)Acetylcholinesterase d)Butyrylcholinesterase CorrectAnswer-CNeuraltubedefectsareassociatedwithhighlevelsofAcetylcholinesterase. Ref:GeneticdisordersandFetus,4thEdition,Page673;IanDonald'sPracticalObstetricProblemByRenuMisra,6thEdition,Page44*Inintraembryoniclife,neuraltubeisopenatbothendandfreelycommunicatewithamnioticcavity.Failureofclosureofneuraltuberesultsinpersistentofthiscommunication.Thisallowsexcretionoffollowingfetalsubstancesintoamnioticcavity?-Alpha-fetoprotein-Acetylcholinesterase*TheseserveasbiochemicalmarkersforNTDsforprenataldiagnosis.
9.Childdrawstriangleatwhatage? a)3years b)5years c)6years d)7years CorrectAnswer-BAns.is'b'i.e.,5yearsAgeMilestone12-24monthsTriestoscribblespontaneously2yearsDrawsaverticalorhorizontalline3yearsDrawsacircle4yearsDrawsacross(plussign)anddrawsarectangle5yearsDrawsatriangle
10.Achildisabletobuildblocksof5Cubes developmentalageis- a)12months b)15months c)18months d)24months CorrectAnswer-CAns.is'c'i.e.,18monthBang2cube-8monthTowerof2cubes-15month4cubes-18month6cubes-22month
11. Achildisabletosayshortsentencesof6 words- a)2years b)3years c)4years d)5years CorrectAnswer-CAns.is'c'i.e.,4yearso2wordsentences=19montho6wordsentences=48montho10wordsentences=60month
12.Delayeddentitionisseeninall/except? a)Downsyndrome b)Congenitalhypothyroidism c)Rickets d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveCausesofdelayintootheruption:1)Impactedteeth4)Conghypothyroidsm2)Downsyndrome5)GaucherCleidocranialdysplasia6)Osteopetrosis
13.WhenICFandECFofchildbecomes equaltoadultperson- a)1year b)2year c)3year d)4year CorrectAnswer-AAns.is'a'i.e.,1yearoInfetus,ECFismuchlargerthanICF.oBytheageof1year,ratioofICFtotheECFvolumeapproachesadultlevel.
14.Uppersegmenttolowersegmentratioin3 yragechildis- a)12 b)1.3 c)1.4 d)1.6 CorrectAnswer-BAns.is'b'i.e.,1.3oThelowersegmentextendsfromthesymphysispubistotheheels.oThelowersegmentgrowsrapidlyafterbirthascomparedtouppersegmentgivingrisetothegradualreductionintheuppersegment/lowersegmentratiowiththeprogressionofage.AgeUppersegment:LowersegmentratioAtbirth1.7:1.03years1.3-1.0At7years1.0:1.0Thereafter1.0:1.1
15.Anewbornbabyhasahead circumferenceof35ems.atbirth,Hisoptimalheadcircumferencewillbe43emsat- a)4monthsofage b)6monthsofage c)8monthsofage d)12monthsofage CorrectAnswer-BAns.is'b'i.e.,6monthsofageoAt6monthofageheadcircumferenceisbetween40.0-43.5cm.
16.Vocabularyof1.5yearoldchildis- a)1-10words b)10-20words c)20-30words d)30-40words CorrectAnswer-BAns.is'b'i.e.,10-20wordsAt18months,thechildcanuse10wordswithmeaning.Othermilestonesaskedinthequestionareachievedinchildrenolderthan18months:?Makingatowerof9cubes-30monthsTurnpagesofbookoneatatime-2yearsRidetricycle-3years
17.Allofthefollowingareessentialfeatures ofattentiondeficithyperactivedisease(ADHD)except- a)Lackofconcentration b)Impulsivity c)Mentalretardation d)Hyperactivity CorrectAnswer-CAns.is'c'i.e.,MentalRetardationInattentiveThismustincludeatleast6ofthefollowingsymptomsofinattentionthatmusthavepersistedforatleast6monthstoadegreethatismaladaptiveandinconsistentwithdevelopmentallevel:Oftenfailstogivecloseattentiontodetailsormakescarelessmistakesinschoolwork,work,orotheractivitiesOftenhasdifficultysustainingattentionintasksorplayactivitiesOftendoesnotseemtolistentowhatisbeingsaidOftendoesnotfollowthroughoninstructionsandfailstofinishschoolwork,chores,ordutiesintheworkplace(notduetooppositionalbehaviororfailuretounderstandinstructions)OftenhasdifficultiesorganizingtasksandactivitiesOftenavoidsorstronglydislikestasks(suchasschoolworkorhomework)thatrequiresustainedmentaleffortOftenlosesthingsnecessaryfortasksoractivities(schoolassignments,pencils,books,tools,ortoys)Ofteniseasilydistractedbyextraneousstimuli
OftenforgetfulindailyactivitiesHyperactivity/impulsivityThismustincludeatleast6ofthefollowingsymptomsofhyperactivity-impulsivitythatmusthavepersistedforatleast6monthstoadegreethatismaladaptiveandinconsistentwithdevelopmentallevel:Fidgetingwithortappinghandsorfeet,squirminginseatLeavingseatinclassroomorinothersituationsinwhichremainingseatedisexpectedRunningaboutorclimbingexcessivelyinsituationswherethisbehaviorisinappropriate(inadolescentsoradults,thismaybelimitedtosubjectivefeelingsofrestlessness)DifficultyplayingorengaginginleisureactivitiesquietlyUnabletobeoruncomfortablebeingstillforextendedperiodsoftime(maybeexperiencedbyothersas"onthego"ordifficulttokeepupwith)ExcessivetalkingBlurtingoutanswerstoquestionsbeforethequestionshavebeencompletedDifficultywaitinginlinesorawaitingturningamesorgroupsituationsInterruptingorintrudingonothers(foradolescentsandadults,mayintrudeintoortakeoverwhatothersaredoing)OtherOnsetisnolaterthanage12yearsSymptomsmustbepresentin2ormoresituations,suchasschool,work,orhomeThedisturbancecausesclinicallysignificantdistressorimpairmentinsocial,academic,oroccupationalfunctioningDisorderdoesnotoccurexclusivelyduringthecourseofschizophreniaorotherpsychoticdisorderandisnotbetteraccountedforbymood,anxiety,dissociative,personalitydisorderorsubstanceintoxicationorwithdrawal
18.DrugsusedinADHDare- a)Atomoxetine b)Methylphenidate c)Dextro-amphetamine d)All CorrectAnswer-DAns.is'a'i.e.,Atomoxetine;'b'i.e.,Methylphenidate;'c'i.e.,Dextro-amphetamineSomecommonstimulantsusedtotreatADHDinclude:Adderall(amphetamine)Ritalin(methylphenidate)Concerta(methylphenidate)Focalin(dexmethylphenidate)Daytrana(methylphenidatepatch)MetadateorMethylin(methylphenidate)DexedrineorDextrostat(dextroamphetamine)Vyvanse(lisdexamfetaminedimesylate)
19.A3yearoldboywithnormal developmentalmilestoneswithdelayedspeechanddifficultyincommunicationandconcentration.Heisnotmakingfriends.Mostprobablediagnosisis? a)Autism b)ADHD c)Mentalretardation d)Specificlearningdisability CorrectAnswer-AAns.is'A'i.e.,AutismDelayedspeech,difficultyincommunicationandconcentrationina3yearoldchildsuggeststhediagnosisofautism.Autismischaracterizedbyimpairedsocialinteractionandcommunication,andbyrestrictedandrepetitivebehavior.Thesesignsallbeginbeforeachildisthreeyearsold.AutismaffectsinformationprocessinginthebrainbyalteringhownervecellsandtheirsynapsesconnectandorganizeItisoneofthreerecognizeddisordersintheautismspectrum,theothertwobeingAspergersyndrome,whichlacksdelaysincognitivedevelopmentandlanguage,andpervasivedevelopmentalDisorder-nototherwisespecified(commonlyabbreviatedasPDD-NOS)
20.Thefollowingarecharacteristicofautism except- a)Onsetafter6yearsofage b)Repetitivebehaviour c)Delayedlanguagedevelopment d)Severedeficitinsocialinteraction CorrectAnswer-AAns.is'a'i.e.,Onsetafter6yearsofageAutismAutismisaneurologicdisrodercharacterizedby? 1. Qualitativeimpairmentinsocialinteraction2. Qualitativeimpairmentincommunication.3. Restrictedrepetitiveandstreotypedpatternsofbehaviour,interests, andactivities.Onsetofsymptomsisusuallybefore3yearsofage.3-5timesmorecommoninboys,butmoreseverewhenoccursingirls.Morecommonamonglowsocio-economicgroups.
21.5yearoldchildbedwettingRxofchoice? a)Notreatment b)Imipramin c)Desmopressin d)Motivationaltherapy CorrectAnswer-AAns.is'a'i.e.,NotreatmentoNotreatmentisgiventochildrenbelow6yearsofagebecauseofhighspontaneouscurerate.oAfter6yearstreatmentinclude.t)Behavioraltherapy:Thisisthetreatmentofchoice.it)Pharmacologicaltreatment:Itisusedwhennon-pharmacological(behavioral)therapyfails.Desmopressinisthedrugofchoice.Otherdrugsusedareimpramineandoxybutinin.
22.Whatisthelarche- a)Pubertalbreastenlargementinboys b)Breastenlargementinpregnancy c)Hormonerelatedbreastenlargementingirls d)Posthormonaltherapybreastenlargementinpostmenopausal females CorrectAnswer-CAns.is'c'i.e.,HormonerelatedbreastenlargementingirlsThelarcheoDefinition:-Beginingofsecondary(Postnatal)breastdevelopmentatonsetofpubertyingirls.Tannerstage2breastdevelopmentUsuallyafter8yearsofageBecauseofrisinglevelofestradiolBreastdevelopmentduringpubertyinmaletermedasgynaecomastianotthelarche.
23.Seleniumdeficiencyisseenin- a)Keshandisease b)Wilsondisease c)Acrodermatitisenteropathica d)Noneofabove CorrectAnswer-AAns.is'a'i.e.,KeshandiseaseoKeshandisease--->DisorderofSemetabolismoWilson'sdisease--->DisorderofCumetabolismoAcrodermatitisenteropathica-->DisorderofZnmetabolism
24.Diarrhoeainachildof12month,doseof Zincis? a)1mg/10-14day b)10mg/10-14day c)15mg/10-14day d)20mg/10-14day CorrectAnswer-DAns.is'd'i.e.,20mg/10-14daysAccordingtoWHOguidlinesDoseofZinc2month-6month=10mg/dayx14days>6months=20mg/dayx14days
25.Phrynodermaisdueto...deficiency- a)VitaminD b)Niacin c)VitaminA d)Essentialfattyacid CorrectAnswer-DAns.is'd'i.e.,EssentialfattyacidInvitamin'A'deficiencythereistoadlikeskinalsoknownasphrynoderma.oButthisisduetoassociateddeficiencyofessentialfattyacids.
26.Allofthefollowingarefeaturesof prematurityinaneonate,except- a)Nocreasesonsole b)Abundantlanugo c)Thickearcartilage d)Emptyscrotum CorrectAnswer-CAns.is'c'i.e.,ThickearcartilageTheearsinaprematureneonatearesoftandflatwithearcartilagebeingdeficientandpliant(andnotthick)FeaturesofprematurityinaNeonate:oBabyissmallinsizeusuallylessthan47cmlong.oHeadisrelativelylarge,suturesarewidelyseparatedandfontanellearelargeoFaceissmallandbuccalpadoffatisminimalSkinisthinandpinkishandappearsshinyduetogeneralizededema.Skiniscoveredwithabundantlanugoandthereislittlevernixcaseosa.SubcutaneousfatisreducedoThebreastnoduleislessthan5mmwideoTheearsaresoftandflatwithearcartilagebeingdeficientandpliantoTestesarenotdescendedintoscrotalsac.(Emptyscrotum)Scrotalsacispoorlypigmentedandhaslessrugosities.oInfemaleslabiamajoraappearswidelyseparated,exposingthelabiaminoraandtheclitoris.oDeepcreasesarenotwelldevelopedinthesole.
(Theremaybeasingledeepcreaseovertheanterioronethirdofthesole)oNeonatalreflexessuchasMoro,Suckling&Swallowingaresluggish.oThereishypotoniawithapoorrecoilofflexedforearmwhenextended.
27.Ababyisbornat27weeksofgestation requiredmechanicalventilationfornext4weeks&02fornext1week.Hemaintainedatroomtemperaturesubsequently.AspernewBronchopulmonarydysplasiadefinition,hehaswhichofthefollowing? a)MildBPD b)ModerateBPD c)SevereBPD d)NoBPD CorrectAnswer-AMildSupplementO2(for28days)and<32weeksGABreathingroomairat36weeksatbirthcorrectedGAoratdischarge(whichevercomesfirst)..32weeksGABreathingroomairby56daysatbirthpostnatalageoratdischarge(whichevercomesfirst).?Thebabyinquestionfallsincategory<32weeksgestationageatbirth.?Simplylookingatquestion,answerseemstobeseverBPDasmechanicalventilation(positivepressureventilation)hasincludedonlyindiagnosticcriteriaofseverBPD.?But,Thisbabywasbornat27weeksofgestationandrequiredmechanicalventilationfor4moreweeks,i.e.upto31weekscorrectedgestationalage.Afterthathemaintainedatroomair.Thus,at36weekscorrectedgestaionalage,babyisbreathingat
Thus,at36weekscorrectedgestaionalage,babyisbreathingatroomair-->diagnosticcriteriaofmildBPD.
28.Whichofthefollowingistheprincipal modeofheatexchangeinaninfantincubator? a)Radiation b)Evaporation c)Convection d)Conduction CorrectAnswer-CAns.is'c'i.e.,Convection"Convectionwarmedincubatorsarebeingroutinelyusedforthermalregulationoftheprematureneonate'sambientair"-Ghai6'/e154
29.Doseofi.v.adrenalineinterminfantis duringneonatalresuscitation- a)0.1-0.3ml/kgin1:1000 b)0.3-0.5ml/kgin1:1000 c)0.1-0.3ml/kgin1:10,000 d)0.3-0.5ml/kgin1:10,000 CorrectAnswer-CAns.isci.e.,0.1-0.3mUkgin1:10,000Doseoradrenlaine?0.1ml/kgto0.3inlikgdiluted(1:I0,000)Routs:(1)Intravenous(umbilicalvein)or(2)EndotrachealIndication?HR<60/minafter30sec.ofpositivepressureventilation&chestcompression
30.Causesofconjugatedhyperbilirubinemia is? a)Rotorsyndrome b)Breastmilkjaundice c)Criglernajjar d)Gilbertsyndrome CorrectAnswer-AAns.is'a'i.e.,RotorsyndromeConjugatedhyperbilirubinemiaisseenwhen?i)Impairedsecretionofconjugatedbilirubinintobile->DubinJohnsonsyndrome,Rotorsyndrome.ii)Impairedbileflow-->Obstructivejaundice,primarybiliarycirrhosis,Neonatalcholestasis,e.g.Extrahepaticbiliaryatresia/neonateidiopathichepatitis,Choledocalcyst,Sclerosingcholangitis,Carolidisease,Metabolic(Tyrosinemia,Wolmandisease,Niemanpickdisease,Galactosemia,Fructosemia).
31.Maximumconcentrationofdextrosethat canbegiventhroughperipheralvascularlineinneonate- a)5 b)10 c)12.5 d)25 CorrectAnswer-CAns.is'c'i.e.,12.5oHypoglycemiainneonatesisbloodsugar<40mg/dloCommoninpreteen,IUGR,infantofdiabeticmothersoTreatedbybreastfeed,formulafeed&I.V.dextrosesolutionInsymptomatichypoglycemia2ml/g10%DxIVbolusgiventhenincreasedextrosecontentsofintravenousfluid.Don'tgive>12.5%dextroseinfusionthroughperipherallinebecauseofriskofthrombophlebitis.(Prefercentralline)
32.HyperglycemiainNeonateifbloodsugar isabove? a)150mg/dl b)125mg/dl c)180mg/dl d)100mg/dl CorrectAnswer-BAns.is'b'i.e.,125mg/dloNoestablisheddefinitionofneonatalhyperglycemiaanduppersafelimitofbloodglucosehasbeendeterminedoVariousresearcheshassuggestedWholebloodglucose>125mg/dlPlasmaglucose>150mg/dl
33.HypoxicIschemicencephalopathytrueis ? a)Lowerlimbsaffectedmorethanupperlimbs b)Prox.Muscles>distalmuscles c)Seizure d)Trunkinvolved CorrectAnswer-CAns.is'c'i.e.,SeizureClinicalfeaturesofhvpoxicischemicencephalopath'oEncephalopathyprogressovertime?1)Birthto12hours-->Decreasedlevelofconciousness,poortone,decreasedspontaneousmovement,periodicbreathingorapnea,seizures.2)12-24hours-4Moreseizuers,Apneicspells,jitteriness,weakness.3)After24hours-->Hypotonia,conciousness,poorfeeding,brainstemsigns(oculomotor)andpupillarydisturbances.
34.Graspreflexdevelopsby- a)20weeks b)24weeks c)28weeks d)32weeks CorrectAnswer-CAns.is'c'i.e.,28weeksReflex-Ageofappearance32-Ageofdisappearance(afterbirth)
35.Whichofthefollowingisbestfor transportofthenewbornwithmaintainanceofwarmtemperature? a)KangarooMotherCare(KMC) b)Transportincubator c)Thermacolbox d)Hotbottle CorrectAnswer-AAnsis'a'i.e.,KangarooMotherCare(KMC)"PreferablymothershouldaccompanyandbabycanbetransportedinKMCposition.EvenfathercanprovideKMCduringtransportifmothercannotacompany."
36.Commonesttypeofcong.cyanoticheart diseaseis- a)ASD b)SD c)TOF d)PDA CorrectAnswer-CAns.is'c'i.e.,TOFTetralogyoffallotisthecommonestcyanoticcongenitalheartdisease.CyanoticCongenitialheartdiseasesoCyanoticCHDsareRighttoLeftshunts.oThesearefurtherdividedinto:?1)CyanoticCHDwithdecreasedpulmonarybloodflow.ThisgroupincludesTOF,Pulmonaryatresiawithintactseptum,tricuspidatresia,totalanomalouspulmonaryvenousreturnwithobstruction.Theselesionshavefollowingcomponents:-a)Obstructiontopulmonarybloodflowattricuspidrightventricularorpulmonaryvalvelevel.b)ApathwaybywhichsystemicvenousbloodentersthesystemiccirculationviaapatentforamenovaleorASDorVSD.Degreeofcyanosisdependsonthedegreeofobstructiontopulmonarybloodflow:-i)MildobstructionCyanosisisprecipitaedbystress,butmaybeabsentatrest.ii)SevereobstructionPulmonarybloodflowisdependentonpatencyoftheductusarteriosus.Whentheductuscloses(10-21days),theneonate
arteriosus.Whentheductuscloses(10-21days),theneonateexperienceprofoundhypoxemia,cyanosisandshock.2)CyanoticCHDwithincreasedpulmonarybloodflow.Thisgroupoflesionsisnotassociatedwithobstructiontopulmonarybloodflow.Cyanosiscausedbyanyofthefollowingmechanisms.i)Abnormalventricular-arterialconnection(e.g.,Transpositionofgreatvessels)Inthis,aortaarisesfromrtventricle,Sothatsystemicvenousbloodreturningtotherightatriumispumpeddirectlybacktothebody,andoxygenatedbloodreturningfromlungispumpedbackintothelungs.ii)Totalmixingofsystemicvenousandpulmonaryvenousblood(e.g.,totalanomalouspulmonaryvenousreturn,truncusarteriosus,acommonatriumorventricle)Deoxygenatedsystemicvenousbloodandoxygenatedpulmonaryvenousbloodmixcompletelyintheheartand,asaresult,oxygensaturationisequalinthepulmonaryarteryandaorta.Ifpulmonarybloodflowisnotobstructed,theseinfantshaveacombinationofCyanosisandheartfailure.InContrast,ifpulmonarystenosisispresent,theseinfantshavecyanosisalone.
37.ASDisassociatedwithallexcept? a)Infectiveendocarditis b)Stroke c)Arrhythemia d)Pulmonaryhypertension CorrectAnswer-AAns.is'a'i.e.,InfectiveendocarditisoASDisusuallysubtleandnothavingsignificantproblemexceptmildgrowthdisturbance.oOstiumsecundunASDisM.C.typeofASD.oOstiumsecundumASDusuallyassociatedwithmitralvalveprolopseorstenosis(Lutembacher'sSyndrome).oComplicationusuallydevelopin4thclecadeandinclude:I)Pulmonaryhypertension2)Rt.sidedheartfailure3)Stroke4)Eisenmenger'ssyndromeInfectiveendocarditisisveryrareinASDandnotrequireanyantibioticprophylaxis.
38.Thefollowingfeaturesaretruefor tetralogyofFallot,except- a)Ventricularseptaldefect b)Rightventricularhypertrophy c)Atrialseptaldefect d)Pulmonarystenosis CorrectAnswer-CAns.is'c'i.e.,ASDTetralogyofFallot*Theclassicalexampleofcyanoticpatientswithpulmonicstenosisistetralogyoffallot.*TOFisthecommonestcongenitalheartdisease.*ConstituentsofTOFVentricularseptaldefectOverridingordextroposedaortaPulmonicstenosisRightventricularhypertrophy.
39.Allofthefollowingarecharacteristic featuresofTricuspidAtresiaexcept- a)LeftAxisdeviation b)Rightventricularhypoplasia c)Pulmonaryvascularityisdiminished d)SplittingofS2 CorrectAnswer-DAns.is'd'i.e.,SplitingofS2Atresiaofthetricuspidvalveresultsintheabsenceofacommunicationbetweentherightatriumandrightventriclethereforetherightventricleisunderdevelopedtheinflowportionbeingabsent.TheonlyexitforsystemicvenousbloodcomingtotherightatriumisbywayofAtrialSepta!defect.Throughthisthebloodgoestoleftatriumfromwhereitentersleftventricle.Aventricularseptaldefectprovidescommunicationbetweentheleftventricleandtheoutflowportionoftherightventricle.TheleftventriclethereforemaintainboththesystemicaswellasthepulmonarycirculationthusthereishypertrophyoftheleftventriclewhichisreflectedbyleftaxisdeviationinECG.Thepulmonarybloodflowisdependentonthesizeoftheventriculardefect,thesmallertheVSD,thelesserthepulmonarybloodflow.90%patientsofTriscuspidAtresiahavediminishedpulmonarybloodflow.oAuscultatoryfindingincaseofTricuspidAtresiaS1-NormalS2-SingleMurmurgradeIItogradeIII/VI
40.TrueaboutEbsteinanomalyis? a)Rightventriculardilatation b)Rightatrialdilatation c)Leftventriculardilatation d)Leftatrialdilatation CorrectAnswer-BAns.is'b'i.e.,RightatrialdilatationEbstein'sanomalyEbsteinanomalyconsistsofdownwarddisplacementofanabnormaltricuspidvalveintotherightventricle.oNormallytricuspidvalvehasthreeleafletsAnterior,posteriorandseptal.Fixedendoftheseleafletsisattachedtovalveringintricuspidarea.InEbsteinanomaly,anteriorleafletisattachedtovalveringasnormal,buttheothertwoleaflets(posteriorandseptal)aredisplaceddownwardandareattachedtothewallofleftventricle.Theportionofrightventricleabovehetricuspidvalvebecomesapartofrightatrium--?atrializedrightventricle.HemodynamicsThetricuspidvalveanomalyresultsinobstructionofbloodflowaswellasregurgitationofbloodfromtherightventricleintotherightatriumDilatationandhypertrophyofrightatriumduetovolumeoverload.BloodflowsrightatriumtoleftatriumthroughpatentforamenovaleorASDRighttoleftshuntandcyanosis.Clinicalmanifestations 1. CyanosisFatigue2. DyspneaonexertionParoxysmalattacksoftachycardiaSigns3. CyanosisandclubbingS.,widersplitbutvariable4. DominantVwaveonJVP.RightventricularS35. SystolicthrillattheleftsternalborderRightatrialS4.
SinormalSystolicmurmurduetoregurgitationattricuspidvalve.Delayeddiastolicmurmurduetoobstructionattricuspidvalveliketricuspidstenosis.Bothsystolicanddiastolicmurmurproducedatthetricuspidvalvehavescratchycharacterlikepericardialfrictionrib.
41.Steroidsaregiveninrheumaticfever whenthereis- a)Carditis b)Chorea c)Subcutaneousnodules d)All CorrectAnswer-AAns.is'a'i.e.,CarditisSuppressivetherapyofRFoIfpatienthascarditiswithCHF-->SteroidsIfpatientshascarditiswithoutCHF-->Steroidsoraspirin(steroidsarepreferred)Ifpatientdoesnothavecarditis-->AspirinThetotaldurationofsuppressivetherapyis12weeks.
42.Inwhichofthefollowingdifferential cyanosisfound? a)VSDwithreversalofshunt b)PDAwithreversalofshunt c)ASDwithreversalofshunt d)TetralogyofFallot CorrectAnswer-BAns.is'b'i.e.,PDAwithreversalofshuntDifferentialcyanosisoWhenoneextremityispinkandtheotherextremityiscyanotic,itisreferredtoasdifferentialcyanosis.
43.Inchild,foreignbodyinlung- a)Rigidbronchoscopy b)Chestx-ray c)Flexibleendoscopy d)Directlaryngoscopy CorrectAnswer-AAns.is'a'i.e.,RigidbronchoscopyoTreatmentofchoiceisremovalofforeignbodybyrigidbronchoscopewithappropriateantibiotics.
44.Inwhichdisease,symptomsimprovewith crying- a)Tetralogyoffallot b)Choanalatresia c)Bronchialasthma d)Allofabove CorrectAnswer-BAns.is'b'i.e.,ChoanalatresiaoBilateralchoanalatresiaisaveryseriouslife-threateningconditionbecausethebabyisunabletobreathdirectlyafterbirthasneonatesareobligatenasalbreathers.oInsomecases,thismaypresentascyanosiswhilethebabyisfeedingbecausetheoralairpassagesareblockedbythetongue.oThecyanosismayimprovewhenthebabycries,astheoralairwayisusedatthistime.oThesebabiesmayrequireairwayresuscitationsoonafterbirth.
45.3monthinfantswithabdominalpalpable mass&nonbiliousvomiting- a)Hypertrophicbiliarystenosis b)Hypertrophicpyloricstenosis c)Tracheoesophagealfistula d)Duodenalatresia CorrectAnswer-BAns.is'b'i.e.,HypertrophicpyloricstenosisHypertophicpyloricstenosisMostcommoncauseofnonbiliousvomitingisHypertrophicpyloricstenosis.Male>female.Vomitingstartswith3weekofage.Palpablemassisseeninepigastricregion.Visibleperistalsisisseensoonafterfeeding.ConfirmedbyUSGabdomen.Contraststudyshows:.Shouldersign.Doubletractsign.Treatmentsurgery=Ramstedtprocedure.
46.Hirschsprungdiseaseisconfirmedby? a)Rectalbiopsy b)Per/Rectalexamination c)Rectalmanometry d)X-rayabdomen CorrectAnswer-AAns.is'a'i.e.,RectalbiopsyoRectalsuctionbiopsyisprocedureofchoice.
47.Skipgranulomatouslesionsareseenin? a)Ulcerativecolitis b)Crohn'sdisease c)Whipple'sdisease d)Reiter'sdisease CorrectAnswer-BAns.is'b'i.e.,Crohn'sDiseaseFeaturesofCDIntheaffectedsegment,mesentricfatwrapsaroundthebowelsurface-->creepingfatoTheintestinalwallisrubberyandthick,asaconsequenceofedema,inflammation,fibrosis,andhypertrophyofthemuscularispropria-->lumenisalmostalwaysnarrowed-->stringsignonbariummeal.oAclassicfeatureofCDisthesharpdemarcationofdiseasedbowelsegmentsfromadjucentuninvolvedbowel.oWhenmultiplebowelsegmentsareinvolved,theinterveningbowelisnormal-->skiplesions.oThereareserpentinelinearulceralongtheaxisofbowel.Astheinterveningmucosatendstoberelativelyspared,themucosaacquiresacoarselytexturedCobblestoneappearance.oNarrowfissuresdevelopbetweenthefoldsofthemucosa.Fissurescanpenetratedeeplythroughthebowelwallandleadingtoboweladhesionsandserositis.oFurtherextensionoffissuresleadstofistulaorsinustractformation.oThereistransmuralinflammationaffectingalllayersofbowelwall.Sarcoidlikenoncaseatinggranulomasmaybepresentinalltissuelayers.oNeutrophilicinfiltrationintothecryptsresultsinformationofcrypt
oNeutrophilicinfiltrationintothecryptsresultsinformationofcryptabscess.oFibrosisofthesubmucosa,muscularispropria,andmucosaeventuallyleadstostrictureformation.ThereisanincreasedincidenceofcancerofGITinpatientswithlong-standingCD,buttheriskofcancerinCDisconsiderablylessthaninpatientswithchronicUC.
48.Mostcommoncauseofsevere hematemesisinachildis- a)Portalhypetension b)Pepticulcer c)Malloryweisssyndrome d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,Portalhypertension"Massivehematemesisinachildisalmostalwaysduetovaricealbleeding".Varicealbleedingisduetoportalhypertension.
49.Chronicconstipationinchildrenisseenin allA/E? a)Hirschspringdisease b)Jejunalpolyp c)Hypothyroidism d)Stricture CorrectAnswer-BAns.is'b'i.e.,JejunalpolypOrganiccausesofconstipationare:i)Intestinal:Hirschprungdisease,Anal/rectalstenosis,Analfissure,anteriorlydisplacedanalopening,strictures.ii)Drugs:Narcotics,vincristine,Psychotropics.iii)Metabolic/endocrine:Cysticfibrosis,hypothyroidism,Panhypopituitrismiv)Neuromuscular:Cerebralpalsy,Psychomotorretardation,spinalcordlesions,Myotonicdystophy,NeuropathyormyopathyofGITv)Othercauses:Lowfibrediet,Milkproteinallergy.
50."Potter'ssyndrome"isassociatedwith- a)Renalanomalies b)Severeoligohydramnio's c)Flattenednose d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheabovePottersyndromePottersyndromeischaracterizedby-i)Bilateralrenalagenesisii)Pulmonaryhypoplasiaiii)Potterfacies-->widelyseparatedeyeswithepicanthicfolds,lowsetears,broadcompressedflatnose,recedingchin.*Thisconditionisincompatiblewithlife,deathoccursshortlyafterbirthfrompulmonaryhypoplasia.*MaternalUSGdemonstrates-i)Oligohydramniosii)Nonvisulizationofbladderiii)Absentkidney
51.Nottrueaboutchronicpyelonephritisin children- a)AssociatedwithUretericreflux b)AssociatedwithIntrarenalreflux c)Associatedwithrenalscarring d)Malesaremoreaffectedthanfemale CorrectAnswer-DAns.is'd'i.e.,Malesaremoreaffectedthanfemaleo3basicformsofUTI-(1)Pyelonephritis(2)Cystitis(3)AsymptomaticbacteremiaChronicPyelonephritis:-Characterisedbyrenalinflammation&fibrostsinducedbyrecurrentorpersistentrenalinfection,vesicouretericrefluxorothercausesofUTI.Progressiverenalscarringwhichleadstoendstagerenaldiseaes.Inreflexnephropathy,Intrarenalreflexofinfectedurineinducesrenalinjurywhichhealsbyrenalscarring.Being-straight,short&wideurethra,recurrentUTIismorecommoninfemale,soCPNisalsotwiceascommonisfemalethanmale.
52.Drugofchoiceforinfantilespasmis? a)Vigabatrin b)Adrenocorticotropichormone(ACTH) c)Ethosuximide d)Carbamazepine CorrectAnswer-AAns.'a'i.e.,VigabatrinVigabatrin(drugofchoice),ACTH(2ndchoice)andcorticosteroidsareusedfortreatment.
53.Mostcommoncauseofneonatal meningitis- a)Staphylococcus b)E.coli c)H.influenze d)Pneumococcus CorrectAnswer-BAns.is'b'i.e.,E.coli"GroupBstreptococcusfollowedbyE.coliarethetwomostcommoncausesofneonatalmeningitis".Mostcommoncauseofneonatalmeningitis-->GroupBstreptococcus(Str.agalactiae)Secondmostcommoncauseofneonatalmeningitis--E.coli
54.Themostcommoncauseofmeningitisin childrenaged5yrsis- a)Hinflunzae b)N.meningitides c)Staphylococcus d)E.coli CorrectAnswer-BAns.is'b'i.e.,N.meningitidesCommonestcausesofmeningitisNeonatal-GroupBstreptococcusmostcommon,E.colisecondmostcommon.2monthsto3years?Pneumococci>Meningococci>H.influenzae3yearsto20yearsMeningococcus>20years?Pneumococci
55.WhichisMCgeneticcauseofmental retardation- a)Tuberoussclerosis b)Cri-du-chatsyndrome c)Fragile-x-syndrome d)Angel'ssyndrome CorrectAnswer-CAns.is'c'i.e.,Fragile-X-syndromeoDown'ssyndromeisthemostcommongeneticcauseofmentalretardation,andfragile-XissecondtoDown's.AlsoknowoMostcommoninheritedcauseofmentalretardationisfragile-X-syndrome(becausedown'ssyndromeiscongenitalcausebutnotinherited).
56.Decorticatechild-Flasestatementis? a)AcuteBraininjurys b)Susthalamic,CT&frontallobelesion c)Moredangerousthandecerebratelesion d)Flexionofarm&extensionoflowerlimb CorrectAnswer-CAns.is'c'i.e.,MoredangerousthandecerebratelesionDecorticalPostureoAlsoknownasflexorposturingorMummybabyoArmsflexed/bentoverchest,handfisted,legextended&rotatedinwardoDamagetoareaincerebralhemisphere,internalcapsule,thalamus&upperpartofbrain.oDecorticatepostureisominoussignofseverebraindamage.DecerebratepostureoAlsoknownasextensorposturingoExtensionofupperlimb&lowerlimb(ELBOWEXTENDED)oIndicatesbrainstemdamage(Belowlevelofrednucleus)oDecerebratepostureismoreominousthandecorticalposture
57.Whichoneofthefollowingisthemost commontumorassociatedwithtypeIneurofibromatosis? a)Opticnerveglioma b)Meningioma c)Acousticschwannoma d)Lowgradeastrocytoma CorrectAnswer-AAns.is'a'i.e.,OpticnervegliomaNeurofibromatosistypeI(Von-Recklinghewsendisease)oNF-1isdiagnosedwhenanytwoofthefollowingsevensignsarepresent.1.Sixormorecafe-au-laitmacules>5mminprepupertalindividuals>15mminpostpubertalindividualsCafe-au-faitspotsarethehallmarkofneurofibromatosisandarepresentinalmost100%ofthepatient.2.Axillaryoringuinalfreckling3.TwoormoreLischnodules.Lischnodulesarehamartomaslocatedwithintheiris.4.Twoormoreneurofibromaoroneplexiformneurofibroma.Typicallyinvolvetheskin,butmaybesituatedalongperipheralnervesandbloodvessels.Theyaresmall,rubberylesionswithaslightpurplishdiscolorationoftheoverlyingskin.5.Adistinctiveosseouslesion.Sphenoiddysplasiaorcorticalthinningoflongbones.6.Opticglioma
6.Opticglioma7.AfirstdegreerelativewithNF-1Otherfindingsare:-Pseudoarthrosisoftibia.ScoliosisisthemostcommonorthopaedicprobleminNF-1,butisnotspecificenoughtobeincludedasadiagnosticcriterian.Shortstature
58.Allofthefollowingarefeaturesofjuvenile CMLexcept- a)Thrombocytopenia b)FetalHbisincreased c)Philadelphiachromosomeispositive d)Lymphadenopathy CorrectAnswer-CAns.is'c'i.e.,PhiladelphiachromosomeispositiveJuvenileCMLismostlyseeninchildrenbelow2yearsofage.Philadelphiachromosomeisnegativeandleukocytecountislessthan100'000/mm3.FeaturesAdultCMLJuvenileCMLAge10-12years<2yearsBleedingmanifestationAbsentFrequentThrombocytopeniaUncommonFrequentRashAbsentFrequentLymphadenopathyRareFrequentSplenomegalyMarkedVariableWBCcountatdiagnosis>100'000<100'000WBCtype
GranulocyteMonocyteNormoblasticUnusualCommonHbFNormalIncreasedImmunoglobulinsNormalIncreasedMuramidaselevelsNormalIncreasedResponsetoBusulphanGoodPoorSurvival2.5-3years9months
59.Commonesttumoroffaceinchidrenis- a)Rhabdomyosarcoma b)Sq.cellcarcinoma c)Basalcellcarcinoma d)Mixedparotidtumor CorrectAnswer-AAns.is'a'i.e.,RhabdomyosarcomaRhabdomyosarcomaoThemostcommonsofttissuesarcomainchildrenisrhabdomyosarcoma.oThecommonsiteofinvolvementare:-oHead&Neck(25%)2"dmostcommonExtremitiesGenitourinary(22%)-->2ndmostcommonRetroperitoneum
60.Highestcurerateisof- a)Wilm'sTumor b)Retinoblastoma c)Rhabdomyosarcoma d)All CorrectAnswer-BAns.is'b'i.e.,RetinoblastomaTumor5yearssurvivalrateRetinoblastoma 97% Wilms tumor 88% Rhabdomyosarcoma61%
61.Mostcommonbenigntumoursduring infancyis- a)Lymphangioma b)Hemangioma c)Cystichygroma d)Lipoma CorrectAnswer-BAns.is'b'i.e.,HemangiomaoHemangiomas,themostcommonbenigntumorsofinfancy,occurin10%ofterminfants.
62.Malepseudohermaphroditismisseenin? a)5-areductasedeficiency b)21hydroxylasedeficiency c)17hydroxylasedeficiency d)aandc CorrectAnswer-DAns.is'a'i.e.,5-areductasedeficiency;'c'i.e.,17hydroxylasedeficiencyMalepseudohermaphroditismGenotypeisXYExternalgenitaliaarefemaleCausesofMalePseudohermaphroditismA.Defectintesticulardifferentiation 1. DeletionofshortannYchromosome3.Mixedgonadal dysgenesis(MGD). 2. XYpuregonadaldysgenesis.4.Dysgenetic malepseudohennaphroditism(DMP).B.Defectintesticularhormonesynthesis1.Leydigcellaplasia2.Inbornerroroftestosteronebiosynthesisi)17-alphahydroxyalsedeficiencyiv)3beta-hydroxysteroiddehydrogenasedeficiency.ii)17-20lyasedeficiencyv)20-22desmolasedeficiencyiii)17-ketosteroidreductasedeficiency.C.DefectinmullerianinhibitinghormoneactionD.Defectinandrogenaction 1. 5-alphareductasedeficiency4.Reifenstein
syndrome 2. Testicularfeminizationsyndrome5.Undertermined etiology 3. Incompletetesticularfeminizationsyndrome TruehermaphroditismBothovarianandtesticulartissuesarepresenteitherinthesame(ovotestis)oroppositegonads.
63.Gonadstotestesdifferentiation- a)SRYgene b)WNT-4gene c)DAX1gene d)None CorrectAnswer-AAns.is'a'i.e.,SRYgeneo46XXchromosomewithgeneticfactorsuchasDAX1andsignallingmoleculeWNT-4arenecessaryfordevelopmentofovary.oYchromosomecontainsSRYgenewhichdifferentiatesgonadstotestes.
64.Whatstimulatesthegonadsinmaleat8 weektosecrettestosterone- a)Inhibinfromcorpusluteum b)GnRHfromhypothalamusofbaby c)PlacentalHCG d)Allofabove CorrectAnswer-CAns.is'c'i.e.,PlacentalHCGDuringembryogenesis,Inmaleembryo,at6-7weekofgestatin,secretionoffirstanti-mullerianhormone(alsok/omullerianinhibitingsubstance)causesregressionofmullerianduct.Thenat8-12week,underinfluenceofPlacentalHCG,testesstartedproducingtestosterone.
65.Precociouspubertyisseenin- a)Hypothyroidism b)CNSirridation c)Mccune-Albrightsyndrome d)All CorrectAnswer-DAns.is'a'i.e.,Hypothyroidism;'b'i.e.,CNSirradiation;'c'i.e.,McCuneAlbrightsyndromePrecociouspubertyoPubertybeforetheageof8yearsingirlsor9yearsinboysisconsideredprecociouspuberty.oMenarchebeforetheageof10yearsingirlsisalsoconsideredasprecocious.oPrecociouspubertyisoftwotypes1.CentralortrueprecociouspubertyResultsfromexcessiveGnRH,gonadotropinsandtargetsexhormoneelaboratedbyprematureactivationofhypothlamicpituitary-gonadal(HPG)axis.2.Peripheralorpseudo-precociouspubertyDuetoincreasedsexsteroidsecretionfromeithertheadrenalglandorthegonads.ItisindependentofHPGaxisactivationCausesofPrecociouspubertyA.Centralprecociouspuberty1.Idiopathic:Sporadicorfamilial.2.Centralnervoussystemabnormalitiesi)CongenitalanomaliesofCNS:Hypothalamichamartoma,hydrocephalus,porencephaly,arachnoidcysts.ii)AcquiredlesionsofCNS:Inflammation,granuloma,trauma,
surgery,radiation,chemotherapy.iii)TumorsofCNS:Pinealtumors,opticglioma,ependymoma,camiopharyngioma.iv)HypothyroidismB.Peripheralprecociouspuberty:IsosexualGirls1.Ovariancauses:McCune-Albrightsyndrome,benignfollicularcysts,granulosa-thecacelltumors;Gonadoblastoma2.Adrenalcauses:Feminizingadrenalneoplasia3.ExogenousestrogenadministrationBoys1.Testis:Leydigcelltumor,adrenalresttumor,testotoxicosis.2.Adrenal:CAH(21or11-(3hydroxylasedeficiency),virilizingtumors.3.hCGsecretingtumors:Hepatoma,hepatoblastoma,choriocarcinoma,chorionepithelioma,teratoma,dysgerminoma.ExogenoustestosteroneC.Heterosexualprecocity1.Girls:VirilizationingirlsduetovirilizingCAH,ovarianoradrenalneoplasia,polycysticovariandisease.2.Boys:Feminizationduetoestogenproducingadrenaltumors,exogenousestrogen,marijuanasmoking.Note-Hypothyroidismusuallycausesdelayedpuberty,butjuvenilehypothyroidismsometimescancauseprecociouspuberty.
66.Featuresofhypothyroidismininfancy includethefollowingexcept- a)Prematureclosureofposteriorfontanelle b)Coarsefacies c)Umbilicalhernia d)Constipation CorrectAnswer-AAns.is'a'i.e.,PrematureclosureofposteriorfontanelleoThereisdelayedclosureofposteriorfontanelle.
67.ThesodiumcontentofReSoMal (rehydrationsolutionformalnourishedchildren)is- a)90mmol/L b)60mmol/L c)45mmoUL d)30mmol/L CorrectAnswer-CAns.is'c'i.e.,45mmol/L
68.Turnersyndromeismaximallyassociated with? a)Horseshoekidney b)Coarctationofaorta c)VSD d)ASD CorrectAnswer-BAns.is'b'i.e.,CoarctationofaortaAmongthegivenoptionsAorticcoarctationismostcommon.Turner'ssyndromeiscommonlyassociatedwithcongenitalheartdiseases.ThemostcommonanomalyassociatedisbicuspidAorticvalvesinonethirdtoonehalfofthepatients(50%).OthercongentialanomaliesassociatedwithTurner'ssyndrome-->Aorticcoarctation(30%),Aorticstenosis,Mitralvalveprolapse,Anomalouspulmonaryvenousdrainage.
69.Barrbodyisabsentinfemalehaving? a)46XXgenome b)45X0genome c)47XXX d)Allofabove CorrectAnswer-BAns.is'b'i.e.,45X0genomeBarrbody(Sex-chromatin)oItisadenselystaininginactivatedcondensed'X'chromosomethatispresentineachsomaticcellsoffemale.oItisfoundinthenucleus.oItisusedasatestofgeneticfemalenessitispossibletodeterminethegeneticsexofanindividualaccordingastowhetherthereisachromatinmasspresentontheinnersurfaceofthenuclearmembraneofcellswithrestingorintermitentnuclei.Rememberfollowingfactandthequestionwillseemveryeasy.Chromatidbody(Barrbodyorsexchromatin)isderivedfromoneofthetwoX-chromosomeswhichbecomesinactivated.ThenumerofBarrbodiesisthusonelessthanthenumberofX-chromosomes.Note-oBarrbodyisfoundinfemaleBut-oKleinefeltersyndromeismalewithBarrbody.oTurnersyndromeisfemalewithoutBarrbody.
70.Rubellacausesallexcept a)Microcephaly b)VSD c)Conductiondefect d)All CorrectAnswer-BAns.is'b'i.e.,VSDOrganofcorti:Sensorineuralhearingloss(Mostcommonclinicalfindingofcongenitalrubella).Heart:PDA(MostcommonCHDincongenitalrubella),PS,VSD,ASDTOF,pulmonaryarteryhypoplasia.Eye:Cataract,retinopathy,microphthalmia,myopia,glaucoma.CNS:Mentalretardation,spasticdiplegia,microcephaly,seizures,behavioraldisorders.Other:IDDM,thyroiddisorders,inguinalhernia,cryptorchidism,interstitialpneumonia.
71.Dengueshocksyndromeischaracterized bythefollowingexcept- a)Hepatomegaly b)Pleuraleffusion c)Thrombocytopenia d)Decreasedhaemoglobin CorrectAnswer-DAns.is'd'i.e.,DecreasedhemoglobinDenguehemorrhagicfeverFeverMinororMajorhemorrhgicmanifestationsHepatomegalyThrombocytopenia100,000/mm3HypoalbuminemiaObjectiveevidenceofincreasedcapillarypermeability(hematocrit20%.)Pleuraleffusion(bychestradiograph)[Nelson,17/e,p1093]CriteriaforDengueshocksyndromeItincludesthosefordenguehemorrhagicfeverplus,Hypotensionornarrowpulse.
72.Retinopathyofprematurityiscommonly predisposedby- a)Lessgestationage b)Lowbirthweight c)O2toxicity d)Carbohydrateexcess CorrectAnswer-AAns.is'a'i.e.,Lessgestationage
73.Headcontrol/neckholdingispossiblein aninfantby:September2012 a)1month b)2months c)3months d)6months CorrectAnswer-CAns.Ci.e.3monthsWhenachildistriedtopulltosit:-i)Headlag-->Ageislessthan4weeksii)Partialheadlag-->2-3monthsiii)Head(Neck)Control--->3months.iv)Liftingofheadup-->5months.
74.Nocturnalenuresismaybeconsidered normalupto:March2005 a)3years b)4years c)5years d)6years CorrectAnswer-DAns.D:6yearsNocturnalenuresisisnormalupto6yearswhileitsnormaluptotheageof4yearsfordaytime.
75.Acutemalnutritioninachildisclinically assessedby:September2005 a)Bodymassindex b)Weightforage c)Heightforage d)Weightforheight CorrectAnswer-DAns.D:WeightforheightAnindicatorknownasweight-for-heightisusedtodeterminewhetherachildisacutelymalnourishedornot.Thechild'sweightiscomparedtothe'normal'weightforthatheight.Basedonthisinformation,theWorldHealthOrganisation(WHO)hasdevelopedchartsknownasinternationalstandardsforexpectedgrowth.Ifachild'sweightfallswithintherangeconsiderednormalforhis/herheight,thechildisfoundtobewell-nourished.Iftheweightislessthantheinternationalstandards,thechildisconsideredacutelymalnourishedorwasted.WHOhascreatedcut-offpointstoindicatetheseverityofthemalnutrition.Ifachild'sweight-for-heightislessthan-2z-scores(orstandarddeviations)ofnormalchildren,s/heisconsideredtosufferfrommoderateacutemalnutritionorwasting.Ifthechild'sweight-for-heightislessthan-3z-scores(standarddeviations)ofnormalchildrens/hesuffersfromsevereacutemalnutritionandisconsideredtobeseverelywasted.Anothermeasurementusedtodetermineachild'snutritionalstatusisthemid-upperarmcircumference(MUAC)measurement.
isthemid-upperarmcircumference(MUAC)measurement.BecauseMUACmeasurementsrequireasimple,colour-codedmeasuringbandratherthanweighingscalesandheightboards,theyareoftenusedduringcrisissituations.Usefulforchildrenbetweensixmonthsandfiveyearsofage,aMUACmeasurementoflessthan12.5cmindicatesthatachildissufferingfrommoderateacutemalnutrition.IftheMUACmeasurementisunder11.0cm,however,theunder-fivechild'slifemaybeindangerasheorsheissufferingfromsevereacutemalnutrition.Althoughnoanthropometricmeasureisaperfectmarkerofacutemalnutrition,inthepast,therehasbeenatendencytoviewW/Hmeasuresasthegold-standardanthropometricmeasuretodiagnoseacutemalnutritioninemergencies.DiscrepanciesbetweenMUACandW/HhavethereforebeenexplainedbyMUACbeingapoorindicatorofnutritionalstatus.Athirdwayofdiagnosingacutemalnutritionisbytestingforthepresenceofoedema.Oedemaaffectsachild'sappearance,givinghimorherapuffy,swollenlookineitherlowerlimbsandfeetorface.Itcanbedetectedbysmallpitsorindentationsremaininginthechild'sloweranklesorfeet,afterpressinglightlywiththethumbs. Thepresenceofoedemainbothfeetandlowerlegsisalways consideredasignofsevereacutemalnutrition.
76.AllofthefollowingaretrueforTurners syndromeexcept:March2012 a)Heightismorethan145cm b)Webbingofneck c)Increasedcarryingangle d)Coarctationofaortamaybeseen CorrectAnswer-AAns:Ai.e.Heightismorethan145TurnersyndromeAdultstatureinTurnersyndromepatientsislessthan145cmAssociatedcongenitaldefectsarecommoninheart(coarctationofaorta)Lymphedema,Shortstature,Webbedneck,Lowposteriorhairline,Cubitusvalgus(increasedcarryingangle),Fingerdeformities,Short4thmetacarpal,45X0karyotypeDownsyndromeMCtrisomy,Brachycephalicskull,Hypotonia,Palpebralfissureslopesupwards,Markedepicanthicfolds,
Brushfield'sspots,Increasednuchalfoldthickness,Iliacindexlessthan60,Simiancrease(singlepalmarcrease),MCassociatedcardiaclesions:VSDDuodenalatresia,CML&transientmyeloproliferativedisordersareseenMaybeassociatedwithAlzheimer'sdementia,MCcauseofdownsyndrome:Maternalnon-disjunctionKlinefeltersyndrome47XXYMCcauseofhypergonadotrophichypogonadism,SubnormalintelligenceFragileXsyndromeLargeforehead,Largehead,Macro-orchidism,Moderatelytoseverelyretarded
77.ProphylacticdoseofvitaminKgivento newborninfantsatdeliveryis? a)1mg b)5mg c)10mg d)15mg CorrectAnswer-AAns.is'a'i.e.,1mgVitaminKDeficiencyinNewbornsThesymptomsofvitaminKdeficiencyareduetohemorrhageNewbornsareparticularlysusceptibletovitaminKdeficiencybecauseoflowfatstores,lowbreastmilklevelsofvitaminK,sterilityoftheinfantileintestinaltract,liverimmaturity,andpoorplacentaltransport.Intracranialbleeding,aswellasgastrointestinalandskinbleeding,canoccurinvitaminK-deficientinfants17daysafterbirth.Thus,vitaminK(1mgIM)isgivenprophylacticallyatthetimeofdelivery.
78.Catbitesinchildtreatment-falseis a)Cleaningthewoundthoroughly b)Puncturewoundmostcommon c)Mayrequirerabiesvaccination d)Allofabove CorrectAnswer-DAns.is`d'i.e.,AllofaboveThemostcommontypeofinjuryfromcatandratbitesisapuncturewound.CatbitesoftenpenetratetodeeptissueInfectionisthemostcommoncomplicationofanytypeofbiteinjuries.Treatmentincludescleansingofwound,debridement,woundculture,tetanusandantirabiesimmunization,andinitiationofantibiotics.Amoxicillin-clavulanateisanexcellentchoiceforempiricaloraltherapyforhumanandanimalbitewoundsbecauseofitsactivityagainstmostofthestrainsofbacteriathathavebeenisolatedfrominfectedbiteinjuries.
79.MostcommonGImalignancyofchildhood a)Adenocarcinoma b)Lymphoma c)Sarcoma d)carcinoid CorrectAnswer-BAns.is'b'i.e.,LymphomaOverallhemangiomaismostcommonTumorininfant.HemangiomaisusuallybenigninNature.Leukemiaismostcommonmalignancyinpediatricagegyp.2"'mostcommonisCNSTumor=Lymphomaisthemostcommonmalignancyofthegastrointestinaltractinchildren.About30%ofchildrenwithnon-Hodgkinlymphomapresentwithabdominaltumors.
80.Swallowingbreathingreflex-notseenin fetusfor? a)14weeks b)12weeks c)16weeks d)Appearinallaboveperiod CorrectAnswer-BAns.is'b'i.e.,12weeksBehaviouraldeveopmentinintrauterinelifeMusclecontractionsfirstappeararound8wk,soonfollowedbylateralflexionmovements.By13-14wk,breathingandswallowingmotionsappearandtactilestimulationelicitsgracefulmovements.oThegraspreflexappearsat17wkandiswelldevelopedby27wk.Eyeopeningoccursaround26wk.Duringthe3rdtrimester,fetusesrespondtoexternalstimuliwithheartrateelevationandbodymovements
81.Mostcommonsiteofextra-pulmonary TBinchildrenis? a)Abdominal b)Genitourinary c)Lymphnode d)Congenital CorrectAnswer-CAns.is'c'i.e.,LymphnodeMostcommonsiteofextrapulmonaryTBislymphnodeMostchildrenwhodeveloptuberculosisdiseaseexperiencepulmonarymanifestations25to35percentofchildrenhaveanextrapulmonarypresentation.Themostcommonextrapulmonaryformoftuberculosisislymphaticdiseaseaccountingforabouttwothirdsofcasesofextrapulmonarytuberculosis.thesecondmostcommonformismeningealdiseaseoccurringin13%ofpatients
82.CharacteristicsofSMR-2inboys? a)Appearanceofpubichair b)Appearanceofaxillaryhair c)Enlargementofscrotum d)Allofabove CorrectAnswer-CAns.is'c'i.e.,EnlargementofscrotumScanty&longpubichairappearatSMR-2.EnlargementofscrotumisthereatSMR-2.
83.Pedigreeanalysischart? a)Usedforgrowthmonitoring b)Toassesssideeffectduringchemotherapy c)Usedtoseegentictransmission d)Toassessdevelopmentaldelayininfant CorrectAnswer-CAns.is'c'i.e.,UsedtoseegenetictransmissionPedigreeProvidegraphicdepictionofafamilystructuremedicalhistory.Personprovidinginformationisformedasproband.Specialsymbolisusedforeachdesignation.Threegenerationpedigreeshouldbemade.Closertherelationshipofprobandtotheperson,greaterischangeofsharedgeneticcomponent.
84.21-Hydroxylasedeficiency-falseis? a)Mostcommoncauseofcongenitaladrenalhyperlasia b)Autosomalrecessive c)Femalpseudohermaphroditism d)Malepseudohermephroditism CorrectAnswer-DAns.is'd'i.e.,MalepseudohermephroditismCongenitaladrenalhvperplasia(CAH)GroupofARdisorderMCadrenaldisorderinchildhoodMostcommon21-hydroxylasedeficiency=Thereiselevatedlevelofpregenolone,17-OHpergeneloneDHEAanddecreaslevelofprogesterone,deoxycortisol,andestradiolso21hydroxylasedeficiencycausesfemalepseudohermaphroditism.
85.AMLbestprognosisisseenwith? a)Acutemyelomonocyticleukemia. b)Acutemonocyticleukemia. c)Acutepromyeloblasticlukemia(M.3). d)Erythroleukemia CorrectAnswer-CAns.is'c'i.e.,Acutepromyeloblasticleukemia(M.3)AcutepromycloblasticleukemiaAlsoknownasM-3Associatedwitht(15:17)DIC,chloromascommonVeryresponsinetoretinoicacidcombinedwithanthracylines.M.7(acutemegakaryocyticleukemia)mostlyseenindownsyndrome.French-American-British(FAB)ClassificationofAcuteMyelogenousLeukemia
86.IdealtimetostartIrontherapyina marasamicchildwithfeverandhemoglobin7gm%is a)Immedietly b)Atdischarge c)Whenfevergoesdown d)Atanytime CorrectAnswer-CAns.is'c'i.e.,WhenfevergoesdownIronat3mg/kg1dayshouldstartedwhenchildgainingweightoncestabilisationphaseisover.oThecoreoftheacceptedWHOmanagementprotocolis10stepsintwophases? 1. Stabilization2. Rehabilitation. These10essentialstepsarelistedbelow: 1. Treat/preventhypoglycemia;2. Treat/preventhypothermia;3. Treat/preventdehydration;4. Correctelectrolyteimbalance;5. Treat/preventinfection;6. Correctmicronutrientdeficiencies;7. StartcautiousfeedingwithF-75;8. Achievecatch-upgrowthbyfeedingF-100afterappetitereturns;9. Providesensorystimulationandemotionalsupport;and 10. Prepareforfollow-upafterrecovery F-75isthe"starter"formulausedduringinitialmanagementofmalnutrition,beginningassoonaspossibleandcontinuingfor2-7
daysuntilthechildisstabilized.Severelymalnourishedchildrencannottoleratenormalamountsofproteinandsodiumorhighamountsoffat.Theymaydieifgiventoomuchproteinorsodium.Theyalsoneedglucose,sotheymustbegivenadietthatislowinproteinandsodiumandhighincarbohydrate.F-75hasisspeciallymixedtomeetthechild'sneedswithoutoverwhelmingthebody'ssystemsintheinitialstageoftreatment.UseofF-75preventsdeaths.F-75contains75kcaland0.9gproteinper100ml.AssoonasthechildisstabilizedonF-75,F-100isusedasa"catch-up"formulatorebuildwastedtissues.F100containsmorecaloriesandprotein:100kcaland2.9gproteinper100ml.
87.Mostcommoncardiovascular abnormalityindownsyndromeis? a)VSD b)Endocardialcushiondefect c)TOF d)COA CorrectAnswer-BAns.is'b'i.e.,EndocardialcushiondefectAbout40%ofdownsyndromehaveCHD.EndocardialcushionAtrioventricularseptaldefectaccountfor40-60%ofcases.Otherfeatureindownsyndrome.Hypotonia,flatface,upwardandslantedpalpebralfissuresandepicanthicfolds,speckledirises(Brushfieldspot);varyingdegreesofmentalandgrowthretardation;dysplasiaofthepelvis,cardiacmalformations,andsimiancrease;short,broadhands,hypoplasiaofmiddlephalanxof5thfinger,duodenalatresia,andhigharchedpalate;5%ofpatientswithDownsyndromearetheresultofatranslocation-t(14q21q),t(15q21q),andt(13q21q)-inwhichthephenotypeisthesameastrisomy21.Otherfeature? 1. Duodenalatresia2. Annularpancreas3. Tracheoesophagealfistula4. Hirschsprungdisease5. Shortstature6. Shortsternum7. Brachycephaly
8. Delayedfontanelclosure9. Threefontanels 10. Frontalsinushypoplasia11. Peripheraljointlaxity12. Atlantoaxialinstability(C1-C2subluxation)13. Exaggeratedspacebetween14. Mottledskinininfancy15. Drycoarseskininadolescence1stand2ndtoes IncreasedRiskforDevelopmentof-Leukemia:AML,ALLMyelodysplasiaTransientlymphoproliferativesyndromeCeliacdiseaseHypothyroidismDiabetesmellitusObesityRefractiveerrorsStrabismusMitralvalveprolapseConductiveand/orObstructivesleepapneaEpilepsysensorineuralhearinglossADHDAlzheimerdiseaseConductoppositionaldisorders
88.Mostcommoncauseoflowerrespiratory tractinfectionin3yearoldchildis a)Klebsella b)H-influenza c)Streptococcalpneumonia d)Stapheaureus CorrectAnswer-CAns.is'c'i.e.,StreptococcalpneumoniaMostcommoncauseofpaediatricpneumoniaisrespiratorysyncytialvirus(RSV).Othervirusescausingpneumoniaareinfluenzavirus(2^dmostcommonvirus),adenovirus,rhinovirus,andparainfluenzavirus.Mostcommonbacterialcauseofpediatricpneumoniaisstreptococuspneumoniae(pneumococcus).Bacteriacausingatypicalpneumoniacommonlyaremycoplasmaandchlamydia.
89.Non-obstructivehydrocephalus-trueis? a)Alsokincommunicatinghydrocephalus b)Duetoobliterationofsubarachrodcistemaeormalfunctionof arachnoidvilli c)Dilatationofall4ventricle d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveHhy_LQggPllalusisnotaspecificdisease;rather,itrepresentsadiversegroupofconditionsthatresultfromimpairedcirculationandabsorptionofCSFor,intherarecircumstance,fromincreasedproductionbyachoroidplexuspapillomaflyLk.QCSPLlalusresultingfromobstructionwithintheventricularsystemiscalledobstructiveornoncommunicatinghydrocephalusTheCSFcirculatesfromthebasalcisternsposteriorlythroughthecisternsystemandovertheconvexitiesofthecerebralhemispheres.CSFisabsorbedprimarilybythearachnoidvillithroughtightjunctionsoftheirendotheliumbythepressureforcesthatwerenotedearlier.CSFisabsorbedtoamuchlesserextentbythelymphaticchannelsdirectedtotheparanasalsinuses,alongnerverootsleeves,andbythechoroidplexusitself.Hydrocephalusresultingfromobliterationofthesubarachnoidcisternsormalfunctionofthearachnoidvilliiscallednonobstructiveorcommunicatinghydrocephalus
90.Praderwillisyndrome,chromosomal defect? a)Chromosome15 b)Chromosome5 c)Chromosome10 d)Chromosome21 CorrectAnswer-AAns.is'a'i.e.,Chromosome15Prader-Willisyndromeisacomplexgeneticconditionthataffectsmanypartsofthebody.Ininfancy,thisconditionischaracterizedbyweakmuscletone(hypotonia),feedingdifficulties,poorgrowth,anddelayeddevelopment.Beginninginchildhood,affectedindividualsdevelopaninsatiableappetite,whichleadstochronicovereating(hyperphagia)andobesity.SomepeoplewithPrader-Willisyndrome,particularlythosewithobesity,alsodeveloptype2diabetesmellitus(themostcommonformofdiabetes).PeoplewithPrader-Willisyndrometypicallyhavemildtomoderateintellectualimpairmentandlearningdisabilities.oBehavioralproblemsarecommon,includingtemperoutbursts,stubbornness,andcompulsivebehaviorsuchaspickingattheskin.Sleepabnormalitiescanalsooccur.Additionalfeaturesofthisconditionincludedistinctivefacialfeaturessuchasanarrowforehead,almond-shapedeyes,andatriangularmouth;shortstature;andsmallhandsandfeet.SomepeoplewithPrader-Willisyndromehaveunusuallyfairskinandlight-coloredhair.Bothaffectedmalesandaffectedfemaleshaveunderdeveloped
genitals.Pubertyisdelayedorincomplete,andmostaffectedindividualsareunabletohavechildren(infertile).
91.Minimumintervalbetween2livevaccine immunization? a)2weeks b)4weeks c)6week d)8weeks CorrectAnswer-BAns.is'b'i.e.,4weeksBasicprincipleofimmunizationMinimum4weekintervalrecommendedbetween2livevaccineadministrationexceptOPVandoraltyphoid.TwoormorekilledvaccinemaybeadministratedsimultaneouslyoratanygivenintervalAliveandkilledvaccinegivensimultaneouslybutatdifferentsite.Ifimmunisationstatusunknown,giveageappropriatevaccineMixingofvaccineinsamesyringenotrecommendedLivevaccineshouldbeavoidedinAIDS,
92.Fanconi'sanemia-falseis? a)Autosomalrecessive b)Pancytopenia c)TypeIRTA d)Allaretrue CorrectAnswer-CAns.is'c'i.e.,TypeIRTAFanconianemiaAutosomalrecessivePancytopeniaHyperpigmentationoftrunk,neck,andinlertriginousarea.GrowthfailureFanconifacies(smallhead,smalleyes)RenalabormalityProximalRTA(typeIIRTA)Renaltubularacidosis3typesDistalRTA(typeI)ProximalRTA(typeII)HyperkalemicRTA(typeIV)
93.Inmarasmuswastingisdueto? a)Prolongedieterydeficiencyofcalori b)Prolongedieterydeficiencyofprotein c)Excesscatabolismoffat&musclemasstoprovideenergy d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveMarasmusProlongedeficiencyofcalory&proteinduetostarvation.Monkeyfacies-lossofbuccalfat.Baggypantsappearance-looseskinofthebuttockshangingdown.Lossofaxillaryfat.Appetiteispreserved.Noedema.
94.AchildhavingH/0profusewatery diarrhoeanottakingoralyandnotpassedurinesince2days,whattobegiven a)Milk b)ORS c)I.V.fluid d)I.V.antibiotic CorrectAnswer-CAns.is'c'i.e.,I.V.fluidChildhavinghistoryofprofusewaterydiarrhoeawithpoororalintakeandnotpassedurinesince2daysissufferingfromdiarrhoeawithdehydrationandprobablyacuterenalfailureofprerenaltypes.HerebestchoiceisintravenousI.V.fluidIfI.V.accessnotpossible,thenyoucangivefeedthroughRyle'stubeorintraosseousfluid.
95.Febrileseizuremostcommon-age groups? a)1monthto1year b)6monthto5year c)6monthto2year d)2monthto5year CorrectAnswer-BAns.is'b'i.e.,6monthto5yearFebrileconvulsion:-CommonestprovokedseizureBetween6monthsto5yearNeurologicallynormalchildOccurswhentempriseabruptlySimplebenignfebrileconvulsionFitsoccurwithin24hourofonsetoffever.Durationlessthan10min.UsuallysingleperfebrileepisodeGeneralisedtypeofconvulsionAtypicalfebrileseizuresPresenceoffamilyhistoryofepilepsyNeurodevelopmentalretardationFocalneurologicaldeficit.
96.Erythroposisstartsinfetalliverduring? a)2-4weeks b)4-6weeks c)6-8weeks d)8-10weeks CorrectAnswer-CAns.is'c'i.e.,6-8weeksDevelopmentalhematopoiesisoccursinthreeanatomicstages:? 1. Mesoblastic2. Hepatic3. Myeloid Mesoblastichematopoiesisoccursinextraembryonicstructures,principallyintheyolksac,andbeginsbetweenthe10thand14thdaysofgestation.By6-8wkofgestationtheliverreplacestheyolksacastheprimarysiteofbloodcellproduction,andby10-12wkextraembryonichematopoiesishasessentiallyceased.Hepatichematopoiesisoccursintheliverthroughouttheremainderofgestation,althoughproductionbeginstodiminishduringthesecondtrimesterasbonemarrow(myeloid)hematopoiesisincreases.Theliverremainsthepredominanthematopoieticorganthroughwk20-24ofgestation
97.Fluidofchoiceinchildwithburn<24 houris a)Freshfrozenplasma b)Isolye-P c)Ringerlactate d)Platlettranfusion CorrectAnswer-CAns.is'c'i.e.,RingerlactateFluidresuscitationinburninjuryParklandformulaaa.Initial24hours:Ringer'slactated(RL)solution4ml/kg/%burnforadultsand3ml/kg/%burnforchildren.RLsolutionisaddedformaintenanceforchildren: a. 4ml/kg/hourforchildrenweighing0-10kgb. 40ml/hour+2ml/hourforchildrenweighing10-20kg c. 60ml/hour+1ml/kg/hourforchildrenweighing20kgorhigher Thisformularecommendsnocolloidintheinitial24hours.bNext24hours:Colloidsgivenas20-60%ofcalculatedplasmavolume.Nocrystalloids.Glucoseinwaterisaddedinamountsrequiredtomaintainaurinaryoutputof0.5-1ml/hourinadultsand1ml/hourinchildren.
98.Antiendomysialantibodyisusedin screeningof? a)Myastheniagravis b)Autoimmunehepatitis c)Coeliacdiseases d)Gravesdisease CorrectAnswer-AAns.is'a'i.e.,CoeliacdiseasesCoeliacdisea.se(CD)isapermanentintoleranceofthesmallintestinetogluten,characterizedbygluten-dependentchangesinvillousmorphologyand/orsignsofimmunologicalactivationdetectableinthelaminapropriaofintestinalmucosa.Thepresenceofserumanti-endomysialantibodies(EMA)isgenerallyconsideredtobehighlysuggestiveforCDbecauseoftheirhighvaluesofsensitivityandspecificity.OtherantibodiesusedfordiagnosisTissuetransglutaminase,AntigliadinantibodiesTreatmentisGluten-freediet
99.Incongenitaladrenalhyperplasia precociouspubertyinmaleisdueto? a)21alphahydroxylasedeficiency b)11(3hydroxylasedeficiency) c)Both d)None CorrectAnswer-CAns.is'c'i.e.,Both21hydroxylaseand3-13-HSD?Saltlosing?Virilizationoffemale(Femalepseudohermaphroditism)?Precociouspubertyinmale
100.Firstsignofpubertyinfemale? a)TannerstageI b)TannerstageII c)Pubichair d)Axillaryhair CorrectAnswer-BAns.is`b'i.e.,Tannerstage11Thelarche-firstsignofpubertyinGirlaroundageof10yearinGirlDefinition:-Beginingofsecondary(Postnatal)breastdevelopmentatonsetofpubertyingirls.Tannerstage2breastdevelopment.BecauseofrisinglevelofestradiolBreastdevelopmentduringpubertyinmaletermedasgynecomastianotthelarche.
101.Trueaboutbartter'ssyndromeareall except? a)Hyperkalemicalkalosis b)Presentsinneonatewithototoxicityhavebartingenemutation c)DecreasedK+assorptionfromthickdescendingloop d)Autosomalrecessive CorrectAnswer-AAns.is'a'i.e.,HyperkalemicalkalosisAntibodiesincoeliacdiseaseareanti-endomysian,antigliadinandanti-transglutaminase.
102.Drugusedincongenitalheartdiseaseto keepPDApatent a)PGEi b)PGE2 c)PGI2 d)Indomethacin CorrectAnswer-AAns.is'a'i.e.,PGE,ProstaglandinEl(PGE1)infusionusuallyeffectiveinkeepingtheductusarteriosusopenbeforesurgicalinterventiontoreducehypoxemiaandacidemiabeforesurgeryinductusdependentlesionlike.PulmonaryatresiaTOFwithseverePSTOFwithpulmonaryatresiaTranspositionofgreatarterieswithVSDandPSIndomethacinisusedforductalclosure
103.Figureof8inchestX-ray? a)SupracardiacTAPVC b)Tetralogyoffallot c)TGA d)Noneofabove CorrectAnswer-AAns.is'a'SupracardiacTAPVCTertralogyoffallot--*bootshapedheartTranspositionofgreatvessel-*eggonsideTPVC(supracardioe)-->snownanorfigureof8configuration
104.Falseregardingcroupis? a)Diseaseincludeepiglottis,laryngitis,laryngotrachictis b)Brassycoughismainpresentingfeature c)Causesupperairwayobstruction d)Allofabove CorrectAnswer-CAns.is'c'i.e.,CausesupperairwayobstructionCroupisvarietyofconditionwhichincludeacuteepiglottis,laryngitis,trachiobronchitis.Infectionoflowerrespiratorytract.Brassycoughmainpresentingfeature.TreatmentHumidifiedI.V.fluidAntibioticsNebulisationSteroid.
105.Mostcommonintraabdominalsolid organtumorinchildis? a)Neuroblastoma b)Rhabdomyoblastoma c)Wilm'stumor d)Hypernephroma CorrectAnswer-AAns.is'a'i.e.,NeuroblastomaMostcommonabdominalcancerofchildhood.Mostcommoncancerofinfancy.Mostcommonextracranialsolidtumorofchildhood(mostcommonsolidtumorofchildhoodisbraintumor).
106.Koplikspottrueis? a)Pathognomicofmeasls b)PresentonbuccalmucosaoppositeP'molar c)Alwayspresent d)Allofabove CorrectAnswer-AAns.is'a'i.e.,PathognomicofmeaslsMeasleCausedbyRNAvirus.Highlycontagiousdropletspreadfromsecretionofnoseandthroat4daybeforeand5daysafterrash.Secondaryattackrate>90%incontact.Prodromalphase-characterizedbyfever,rhinorrhea,conjuctivalcongestionanddryhackigcough.Koplikspots-bluish-grayspecksor"grainsofsand"onaredbase-developonthebuccalmucosaoppositethesecondmolarsGenerallyappear1-2daysbeforetherashandlast3-5daysPathognomonicformeasles,butnotalwayspresentRashappearsonD4firstbehindpinnaonneckthespreadofface,thrunkandabdomen.SSPEislongtermcomplicationseeninmeasls.
107.Exchangebloodtransfusionwhatis used? a)Wholeblood b)EPP c)Serum d)Packcell CorrectAnswer-AAns.is'a'i.e.,WholebloodExchangetransfusionistheprocessofslowlyremovingpatientbloodandreplacingwithfreshdonorwholeblood.
108.LargePDAleadsto? a)Endocardialvalvulitis b)Eisenmengersyndrome c)CHF d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofabovePatentductusarteriosus(PDA)SmallPDAmaynotcauseanycomplicationbutlargedefectifuntreadmayleadsto:PulmonaryhypertensionLefttoRightshuntleadstotoomuchcirculationofbloodinlungwhichleadstopulmonaryhypertension.Eisenmenger'ssyndrome-LargestandingpulmonaryhypertensionleadstopermanentlungdamageandcausesRighttoLeftshunt.Endocarditis.ArrhythmiaEnlargementofheartduetoPDAincreaseriskofarrhythmias
109.ITPfalseis? a)Plattettransfusionshouldbeavoided b)Anticedenthistoryoffebrileillness c)Overactiveimmunesystem d)Steroidshouldbeavoided CorrectAnswer-DAns.is'd'i.e.,SteroidshouldbeavoidedIdiopathicthrombocytopenicpurpura(ITP)Commonestbleedingdisorderpresentinginchildrenbetween1-7yearofage.ITPisproposedtobeoccurduetooveractiveimmuneresponse.AntecedentH/ofebrileillnesspresent.TreatmentPlatlettransfusionshouldbeavoidedIVIGorsteroid.
110.Posteriorurethralvalve-trueA/E? a)Palpablebladder b)Hydronephrosis c)Painfulstressincontinence d)RecurrentUTI CorrectAnswer-CAns.is`c'i.e.,PainfulstressincontinencePosteriorurethralvalveMostcommoncauseofsevereobstructiveuropathyinchildren.30%ofchildrenexperiencedendstagerenaldisease/CRFDilatedprostaticurethra.HypertrophyofbladdermuscleVesicoureticrefluxseenin50%ofcases.Backpressurechange:HydronephrosisDistendedbladderThinurinarystreamRecurentUTIbecauseofurinarystasis
111.Ininfant,bonemarrowbiopsyisdone from? a)Sternum b)Iliaccrest c)Tibia d)Allofabove CorrectAnswer-CAns.is'c'i.e.,TibiaSternum:-->HematopoiticallyactiveSiteincooperativepatientlikeadultIlium:ApprehesivepatientUsefulinolderchildren&adultTibia:Usefulinnewborn&infantandchildrenbelow2yearofage.
112.Mostcommonmalignancyinchildrenis ? a)ALL b)AML c)Neuroblastoma d)Wilm'stumor CorrectAnswer-AAns.is'a'i.e.,ALLLeukemiaismostcommonmalignancyinpediatricagegroup.oLeukemia/lymphoma=40%(ALLismorecommonthanAML)CNSTumor=30%Embryonal&Sarcoma=10%2ndmostcommonisCNSTumor(30%)
113.Alopeciathinbrittlenail,sparsehairwith thinenameldiagnosisis? a)Ectodermaldysplasia b)Alopeciaaerata c)Alopicacongenita d)Noneofabove CorrectAnswer-AAns.is'a'i.e.,EctodermaldysplasiaEctodermaldysplasiaGroupofsyndromeAllderivedfromectodemalstructureAbnormalitiesoftwoormoreectodermalstructuresuchasHairTeethNailSweatglandCraniofacialstructureDigit
114.MostcommonASDis? a)Ostiumprimum b)Patentforamenovale c)Ostiumsecondum d)Sinusvenosus CorrectAnswer-CAns.is'c'i.e.,OsteumsecondumASDcanoccurinanyportionofatrialseptum-SecundumPrimumSinusvenosusAbsentatrialseptum(leadstosingleatrium)OstiumsecondumdefectDefectinregionoffossaovalisMostcommonformofASD
115.MostcommonASDindownsyndromeis ? a)Ostiumprimum b)Ostiumsecundum c)Absentatrialseptum d)Sinusvenosus CorrectAnswer-AAns.is'a'i.e.,OstiumprimumAbout40%childrenwithdownsyndromehavecongenitalheartdisease.Endocardialcushiondefect(ASDwithostiumprimum)accountfor40-60%ofcases.
116.Sittingwithoutsupportisappearat whichmonth a)5month b)6month c)7month d)8month CorrectAnswer-BAns.is'b'i.e.,6month3monthNeckholding5monthRollover6monthSitsintripodposition8monthSittingwithoutsupport9monthStandwithsupport
117.Weightofchildis70%ofnormal accordingtoIAPclassification,categorisedin? a)Mild b)Moderate c)Severe d)Normal CorrectAnswer-BAns.is`b'i.e.,Moderate
118.Influenzavaccinecause? a)Localswelling b)Fever c)Itching d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveMildproblemsfollowinginactivatedfluvaccine:Soreness,redness,orswellingwheretheshotwasgivenHoarsenessSore,redoritchyeyesCoughFeverAchesHeadacheItchingFatigueIftheseproblemsoccur,theyusuallybeginsoonaftertheshotandlast1or2days.Moderateproblemsfollowinginactivatedfluvaccine:Youngchildrenwhogetinactivatedfluvaccineandpneumococcalvaccine(PCV13)atthesametimemaybeatincreasedriskforseizurescausedbyfever.Askyourdoctorformoreinformation.Tellyourdoctorifachildwhoisgettingfluvaccinehaseverhadaseizure.Problemsthatcouldhappenafteranyvaccine:Brieffaintingspellscanhappenafteranymedicalprocedure,includingvaccination.Sittingorlyingdownforabout15minutescan
helppreventfainting,andinjuriescausedbyafall.Tellyourdoctorifyoufeeldizzy,orhavevisionchangesorringingintheears.Severeshoulderpainandreducedrangeofmotioninthearmwhereashotwasgivencanhappen,veryrarely,afteravaccination.Severeallergicreactionsfromavaccineareveryrare,estimatedatlessthan1inamilliondoses.Ifoneweretooccur,itwouldusuallybewithinafewminutestoafewhoursafterthevaccination.
119.Hairansyndromeisconsistsof? a)Hyperandrogenism b)Acanthosisnigricans c)Insulinresistance d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveHAIR-ANsyndromeconsistsofhyperandrogenism(HA),insulinresistance(IR),andacanthosisnigricans(AN).Itisasubsetofpolycysticovarysyndrome
120.RenaltubuleracidosiswithABGvalue pH=7.24P02=80;PaCO2=36Na=131;HCO3=14C1=90;BE=-13Glucose=135aboveABGpicturesuggest? a)Metabolicacidosis b)Respiratoryacidosis c)Respiratoryalkalosis d)Metabolicalkalosis CorrectAnswer-AAns.is'a'i.e.,MetabolicacidosisThegivenvalueshavelowpH,andlowHCo2-IndicatemetabolicacidosisPCO2inlowernormalrange(normalvalue35-45mm/hg)
121.GrimacewithAPGARscore- a)0 b)1 c)2 d)3 CorrectAnswer-BAns.is`bi.e.,1
122.PDAtrueisallexcept? a)Morecommoninpretermbaby b)Lefttorightshunt c)Acyanoticcongenitalheartdisease d)Morecommonintermbaby CorrectAnswer-DAns.is'di.e.,MorecommonintermbabyDuringfetallife,mostofthepulmonaryarterialbloodisshuntedthroughtheductusarteriosusintotheaorta.Functionalclosureoftheductusnormallyoccurssoonafterbirth,butiftheductusremainspatentwhenpulmonaryvascularresistancefalls,aorticbloodisshuntedintothepulmonaryartery.Theaorticendoftheductusisjustdistaltotheoriginoftheleftsubclavianartery,andtheductusentersthepulmonaryarteryatitsbifurcationFemalepatientswithPDAoutnumbermales2:1.PDAisalsoassociatedwithmaternalrubellainfectionduringearlypregnancy.Itisacommonprobleminprematureinfants,whereitcancauseseverehemodynamicderangementsandseveralmajorsequelae
123.Mostcommonpresentationofwilm's tumor? a)Hematuria b)Asymptomaticabdominalmass c)Abdominalpain d)Headache CorrectAnswer-BAns.is`b'i.e.,AsymptomaticabdominalmassWilm'stumor(Nephroblastoma)Mostcommonmalignanttumorofkidney.80%oftumorpresentbelow5yearofage.Presention:?Asymptomaticabdominalmass(M.C.).Haematuria(10-25%).Hypertension(25%).Abdominalpain(30%).Fever(20%).
124.Confirmationofmaleintersexby? a)USGabdomen b)Genetictesting c)Hormonalstudy d)Allofabove CorrectAnswer-BAns.is'b'i.e.,GenetictestingIntersex:(DSD)DiscrepancybetweenmorphologyofgonadsandthatofextemalgenitaliaNowDisorderofSexdevelopment(DSD)ispreferredinsteadofintersexDistinctlynotdefinedasmaleorfemaleIntersextraitnotalwaysmanitestatbothSomeasnotawareofintersexanditisconfirnedbyGenetictestingMostcommonisvirilisationoffemale46XXDSD.46XXDSD-Phenotypeisxx&gonadsareovarybutexternalgenitaliaisvirilised.(duetolackofantimullerianhormone(AMH))Mostcommoniscongenitaladrenalhyperplasia(CAH)Mostcommonly21ahydroxylase&11[3-Hydroxylasedeficiency.
125. Posttermbabywithtachypnea- commonestcause? a)Transienttachypneaofnewborn b)Meconiumaspirationsyndrome c)Hyalinemembranedisease d)Infection CorrectAnswer-BAns.is'b'i.e.,meconiumaspirationsyndromeTransientTachypneaoftheNewbornTransienttachypneaofthenewbornisthemostcommoncauseofneonatalrespiratorydistress,constitutingmorethan40percentofcases.1Abenigncondition,itoccurswhenresidualpulmonaryfluidremainsinfetallungtissueafterdeliveryoRespiratoryDistressSyndromeRespiratorydistresssyndromeofthenewborn,alsocalledhyalinemembranedisease,isthemostcommoncauseofrespiratorydistressinprematureinfantsImmaturetypeIIalveolarcellsproducelesssurfactant,causinganincreaseinalveolarsurfacetensionandadecreaseincompliantMeconiumAspirationSyndromeMeconium-stainedamnioticfluidoccursinapproximately15percentofdeliveries,causingmeconiumaspirationsyndromeintheinfantin10to15percentofthosecases,typicallyintermandpost-terminfantsInfectionBacterialinfectionisanotherpossiblecauseofneonatalrespiratorydistress.CommonpathogensincludegroupBstreptococci(GBS),
Staphylococcusaureus,Streptococcuspneumoniae,andgram-negativeentericrods.Pneumoniaandsepsishavevariousmanifestations,includingthetypicalsignsofdistressaswellastemperatureinstability
126.Majorcriteriaforrheumaticfever-AJE a)Carditis b)Arthralgia c)Erythemamarginatum d)Subcutaneousnodule CorrectAnswer-BAns.is'b'i.e.,ArthralgiaJone'scriteriaMajorcriteriaare:Carditis,arthritis,subcutaneousnatule,chorea,anderythemamarginatum
127.0.9%NaCIcontainsTrueas? a)0.9gmofNaclin1000mloffluid b)77megofsodiumis1000mloffluid c)154megofchloridein1000mloffluid d)30megofsodiumin1000mloffluid. CorrectAnswer-CAns.is'c'i.e.,154meqofchloridein1000mloffluidNomalsaline(Isotonicsaline)Contains-9gmsofNaclin1000mloffluid154meq/sodiumin1000mloffluid154meqChloridein1000mloffluid
128.Handednessdevelopsbyageof? a)2years b)3years c)4years d)5years CorrectAnswer-BAns.is'b'i.e.,3yearHandednessisusuallyestablishedbythe3rdyr.Frustrationmayresultfromattemptstochangechildren'shandpreference.Variationsinfinemotordevelopmentreflectbothindividualproclivitiesanddifferentopportunitiesforlearning.Childrenwhoareseldomallowedtousecrayons,forexample,developamaturepencilgrasplater
129.Drugusedinneonatalresuscitation a)Adrenaline b)Sodabicarbonate c)Naloxone d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveDrugusedduringneonatalresuscitationEpinephrine./AdrenalinNSorRLNaloxoneSodium-by-carbonate
130.Delayedpubertyinfemale? a)Nobreastbuddingin10years b)Menarche>16year c)menarche>1yearofbreanbudding d)FSH CorrectAnswer-BAns.is'b'i.e.,Menarche>16yearDelayedPubertyMorecommoninboythangirlMostcommoncauseinconstitutionaldelayGirls-DelayedpubertyisdefinedasLackofsecondarysexualcharacterbyageof17yearsAbsenceofmenarchebyageof16year5yearafterpubertalonset.Boys-Lackofpubertalchangesbytheageof14years.
131.Reyesyndromefalseis? a)Associatedwithsalicylateingestion b)Hepatomegaly c)Jaundice d)Hypoglycemia CorrectAnswer-CAns.is'c'i.e.,JaundiceRevesyndromeDetrimentaleffectstomanyorgans,especiallythebrainandliver,aswellascausinglowbloodsugarandincreaseammonialevel.SecondaryMitochondriahepatopathyH/oviralinjection(Influenza,varicella)&salicylateinteractions.Highermortalityrate.Thediseasecausesfattyliverwithminimalinflammationandcerebraledema(swellingofthebrain).Jaundiceisnotusuallypresent.Withraisedenzymewithnormalbilirubin.Childrenofages4to12aremostcommonlyafflicted.Earlydiagnosisisvital;althoughmostchildrenrecoverwithsupportivetherapy,itmayleadtoseverebraininjuryanddeath
132.3yearoldchildcomeinERwithH/o vomiting,loosewateymotionfor3days.onexamination,childwasdrowsy,sunkeneye.Hypothermiaandskinpinchtaketimetorevertback,diagnosis? a)Nodehydration b)Milddehydration c)Somedehydration d)Severedehydration CorrectAnswer-DAns.is'd'i.e.,SeveredehydrationAchildwithseveredehydrationwillhaveatleasttwoofthefollowingfoursigns:sensoriumisabnormallysleepyorlethargic,sunkeneyes,drinkingpoorlyornotatall,andaveryslowskinpinch.Achildwithsomesignsofdehydrationwillhavetwoofthefollowing:restlessnessorirritability,sunkeneyes,drinkingeagerlyorslowskinpinch.Achildwitheitheroneornoneofthesesignsisclassifiedashavingnosignsofdehydration.
133.Induschenethekneejerk? a)Exaggerrated b)Decrease c)Maybenormalinitiallylateronincrease d)Maybenormalinitiallylaterondecrease CorrectAnswer-DAns.is'd'i.e.,MaybenormalinitiallylaterondecreaseDuchenneandBecker'smusculardystrophy.X-likerecessiveSoexpressionofgeneisessentiallyconfirmedinmales.FemalesareaffectedonlyifX-chromosomecarryingthenormalalleleislostorinactivatedBeckerismilderformwithlateonsetandslowprogression.Induchenni,onsetisearlywithdeloyedmisection.Pseudohypertrophyofcalfmuscle,glutei,deltiod,Gowersignmaypositiveatageof3year.Cardiacinvolvementstartedat10yearofage.DeeptendonreflexesremainnormaloraredecreasedinpatientswithDMD.Anklejerksarerelativelypreserveduntiltheterminalstages,whilethekneejerkreflexislessbriskthantheanklesbyagesix,butiseventuallylost.Histopathologyshowsdiffusedegeneration®enerationofmusclefibre.SerumCPXaremarkedlyhigh.
134.Intrauterinehydronephrosisof32-34 weeks-management? a)Intrauterinedrainage b)Waituntil3weeks c)Immediatedelivery d)RequireserialUSGandotherassociatedanomalies CorrectAnswer-DAns.is`d'i.e.,RequireserialUSGandotherassociatedanomaliesAntenatalhydronephrosis(ANH)istransientandresolvesbythethirdtrimesterinalmostone-halfcases.Thepresenceofoligohydramniosandadditionalrenalorextrarenalanomaliessuggestssignificantpathology.oAllpatientswithANHshouldundergopostnatalultrasonographyTheintensityofsubsequentevaluationdependsonanteroposteriordiameter(APD)oftherenalpelvisand/orSocietyforFetalUrology(SFU)grading.PatientswithpostnatalAPDexceeding10mmand/orSFUgrade3-4shouldbescreenedforupperorlowerurinarytractobstructionandvesicouretericreflux.SurgeryisconsideredinpatientswithincreasingrenalpelvicAPDand/oranobstructedrenogramwithdifferentialrenalfunction<35-40%oritssubsequentdecline.
135.Childknowshis/hersexbyageof? a)2year b)3year c)4year d)5year CorrectAnswer-BAns.is'b'i.e.,3year RidestricycleStandsmomentarilyononefoot.DrawsacircleCandressorundresshimselfcompletelyBuildstowerof10cubesKnowshisageandsex.Repeatasentenceof6syllablesHasavocabularyof250words.Counts3objectscorrectly.Canwithholdandpostponebowelmovement.
136.TrueaboutSLEis? a)Autoimmunedisease b)ChildhoodSLEhadpoorprognosisthanadultSLE c)PresenceofANA d)Allaretrue CorrectAnswer-DAns.is'd'i.e.,AllaretrueSLE(sytemiclupusErythematosus)AutoimmunedisorderInflammationofbloodvesselChildhoodSLEhadpoorpnognosisthanadultSLEHallmarkofSLEispresenceofantinucleanantibody(ANA)Morecommoninfemale.MalarrashinpathognomicofSLENon-erosivearthritisNephritisEncephalopathyPleuritis/PericarditisCytopenia
137.Caseofhemorrhagicdiseaseofnewborn bleedon2ndday? a)2,7,9,10 b)3,7,9,10 c)2,8,9,10 d)2,5,9,10 CorrectAnswer-AAns.is'a'i.e.,2,7,9,10HemorrhagicdiseaseofnewbornisduetodeficiencyofVitaminKdependentfactors-->II,VII,IXandX.
138.8yearoldchildwithhematuriain5days afterthroatinfection? a)Poststreptococcalnephropathy b)IgAnephropathy c)Nephroticsyndrome d)canbeaorb CorrectAnswer-BAns.is'b'i.e.,IgANephnopathyIgAnephropathyPredominantdepositionofIgAinglomeruli.RECURRENTepisodeofgrossrematuriathatalsoprecipitationbyURTIinlast2-5days.PSGNAcuteGNfollowinginfectionbygroupA--hemolyticstreptococci.Commoninschoolagechildren.oStreptococcalinfectionusuallyofthroat(4or12strain)orskin(strain49)by1-4weekpriortoAGN.Edema,oliguria,hypertension,ARF,hematureaofabruptonset.
139.HemophiliaX-linked? a)HemophiliaA b)HemophiliaB c)HemophiliaC d)BothA&B CorrectAnswer-DAns.is'D'i.e.,Botha&bHemophiliaA(alsoknownasclassichemophiliaorfactorVIIIdeficiency)andhemophiliaB(alsoknownasChristmasdiseaseorfactorIXdeficiency)areinheritedinanX-linkedrecessivepattern.HaemophiliaCiscausedbyadeficiencyofcoagulationfactorXIandisdistinguishedfromhaemophiliaAandBbythefactitdoesnotleadtobleedingintothejoints.Furthermore,ithasautosomalrecessiveinheritance
140.Kwashiorkornottrueis? a)Apathy b)Flakypaintdermatosis c)Increasedtransaminase d)Voraciousappetit CorrectAnswer-DAns.is'd'i.e.,VoraciousappetiteThereisdecreasedappetiteinkwasiorkor(notvaraciousappetite).KwashiorkarKwashiorkarrepresentstheuncompensatedphaseofPEM.Itischaracterizedbyclassical'triad'ofedema(Duetohypoalbuminemia),markedlyretardedgrowth,andpsychomotor(mental)changes
141.MostcommoncardiacdefectinTurner syndrome a)Coartactionofaorta b)VSD c)ASD d)TOF CorrectAnswer-AAns.is'a'i.e.,CoartactionofaortaDisordersAssociatedwithTurnerSyndromeShortstatureCongenitallymphedemaHorseshoekidneyPatelladislocationIncreasedcarryingangleofelbowMadelungdeformity(chondrodysplasiaofdistalradialepiphysis)CongenitalhipdislocationScoliosisWidespreadnipplesShieldchestRedundantnuchalskin(inuterocystichygroma)LowposteriorhairlineCoarctationofaortaBicuspidaorticvalveCardiacconductionabnormalitiesHypoplasticleftheartsyndromeGonadaldysgenesis(infertility,primaryamenorrhea)Gonadoblastoma(ifYchromosomematerialpresent)Learningdisabilities(nonverbalperceptualmotorandvisuospatial
skills)[in70%]Developmentaldelay(in10%)SocialawkwardnessHypothyroidism(acquiredin15-30%)Type2diabetesmellitus(insulinresistance)StrabismusCataractRed-greencolorblindness(asinmales)RecurrentotitismediaSensorineuralhearinglossInflammatoryboweldiseaseCeliacdisease
142.InHSPgrosshematureaisseeninwhat %ofchildren? a)5-10% b)10-20% c)20-30% d)30-40% CorrectAnswer-CAns.is'c'i.e.,20-30%Henoch-schonlein_purpura(HSP)SmallvesselvasculitisPurpuricrashArthritisAbdominalpainGlomerulonephritisGrosshematuriaisseenin20-30%ofcases
143.Childhaslesiononbuttockssince2year spreadingperipherallywithcentralscarringnonsymptomaticdiagnosis? a)Erythemaannularcetrifugam b)Erythemamigrains c)Erythemamarginatum d)ErythemaGyratum CorrectAnswer-AAns.is'a'i.e.,ErythemaannulasecetrifugamErythemaannularecentrifugum:anasymptomaticorpruriticeruptionofvariableduration.Theeruptionmaybeassociatedwithanunderlyingdisease(eg,infection,malignancy,sarcoidosis,othersystemicillness)Theeruptionbeginsaserythematouspapulesthatspreadperipherallywhileclearingcentrally.Theselesionsenlargeatarateofapproximately2-5mm/dtoproduceannular,arcuate,figurate,circinate,orpolycyclicplaquesLesionsdemonstrateapredilectionforthethighsandthelegs,buttheymayoccurontheupperextremities,thetrunk,ortheface.Thepalmsandthesolesarespared.Erythemamigrans:Theselesionsaretypicallylessnumerous,lesscircinateinconfiguration,andoftenaccompaniedbyahistoryofatickbite.Erythemagyratumrepens:EACcanbedistinguishedfromthisconditionbyitsslowerrateofspreadandbyitslessbizarreconfiguration.Also,erythemagyratumrepensisalmostalwaysassociatedwithanunderlyingmalignancy.
Erythemamarginatumrheumaticum:Thisisanonscalinggyrateerythemathatbydefinitionisfoundinassociationwithrheumaticfever(10-18%ofpatientswithrheumaticfever).
144.Infanthasfever,oneepisodeoffebrile convulsionsadmittedforobservation,feverthansubsidedandfollowedbyrashonabdomen&chest,maculopapularerythematous-whatisthecause? a)Chickenpox b)Measles c)Typhoid d)Dengue CorrectAnswer-AAns.is'a'i.e.,ChickenpoxInthisquestion,infanthaddeveloprashonfirstdayoffever&distributionofrashisinfavourofchickenpox,orvaricella.MnemonicforDayofappearanceofrashinafebrilepatientisVerySickPersonMustTakeDoubleTabletsVery-Varicella(day1)Sick-Scarletfever(day2)Person-Pox-smallpox(day3)Must-Measles(day4)Take-Typhus(day5)Double-Dengue(day6)Tablets-Typhoid(day7)Chickenpox(Varicella):CausedbyvirusChilddevelopfeverwithrashRasharemacular,maculo-papular,vesicular(pleomorphic)
DistributionisusuallycentripetalComplicationinclude-moreseeninimmunocompromisedchild. a. Mildthrombocytopeniab. Hematurea c. GIBledding d. Encephalitise. Pneumonia
145.7yearoldboyisillandhasfever.whatis thecaloricrequirement? a)1200kcal/d b)1500kcal/d c)1900kcal/d d)2200kcal/d CorrectAnswer-CAns.is'c'i.e.,1900kcal/dayChildren6year7->16909year->1950
146.Boypowerschoolpreferencenospoken atschool,normalspeechatotherplace,IQassessmentnormaldiagnosisis? a)Selectivemutism b)ADHD c)Autism d)Dyslexia CorrectAnswer-AAns.is'a'i.e.,SelectivemutismAutismtypicallydiagnosedbefore36monthofage.Autismisaneurodevelopmentaldisorderofunknownetiology,butwithastronggeneticbasis.Itdevelopsandistypicallydiagnosedbefore36moofage.Itischaracterizedbyabehavioralphenotypethatincludesqualitativeimpairmentintheareasoflanguagedevelopmentorcommunicationskills,socialinteractionsandreciprocity,andimaginationandplay.Selectivemutismisdefinedasafailuretospeakinspecificsocialsituations,despitespeakinginothersituations;itistypicallyasymptomofanunderlyinganxietydisorder.Childrenwithselectivemutismcanspeaknormallyincertainsettings,suchaswithintheirhomeorwhentheyarealonewiththeirparents,butdonotspeakinothersocialsettings,suchasatschooloratotherplacesoutsidetheirhome.Attention-deficit/hyperactivitydisorder(ADHD)isthemostcommonneurobehavioraldisorderofchildhood,1ofthemostprevalentchronichealthconditionsaffectingschool-agedchildren.
ADHDischaracterizedby:Inattention,includingincreaseddistractibilityanddifficultysustainingattention.Poorimpulsecontrolanddecreasedself-inhibitorycapacityMotoroveractivityandmotorrestlessness.Dyslexiaischaracterizedbyanunexpecteddifficultyinreadinginchildrenandadultswhootherwisepossesstheintelligence,motivation,andopportunitiestolearnconsiderednecessaryforaccurateandfluentreading.Dyslexiaisthemostcommonandmostcomprehensivelystudiedofthelearningdisabilities
147.Kangaroomothercare-Falseis? a)Canalsobegivenbyfather b)Especiallyforlowbirthweightbody c)Effectivethermalcontrol d)Allofabove CorrectAnswer-AAns.:A.)CanalsobegivenbyfatherKANGAROOMOTHERCARE?KMCiscareofpretermorLBWinfantsbyplacingskin-to-skincontactwiththemother?Position:verticalpositionbetweenthemother'sbreastsandunderherclothes?Thepositionismaintaineduntiltheinfantnolongertoleratesit(indicatedbysweatingorbabyrefusestostayinKMCposition)?Kangaroonutrition:exclusivebreastfeeding?ContinuousKMCisanalternativetominimalcareinanincubatorforinfantswhohavealreadyovercomemajorproblemswhileadaptingtoextra-uterinelifeAbletosuckandswallowproperlyThrivinginneutralthermalenvironment?IntermittentKMC(atleast1-2hour)whencontinuousKMCisnotpossible?AllmotherscanprovideKMCirrespectiveofage,parity,education,cultureorreligion?InitiatedinafacilityandcontinuedathomeClinicalbenefits?Significantlyincreasesmilkproductioninmothers?Increasesexclusivebreastfeedingrates
?Reducesincidenceofrespiratorytractandnosocomialinfection?Bettercardiorespiratorystability?Fewerapneicepisodes?Improvedweightgain?Improvesthermalprotectionininfantsandthereisareducedchanceofhypothermia?Improvesemotionalbondingbetweentheinfantandmothers?Reducesthedurationofhospitalstay?ImprovedsurvivalinlowresourcesettingCriteriaforeligibilityforKMC?IndicatedinallstableLBWbabies?Verysickbabiesneedingspecialcareshouldbecaredforunderradiantwarmerinitially.KMCshouldbestartedafterthebabyishemodynamicallystable?ShortKMCsessionscanbeinitiatedduringrecoverywithongoingmedicaltreatment?KMCcanbeprovidedwhilethebabyisbeingfedviaorogastrictubeoronoxygentherapy?BW>1800g:generallystableatbirthandKMCinitiatedsoonafterbirth?BW1200--1799g:manybabieshavesignificantneonatalproblems.ItmighttakeafewdaystostartKMC?BW<1200g:itmighttakedaystoweeksbeforeinitiatingKMCWhentostopKMC?Whenthebabyattainsaweightof2500gandagestationof37weeks?Ababywhouponbeingputinkangarooposition,tendstowriggleout,pulllimbsoutorcries,isnotinneedofKMCanymore
148.Childhavinglonghistoryofhemoglobin 5gm%nextstep? a)Bloodtransfusion b)CBC,reticountwithperiphesalsmear. c)StartIron d)Hbelechophoresis CorrectAnswer-BAns.is'b'i.e.,CBC,reticountwithperipheralsmearInabovequestion,ifchildisstable,thennoneedtogivebloodtransfusion.BeforestartingIron,wehavetoruleouttypesofanemiaasIronisindicatedonlyinnutritioralanemia.Hbelectrophoresisisindicatedifthereisfeatuerofhemolyticanemia(thalassemia)sooverallournextstepiscompletehemogramwithmanualperipheralsmearexamination.(obtionb).
149.3yearoldchildwithnormalheightfor age,abnormalweightforageandabnormalweightforheight,whatItisnotbe? a)Acutemalnutrition b)ChronicMalnutrition c)Acuteonchronic d)Noneofabove CorrectAnswer-BAns.is'b'i.e.,ChronicmalnutritionForthispurposewastingandstuntingaremeasured:-i)Wasting(deficitinweightforheight)4Acutemalnutrition.ii)Stunting(deficitinheightforage)-Chronicmalnutrition.iii)Wastingandstunting-Acuteonchronicmalnutrition.
150.Hypergonadotropichypogonadismis seaninallexcept? a)Turnersyndrome b)Downsyndrome c)Klinefeltersyndrome d)Swyer'ssyndrome CorrectAnswer-BAns.is'b'i.e.,DownsyndromeHypergonadotropichypogonadismAlsoK/aprimaryorperipheralhypogonadism.Characterisedbyhypogonadismduetoanimpairedresponseofthegonadstothegonadotropin,FSHandLH.Inturnalackofsexsteroidproductionandelevatedgonadotropinlevel.Causes:ChromosomalabnormalitisTurner'ssyndromeKlinefeltersyndromeSwyer'ssyndromeEnzymedefect17,hydroxylase17,20lyasedeficiency
151.Turnersyndrome-karyotypingis? a)45,X0 b)46X0 c)47XXX d)Trisomy21 CorrectAnswer-AAns.is'a'i.e.,45XO45X0Lymphademaofdorsumofhand&fatLooseskinfoldatnapeofneckShortstatureShortNeck(withwebbingofneck)AnomaliesearBroadshieldlikechestwithwidelyspacedsmallnippleRenalanomalies(Horse-shoe,soubleorcleftrenalpelvis)Coartofaorta
152.Notafindinginpottersyndrome? a)Bilateralrenalagenesis b)Polyhydromnios c)PulmonaryHyperplasia d)Flatchain CorrectAnswer-BAns.is'b'i.e.,PolyhydromniosPottersyndromeBilateralrenalagenesisisincompatiblewithextrauterinelifeandistermedPottersyndrome.Deathoccursshortlyafterbirthfrompulmonaryhypoplasia.Thenewbornhasacharacteristicfacialappearance,termedPotterfacies.Theeyesarewidelyseparatedwithepicanthicfolds,theearsarelowset,thenoseisbroadandcompressedflat,thechinisreceding,andtherearelimbanomalies.Bilateralrenalagenesisshouldbesuspectedwhenmaternalultrasonographydemonstratesoligohydramnios,nonvisualizationofthebladder,andabsentkidneys.
153.Drugusedforabsenceseizure? a)Lamotrigine b)Carbamazepine c)Phenytoin d)Vigabatrine CorrectAnswer-AAns.is'a'i.e.,LamotrigineDrugofchoiceforabsenceseizuresisValproate(Previouslyitwasethosuxamide).Otherdrugsusedarelamotrigineandclonazepam.
154.Mostcommoncauseofacquiredheart diseaseinchildren a)Acuterheuamaticfever b)Kawasaki c)Takayasu d)Diabetes CorrectAnswer-AAns.is'a'i.e.,AcuteRheumaticfeverAcuterheumaticfeverMostcommoncauseofacquiredheartdiseaseinchildren.CausedbygroupAf3hemolyticstreptococciUsuallyseeninschoolgoingchildrenJonescriteria=veryimpotrantMitralvalvemostcommonfollowedbyaorticvalveInacutephase-MRseenInRI-IDMSseen
155.Mildlyelevatedbilirubin,normalliver enzymesareseenin? a)Malaria b)Thalassemia c)G-6PDdeficie d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveMildlyelevatedbilirubinespeciallyindirectandnormalliverenzymeseeninhemolyticanemia.Inabovequestionallcauseshemolyticanemia.
156.Singleumblicalarteryisassociated with? a)NTD b)Hydropsfetalis c)Congenitalheartdisease d)Inuterodeath CorrectAnswer-CAns.is`c'i.e.,CongenitalheartdiseaseApproximately30%ofinfantswithasingleumbilicalarteryhavecongenitalabnormalities.Trisomy18isoneofthemorefrequentabnormalities.Themostcommoncongenitalanomaliesinchromosomallynormalfetusesandneonateswere.Genitourinary(6.48%)Cardiovascular(6.25%)Musculoskeletal(5.44%).
157.Hypocalcemiainachildmaybe associatedwith a)Digeorgesyndrome b)Hypoparathyroidism c)Magnesiumdeficiency d)Allofabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveCausesofhypocakemiaHypoparathyroidismDigeorgesyndromePTHreceptordefect(pseudohypoparathyroidism)MagnesiumdificiencyExogenousorganicphosphateexcessVitDdifeciency
158.Femalehermaphroditeis? a)Femalesexualcharactersticwithtestes b)Malesexualcharatersticwithovary c)XY d)Femalesexualcharacteristicwithbothtestes&ovary CorrectAnswer-BAns.is'b'i.e.,MalesexualcharacteristcwithovaryFemalepseudohermaphroditismHaveinternalgenitaliafemaletypeKaty()typeXXMasculinisationofexternalgenitaliaMostcommon-CANCongenitaladrenalhyperplasiaM-C.21hydroxylasedeficiencyOthercauseexcessmaternalandrogendueto-oMaternalovariantumor.MaternaldrugintakeTreatmentHormonaltherapy
159.Baby'0*positive,bloodgroup,mother Rhnegative,cordbilirubin7mg%,conjugatedInowtreatmentis? a)Nothing b)Stopbreastfeedingfor48hours c)Continuebreastfeedingandphototherapy d)Stopbreastfeedandprepareforexchangebloodtransfusion CorrectAnswer-DAns.is'd'i.e.,Stopbreasttadandprepareforexchangebloodtransfusion?Inhemolyticdisease,immediateexchangetransfusionindication: a)Cordbilirubinis>4.5mg/dlandHb<11gm%b)Bilirubinrising>1mg/dl/hourdespitephototherapyc)Hblevel11-13gm/dlandbilirubinrisingmorethan0.5mg/dl/hourd)Bilirubinisrisinginspiteofphototherapy
160.3daysoldnewbornwithunknowninborn errorofmetabolism,hyperammonemiainblood. a)Maplesyrupurinedisease b)Ureacycleenzymedificiency c)Organicacidurea d)Phenylketonuria CorrectAnswer-BAns.is'b'i.e.,UreacycleenzymedeficiencyUreacycleenzymedefectCatabolismofaminoacidleadstofreeammoniawhichishighlytoxicFreeammoniaisconvertedintoureabygroupof5enzymeNewbornisusuallyasymphomaticbutleteronbecomesymptomaticaftergivingproteinTreatmentisdieteryproteinrestrictionMSUD(maplesyrupurinedisease)Defectivedecorboxglationofbranchchainaminoacid(leucine,Isoleuvine,valine)AutosomalrecessineSmellofmaplesyrupinurine.PhenylketonuriaAutosomalrecessiveDeficiencyofphenylalaninehydroxylase.Defectinconversionofphenylalaninetotyrosine.Thisleadstoincreaselevelofphenylalanine.Thisincreasephenlylalanineconvertedintophenylpyruvateand
phenylacetate.Thisphenylacetategivesmousyormustyodourinurine/body.Otherpointtoremember?Sweatyfeatodour-IsovalericacademiaInAlkaptanuria-Urinebecomedarkishbrownwhenexposedtoairwhilepurplishbrowninporphyria.Smokysweat-MSUDMousyorMusty-PhenylketonuriaBoiledcabbage-Tyrosinemia
161.10montholdchildcannotperform? a)Standingwithsupport b)Pincergroup c)Walkingwithsuppor d)Twowordswithmeaning CorrectAnswer-DAns.is'd'i.e.,TwowordswithmeaningoAchildcantransfertheobjectsfromonehandtoanotherby5-7months.oAchildcanbuildatowerof6cubesby21monthsoAchildcanpullhimselfupbytheageof10months.oAchildmakesasimplesentencefirsttimebytheageof2years.oPincergraspdevelopsby9months.
162.Childcomeswithbloodsugar32mg/dl withconvulsionsTreatmentis? a)5%dextrose2ml/kg b)10%dextrose2ml/kgbolus c)10%dextrose4ml/kg d)5%Dextrose4ml/kg CorrectAnswer-CAns.is'c'i.e.,10%Dextrose4ml/kgSymtomaticHypoglycemia(<40mg/d1)shouldbemanagedwith10%IVDextrose.Inseizures,doseof10%dextroseis4ml/kg.
163.OmalizumabTruestatementis? a)Anti-IgE b)Usedasaddontherapyinmoderatetosevereasthma prophylaxis c)Givnsubcutaneously d)Alloabove CorrectAnswer-DAns.is'd'i.e.,AllofaboveAnti-IgE(Omalizumab).OmalizumabisahumanizedmonoclonalantibodythatbindsIgE,therebypreventingitsbindingtothehigh-affinityIgEreceptorandblockingIgE-mediatedallergicresponsesandinflammation.approvedforpatients>12yroldwithmoderatetosevereasthma,Itisgivenevery2-4wksubcutaneouslybasedonbodyweightandserumIgElevels.Itsclinicalefficacyasan"add-on"therapyforpatientswithmoderatetosevereallergicasthmaItisgenerallywelltolerated,althoughlocalinjectionsitereactionscanoccur
164.Pigmentationandgrowthretardationis seenin? a)Zincdeficiency b)Riboflavindeficiency c)Niacindeficiency d)VitAdeficiency CorrectAnswer-AAns.is'a'i.e.,Zincdificiency Dwarfism(growthretardation)DiarrheaDermatitisHepatosplenomegalyIrondeficiencyanemiaAcrodermatitisenteropathicaHyperpigmentation
165.NotincludedinmodifiedJonescriteria? a)Polyarthalgia b)Carditis c)Chorea d)Erythemamarginatum CorrectAnswer-AAns.is'a'i.e.,PolyarthalgiaAllthegivenoptionsareincludedinmodifiedJonescriteria.Carditis,choreaanderythemamarginatumaremajorcriteria.Onlypolyarthralgia(arthralgia)isminorcriterian.
166.Trueaboutforemilk&hindmilk? a)Foremilkhasfat b)Hindmilkrelievehunger c)Foremilkrelievehunger d)Hindmilkisrichinprotein CorrectAnswer-BAns.is'b'i.e.,HindmilkrelivehungerTheforemilk(themilk"infront");isproducedatthebeginningofeachfeeding.Itcontainswater,vitamins,andproteinandrelievethurst.Thehindmilk;ispushedoutlatter,itisheavier,richerinlipidandsatisfyhunger.
167.13yearoldfemalehavingsuddenonset highgradefeverwithdelirium.CT.findings/oinvolvementoflimbicsystem&medialtemporallobe-Dxis a)Subarachnoidhemorrhage b)Herpessimplexencephalitis c)Pyomeningitis d)Cerebralmalaria CorrectAnswer-BAns.is'b'i.e.,HerpessimplexencephalitisHerpessimplexencephalitisAcutenecrotisinginfectioninvolvingfrontal,temporallobe&limbicsystem.FeatureNonspecific-fever,headache,nuchalrigidity.convulsion,alteredsensorium.ConfirmedbyCSFexamin&radioimaging.TreatmentsupportiveandAcyclovir
168.Heightofchildacquire100cmin? a)2.5year b)3.5year c)4.5year d)5.5year CorrectAnswer-CAns.is'c'i.e.,4.5year1Year-75cm2Year-90cm41/2Year-100cm
169.mentalretardationcanbeprovedif delayedmilestonesandsloworretardedgrowthseenuptowhichage(inyear)? a)12 b)16 c)18 d)20 CorrectAnswer-CAns.is'c'i.e.,18yeara)Significantlysub-averageintellectualfunctioning:anIQscoreof70orbelowonanindividuallyadministeredIQtest(forinfants,aclinicaljudgmentofsignificantlysub-averageintellectualfunctioning).
170.Mostcommonorganinvolvedin congenitalTbis? a)Liver b)Pancreas c)Kidney d)Lung CorrectAnswer-AAns.is'a'i.e.,LiverCongenitaltuberculosisAlthoughitisrareasmotherhavingtuberculosisprimarilypresentwithinfertility.Tuberculousbacillisometimespassthroghumblicalveinandmaydevelopfocusinliver(hepaticcomplex).WhenneonateaspirateamnioticfluidcontainingbacillithendevelopGItuberculosisorlunginfection.Neonateusuallypresentasrespiratorydistress,hepatosplenomegalylymphadenopathy.Overallliverismostcommonlyinvolvedincongenitaltuberculosis
171.Bivalentmeningococcalvaccineis? a)AY b)AC c)Cy d)AW-I35 CorrectAnswer-BAns.is'b'i.e.,ACTwotypeofmeningococcalvaccinedevelopUnconjugatedpolysaccharidevaccine.ConjugatedgroupCvaccine.PolysaccharidevaccinesInternationallymarketedmeningococcalpolysaccharidevaccinesareoBivalent(AandC),Trivalent(A,CandW-135)Tetravalent(A,C,YandW-135).Thevaccinesarepurified,heat-stable,lyophilizedcapsularpolysaccharidesfrommeningococcioftherespectiveserogroups.Aprotectiveantibodyresponseoccurswithin10daysofvaccination.Inschoolchildrenandadults,onedoseofthesepolysaccharidevaccinesappearstoprovideprotectionforatleast3years,butinchildrenunder4yearsofagethelevelsofspecificantibodiesdeclinerapidlyafter2-3years.
172.Apneaofprematurity? a)>10sec b)>15sec c)20sec d)>30sec CorrectAnswer-CAns.is'c'i.e.,20secApneaofprematuritydefinedassuddenstoppageofbreathingthatlastsfor20secorisassociatedwithbradycardiaorcyanosis.Apneaofprematurityshouldbedifferentiatedfromperiodicbreathingwhichisnormalphenomenonispretermneonate
173.Downsyndrome-allareseenexcept- a)t(14;21) b)t(11:14) c)Trisomy21 d)t(15:21) CorrectAnswer-BAns.is'b'i.e.,t(11:14)In95%ofcasesofDownsyndrome-trisomyof21:-Extrachromosomeisofmaternalinorigin.I%havemosaicwithsomeallhave46chromosome.4%haverobertsoniantranslocation.t(13:21)t(14:21)t(15:21)Veryrarelylongarmofchromosome21istriplicate(Partialtrisomy).
174.Bidextrousgripisseenatwhatage? a)4months b)5months c)6months d)7months CorrectAnswer-AAns.A.4monthsFINEMOTORMILESTONES: Age Milestone 4months Bidextrousreach6months Unidextrousreach9months Immaturepincergrasp12months Maturepincergrasp Imitatesscribbling,towerof2 15months blocks18months Scribbles,towerof3blocks Towerof6blocks,vertical& 2years circularstroke 3years Towerof9blocks,copiescircle 4years Copiescross,bridgewithblocks 5years Copiestriangle
175.Whichvaccinetobegiveneveryyear? a)HepatitisA b)HepatitisB c)Influenza d)Chickenpox CorrectAnswer-CAns.C.InfluenzaInfluenza(Flu):Thefluvaccineisrecommendedeveryyearforchildren6monthsandolder:Kidsyoungerthan9whogetthefluvaccineforthefirsttime(orwhohaveonlyhadonedosebeforeJuly2017)willgetitintwoseparatedosesatleastamonthapart.Thoseyoungerthan9whohavehadatleasttwodosesoffluvaccinepreviously(inthesameordifferentseasons)willonlyneedonedose.Kidsolderthan9onlyneedonedose.Thevaccineisgivenbyinjectionwithaneedle(theflushot)orbynasalspray.Theflushotispreferredforchildrenofallagesbecauseithasbeenshowntobesafeandeffective.Althoughthenasalspraywasnotusedinrecentyears,achangedversionofitisnowrecommended(forthe2018?2019fluseason)forkidswhomayotherwisenotgetaflushot.Thenasalsprayisonlyforhealthypeopleages2through49.Peoplewithweakenedimmunesystemsorsomehealthconditions(suchasasthma)andpregnantwomenshouldnotgetthenasalsprayvaccine.
176.APGARscore3at1minuteindicates: a)Mildlydepressed b)Furtherresuscitationnotneeded c)Severelydepressed d)Normal CorrectAnswer-CAns.C.SeverelydepressedAPGARCRITERIA: Component Scoreof Scoreof1 Scoreof2 of 0 backronym blueat nocyanosis blueor extremities bodyand Skincolor paleall Appearance bodypink extremities over (acrocyanosis) pink<100beatsper >100beats Pulserate absent Pulse minute perminute no grimaceon Reflex response suctionor cryon irritability Grimace to aggressive stimulation grimace stimulation stimulation flexedarmsandlegsthat Activity none someflexion Activity resistextension Respiratory weak,irregular, strong,robust absent Respiration effort gasping cry
INTERPRETATION:Thetestisgenerallydoneat1and5minutesafterbirthandmayberepeatedlaterifthescoreisandremainslow.Scores7andabovearegenerallynormalScore4to6,fairlylowScore:3andbelowaregenerallyregardedascriticallylowandcauseforimmediateresuscitativeefforts.
177.SevereacutemalnutritionasperWHO criteria- a)Weightforagelessthanmedianplus?2SD b)Weightforheightlessthanmedianplus2SD c)Weightforagelessthanmedianplus3SD d)Weightforheightlessthanmedianminus-3SD CorrectAnswer-DAns.D.Weightforheightlessthanmedianminus-3SDSevereacutemalnutritionisdefinedbyaverylowweightforheight(below-3zscoresofthemedianWHOgrowthstandards),byvisibleseverewasting,orbythepresenceofnutritionaloedema.WorldHealthOrganization(WHO)classificationofnutritionalstatusofinfantsandchildren: Nutritionalstatus Age:birthto5yearsWeight-for-length/heightorBMI-for-age>3 Obese standarddeviations(SD)ofthemedianWeight-for-length/heightorBMI-for-age>2SD Overweight and3SDofthemedian Moderately Weight-for-age underweightSeverely Weight-for-age underweight Weight-for-length/heightorBMI-for-age?2SD Moderateacute and?3SDofthemedian,ormid-upperarm malnutrition circumference115mmand Severeacute Weight-for-length/heightorBMI-for-age malnutritionModeratelystunted
Moderatelystunted Length/height-for-age?2SDand?3SDof (moderatechronic themedian malnutrition)Severelystunted(severechronic Length/height-for-age malnutrition) Weight-for-length/height?2SDand?3SDof Moderatelywasted themedianSeverelywasted Weight-for-length/height
178.Wheretolookforpre-ductalO2 saturationinPDAina3minuteborninfant? a)FetalleftUpperlimb b)Fetalleftlowerlimb c)FetalrightUpperlimb d)Fetalrightlowerlimb CorrectAnswer-CAns.C.FetalrightUpperlimbAsimplerwaytodetectthisright-to-leftshuntingistousetwopulseoximetersandmeasurepreductalandpostductalSpO2.Inonestudyitwasfoundthatarterialsaturationintherightarm(preductal)ofatleast3%abovethelowerlimb(postductal)isevidenceofright-to-leftductalshunting.
179.TrueaboutFragileXsyndromeis- a)TriplenucleotideCAGSequencemutation b)10%Femalecarriersmentallyretarded c)MaleshaveIQ20-40 d)Gainoffunctionmutation CorrectAnswer-CAns.C.MaleshaveIQ20-40FragileXSyndromeFragileXsyndromeisassociatedwithafragilesiteonchromosomeX(Xq29.3)TriplenucleotideCGGSequencemutationAbout20%ofwomenwhoarecarriersforthefragileXpremutationareaffectedbyfragileX-relatedprimaryovarianinsufficiency.IndividualswithFXSmaypresentanywhereonacontinuumfromlearningdisabilitiesinthecontextofanormalintelligencequotient(IQ)tosevereintellectualdisability,withanaverageIQof40inmaleswhohavecompletesilencingoftheFMR1gene.Fragilesitesareregionsofchromosomesthatshowatendencytoseparationbreakageorattenuationtinderparticulargrowthconditions.InheritanceInheritancedoesnotfollowtheusualMendeliansinglegenepatternsItisduetoAllelicexpansion.ClinicalManifestations:Themainclinicalmanifestationsare:1.MentalRetardationInfactitisthecommonestcauseofmentalretardationinmales.2.Macroorchidism.
3.Characteristicfacialappearancewith:LongfaceLargeprominentearsProminentJaw
180.TrueaboutRETTSyndrome? a)Macrocephaly b)Cardiacarrhythmia c)Seizures d)Mentalretardation e)Autisticbehaviour CorrectAnswer-B:C:D:EAns.is'b'i.e.,Cardiacarrhythmia,'c'i.e.,Seizures,'d'i.e.,Mentalretardation&'e'i.e.,AutisticbehaviourRett'sSyndromeThisisthecharacteristicfeatures,thattheybegintoloosetheiracquiredskills,e.g.,cognitiveandheadgrowthisnormalduringearlyperiodafterwhichthereisanarrestofgrowth.AcquiredmicrocephalyMostchildrendeveloppeculiarsighingrespirationswithintermittentperiodsofapneathatmaybeassociatedwithcyanosisBreathholdingspells.AutisticbehaviourImpairedsocialinteraction,languageandcommunication.Generalizedtonic-clonicconvulsionsoccurinthemajority.Feedingdisorderandpoorweightgain
181.TrueaboutAspergersyndrome: a)Morecommoningirl b)Repetitiveactivitypattern c)Subnormalintelligenceisconsistentfeature d)Severelanguageimpairmentsischaracteristic e)All CorrectAnswer-BAns.b.RepetitiveactivitypatternAspergersyndrome:Itisfourtimesmorelikelytooccurinmalesthaninfemalesandusuallyisfirstdiagnosedinchildrenbetweentheagesof2and6.Thecommoncharacteristicsincludeaverageoraboveaverageintelligence"Thereisnoclinicallysignificantgeneraldelayinspokenorreceptivelanguageorcognitivedevelopment.Self'helpskills,adaptivebehaviour,andcuriosityabouttheenvironmentduringthefirst3yearsshouldbeatalevelconsistentwithnormalintellectualdevelopment
182.WhichofthefollowingispresentinaXY childbutnotinaXXchild? a)Epoophoron b)Paroophoron c)Cowper'sglands d)Gartner'sduct CorrectAnswer-CAnswer-C.Cowper'sglandsBulbourethralgland(Cowper'sgland)arefoundinmales(XY)andarehomologoustoBartholin'sglandinfemales(XX).[Ref:"Differentiationoftheurogenitalsinusinmales".Embryology]
183.Therepeuticphlebotomyisnotdonein whichofthefollowingconditions? a)CML b)Polycythemiavera c)Hemochromatosis d)Porphyriacutaneatarda CorrectAnswer-AAnswer-A.CMLIndicationsfortherepeuticphlebotomy-PolycythemiaveraHemochromatosisSecondarypolycythemiaPorphyriacutaneatarda[RefCurrentapplicationsoftherapeuticphlebotomyTarekBouAssiandElizabethBaz.BloodTransfus.2014Jan;12(Suppl1):s75-s83]
184.WhatistheIQofaborderlinedeficiency? a)70-80 b)50-69 c)20-49 d)0-20 CorrectAnswer-AAnswer-A.70-80 IQRange IQClassification 70andBelow ExtremelyLow71-79 Borderline 80-89 LowAverage 90-110 Average 111-120 Bright 121-130 VeryBright 131andOver ExtremelyBright
185.Whichisfalseaboutdevelopment milestonesat6monthsofage? a)Watchingselfinmirror b)Sittingintripodposition c)Pincergrasp d)Monosyllablesounds CorrectAnswer-AAnswer-A.WatchingselfinmirrorMilestonesat6monthsofageInpronepositionliftshisheadandgreaterpartofhischestwhilesupportingweightonextendedarms.Producesmonosyllablesoundslikeda,ma.Enjoyswatchinghisownimageinthemirror.Binocularvisiondevelops(between3-6months).Purposefulmovementsinspace(6-8months).Sitsintripodposition.
186.Atwhatagechildbeginstousepastand presenttense a)1Years b)2Years c)18Months d)30Months CorrectAnswer-DAnswer-D.30MonthsBegintoidentifyobjectsfromagroupbytheirfunctionandparts(ie."whichonehaswheels","whichonecanweeat")Begintouseverbswith"ing"endings(i.e."eating");Earlyconceptssuchas"big,little"areidentified;Childwilluse"no,not"andanswer"where"questions
187.ReducedosmolarityORSdoesnot containwhichofthefollowingion- a)Sodium b)Potassium c)Lactate d)Citrate CorrectAnswer-CAnswer-C.LactateTable1:CompositionofstandardandreducedosmolarityORSsolutions ORS Standard ReducedOsmolarity Contents mEq/L mEq/L Glucose 111 75 Sodium 90 75 Choride 80 65 Potassium 20 20 Citrate 10 10 Osmoarity 311 245 30mmol/lofbicarbonateinsteadof10mmol/lofcitrate
188.Mostcommonsiteforbonemarrow aspirationinneonatesis- a)Anteriorsuperioriliaccrest b)Posteriorsuperioriliaccrest c)Sternum d)Anteromedialtibia CorrectAnswer-DAnswer-D.AnteromedialtibiaPreferredsiteforbonemarrowaspirationinchildren-Posteriorsuperioriliaccrest.Inchildren<18monthofageAnteromedialtibiaispreferred.
189.Milestonesat1yearofageareallexcept a)Playingasimpleballgame b)Using2wordsthataremeaningful c)Spontaneousscribbling d)Walkingupstairs1stepatatime CorrectAnswer-DAnswer-D.Walkingupstairs1stepatatimeTriestoremovehiscoatandattemptstowearhissocksorshoeswithoutsuccess.Doesmimicry.PlaysasimpleballgameCanuse2wordswithmeaningTriestobuildaTowerof2cubesTriestoscribblespontaneously(between12-24months).
190.Floorofnasalcavityinchildrenismade of- a)Palatineboneandvomer b)Sphenoidandethmoid c)Nasalboneandmaxilla d)Palatineboneandmaxilla CorrectAnswer-DAnswer-D.Palatineboneandmaxilla"Thefloorofthenasalcavities,whichalsoformtheroofofthemouth,ismadeupbythebonesofthehardpalate:thehorizontalplateofthepalatineboneposteriorlyandthepalatineprocessofthemaxillaanteriorly."[RefMoore,KeithL;Dailey,ArthurF.(1999).ClinicallyOrientedAnatomy.LippincottWilliamserWilkins.]
191.Strangeranxietydevelopsat a)3months b)4months c)7months d)11months CorrectAnswer-CAnswer-C.7monthsMilestonesatmonthHoldstheobjectswithcrudegraspfrompalm(palmargrasp)PivotsShowsstrangersanxietyResistsifatoyispulledfromhishand.Babbles
192.Consanguinousmarriagesincreaserisk ofdiseases- a)Autosomaldominantdisease b)Autosomalrecessivedisease c)Xlinkeddominantdiseases d)Environmentaldiseases CorrectAnswer-BAnswer-B.AutosomalrecessivediseaseIncreasesriskof-autosomalrecessivediseaseNochangeinriskof-autosomaldominant,Xlinkedrecessive(ifneitherparentaffected)NotProven-complexlateonsetdiseaseslikediabetes,schizophrenia,cardiovasculardiseases
193.Whatistheaverageweightgainofthe neonateperday a)5-10g b)25-30g c)50-60g d)100-150g CorrectAnswer-BAnswer-B.25-30gTheygainweightatarateofapproximately25to30gmperdayforthefirst3monthsoflife.Thereaftertheygainabout400gmofweighteverymonthfortheremainingpartoffirstyear.[RefGhai7th/ep.6]
194.Japaneseencephalitisvaccineinroutine scheduleisgiveninhowmanydoses- a)Twodoses1monthapartwithaboosterafter1-2yearsif needed b)Singledosevaccine c)Threedoses1monthapartfollowedbyaboosterifneeded d)Threedoseswiththeseconddose1monthand3'dose6 monthsafterthefirstdose CorrectAnswer-AAnswer-A.Twodoses1monthapartwithaboosterafter1-2yearsifneededAVerocell-derived,inactivatedandalum-adjuvantedJEvaccinebasedontheSA14-14-2strainisused.Theprimarytwodosesareadministered4weeksapart.Aboosterdoseisrecommended1-2yearsaftertheprimaryimmunization
195.Newbornloseshowmuchweightinfirst week? a)5-10% b)1-2% c)10-20% d)None CorrectAnswer-AAnswer-A.5-10%Theaveragebirthweightofneonatesisabout3Kg.Duringfirstfewdaysafterbirth,thenewbornlosesextracellularfluidequivalenttoabout10%ofthebodyweight.
196.Inacutediarrheafollowingisusedto decreasedurationandseverity- a)Zn b)Mg c)Fe d)Ca CorrectAnswer-AAnswer-A.ZnRecentstudiessuggestthatadministrationofzincalongwithnewlowosmolarityoralrehydrationsolutions/salts(ORS),canreducethedurationandseverityofdiarrhealepisodesforuptothreemonths.[RefSachdevHP,MittalNK,YadavHS.Oralzincsupplementationinpersistentdiarrheaininfants.AnnTropPaediatr.1990;10:63-9.]
197.Whatisthecardiothoracicratioin childrenis- a)30-35% b)40-45% c)50-55% d)60-65% CorrectAnswer-CAnswer-C.50-55%"Thecardiacsilhouetteoccupies50-55%ofthechestwidth.Cardiomegalyispresentwhenthecardiothoracic(CT)ratioismorethan55%."
198.Eyelidpapulesandhoarsecryinachild issuggestiveof- a)Congenitalsyphilis b)Croup c)Lipoidproteinosis d)Acrodermatitisenterohepatica CorrectAnswer-CAnswer-C.LipoidproteinosisLipoidproteinosisalsoknownashyalinosiscutisetmucosaorUrbach-Weithediseaseisarareautosomalrecessivedisorder.characterizedclinicallybyamyriadsignsandsymptomsthatincludehoarsenessofthevoice,beadedeyelidpapules(Moniliformblepharosis),yellowish-whitemucocutaneousinfiltrates,andatrophicpock-likescars.
199.Thefetalcirculationchangestonormal circulationatbirthwith a)Closureofpatentductusarteriosus b)Closureofductusvenosus c)IncreasedactivityofrightVentricle d)OpeningoffossaOvalis CorrectAnswer-AAnswer-A.ClosureofpatentductusarteriosusTheincreaseintheconcentrationofoxygeninthebloodleadstoadecreaseinprostaglandins,causingclosureoftheductusarteriosus.Theseclosurespreventbloodfrombypassingpulmonarycirculation,andthereforeallowtheneonate'sbloodtobecomeoxygenatedinthenewlyoperationallungs.
200.Mostcommoncauseofpneumoniain earlyonsetsepsisaneonateis a)Pnemococcus b)S.Pyogens c)EColi d)S.Aureus CorrectAnswer-CAnswer-C.EColiEarlyonsetsepsisItiscausedbyorganismsprevalentinthegenitaltractorinthelaborroomandmaternityoperationtheatre.InthewestitismostlycausedbygroupBstreptococcusandE.coli.Inourcountryitismostlyduetogramnegativeorganisms-E.coli,ldebsiellaandenterobactorsp.
201.Testdonetodiagnosesyphilisin newbornifmotherissyphilitic- a)SyphilisCapitaMtest b)DetectionofIgG c)ZNstaining d)Fluoroescentantigentest CorrectAnswer-AAnswer-A.SyphilisCapitaMtestTheteststodetectIgMare- 1. FTA-ABS(19SIgMFTA-ABS).2. SyphilisCapitaMtest.
202.Inotropicsupportforseverely dehydratedchildwithdopamineisdoneatwhatrate- a)0.1-0-5microgram/kg/min b)1-5microgram/kg/min c)1-5mg/kg/min d)10-15mg/kg/min CorrectAnswer-BAnswer-B.1-5microgram/kg/minInhighdoses,itactsonalpha-adrenergicreceptorstoincreasesystemicvascularresistanceandraisebloodpressure.1-5mcg/kg/minIV,increasedto5-20mcg/kg/min;nottoexceed50mcg/kg/min.
203.Neonatalresuscitation-whichofthe followingdrugsisused? a)Dopamine b)SodiumBicarbonate c)Noradrenaline d)Dobutamine CorrectAnswer-BAnswer-B.SodiumBicarbonateImportantdrugsusedforneonatalresuscitationareEpinephrine(adrenaline),Normalsalineorringerlactate,NaloxoneandSodabicarbonate.
204.Whichofthefollowingiscorrectabout shockinchild? a)Tachycardiaisaverysensitiveindicatorofdepletionof intravascularvolume b)Mottlingofextremitiesisseeninearlyshock c)Confusion,stuporandcomaareearlysigns d)Respiratoryrateismoresensitivethanheartrateasan indicatorofearlyshock CorrectAnswer-AAnswer-A.TachycardiaisaverysensitiveindicatorofdepletionofintravascularvolumeHypovolemicshockinchildrenmayhavefollowingstages:-i)EarlycompensatedImmediatelyafterhypovolemia,bodytriestomaintaintheBPtomaintainadequateperfusiontovitalorgansthroughacompensatorymechanisms.Anincreaseinheartrate(Tachycardia)istheearliestandmostsensitiveindicatorforintravascularvolumereductionii)LateuncompensatedIfshockstatecontinuesorthecompensatorymechanismsarenotenoughtomaintainthemetabolicneedsofthetissue,theshock,goesintouncompensatedphase.
205.Whendoescryingstopincyanoticspells ? a)ForcedExpiration b)Forcedinspiration c)Midinspiration d)Cryingiscontinuous CorrectAnswer-AAnswer-A.ForcedExpirationCyanoticform(cyanoticspells)Thisismorecommonandisprovokedinresponsetofrustrationandangerprecipitatedbyupsettingorscoldinginfant/child.Cyanoticspellsareduetocentralsympatheticoveractivity.Clinicalfeaturesincludegeneralizedcyanosis,apnea,forcedexpiration(cryingstops),opisthotonus,shrillcryandbradycardia.Seizuresmayoccurduetocerebralhypoxia,butantiepilepticsarenotrequired.Theonlytreatmentissupportandreassurancetoparents
206.AbdominalpaininHenochSchonlein purpuraisdueto- a)MucosalerosionsandswellingoftheGImucosa b)Gastrointestinalhemorrhage c)Volvulus d)Associatedpancreaticinflammation CorrectAnswer-AAnswer-A.MucosalerosionsandswellingoftheGImucosaThesecondmostfrequentsymptomofHenoch-SchOnleinpurpuraisabdominalpain,whichoccursinupto65percentofcases.Themostcommoncomplaintiscolickyabdominalpain,whichmaybesevereandassociatedwithvomiting.Endoscopicevaluationoftenshowsmucosalerosionsandswelling.
207.Treatmentofchoiceforsymptomatic neonatalhypoglycemiais a)Dextrosenormalsaline b)5%dextrose c)10%dextrose d)25%dextrose CorrectAnswer-CAnswer-C.10%dextroseSymptomaticorasymptomaticwithbloodglucose<20mg/dlBolus10%dextrose2ml/kgisgivenIV.Followedbycontinuousinfusionof6mg/kg/minute.Ifnormoglycemiaisnotachievedwithin24hours,glucocorticoids(prednisoneorhydrocortisone)shouldbeadministered.Forintractablehypoglycemia,glucagon,epinephrineordiazoxidecanbegiven.Inhypoglycemicseizures,doseof10%dextroseis4ml/kg
208.ALLofthefollowingarecausesof neonatalbradycardiaexcept a)Hypoxia b)Hypothermia c)Headinjury d)BCGVaccine CorrectAnswer-DAnswer-D.BCGVaccineNeonatalbradycardiaisdefinedasadecreaseinheartby30bpmfrombaseline.Regardingneonatalresuscitation,bradycardiaisconcerningwhentheheartrateislessthan100bpm.
209.InvestigationofchoiceforCONFIRMING HenochSchonleinpurpurais- a)SerumIgAlevels b)CRPlevels c)RenalBiopsy d)DTPA CorrectAnswer-CAmswer=C.RenalBiopsyBiopsyofthekidneymaybeperformedbothtoestablishthediagnosisortoassesstheseverityofalreadysuspectedkidneydisease.
210.Whichofthefollowingisnotacauseof neonatalanaemia? a)SubgalealHemorrhage b)Abruptioplacentae c)DiamondBlackfansyndeome d)Wilson'sDisease CorrectAnswer-DAnswer-D.Wilson'sDiseaseInternalhemorrhagesuchasintracranialhemorrhage,subgalealhemorrhage,cephalohematoma,adrenalhemorrhage,subcapsularhematomaofliverorrupturedviscusObstetricalcauses:placentalabruption,placentaprevia,traumatoplacentaorumbilicalcordduringdeliveryandruptureofanomalousplacentalvesselsTwin-twintransfusionRBCdestructionRBCproduction
211.AutosomalrecessivePolycystickidneys -allaretrueexcept- a)Seeninadults b)DefectivegeneisPKHD1 c)Bothkidneysshowinnumerablecysts d)USGshowssaltandpepperappearance CorrectAnswer-AAmswer-A.SeeninadultsChildhoodpolycystickidneydiseasehasautosomalrecessiveinheritance,thereforeitisalsoknownasautosomalrecessivepolycystickidneydisease.DefectivegeneisthePKHD1(PolycysticKidneyandHepaticDisease1)whichcodesforaproteinfibrocystinBothkidneysaremarkedlyenlargedandshowinnumerablecystsradiatingfrommedullathecortex.MRIofkidneyshowsradiallyarrangedfusiformdilatedcollectingducts.PrenatalUSGshowsasaltandpepperappearanceofkidney.
212.3montholdchildwithindrawingchest withrespitratoryrate52/minclassifiedas a)SIRS b)Respiratorydistress c)Tachypnoea d)ARDS CorrectAnswer-BAnswer-B.RespiratorydistressTachypnea(fastbreathing):Fastbreathingisdefinedas:- 1. Lessthan2monthsofage->60breathsperminute2. Childaged2monthsupto12months-50breathsperminute3. Childaged12monthsupto5years->40breathsperminute
213.45dayoldinfantpresentswithseizures. Examinationrevealsheisicteric,havingbulgingfontanellesandopisthotonicposture.Treatmentisallexcept a)Phototherapy b)ExchangeTransfusion c)Phenobarbitone d)Chlorpromazine CorrectAnswer-DAnswer-D.ChlorpromazineChlorpromazineisnotusedinhyperbilirubinemia.Treatmentofhyperbilirubinemiaincludes 1. Pharmacologicaltharapy:Barbiturates(phenobarbitone), metallloporphyrins(Tin/SnandZinc/Zn) 2. Phototherapy3. Exchangetronsfusion
214.MostcommonsiteforopeningofTAPVC is- a)Supracardiac b)Cardiac c)Infracardiac d)Multiple CorrectAnswer-AAnswer-A.SupracardiacTypeI(SupraCardiac)TAPVCMostcommon45%TypeII(Cardiaclevel)TAPVC-25%TypeIII(InfraCardiac)TAPVC-25%TypeIV(Multiplelevel)TAPVC45%
215.Chroniclungdiseaseinainfancyis definedas a)Needforsupplementaloxygenat36weeksafterconception b)Tachypnoea>50breaths/minwithin1weekofbirth c)PresenceofbilateralinfiltratesonchestXrayfor2weeks d)ReticulogranularpatternonchestXrayfor6weeks CorrectAnswer-AAnswer-A.Needforsupplementaloxygenat36weeksafterconceptionChroniclungdiseaseofinfancywasformerlycalledbronchopulmonarydysplasia.Bronchopulmonarydysplasiaisusuallydefinedasaneedforsupplementaloxygenat36weeksafterconception.Bronchopulmonarydysplasiaisusuallydefinedasaneedforsupplementaloxygenat36weeksafterconception.BPDisusuallydefinedasaneedforsupplementaloxygenat36wkafterconception.BPDisaresultoflunginjuryininfantsrequiringmechanicalventilationandsupplementaloxygen.
216.Mostcommonantigeninvolvedin erythroblastosisfetalisis a)CantigeninRhgroup b)DantigeninRhgroup c)EantigeninRhgroup d)Duffyantigen CorrectAnswer-BAnswer-B.DantigeninRhgroupRBCantigensarecapableofelicitinganantibodyresponse,significantdiseaseisassociatedprimarilyDantigenofRhgroupandwithABOincompatibility
217.Eryhtematousblotchyrashisseenon theabdomen,trunkandfaceofa3dayoldchildalongwithyellowishpapules.Howeverthechildfeelswell.Whatisthemanagement? a)Steroidandantibioticlotion b)Notreatment c)Steroidcream d)Urgentintravenousantibiotics CorrectAnswer-BAnswer-B.NotreatmentErythematoxicumneonatorumisabenignself-limitederuptionoccurringprimarilyinhealthynewbornsintheearlyneonatalperiod.ItischaracterizedbyErythematouspapulesontrunk&face.Theyappearon2nd&3rddayanddisappearspontaneously.
218.Furtherinvestigationisessentialina newbornwithwhichcondition? a)Erythematoxicum b)Vaginalbleed c)Subconjunctivalhemorrhage d)Lensopacity CorrectAnswer-DAnswer-D.LensopacityTheproblemsare 1. Milia2. Erythematoxicum3. Storkbites4. Peelingofskin5. Subconjuctivalhemorrhages6. Breastengorgment7. Epsteinpearl8. Pre-deciduous(natalteeth)9. Vaginalbleeding 10. Vaginalmucoiddischarge11. Hymenaltags12. Physiologicalphymosis13. Mongolianspots
219.Anewbornpresentswith subconjunctivalhemorrhage.Thetreatmentis a)Notreatment b)Antibioticeyedrops c)Aspitation d)Antibioticandsteroiddrops CorrectAnswer-AAnswer-A.NotreatmentSubconjunctivalhemorrhageinnewbornisanormalphenomenomwhichdisappearsspontaneously.
220.Whatistheshapeofcaecuminthe newborn? a)Ovoid b)Trapezoid c)Globular d)Conical CorrectAnswer-DAnswer-D.ConicalTheshapeofthecaecuminaninfantisconicalwiththeappendixborneatthebaseofthecone.
221.MostcommoncomplicationofMeckel's Diverticulumlitchildren a)Abdominalpain b)Pepticulcers c)Intestinalobstruction d)PainlessRectalbleeding CorrectAnswer-DAnswer-D.PainlessRectalbleedingMostcomnmonpresentationofMeckel'sDiverticuluminchildrenispainlessrectalBleeding.[RefAlemayehuH,HallM,DesaiAA,StPeterSD,SnyderCL.DemographicdisparitiesofchildrenpresentingwithsymptomaticMeckel'sdiverticuluminchildren'shospitals.PediatricSurgeryInternational.2014Jun30.6:649-653]
222.WhichofthefollowingisaXlinked metabolicdisorder? a)Fabry'sdisease b)Sandoffsdisease c)Pompedisease d)Gaucherdisease CorrectAnswer-AAnswer-A.Fabry'sdiseaseAlllysosomaldisordersare`autosomalrecessive'exceptforHunter'ssyndromeandFabry'sdisease,whichareX-linkedrecessive.ThusHunter'ssyndromeandFabry'sdiseaseaffectonlymale.
223.Testesarenotpalpablein a)SRYdeletion b)DAX1deletion c)WNT-4genemutation d)RSPO-1genemutation CorrectAnswer-AAnswer-A.SRYdeletionSRYgeneisinvolvedindevelopmentofmalegonds(testes)fromprimitive(bipotentialgonads).DAX-1,WNT-4andRSPO1genesareinvolvedindevelopmentoffemalegonads(ovary).
224.Whatisthemaintainancefluid requirementina6kgchild? a)240ml/day b)600ml/day c)300ml/day d)1200ml/day CorrectAnswer-BAnswer-B.600ml/dayFluidRequirementsin:InfantsandChildren HOLLIDAY-SEGARMETHOD 100ml/kg First10kgl Na+3 (4ml/kg/hr)1000ml+50ml/kgforeachKg>10kg 10-20kg K+2 (40ml/hr+2ml/kg/hr(wt-10kg)1500ml+20ml/kgforeachKg>20kg >20kg Cl-2 (60ml/hr+1ml/kg/hr(wt-20kg)
225.Kwashiorkor-Triadincludesallexcept- a)Psychomotorchanges b)Hypoglycemia c)Edema d)Growthretardation CorrectAnswer-BAnswer-B.HypoglycemiaClassicaltriadofkwashiorkorismarkedlyretardedgrowth,psychomotor(mental)changesandedema.
226.Childwith10episodesofdiarrheainlast 24hourswithsunkendryeyes,veryslowskinpinch,andabsenttears.Managementis a)ORSsolution b)breastfeeding c)Start10%dextrose d)StartRinger'slactate CorrectAnswer-DAnswer-D.StartRinger'slactateThisisacaseofseveredehydration.SevereDehydrationStartIVfluidsimmediatelyBestIVfluidsolutionisRingerlactateNormalsalinecanbeusedDextroseisnoteffective100ml/kgistobegivenasshownbelow: AGE FIRST THEN <12months 30nil/kginIhours 70ml/kg5hours 12monthsto5yrs. 30minutes 21/2hrs
227.1yearoldchildwithmultipleepisodesof diarrheapresentswithsunkendryeyes,depressedfontanelles,veryslowskinpinch.Theamountoffluidtobegiveninthefirst6hoursis a)600ml b)900ml c)1200ml d)1500ml CorrectAnswer-BAnswer-B.900mlTheapproximateweightofa1yearoldchildis9kg(iethricethebirthweight)Thedescriptionofdehydrationgivenaboveisconsistentwithseveredehydration.T
228.A6yearoldchildpresentswithan abdominalmass,fever,bonepainandIVCthrombosis,thediagnosiscouldbe- a)Wilm'stumour b)Neuroblastoma c)LangerhanscellHistiocytosis d)Gastriclymphoma CorrectAnswer-BAmswer-B.NeuroblastomaRenalveininvasionismorecharacteristicofneuroblastoma(itisrareinwilmstumor).
229.Whatisthefirstlinetreatmentofa4year oldchildpresentingwithintussusception? a)Conservativemanagementwithwaitandwatchpolicy b)Immediateattempttoreductionusingbariumedema c)Surgicalcorrection d)Exploratorylaparotomywithresectionoftheaffectedsegment CorrectAnswer-BAnswer-B.ImmediateattempttoreductionusingbariumedemaCorrectionofintussusceptionbybariumenemaistheinitialmanagementofchoice.Ifitfails,surgicalcorrectionisdone.
230.Hutchison'sTriadisseenin a)CongenitalSyphilis b)Tertiarysyphilis c)SecondarySyphilis d)Primarysyphilis CorrectAnswer-AAnswer-A.CongenitalSyphilisHutchinson'striadisacommonpatternofpresentationofCongenitalsyphilis.Itconsistsofthreephenomena: 1. Interstitialkeratitis,2. Hutchinsonincisor,3. Eighthnervedeafness
231.A8yearoldchildpresentswithamass inthelumbarregionwithabdominalpainwithexcruciatingbonepain.Possiblediagnosisis- a)Neuroblastoma b)Wilm'sTumour c)Lymphoma d)Angiomyolipoma CorrectAnswer-AAmswer-A.NeuroblastomaThisisacaseofneuroblastomathathasmetastatizedMetastasisispresentin60-70%atthetimeofdiagnosis.Commonestsiteofmetastasisisskeletalsystemandneuroblastomaisthemostcommonchildhoodmalignancymetastasizestobone.
232.Triadofnormalpressurehydrocephalus includesallexcept- a)Dementia b)Gaitdisturbance c)Urinaryincontinence d)Browache CorrectAnswer-DAnswer-D.BrowacheTriadofnormalpressurehydrocephalus/Adam'striad/Hakim'striadDementiaGaitdisturbanceUrinaryincontinece(wet,wackyandwobbly)
233.Trueaboutcephalhematomais- a)Itishemorrhagebetweentheskullandperiosteum b)Itishemorrhagewithinthesubcutaneoustissuearoundthe skull c)Itistypeofsubduralhemorrhage d)Itisextraperiostealbleedingintheskull CorrectAnswer-AAmswer-A.ItishemorrhagebetweentheskullandperiosteumCephalhematomaissubperiostealbleeding,i.e.betweenskullboneandperiosteum.
234.Medulloblatomaarisesexclusivelyfrom thecellsof a)Immatureembryonalcells b)Ependymalcells c)Neurons d)Spindleshapedcells CorrectAnswer-AAnswer-A.ImmatureembryonalcellsMedulloblastomaisthemostcommonPNET(primitiveneuroectodermaltumor)locatedinposteriorcranialfossa.[RefHinz,Chris;Hesser,Deneen.FocusingOnBrainTumors:Medulloblastoma.AmericanBrainTumorAssociation]
235.Whichofthefollowingisnottrueabout encephalocoele? a)Itisaneuraltubedefect b)Commoninthefrontalregion c)Canbeassociatedwithhydrocephalus d)Itisprotrusionofneuraltissuethroughadefect CorrectAnswer-AAnswer-A.ItisaneuraltubedefectPerinatalasphyxia,moreappropriatelyknownashypoxic-ischemicencephalopathy(HIE),ischaracterizedbyclinicalandlaboratoryevidenceofacuteorsubacutebraininjuryduetoasphyxia.Theprimarycausesofthisconditionaresystemichypoxemiaand/orreducedcerebralbloodflow(CBF)
236.Mostcommonconotruncalanomaly a)TGA b)Tetralogyoffallot c)Truncusarteriosus d)Doubleouletrightventricle CorrectAnswer-AAnswer-A.TGAConotruncaldefectsareabnormalitiesofoutflowtractseptationorectomesenchymaltissuemigrationabnormalities.Mostcommonconotructaldefectistranspositionofgreatarteries(TGA).
237.Meconiumcanpasseduptodaysin healthybady- a)1 b)3 c)5 d)7 CorrectAnswer-BAnswer-B.3Meconiumispassedwithin24hoursofbirth.Meconiumstoolsarepassedupto3days.Transitionstoolsarepassedzith&5thdays.RegularmilkstoolsarepassedAfter5days.
238.Fallotphysiologyincludesallexcept a)TOF b)Eisenmengercomplex c)TGA d)Tricuspidatresia CorrectAnswer-BAnswer-B.EisenmengercomplexTheseincludes 1. TOF2. SingleventriclewithPS3. TGAwithVSD&PS4. CorrectedTGAwithVSD&PS5. TA6. DoubleoutletrightventriclewithPS
239.Pulmonaryplethoraisseenwith-all except a)TGA b)Hypoplasticleftheartsyndrome c)Ebsteinanomalis d)Doubleoutletrightventricle CorrectAnswer-CAnswer-C.EbsteinanomalisPulmonaryoligamiaTOFTAEbstein'sanomalyPulmonaryatresia
240.Childwithrash-wrongis a)Typhus-day5 b)Varicella-day1 c)Typhoid-day5 d)Measles-day4 CorrectAnswer-CAnswer-C.Typhoid-day5VerySickPersonMustTakeDoubleTabletsVeryVaricella(day1)SickScarletfever(day2)PersonPox-smallpox(day3)MustMeasles(day4)TakeTyphus(day5)DoubleDengue(day6)TabletsTyphoid(day7)
241.Whatisrecurrenceoffebrileseizure- a)10-20% b)20-30% c)30-50% d)50-70% CorrectAnswer-CAnswer-C.30-50%Recurrentfebrileseizuresoccurin30-50%ofcases.Morethan90%offebrileseizuresaregeneralized.Acuterespiratoryillnessaremostcommonlyassociatedwithfebrileseizures.
242.Inneonate,intramuscularinjection givenat- a)Deltoid b)Gluteal c)Thigh d)Abdomen CorrectAnswer-CAnswer-C.ThighAnterolateralaspectofthighbecauseoflackofimportantbloodvessel&nerveispreferredsiteupto12monthofage.
243.SittinginTripodpositionatwhichmonth ? a)5months b)6months c)8months d)9months CorrectAnswer-BAnswer-B.6months6MonthSitwithsupport,sitsintripodposition8MonthSitwithoutsupport9MonthStandwithsupport12MonthStandwithoutsupportWalkwithsupport15MonthWalkalone,creepupstair
244.Weightofnewbornquadrupletsby- a)9months b)12months c)2year d)3years CorrectAnswer-CAnswer-C.2yearTriple-1yrFourtimes-2yrsFivetimes-3yrs
245.From6weeksto12weeks...Infant weightincreasesatrateof- a)30g/d b)40g/d c)50g/d d)60g/d CorrectAnswer-AAnswer-A.30g/dAverageweightofNewbornbabyis3kg.Newbornlosesextracellularfluidabout10%ofbodyweightandstartgainingweightandbecomeequaltobirthweightatday10oflife.Subsequently,theygainweightatarateofapproximately25to30gmperdayforthefirst3monthoflife.
246.Armspanandheightbecomesameat whatage(year)- a)9 b)11 c)13 d)15 CorrectAnswer-BAnswer-B.11Inunder-5children,armspanis1to2cmsmallerthanbodylength.During10-12yearsofage,armspan=height.Inadultsarmspanismoreinadultsby2cm.Abnormallylargearmspanisseeninpatientswith:(1)Arachnodactyly(Marfansyndrome)(2)Eunuchoidism(3)Klinefelter'sSyndrome(4)Coarctationofaorta.
247.Inproteindeficiencyallareseenexcept - a)Flakypaintlikeskin b)Glossitis c)Nailchange d)Cherrylikeskin CorrectAnswer-DAnswer-D.Cherrylikeskinrednessontheskin,brittlenails,thinhairGlossitisRiskofinfectionsFattyliverProteindeficiencymayleaveitsmarkontheskin,hairandnails.
248.Inachildhavingdiarrhoeawithperianal moistcrust.Thediagnosisis- a)Acrodermatitisenteropathica b)Riboflavindificiency c)Pellagra d)Noneofabove CorrectAnswer-AAnswer-A'AcrodermatitisenteropathicaAcrodermatitisenteropathicaisarareautosomalrecessivedisordercausedbyaninabilitytoabsorbsufficientZincfromthediet.Associatedmanifestations:-Chronicdiarrhoea,stomatitis,glossitis,Paronychia,Naildystrophy,Growthretardation,irritability,delayedwoundhealing,Bacterial&candidalinfection.
249.VitaminB6isusedintreatmentof- a)Homocystinuria b)Xanthourenicaciduria c)Cystathionuria d)Allofabove CorrectAnswer-DAnswer-D.AllofaboveVitB6dependentconvulsion.VitB6responsiveanemia.XanthurenicacidmiaCystathioninuriaHomocystinuria
250.ProstaglandinanalogueusedinPDAis- a)Anaprastone b)Misoprost c)Danaprostone d)PGE-2 CorrectAnswer-BAnswer-B.MisoprostProstaglandininhibitorsuchasindomethacinandspecialformofibuprofenareusedforductclosureinpreterm.PGE-1usedtokeepopenductareAlprostadilormisoprostol.
251.DrugusedtokeepPDAopen- a)PGE1 b)PGI2 c)PGE d)PGH2 CorrectAnswer-AAnswer-A.PGE1Prostaglandinnt1fbe,;infusionusuallyefectiveinkeepingtheductusarteriosusopenbeforesurgicalinterventiontoreducehypoxemiaandacidemiabeforesurgeryinductusdependentlesionlike.
252.WPWsyndromeisassociatedwith- a)Ebsteinanomaly b)TOF c)VSD d)TAPVC CorrectAnswer-AAnswer-A.EbsteinanomalyWolff-Parkinson-Whitesyndrome(WPW)isoneofseveraldisordersoftheconductionsystemoftheheartthatarecommonlyreferredtoaspre-excitationsyndromes.PeoplewithWPWmayhavemorethanoneaccessorypathwayseeninindividualswithEbstein'sanomaly.
253.Mostcommonsyndromeassociatedwith A-Vcanaldefect- a)Downsyndrome b)Klinfiltersyndrome c)Turnersyndrome d)Marfansyndrome CorrectAnswer-AAnswer-A.DownsyndromeItisalsocalledasatrioventricularcanaldefect(AVCD)orendocardialcushiondefect.ItcoversaspectrumofcongenitalheartmalformationcharacterizedbycontiguousatrialandventricularseptaldefectswithmarkedlyabnormalAVvalve.AVSDmaybe:- 1. IncompleteAVSD:Itisthesimplestformandnothingelsebut ostriumprimumtypeofASDinwhichthereisacommonatrioventricularjunctionbutseparatevalvularorificesforrightandleftventricles.ItismorecommoninDownsyndrome. 2. CompleteAVSD:Thereisacommonatriventricularjunctionand singlecommonvalvularorifice.
254.%ofchildrenwithsimplefebrileseizure developingepilepsyis- a)1-2% b)2-5% c)5-10% d)10-15% CorrectAnswer-AAnswer-A.1-2%Between2%to7%ofallchildrenwithfebrileseizuresdevelopepilepsyiffolloweduptotheageof25years.Riskdependsontypeoffebrileseizure: 1. Simplefebrileseizures42%ofallchildrenwithsimplefebrile seizures. 2. Complexfebrileseizures-6-8%ofallchildrenwithcomplexfebrile seizures.
255.CommondeformityinchiariH malformationis- a)Syringomyelia b)Meningomyelocele c)Hydrocephalus d)Allofabove CorrectAnswer-DAnswer-D.AllofaboveChiarimalformationisdividedinto: 1. TypeI:Producesymptomsduringadolescenceoradulthoodis usuallynotassociatedwithhydrocephalus.Thedeformityconsistsofdisplacementofcerebellartonsilsintothecervicalcanal. 2. TypeII:Itischaracterizedbyprogressivehydrocephaluswitha myelomeningoceleinnewborns.Thereisafailureofpontineflexureduringembryogenensis,whichresultsinelongationof4thventricle;kinkingofbrainstemandbreakingofquadrigeminalplate(tectum);alongwithdisplacementofinferiorvermis,ponsandmedullaintocervicalcanal.Thiscauseswideningofcervicalcanal(syringomyelia). 3. TypeIII:Usuallyassociatedwithoccipitalencephaloceleand causesabundantneurologicaldeficit. 4. TypeIV:Characterisedbylackofcerebellerdevelopmentand usuallynotcompatablewithlife.
256.Achildoflessthanoneyearwithasthma treatment- a)MDIwithSpacer b)MDIwithMask c)MDIwithSpacerwithMask d)MPIwithmask CorrectAnswer-CAnswer-C.MDIwithSpacerwithMaskMDIalonerequirebetterpressandbreathco-ordinationsousedabove12yearsofage.MDIwithspacerovercomebreathco-ordinationsousedabove4yearsofage.MDIwithspacerwithmaskcanbeusedsuccessfullyinchildrenbelow4yearsofage.
257.Treatmentofbronchiolitisincludesall except- a)Macrolides b)Humidoxygen c)Bronchodilator d)Allofabove CorrectAnswer-AAnswer-A.MacrolidesBronchiolitisispredominantlyaviraldisease. 1. RSV(mostcommon)2. Parainfluenzavirus3,1,23. Adenovirus4. Influenzavirus5. Mycoplasmapneumoniae Treatmentismainlysymptomaticwhichincludeshumidatmosphere,bronchodilators(n-agonist,ipratromium,epinephrinenebulized)andantipyretics.Thoughantibioticshavenorole,ribavarin,whenindicated,istheantiviralagentofchoice.
258.Mostcommonpulmonarytumorin childrenis- a)Carcinoid b)Smallcellcarcinoma c)Adenocarcinoma d)Squamouscellcarcinoma CorrectAnswer-AAnswer-A.CarcinoidThemostcommontumortypesarecarcinoid,inflammatorymyofibroblastictumor,andpleuropulmonaryblastomaRarepediatriclungtumorsincludingsmallcellcarcinoma,adenocarcinoma,andpulmonarycapillaryhemangiomatosiswerealsoseen.
259.Mostcommoncauseofperrectal bleedingininfantis- a)Analfissure b)Rectalpolyp c)Intussusception d)Hypertension CorrectAnswer-AAnswer-A.AnalfissureAnalfissuresarethemostcommoncauseofrectalbleedingininfantsandchildren.
260.Mostcommonanomalyofupper urogenitaltractis- a)Ureteropelvicjunctionstenosis b)Ectopicuretheralopening c)Ureterocele d)Ectopicureter CorrectAnswer-AAnswer-A.UreteropelvicjunctionstenosisMostcommoncauseofurinarytractobstructioninchildren-Posteriorurethralvalves.Mostcommoncauseoflowerurinarytractobstructioninchildren->Posteriorurethralvalves.Mostcommoncauseofupperurinarytractobstructioninchildren4PUJobstruction.
261.Featuresofcystinuriaare a)Impairedproximaltubularreabsorptionofcystine b)Autosomalrecessive c)Recurrentrenalstone d)Alloftheabove CorrectAnswer-DAnswer-D.AlloftheaboveCystinuriaBiochemicalDefect:Anautosomalrecessivedisorderthatresultsintheformationofadefectiveaminoacidtransporterintherenaltubuleandintestinalepithelialcells.Pathophysiology:Theaminoacidtransporterisresponsiblefortransportingcystine,ornithine,lysine,andarginine.Defectivetubularreabsorptionoftheseaminoacidsinthekidneysresultsinincreasedcysteineintheurine,whichcanprecipitateandcausekidneystones.ClinicalManifestations:Cysteinekidneystonespresentingwithsevere,intermittentflankpainandhematuria.Labfindings:Increasedurinaryexcretionofcystine,ornithine,arginine,andlysineonurineaminoacidchromatography;hematuriaandcysteinecrystals(hexagonal)onthecoolingofacidifiedurinesediment.Imaging:RadiopaquekidneystonesonCTscan.Themostspecifictestisthecyanide?nitroprussidetestTreatment:Low-methioninediet;increasedfluidintake;acetazolamidetoalkalinizetheurine.Ifthisfailsthenpatientsareusuallystartedonchelatingtherapywithpenicillamine.
262.Seconddegreeconsanguineous marriage,babywithdiarrhoea,perianaldiaperarearedness- a)Lactoseintolerance b)Shigelladiarrhoea c)Salmonella d)Fungal CorrectAnswer-AAnswer-A.LactoseintoleranceInLactoseintolerance,thereisdeficiencyofenzymelactase.SoNonaturalbreakdownoflactose-acarbohydratepresentinmilk.Thiscausesdiarrhoea.Stoolcontainsreducingsugarwhichcausesperianalexcoriation.
263.OnUSGamasswasfoundinabdomen whichwasdisplacingthekidneylaterallyin1yearoldchild- a)Neuroblastoma b)Nephroblastoma c)RCC d)Alloftheabove CorrectAnswer-AAnswer-A.NeuroblastomaThecommonestintra-abdominaltumorinfirsttwoyearsoflifeNeuroblastoma
264.DrugsusedinALLinchildareallexcept - a)Methotrexate b)Vincristine c)Vinblastine d)Cyclophosphamids CorrectAnswer-CAnswer-C.VinblastineTreatmentofALLisdividedinto4stages.Thetotaldurationoftreatmentrangesbetween2and2%years.1.InductionofremissionInductiontherapyisusedtoattainremision,i.e.,toeradicatetheleukemiccellsfrombonemarrow.Drugsusedare4Vincristine,Prednisolone,L-Asparginase,Anthracycline.Durationoftherapyis4-6weeks..2.CNStherapyMostchildrenwithleukemiahavesubclinicalCNSinvolvementatthetimeofdiagnosis.Moreover,CNSactsasasanctuarysitewhereleukemiccellsareprotectedfromsystemicchemotherapybecauseofbloodbrainbarrier.So,treatmenttokeepleukemiacellsfromspreadingtotheCNSisoftenstartedwithinduction.Treatmentinclude4Intrathecalmethotrexatepluscranialradiation.3.IntensificationIfthepatientgoesintoremission,thenextstepistointensifythetherapyforashortperiod.Drugsusedare4Methotrexate,L-Asparginase,Epipodophyllotoxin,Cyclophosphamide,Cytarabine.4.Maintenancetherapy
Afterconsolidation,thepatientisgenerallyputonamaintenancetherapytomaintainetheremissionstateandpreventrelapse.Drugsusedare46-mercaptopurine,Methotrexate,Prednisolone,Vincristine.Durationofmaintenacetherapyis2-2.5years.
265.34weekprimigravidapunjabikhatri comeswithhistoryofconsanguineousmarriage,withhistoryofrepeatedbloodtransfusiontohersiblingsince8monthsofage.Thefirstdiagnostictestis- a)HPLC b)Bloodsmear c)Bonemarrow d)Hbelectrophoresis CorrectAnswer-BAnswer-B.BloodsmearTypeofhemoglobinisdetectedbyHbelectrophoresis.Inthiscase,Hbelectrophoresisofthewomanshouldbedone.Ifshecomespositiveforabnormalhemoglobin,sheshouldbecounselledaboutterminationofpregnancy.
266.3betahydroxysteroiddehydrogenase deficiencycausesincreaseproductionof- a)DHEA b)Progesterone c)Deoxycortisol d)Estradiol CorrectAnswer-AAnswer-A.DHEAThereiselevatedlevelofpregenolone,17a-OHpergeneloneDHEAanddecreaslevelofprogesterone,deoxycortisolandestradiol.
267.2-5yearoldchildwithDM,targetHbA,C is- a)<8% b)<7% c)<9% d)<6% CorrectAnswer-CAnswer-C.<9%Inchildrenbelow5yearofage,targetHBA1Cis7.5-9%.
268.PrenataldiagnosisofDownSyndromeis by- a)Karyotyping b)Tripletest c)Fetalultrasonography d)Allofabove CorrectAnswer-DAnswer-D.AllofaboveFollowingmethodsareused: 1. Tripletest:Itincludes(i)Unconjugatedestrogen(estriol): decreased;(ii)Maternalserumalpha-fetoprotein(MSAFP):decreased;and(iii)hCG:increased(Note:AllthesethreemarkersaredecreasedinEdwardsyndrome) 2. Newmarkers:Theseare(i)IncreasedinhibinAinmaternalblood; and(ii)DecreasedPAPA(pregnancyassociatedplasmaprotein). 3. USG:Itshows:(i)Increasednuchaltranslucency(increasednuchal foldthickness)infirsttrimester;(ii)Ductusvenousflowreversed;and(iii)Nasalbonehypoplasia. 4. Karyotyping:Itcanbedonebychorionicvillussamplingat10-12 weeksoraminocentesisat16-18weeks.
269.5yearoldchilddevelopfeverandrash onfirstdayandrashdisappear,afterfewdaysdevelopchilddevelopataxia.Mostprobablediagnosisis- a)Measles b)Fifthdisease c)Chickenpox d)Rockymountainspottedfever CorrectAnswer-AAnswer-A.MeaslesInformation: 1. Rashon1stday2. Complicationlikeataxia3. Diagnosisischickenpox.
270.MCsymptomofAIDSininfantis- a)GIinfection b)Persistentcough c)Failuretothrive d)Lymphadenopathy CorrectAnswer-AAnswer-A.GIinfectionFeaturesinolderchildren-GrowthfailureFeverDiarrheaSecondaryinfection
271.Babybornetopatientsuspectedof chlamydialinfectionsampletobetakenfordiagnosis- a)Conjunctival b)Urethral c)Urinesample d)Blood CorrectAnswer-AAnswer-A.ConjunctivalAbout70%ofbabyborntopositivechlamydalinfectiondevelopconjuctivitisatday5oflifesosampletakenfordiagnosisisconjuctival.Chlamydalinfectionismostcommoncauseofconjuctivitisinnewborn.Chlamydalinfectioncauseswateringdischangeformeye(unlikepurulentdischangeinGonococcal).[RefDebbie-MetalNewborn&InfantNursingReview(NAINR2004)]
272.FeaturesofRefsumdiseaseareall except- a)Ataxia b)CCF c)Ichthiois d)Retinitispigmentosa CorrectAnswer-BAnswer-B.CCFPeroxisomaldisorder.Defectiveenzyme-phytonoylCoAoxidase.Clinicalfeatureincludes 1. Impairedvision(retinitispigmentosa).2. Icthyosis3. Peripheralneuropathy.4. Ataxia
273.Youngchildwithlaughingspells. Diagnosis- a)Hypothalamichamartoma b)Tetralogyoffallot c)Nitrousoxidepoisoning d)Noneoftheabove CorrectAnswer-AAnswer-A.HypothalamichamartomaLaughingspills(alsoknowasGelasticseizure)Gelasticseizuresareepilepticeventscharacterizedbyboutsoflaughter.Laughter-likevocalizationisusuallycombinedwithfacialcontractionintheformofasmile.Autonomicfeaturessuchasflushing,tachycardia,andalteredrespirationarewidelyrecognized.Gelasticseizureshavebeenassociatedclassicallytohypothalamichamartomas.
274.ThirteenpairofRibsareseenin? a)Downsyndrome b)Holtoram c)Turner d)Fibrousdysplasia CorrectAnswer-AAnswer-A.Downsyndrome7pairTrisomy21,cleidocranialdysplasia11pairTrisomy18,2113pairTrisomy2114pairVATERSyndrome[RefAbnormalnumberoffetalribsinUSGbyLiatGindeset.al.]
275.Whatistheageofthechildwhodrawsa circleandbuildstowerof7cubes? a)1year b)2years c)21/2years d)3years CorrectAnswer-DAnswer-D.3years Age Milestone Age Numberofcubesoftower 12-24 Triestoscribble 12months 2 spontaneously 3 months 2years Drawsaverticalor 15months 4 horizontalline 3years Drawsacircle 18months 6 4years Drawsacross(plus 21months 7 sign)anddrawsa 24months rectangle 5years Drawsatriangle 30months 9 36months 10
276.Bywhatageisthemilestoneofclimbing stepswithalternatefeetachieved? a)2years b)3years c)4years d)5years CorrectAnswer-BAnswer-B.3yearsWalkindependently-1yearunwell,climbingupstairsandgoingdownstairswithonestepatatime-2yearsRidetricycle;climbingupstairswithalternatefeet-3yearsHopping;goingdownstairswithalternatefeet-4yearsSkipping-5years
277.Maturefingergripcomesatwhatage? a)5months b)7months c)9months d)1year CorrectAnswer-CAnswer-C.9months6monthsDropsoneobjectwhenanotherisoffered7monthsTransfersobject&unidextrousapproach9months-pPincergrasp12--13monthsCastingappear,mouthingdisappear15monthsFeedshimselfwithcup,slightspillage
278.Socialsmileisattainedatwhatage? a)2months b)5months c)9months d)1year CorrectAnswer-AAnswer-A.2monthsSocialsmiledevelopsat2months.
279.Arrangethefollowingmilestonesinthe correctorderoftheirattainmentI.Buildtowerof4cubesII.MakesimplesentencesIII.DrawingacircleIV.Drawingarectangle a)IIIIIIVI b)IIIIIIIV c)IIIIIIIV d)IIIIVIII CorrectAnswer-BAnswer-B.IIIIIIIVTheageofattainmentofthemilestonesis:-Buildsatowerof4cubes18monthsMakessimplesentences2yearsDrawingacircle3yearsDrawingarectangle4years
280.Bywhatagecananewbornrecognize mother? a)2months b)3months c)6months d)7months CorrectAnswer-BAnswer-B.3monthsHeadcontrolStartscooingRecognizesmotherCanfollowanobjectupto180?Onpullingthechildtosit,headlagspartially(between2-3months).After3monthsheadcontroldevelops.
281.Whichofthefollowingcanbedonebyan 18monthsoldbaby? a)Makingtowerof9cubes b)Canuse10wordswithmeaning c)Ridetricycle d)Turnpagesofbookoneatatime CorrectAnswer-BAnswer-B.Canuse10wordswithmeaningAt18months,thechildcanuse10wordswithmeaning.
282.Achildof5yearscanusesentencesof aroundhowmanywords? a)6words b)10words c)100words d)250words CorrectAnswer-BAnswer-B.10wordsAlthoughachildhasavocabularyof250wordsat3years,thechildcanusesentenceof10wordsat5years.
283.Milestonesachievedbya10monthsold childareallexcept- a)Pincergrasp b)Wavingbye-bye c)Standingwithoutsupport d)Playsapeek-a-boogame CorrectAnswer-CAnswer-C.StandingwithoutsupportBabystandswithoutsupportby1yearofage.Pincergrasp9monthsWavingbye-bye9monthsPlaysapeek-a-boogame10months
284.Whatistheageofachildwhocan identify4coloursanddrawatriangle? a)21/2years b)3years c)4years d)5years CorrectAnswer-DAnswer-D.5yearsAchildlearnstodrawatriangleattheageof5years.Identificationoffourcoloursisattainedattheageof4years.
285.Weightofaninfantdoublesbywhat age? a)6months b)1year c)2years d)3years CorrectAnswer-CAnswer-C.2yearsWeightofaninfantdoublesby5monthsandquadruplesby2yearsofage.
286.Growthofheadcircumferencein1st3 monthsoflifeisby a)2cm b)3cm c)5cm d)10cm CorrectAnswer-CAnswer-C.5cmHeadcircumferenceismeasuredfromtheoccipitalprotuberancetothesupraorbitalridgeofforeheadwhichisthemaximumoccipitofrontaldiameterofskull.Theheadcircumferenceinuterogrowsby0.5cminfirst2weeks,0.75cmin3rdweekandafterthat1cm/weektillbirth.
287.Delayederuptionisfailureofteethto appearby a)6months b)13months c)25months d)37months CorrectAnswer-BAnswer-B.13monthsDelayederuptionisusuallyconsideredwhentherearenoteethbyapproximately13monthsofage(mean+3SD).Commoncausesofdelayederuptionofteethinclude:-Idiopathic(Mostcommon).HypothyroidHypoparathyroidFamilial
288.Breastmilkprotectsfrominfectionsasit containsallofthefollowingexcept: a)IgE b)Lactoferrin c)Bifidusfactor d)PABA CorrectAnswer-AAnswer-A.IgEBreastmilkcontainsseveralantiinfectivefactors 1. Antibodies-3secretoryIgA,IgM2. Lysozyme3. Antistaphylococcalfactor4. Specificinhibitorysubstancesagainstviralinfections.5. LactoferrinInhibitsgrowthofE.coli.6. BilestimulatedlipasekillsentamoebahistolyticaandGiardia lamblia. 7. BifidusfactorInhibitsgrowthofE.coli8. Para-amino-benzoicacid(PABA)Providesprotectionagainst malariaix)Phagocyticmacrophagesandlymphoidcells
289.Whichofthefollowingistrueregarding prematuremilkascomparedtomaturemilk? a)Lesslactose b)Lessiron c)Lessimmunoglobulins d)Lesssodium CorrectAnswer-AAnswer-A.LesslactosePretermmilkThemilkofmotherwhodeliversprematurelydiffersfromthemilkofamotherwhodeliversatterm.Pretermmilkcontains:Lesslactose(incomparisontotermmilk).ContainsmoreproteinS,sodium,iron,immunoglobinsandcaloriesastheyareneededbythepretermbaby.
290.Allofthefollowingaretrueregarding breastmilkascomparedtocow'smilkexcept a)Containsmorelactose b)Moreamountofproteins c)Lessamountoffatcontent d)Mineralsandsaltsisless CorrectAnswer-BAnswer-B.MoreamountofproteinsIncomparisontocowmilk,humanmilkcontainslessamountof:Proteins(1gm/100ml),salts(sodium,chloride,potassium),fat(3.4gm/100ml),andminerals(calcium,phosphate)&more:Lactose(7g/100mlor7%).
291.Whichofthefollowingisthebest referenceforgrowthmonitoringinchildren? a)ICMR b)NCHS c)Boston d)IAP CorrectAnswer-BAnswer-B.NCHSWHOreferencevalues(NCHSstandards)Thesearemostcommonlyusedandbestavailablereferencevaluesforinternationaluse.ThesevaluesarebasedonthedataassembledbyUnitedStatesNationalCentreforHealthStatistics(NCHS).ClassificationofPEMisbasedonthesestandards
292.Kwashiorkarisduetodeficiencyof a)Calories b)Minerals c)Vitamins d)Zinc CorrectAnswer-AAnswer-A.CaloriesMarasmusandkwashiorkorareduetodeficiencyofproteinsandcalories.Itischaracterizedbyclassical'triad'ofedema(Duetohypoalbuminemia),markedlyretardedgrowthandpsychomotor(mental)changes.
293.Featuresofmarasmusareallexcept: a)Absenceofanasarca b)Increasedappetite c)Excessivecatabolismofadiposetissueandmuscleprotein d)UncompensatedphaseofPEM CorrectAnswer-DAnswer-D.UncompensatedphaseofPEMItisduetoprolongdeficiencyofcaloriesandproteins.Thusthereisexessivecatabolismofadiposetissueandmuscleprotein.Itischaracterizedbygrosswastingofmuscleandsubcutaneoustissuesresultinginemaciationandmarkedstunting.Childmayshowvoraciousappetite.MarasmusrepresentsthecompensatedphaseofPEM.
294.Allofthefollowingarecausesof pseudoparalysisexcept a)Osteomyelitis b)Scurvy c)Septicarthritis d)Polio CorrectAnswer-DAnswer-D.PolioCausesofpseudoparalysis 1. Scurvy(vitaminCdeficiency)2. Osteomyelitis3. Septic(arthritis)4. Congenitalsyphilis
295.Whichofthefollowingcanleadto regressionofdevelopmentalmilestones a)Rett'ssyndrome b)Autism c)Neuromusculardiseases d)Alloftheabove CorrectAnswer-DAnswer-D.AlloftheaboveThehallmarkofmanydegenerativedisordersisneurologicalregression.Lossofonlylanguageskills?autism?suspected.RegressionofbothlanguageandmotormilestonesRett'ssyndrome.
296.AllofthefollowingarefeaturesofRett's syndromeexcept a)Microcephaly b)Regressionofmilestones c)Cardiaarrhythmias d)FocalConvulsions CorrectAnswer-DAnswer-D.FocalConvulsionsThisisthecharacteristicfeatures,thattheybegintoloosetheiracquiredskills,e.g.,cognitiveandheadgrowthisnormalduringearlyperiodafterwhichthereisanarrestofgrowth.Acquiredmicrocephaly(Declerationofheadgrowthduetosignificantlyreducedbrainweight).Mostchildrendeveloppeculiarsighingrespirationswithintermittentperiodsofapneathatmaybeassociatedwithcyanosis-4Breathholdingspells.
297.Childwhileplayinghassuddenlossof consciousnessandappearspale.Thereisnosignificantmedicalhistoryandthechildwasotherwisehealthy.Whichofthefollowingisthemostprobablediagnosis? a)Attentiondeficithyperkineticdisorder b)Breathholdingspell c)Autism d)Rett'ssyndrome CorrectAnswer-BAnswer-B.BreathholdingspellPallidform(Pallidspells)Theseareinitiatedbypainfulexperience,e.gfallingandstrikingthehead.Pallidspellsareduetoexcessivecentralparasympetheticactivity.Clinicalfeaturesincludepallor,apnea,lossofconsciousness,hypotonia,seizuresandbradycarda.Treatmentincludessupportandreassuranceofparents.Atropinemaybeusedinrefractorycases
298.Infantilebodyproportioninadultsis seeninallexcept- a)Achondroplasia b)Hypothyroidism c)Klinefelter'ssyndrome d)Cretinism CorrectAnswer-CAnswer-C.Klinefelter'ssyndromeInfantiletypebodyporportionAchondroplasiaJuvenilemyxedema(hypothyroidism)Cretinism
299.Ifchronologicalage>skeletalagewith normalgrowthvelocity,thenthefinalheightthatisexpectedtobeachievedis a)Normal b)Lessbecauseofsmallbones c)Morethanexpected d)Lessbecauseofepiphysealclosureduetoacceleratedgrowth velocity CorrectAnswer-AAnswer-A.NormalIfthegrowthvelocityisnormalbutthechronologicalageismorethantheboneage,thenthediagnosisisConstitutionaldelayingrowth.ConstitutionaldelayingrowthItisthemostcommoncauseofshortstatureinmidchildhoodperiodbuttheultimateheightisnormal.Theirbirthweightandheightarenormal.Strongfamilyhistoryofparentshavingshortstatureinchildhoodwithdelayinonsetofpubertyisusuallypresent.
300.Whichofthefollowingabouthormone levelsinamalnourishedchildistrue? a)Increasedinsulinlevels b)Decreasedcortisollevels c)Increasedgrowthhormone d)Alloftheabove CorrectAnswer-CAnswer-C.IncreasedgrowthhormonechangesinPEMDecreasedinsulinlevelsIncreasedcortisolIncreasedgrowthhormone
301.A9montholdchildwithrespiratoryrate 53/minandpresenceofcoughisclassifiedas: a)SIRS b)Respiratorydistress c)Tachypnoea d)ARDS CorrectAnswer-CAnswer-C.TachypnoeaTachypnea(fastbreathing):Fastbreathingisdefinedas: 1. lessthan2monthsofage->60breathsperminute2. Childaged2monthsupto12months-50breathsperminute3. Childaged12monthsupto5years-40breathsperminute
302.Anewbornafterprolongedlabourisnot breathingwellandafter30secondsofreceiving100%oxygenbybagandmask,heartrateis88beatspermin,whatisthenextstepinmanagement? a)Discontinueoxygenandventilation b)Discontinueoxygen,continueventilation c)Continueoxygenandventilation d)Startchestcompressions CorrectAnswer-CAnswer-C.ContinueoxygenandventilationAftertheinfanthasreceived30secondsofventilationwith100%oxygenbybagandmask,evaluationofheartrateshouldbedone-HR>100Discontinueventilationifspontaneousrespirationispresent.HR60to100ContinueventilationBelow60Continueventilation+chestcompressionsAfter30secondsofchestcompressions,theheartrateischecked.HR<60Continuechestcompressionandbag&maskventilation+initiatemedications.HR>60Discontinuechestcompressionbutcontinuebag&maskventilationuntiltheheartrateisabove100.[Ref:O.P.Ghai7th/ep.98]
303.Howarechestcompressionsgivenina newborn? a)Usingpalmonthelowerthirdofsternum b)Usingtwofingersonthemiddlethirdofsternum c)Usingthetwothumbsonthelowerthirdofsternum d)Usingthreefingersonthelowerthirdofsternum CorrectAnswer-CAnswer-C.UsingthetwothumbsonthelowerthirdofsternumTwo-fingertechniqueThetipsofthemiddlefingerandeithertheindexfingerorringfingerofonehandareusedtocompressthesternum.Theotherhandisusedtosupporttheinfant'sback,unlesstheinfantisonaveryfirmsurface.
304.Asymmetrictonicneckreflexdisappears atwhatage? a)2months b)3months c)6months d)8months CorrectAnswer-CAnswer-C.6monthsAssymmetictonicneck-wksofgestation4-66-7months
305.Trueabouttonicneckreflexis a)Extensionofarmonipsilateralside,flexiononcontralateralside b)Extensionofarmoncontralateralside,flexiononipsilateralside c)Extensionofarmsonbothsides d)Flexionofarmsonbothsides CorrectAnswer-AAnswer-A.Extensionofarmonipsilateralside,flexiononcontralateralsideThetonicneckreflexisproducedbymanuallyrotatingtheinfant'sheadto1sideandobservingforthecharacteristicfencingposture(extensionofthearmonthesidetowhichthefaceisrotatedandflexionofthecontralateralarm).Anobligatorytonicneckresponse,inwhichtheinfantbecomes"stuck"inthefencingposture,isalwaysabnormalandimpliesaCNSdisorder.
306.Closureofpatentductusarteriosusis stimulatedby? a)ProstaglandinF2a b)Cycloxygenase c)Increasein02tensionatbirth d)Hypercarbia CorrectAnswer-CAnswer-C.Increasein02tensionatbirthThemechanismproducingtheinitialconstrictionofductusarteriosusisnotcompletelyunderstood,buttheincreaseinarterial02tensionplaysanimportantrole.Onemorefactorwhichhelpsinclosureoftheductusarteriosusisthedecreaseinconcentrationofprostaglandinsatthetimeofbirth.
307.FalseaboutPDAis a)Morecommoninfemales b)Anatomicalclosuretakes21hoursafterbirth c)PGEmaintainspatencyofductus d)Dilatationofascendingaorta CorrectAnswer-BAnswer-B.Anatomicalclosuretakes21hoursafterbirthPatentductusarteriosusisacommunicationbetweenthepulmonaryarteryandaorta.'Functionalclosure'takesplacewithin15hoursofbirth.'Anatomicclosure'ofductusarteriosusoccurs10-21daysafterbirth.Prostaglandinsmaintainthepatencyofductus.Thepersistenceoffunctionofductusarteriosusbeyond24hoursafterbirthisconsideredasPDAintermneonate,i.e.iffunctionalclosuredoesnottakeplacein24hoursafterbirth,itisconsideredasPDA.
308.Whichofthefollowingisnotseenin patentductusarteriosus? a)Leftatrialhypertrophy b)Leftventricularenlargement c)Continuousmurmur d)AttenuatedSI CorrectAnswer-DAnswer-D.AttenuatedSIIncreasedflowafterpassingthroughlungreachestheleftatriumandcausesvolumeoverloadLeftatrialdilatationandhypertrophy.Increasedbloodvolumepassesfromleftatriumtoleftventriclethroughmitralvalve,i.e.,increasedflowthroughmitralvalveAccentuationofS1anddelayeddiastolicmurmur.LeftventriclereceiveslargeramountofbloodthatresultsinvolumeoverloadLeftventricleenlargement.
309.Whichofthefollowingcongenital anomaliesleadstoheartfailureatbirth? a)Totalanomalouspulmonaryvenousconnection b)Transpositionofgreatarteries c)Pulmonaryatresia d)Coarctationofaorta CorrectAnswer-CAnswer-C.PulmonaryatresiaTimingofCHFincongenitalheartdiseases-Pulmonary,mitralandaorticatresiasHypoplasticleftandrightheartsyndromes,transpositionandmalpositionofgreatateries.
310.Mostimportantprognosticmarkerof tetralogyoffallot a)VSD b)Pulmonarystenosis c)Overridingofaorta d)Rightventricularhypertrophy CorrectAnswer-BAnswer-B.PulmonarystenosisTetrologyoffallothas4components: 1. Obstructiontorightventricularoutflow(pulmonarystenosis),2. Amal-alignmenttypeofventricularsepta]defect(VSD),3. Dextropositionoftheaortasothatitoverridestheventricular septum,and 4. Rightventricularhypertrophy [RefNelson20thlep.2211]
311.Microcephalyiscommoninchildrenof motherswithallexcept a)Alcoholintake b)Warfarinintake c)Warfarinintake d)Varicella CorrectAnswer-BAnswer-B.WarfarinintakeSecondaryStructuraldefects:Neuraltubedefects(anencephaly,encephalocele).Metabolicdisorders:Rhenylketonuria,citrullinemia,methylmalonicaciduria.Congenitalinfections:Rubella,CMV,HSV,toxoplasmosis,syphilis,varicella.Teratogens:Alcohol,tobacco,cocaine,heroin.Others:Maternaldiabetes,maternalphenylketonuria,hypothyroidism,hypopituitrism,adrenalinsufficiency.
312.Whatisthecapacityofstomachatbirth a)5ml b)25ml c)50ml d)100ml CorrectAnswer-CAnswer-C.50mlDay15-7ml.SizeofcherryDay322-27ml.SizeofwalnutOneweek45-60ml.SizeofanapricotOnemonth80-150ml.Sizeofalargeegg
313.Colourofstoolsinbreastfednewbornis - a)Red b)Green c)Black d)Golden CorrectAnswer-DAnswer-D.GoldenColourofstoolsinneonateMeconium(firststool)ispassedwithin24hours.Afterthatmeconiumstools(blacktarry)canbepassedupto3days.On4th-5thdaystransitionalstools(greenish)arepassed.After5daysregularmilkstools(goldenyellow)arepassed.Thereisgoldendiscolorationofstool.
314.Trigonocephalyisduetopremature closureofwhichsuture? a)Sagittalsuture b)Metopicsuture c)Lambdoidsuture d)Coronalsuture CorrectAnswer-BAnswer-B.MetopicsutureTrigonocephal-MetopicsutureKeelshapedforeheadHypotelorismAbnormalitiesofforebrain
315.Whichofthefollowingisnotafeatureof Minimalchangedisease? a)Hypertension b)Edema c)Proteinuria d)Responsivetosteroidtherapy CorrectAnswer-AAnswer-A.HypertensionMinimalChangeDiseaseisthemostcommoncauseofNephroticsyndromeinchildren.EdemaandSelectiveproteinuriaarefeaturesofnephroticsyndrome.Fevermaybepresentonaccountofincreasedsusceptibilitytoinfection.Minimalchangediseaseprsentswithinsidiousonsetofnephroticsyndromeinchildrenbelow6yearsofage.HypertensionisnotafeatureofnephroticsyndromeandisrareinMinimalchangedisease.Hematuria(afindingofnephriticsyndrome)isalsorare.
316.WhatistherateofCSFformationin children? a)0.3ml/min b)1ml/min c)3ml/min d)20ml/min CorrectAnswer-AAnswer-A.0.3ml/minTherateofCSFformationinchildrenandadultsis:-0.3to0.4ml/minOR18to20ml/hour
317.Mostcommoncauseofcranial irradiationinchildrenis a)SmallcelllungCa b)ALL c)AML d)Craniopharyngioma CorrectAnswer-BAnswer-B.ALLALLandsmallcelllungCaaretwomajorindicationsforcranialirradiation,evenprophylacticallytopreventbrainmetastasis.Inchildren,ALListhemostcommoncause.
318.Whichofthefollowingisnotafeatureof physiologicalanaemiaofinfancy? a)Terminfanthemoglobin7gm% b)Preterminfanthemoglobin7gm% c)Terminfanthemoglobin9gm% d)Preterminfanthemoglobin9gm% CorrectAnswer-AAnswer-A.Terminfanthemoglobin7gm%PhysiologicAnemiaofInfancy 1. Hemoglobindropstolowpointatage6to8weeks2. ErythropoietinnadirdropsHemoglobin3. TermInfants:Hemoglobindropsto9-11g/dl4. PretermInfants:Hemoglobindropsto7-9g/dl [RefAnemiaininfancy,pediatricinreviewAmericanacademyofpediatrics2012]
319.Meanhemoglobinina1yearoldchild is a)18.5g/dl b)16.5g/d1 c)14g/c11 d)12g/dl CorrectAnswer-DAnswer-D.12g/dl Hblevel Prevalence(%) (g/L) Age Mildanemia ModeratetoSevere N Meam SE (mo) (Hb<110g/L) anemia(Hb<80g/L) 0-5 56 9.8 0.21 78.1 5.2 6-11 88 10.08 0.17 75.3 5.8 12-23 128 10.04 0.21 63.3 11.9 24-60 251 10.18 0.13 68.3 8.1 Totel 523 10.09 0.09 69.3 8.3 Hb,hemoglobina.Meansandfrequenciesareweighted.
320.Aminoacidmetabolismisimplicatedin whichdisease? a)Maplesyrupurinedisease b)Reye'ssyndrome c)VonGierke'sdisease d)McArdle'sdisease CorrectAnswer-AAnswer-A.MaplesyrupurinediseaseItisduetodeficiencyofenzymethatcatalyzesthesecondreactionintheseaminoacidsmetabolismi.e.branchedchain-aketoaciddehydrogenasewhichcatalysesdecarboxylationofbranchedchainaminoacids.
321.A3monthsoldchildwasstartedon supplementalfoodsalongwithbreastmilk.Thechildwasfedwithfruitpulpandsweetenedcereals.Soonthechilddevelopedbloatingofabdomen,vomiting,lethargy,irritability.Oninvestigation,therewashyperbilirunemiaandelevatedtransaminaselevels.Thechildissufferingfromwhichofthefollowingenzymedeficiencies? a)Fructokinase b)AldolaseB c)Galactokinase d)Galactose-1-phosphateuridyltransferase CorrectAnswer-BAnswer-B.AldolaseBSymptomsoccurwhenfoodsorformulascontainingthesesugarsareintroducedintothediet.Clinicalmanifestationsresemblegalactosemiaandincludejaundice,hepatomegaly,vomiting,lethargy,irritability,andconvulsions.Laboratoryfindingsincludeaprolongedclottingtime,hypo-albuminemia,elevationofbilirubinandtransaminaselevels,andproximaltubulardysfunction.
322.Allaretrueaboutsacrococcygeal teratomaexcept a)Notassociatedwithincreasedserummarkers b)Inmostcasesisnotvisibleexternally c)Ifassociatedwithhydrops,shouldberesectedantenatally d)Mostcommontumoroffetus CorrectAnswer-BAnswer-B.InmostcasesisnotvisibleexternallyUretersmaybepartiallyobstructedresultinginhydro-ureterandhydronephrosis.SacrococcygealTeratoma(SCT)isthemostcommonneoplasminthefetusandnewbornMostcommontumorinfetusandneonatesacrococcygealteratomaMostcommontumorininfancyneuroblastoma.Theyarenotassociatedwithelevatedmarkersunlessmalignancyispresent.Sacrococcygealteratomawithhydrops:-Treatment-Inuteroresectionorcatheterdirectedvesselobliteration
323.MostcommonsignofLRTI[Lower respiratorytractinfection]inchildrenis a)Chestindrawing b)Tachypnea c)Nasalflaring d)Failuretofeedwell CorrectAnswer-BAnswer-B.TachypneaTachypneaisthemostconsistentmanifestationofpneumonia.Pneumoniaisaninflammationoftheparenchymaoflungs,andmostlycausedbybacterialorviralinfection.Mostcommoncauseofpaediatricpneumoniaisrespiratorysyncytialvirus(RSV).Othervirusescausingpneumoniaareinfluenzavirus(2"?mostcommonvirus),adenovirus,rhinovirus,andparainfluenzavirus.
324.Whichofthefollowingisnotasignof severedehydration? a)Tachycardia b)Anuria c)Increasedthirst d)Delayedcapillaryrefill[>3sec] CorrectAnswer-CAnswer-C.IncreasedthirstPeripheralpulseseitherrapidandweakorabsentDecreasedbloodpressureNourineoutputVerysunkeneyesandfontanelNotearsParchedmucousmembraneDelayedelasticity(poorskinturgor)Verydelayedcapillaryrefill(>3sec)ColdandmottledLimpDepressedconsciousness
325.Whatisthegradeofdehydrationifa childdemonstratesexcessivethirstanddecreasedurineoutput? a)Nodehydration b)Milddehydration c)Moderatedehydration d)Severedehydration CorrectAnswer-BAnswer-B.MilddehydrationNormalorincreasedpulseDecreasedurineoutputThirstyNormalphysicalfindings
326.Whichofthefollowingcannotbeusedto detectHIVstatusinearlyinfancy? a)DNA-PCR b)HIVculture c)ELISA d)P-24antigenassay CorrectAnswer-CAnswer-C.ELISAELISAorWesternblottestarenotasreliableinyounginfants.Inolderinfants(>6months),detectionofanti-HIVIgAantibodiesbyELISAisdiagnostic.Inchildren(>18months)demonstrationofanti-HIVIgGantibodiesbyELISAisused.
327.Teratologyisastudyof a)Congenitalheartdefect b)Congenitalabnormalities c)Woundsandinjuries d)Noneoftheabove CorrectAnswer-BAnswer-B.CongenitalabnormalitiesStudyofCongenitalheartdefectsisapartofthebroadspectrumofcongenitalabnormalities,thestudyofwhichisknownasTeratology
328.Russellsilversyndromeisassociated withwhichofthefollowing? a)Autosomalinheritance b)X-linkedinheritance c)Sporadicgenemutation d)Uniparentaldisomy CorrectAnswer-DAnswer-D.UniparentaldisomyAngelmansyndromePraderWillisyndromePseudohypoparathyroidismIbTransientneonataldiabetesmellitusBeckwith-WiedemannsyndromeRussellsilversyndromeWangsyndromeTemplesyndrome
329.Whichofthefollowingisnotafeatureof Down'ssyndrome? a)Hypotonia b)Infections c)Femaleinfertility d)EarlyonsetAlzheimer'sdisease CorrectAnswer-CAnswer-C.FemaleinfertilityGIT:-Analatresia,Duodenalatresia,Hirschsprungdisease,annularpancreas.Increasedincidenceofleukemia(1%).LeukemiascommonareALL(mostcommon),AML(M7-AML)transientmyeloproliferativedisorders,andJuvenilCML.Others:EarlyonsetofAlzheimer'sdisease,Decreasedimmunitywithrecurrentinfections,obesity,DM,Hypothyroidism(mostcommonendocrineabnormality).
330.Whichofthefollowingisnotafeatureof Turner'ssyndrome? a)Cubitusvalgus b)Cryptorchidism c)Shortfourthmetacarpal d)Shieldchest CorrectAnswer-BAnswer-B.CryptorchidismClinicalfeaturesinadolescentsareshortstature,webbedneck,lowposteriorhairline,widelyspacednippleswithbroadchest(shieldchest),hypertelorism,epicanthus,slantedpalpebralfissure,ptosis,micrognathia,cubitusvalgus(increaredcarryingangle),sensorineuralhearingloss,shortfourthmetacarpal,hypothyroidism,streakovaries,andsexualinfantilism.Turnersyndromeisthemostimportantcauseofprimaryamenorrhea.
331.Whichofthefollowingistrueregarding Turner'ssyndrome? a)Cubitusvalgus b)Autosomaldominant c)Monosomyofchromosome12 d)Sensorineuralhearingloss CorrectAnswer-AAnswer-A.CubitusvalgusTurnersyndromeisamonosomyofsexchromosome(notautosomaldominant).CubitusvalgusisafeatureofTurnersyndrome.SNHLisnotafeature.
332.Mostcommoncauseofshockinchild a)Septicshock b)Hypovolemicshock c)Cardiogenicshock d)Anaphylacticshock CorrectAnswer-BAnswer-B.HypovolemicshockHypovolemiaisthemostcommoncauseofshockinchildren.The2ndmostcommoncause-Septicordistributiveshock.3rdmostcommon-Cardiogenicshock
333.Whichistheprognosticscoringsystem forheadinjuryinchildren? a)CCS b)AUDIT c)Injuryseverityscore d)PediatricTraumaScore CorrectAnswer-AAnswer-A.CCS Table1:ChildrenComaScore(CCS)<2years" OcularResponse 4 Pursuit 3 Extraocularmusclesintactreactivepupils 2 FixedpupilsandEOMimpaired 1 FixedpupilsandEOMparalyzed Verbalresponse 3 Cries 2 Spontaneousrespiration 1 Apneic Motorresponses 4 Flexesandextends 3 Withdrawsfrompainfulstimuli 2 Hypertonic 1 Flaccid TotalMax.Score 11TotalMinScore
334.Whichofthefollowingisacriteriafor clinicalStageIIofAIDSinchildren? a)Lymphadenopathy b)Oralcandidiasis c)Hepatosplenomegaly d)Oesophagealcandidiasis CorrectAnswer-CAnswer-C.HepatosplenomegalyClinicalStage2HepatosplenomegalyPapularpruriticeruptionsSeborrhoeicdermatitisExtensivehumanpapillomavirusinfectionExtensivemolluscumcontagiosumFungalnailinfectionsRecurrentoralulcerationsLinealgingivalerythema(LGE)AngularcheilitisParotidenlargementHerpeszoster
335.Whichofthefollowingisclosedatbirth? a)Foramenovale b)Posteriorfontanelle c)Ductusvenosus d)Anteriorfontanelle CorrectAnswer-BAnswer-B.PosteriorfontanellePosteriorfontanellePosteriorfontanellegenerallyclosesby2-4monthsafterbirth.Posteriorfontanelleusuallyclosesbytheageof1-4months.Butsometimeitmaybeossified(closes)atbirth.Thus,itisthebestansweramongthegivenchoices.
336.Harlequinskinchangeisseendueto mutationofwhichgene? a)ABCA12 b)FAD c)Keratin1 d)ALOXE3 CorrectAnswer-AAnswer-A.ABCA12Harlequinichthyosis(HI)iscausedbymutationsintheABCAl2gene.MutationinthegeneleadstodefectivelipidtransportandABCAl2activityisrequiredforthegenerationoflong-chainceramidesthatareessentialforthedevelopmentofthenormalskinbarrier.Itisinheritedbyautosomalrecessivemodeofinheritance.
337.Ritterdiseaseisadiseasecausedby- a)Infection b)Autoimmune c)Genetic d)Metabolicdisorder CorrectAnswer-AAnswer-A.InfectionStaphylococcalscaldedskinsyndromeiscausedpredominantlybyphagegroup2staphylococci,particularlystrains71and55,whicharepresentatlocalizedsitesofinfection.
338.PinkcolorintheIMNCIchartis suggestiveof a)Normalzoneofweightforage b)Undernutrition(Upto-2SD) c)Severelyunderweightzone(Upto-3SD) d)Veryseverelyundernourished(Upto-5SD) CorrectAnswer-CAnswer-C.Severelyunderweightzone(Upto-3SD)Green-NormalzoneofweightforageYellow-Undernutrition(upto-2SD)Pink-Severelyunderweightzone(upto-3SD)
339.5DHTisnecessaryfordevelopmentof whichofthefollowing? a)Externalgenitalia b)Internalgenitalia c)Mullerianstructures d)Wollfianstructures CorrectAnswer-AAnswer-A.ExternalgenitaliaVirilizationofthewolffianductiscausedbytheactionoftestosteroneitself.MasculinizationoftheurogenitalsinusandexternalgenitalsdependsontheactionofDHT(Dehydrotestosterone)duringthecriticalperiodoffetalmasculinization.
340.Prevalenceofomphaloceleatbirthis a)1in100livebirths b)1in2000livebirths c)1in4000livebirths d)1in10,000livebirths CorrectAnswer-CAnswer-C.1in4000livebirthsIncidenceofomphaloceleat11-14weeksgestation-1in1100pregnancies.Prevalenceatbirth-1in4000-6000livebirths.Thisindicatessuddenmortalitymostlikelyduetoinuterofetaldemisefromassociatedchromosomalanomaliesaswellaselectiveterminationafterthediagnosis
341.Pectusexcavatumis a)Protrusionofsternum b)Sternaldepression c)Sternalcleft d)Lateraldisplacementofsternum CorrectAnswer-BAnswer-B.SternaldepressionPectusexcavatum(funnelchest)ismidlinenarrowingofthoraciccavityduetosternaldepression.Mayoccurinisolationormaybeassociatedwithaconnectivetissuedisorder,MarfanorEhlers-Danlossyndrome.Secondarytochroniclungdisease,neuromusculardisease,ortrauma.
342.Achildaged7yearshashowmanyteeth a)15 b)20 c)26 d)32 CorrectAnswer-CAnswer-C.26Permanentteeththatappear:1stmolars:-4Centralincisors:-2Temporaryteeth:-20(sincemolarsaresuperaddedpermanentteethandcentralincisorsarereplaced).Soinall26teeth(Range24to26)-at7yearsofage.
343.Childstartsmonosyllablesspeechin whichage a)4months b)6months c)8months d)10months CorrectAnswer-BAnswer-B.6months3months-Startscooing6months-Producesmonosyllablesoundslikeda,ma9months-Producesbisyllablesoundlikebaba,mania
344.Nocturnalenuresisbestt/tis a)Positivereinforcement b)Punishment c)Bedalarm d)Desmopressin CorrectAnswer-AAnswer-A.PositivereinforcementConsistentdrybedtrainingwithpositivereinforcementhasasuccessrateof85%andbedandpadalarmsystemshaveasuccessrateofapproximately75%withrelapseratethatarelowerthanthosewithpharmacotherapy.
345.Neonatallupus- a)Heartblock b)Thrombocytopenia c)Cutaneouslesion d)Allofabove CorrectAnswer-DAnswer-D.AllofaboveNeonatallupusAgeofonsetnewbornto6monthSkinlesioninclude:Annularerythematousscalyplaque.Seenonsunexposed=head,neckMaybeassociatedwithheartblock/thrombocytopeniaDiagnosedby:ANAAntiROantibodies
346.InPrecociouspubertyagelimitofgirls is- a)8year b)10year c)9year d)11year CorrectAnswer-AAnswer-A.8yearPrecociouspubertyinagirlistheappearanceofanyofthesecondarysexualcharacteristicsbeforetheageof8yearsortheoccurrenceofmenarchebeforetheageof10years.Precociouspubertyinboysistheonsetofsecondarysexualcharacteristicsbeforetheageofnineyears.
347.Malnourishedchildminimumweight gain a)5gm/kg/day b)10gm/kg/day c)15gm/kg/day d)20gm/kg/day CorrectAnswer-AAnswer-A.5gm/kg/dayInmalnourishchildifthere>10gm/kg/day=goodweightgain5-10gm/kg/day=moderateweightgain<5gm/kg/day=poorweightgain
348.CPRwith2candidateisdoneatrateof (ininfant)- a)15:2 b)30:2 c)1:3 d)1:5 CorrectAnswer-AAnswer-A.15:2Ininfantchildrenwithtworesuscitator=15:2Inadultwithtworesuscitator-30:2Insingleresuscitatorchestcompresionventilationratioinallagegroupi.e.Infant,children&adult=30:
349.Pretermbabyhave a)Continueextramedullaryhematopoesis b)Greaterriskofhypothermia c)Greaterriskofhypoglycemia d)Allofabove CorrectAnswer-DAnswer-D.AllofabovePretermbaby(<37weekofgestation).HavehighriskforRDS(HMD)Bronchopulmonarydysplasia(BPD)PDAAnemia(early&late)IVHSepsisNECJaundiceHypoglycemia,hypokalemia,hypothermiaIVHROP(Retinopathyofprematurity).
350.Picarefersto- a)Icesucking b)Thumbsucking c)Foreignobjectbeingputinthemouth d)Noneofabove CorrectAnswer-CAnswer-C.ForeignobjectbeingputinthemouthPicainvolvesrepeatedorchronicingestionofnon-nutritivesubstances,whichincludeplaster,charcoal,clay,wool,ashes,paint&earth.
351.Lowglucoselevelinpremature a)Increasedbraintobodyratio b)Decreasedglycogenstores c)Decreasedactionofpyruvatecarboxylase d)Allofabove CorrectAnswer-DAnswer-D.AllofaboveHypoglycemiaiscommoninpretem&IUGRbabiesb/callthreereason 1. Increasedbraintobodyratio.2. Decreaseactionofpyruvatecarboxylase.3. Decreaseglycogenstore.
352.TemperatureofNICUis a)20-22?C b)22-26?C c)26-30?C d)30-35?C CorrectAnswer-BAnswer-B.22-26?CStandardsforNICUthermalinvornmentSpecify72-76?F(22-26?C)asacceptablerangeforairtemperature.
353.GBSinachildtreatment- a)IVIg b)Ventilation c)Plasmapharesis d)Allofabove CorrectAnswer-DAnswer-D.AllofaboveTreatmentofGuillain-barresyndrome-Selflimitedinmajorityofcases.Intravenousimmunoglobinshowsgoodresponse.Plasmapharesis-Removalofautoantibodies.Assistedventilation-Ifpatienthadrespiratorymuscleparalysis.Physiotherapy.
354.Anemiaofprematurity-Trueis a)Marginalreticulocytosis b)<10gmcriteria(Hblevel) c)10ml/kgpackedcell d)Microcytichypochromictype CorrectAnswer-BAnswer-B.<10gmcriteria(Hblevel)Normocytic,normochromic,hyporegenerativeanemiawithEPOlevel.AOPusuallyresolvespontaneouslywithin3-6months.Aetiology 1. RBCproduction(Reti.count)2. RBClifespan3. Bloodloss Lowhemoglobin(below10gm%)Reticulocytecountislow.Treatment:Requirebloodtransfusionifneeded.Observeifneonateisasymptomatic.
355.LEOPARDsyndromeincludesallexcept - a)Growthretardation b)ECGchanges c)Hypertelorism d)Hypergonadism CorrectAnswer-DAnswer-D.HypergonadismLEOPARDsyndromeLentiginesElectrocardiographicconductionabnormalitiesOcularhypertelorismPulmonarystenosisAbnormalgenitaliaRetardedgrowthDeafness
356.Bloodtransfusiontoneonaterateof a)1-5ml/min-5ml/min. b)5-10ml/min c)10-15ml/min d)15-20ml/min CorrectAnswer-BAnswer-B.5-10ml/minA)ExchangetransfusionForterminfant=80-160ml/kgForpreterm=100-200ml/kgB)Top-uptransfusionDesiredHb(glds)-actualhbxkgx3(usually10-20ml/kg).Rateoftransfusion5-10ml/min.
357.TBinchildren,mostcommonis- a)Abscess b)Consolidation c)Hilaradenopathy d)CNStuberculosis CorrectAnswer-CAnswer-C.Hilaradenopathy"MostcommonformofprimaryTBinchildrenispulmonaryTB.Thiscouldbeintheformofhilarlymphadenopathywithorwithoutlungparenchymalinvolvement".
358.Inchildren,CHF(congestionheart failure)isdiagnosedby a)RaisedJVP b)Pedaledema c)Tenderhepatomegaly d)Basalcrepts CorrectAnswer-CAnswer-C.TenderhepatomegalyHeartfailureininfants&childrenresultssomedegreeofhepatemegalywhichisusuallytender&sometimessplenomegaly.Peripheraledemaisagedependent:Ininfants,edemausuallyeye&overflank.Olderchildern&adolescentshowsbothperiorbitaledema&pedaledemaandoccurslate.
359.Doublearchaortaisseenin a)CATCH22 b)Digeorgesyndrome c)Sphrintzenvelocardiofacialsyndrome d)Noneofabove CorrectAnswer-AAnswer-A.CATCH22CATCH22standsforCardiacdefect-doublearchaorta.VSD,pulmonaryatresia.CleftpalateAbnormalfaciesHypocalcemiaThymichypoplasia
360.Simiancreaseisnotseenin- a)Down b)Trisomy13 c)Atopicdermatitis d)Noonansyndrome CorrectAnswer-CAnswer-C.AtopicdermatitisSimiancreaseSingletransversepalmercreaseResemblesnon-human-simiansoknownassimiancrease.Itisseenin: 1. Downsyndrome2. Fetalalcoholsyndrome3. Cri-duchatsyndrome(Chr.5)4. Klinefelter(XXY)5. Noonan(Chr.12)6. Patau(Chr.13)7. Edward(Chr.18)
361.Treatmentofsimplefebrileconvulsionis basedon a)Controloffever b)Rectaldiazepam c)CSFfinding d)Bloodreports CorrectAnswer-AAnswer-A.ControloffeverPromptreductionoftemperaturebyhydrotherapy(sponging)andantipyretics(paracetamole,ibuprofen)isthemostimportantmeasure.Ifseizureslastsformorethan5minutes,diazepam(rectalorIV)istheanticonvulsantofchoice.Phenobarbitoneisanalternative
362.Rehydrationtherapyina2yearold severelydehydratedchildis- a)30ml/kgin1hour,70mlin5hours b)30ml/kgin30min,70ml/kgin2'/2hours c)20ml/kgin30min,80ml/kgin2'/2 d)75ml/kgin4hours CorrectAnswer-BAnswer-B.30ml/kgin30min,70ml/kgin2'/2hours12Month-5year30ml/Kgin30min70ml/Kgin2.30hour
363.Whatiscorrectaboutfebrileseizures a)NormalEEG b)Focaldeficits c)Repeatedseizure d)AbnormalEEG CorrectAnswer-AAnswer-A.NormalEEGSpontaneousremmissionoccurswithnopostictalneurologicaldeficitandEEGchangesfewdaysaftertheseizureisnormal.Recurrentfebrileseizuresoccurin30-50%ofcases.Morethan90%offebrileseizuresaregeneralized.Acuterespiratoryillnessaremostcommonlyassociatedwithfebrileseizures.
364.Causeofneonatalhyperbilirubinemia? a)Inefficienterythropoiesis b)RBChemolysis c)Immatureliverenzyme d)Allofabove CorrectAnswer-DAnswer-D.AllofaboveImpairedbileflowObstructivejaundice,primarybiliarycirrhosis,Neonatalcholestasis,e.g.Extrahepaticbiliaryatresia/neonateidiopathichepatitis,Choledocalcyst,Sclerosingcholangitis,Carolidisease,Metabolic(Tyrosinemia,Wolmandisease,Niemanpickdisease,Galactosemia,Fructosemia).
365.Dosageofintravenousfluidfor2month oldchildindiarrhoeawithseveredehydration- a)100ml/Kgin6hour b)50ml/Kgin6hour c)75ml/Kgin6hour d)80ml/Kgin6hour CorrectAnswer-AAnswer-A.100ml/Kgin6hourSototalfluidtobegiven100ml/Kgin6hour.
366.InDiapragmaticHernia.Mostcommon anomalyisseenin a)Cardiovascularanomalies b)Urinarytract c)Craniofacialanomaly d)Skullanomaly CorrectAnswer-AAnswer-A.CardiovascularanomaliesDiaphragmaticHerniaisdefinedasacommunicationbetweenabdominal&thoraciccavitieswithorwithoutabdominalcontentsinthorax.Femalesareaffectedmorethanmales.Morecommononleftsideandisposterolateral.Associatedanomaliesmaybeseen30%ofcasesCNSlesions,esophagealatresia,omphaloceleandCVSlesions.Mostcasesaresporadic.CardiacanomalisisMCanomalis.
367.Causesofmentalretardationin congenitalhypothyroidismis- a)Decreasecerebralgrowth b)DecreasemyelinationofCNSneuron c)Decreasegrowthhormonebypitutaryglands d)Decreaeproductionofneurotransmitters CorrectAnswer-AAnswer-A.Decreasecerebralgrowthis'a'i.e.,Decreasecerebralgrowth[Ref:Ghai7h/ep.481;JornalofAmericalPhysiologicalReview]Thyroidhormonehasmajoreffectonbraininutero&neonatalperiod,deficiencycausediminshaxonalgrowth,dendriticarborisation,delayproliferation&migrationofgranulecellsoitdecreasecerebralgrowth.
368.Mousyurineinachildduetodefectin phenylalamineto a)Tyrosine b)Homogentisicacid c)Phenylacetate d)Phenylpyruvate CorrectAnswer-AAnswer-A.TyrosinePhenylketonuria:AutosomalrecessiveDeficiencyofphenylalaninehydroxylase.Defectinconversionofphenylalaninetotyrosine.Thisleadstoincreaselevelofphenylalanine.Thisincreasephenlylalanineconvertedintophenylpyruvateandphenylacetate.Thisphenylacetategivesmousyormustyodourinurine/body.
369.Mostcommonsiteofextramedullary relapseofALLin6yearoldis a)Testes b)Liver c)Lung d)None CorrectAnswer-AAnswer-A.TestesThecommonsitesofrelapseofALLaftercompleteremissionare:Bonemarrow(mc),CNS(2mc)andtestis.
370.Malepseudohermaphrodismmost commoncause- a)Congenitaladrenalhyperplasia b)Adrenocorticaltumor c)Chromosomalabnormalities d)Cytogeneticabnormalities CorrectAnswer-DAnswer-D.CytogeneticabnormalitiesMostcommoncauseoffemalepseudohermaphroditism-CAHdueto21hydroxylasedeficiency.Mostcommoncauseofmalepseudohermaphroditism-Gonadaldysgenesisanddefectinandrogenaction.
371.Enzymeusedastreatmentforsicklecell anemia a)Chymotrypsin b)Glucose6-phosphatase c)Trypsin d)Noneofabove CorrectAnswer-AAnswer-A.ChymotrypsinChymotrypsisusedinSicklecelldisease.
372.XXbabypresentingwithpenis& scrotumcause- a)Highleveloftestosteroneinmaternalblood b)Klinfiltersyndrome c)Turnersyndrome d)Noneofabove CorrectAnswer-AAnswer-A.HighleveloftestosteroneinmaternalbloodThisisacaseoffemalepseudohermaphroditismi.e.XXkaryotypewithvirilizedexternalgenitalia.Maternalandrogen(testosterone)isthecauseofthis.FemalepseudohermaphroditismGenotypeisXX.Internalgonadisovarybutexternalgenitaliaarevirilized(maledifferentiation).Congenitaladrenalhyperplasia(CAH)dueto21-hydroxylasedeficiencyisthecommonestcause.Othercausesarematernalvirilizingtumor(arrhenoblastoma),maternalandrogenadministration,CAHdueto11-betahydroxylasedeficiency,fetalplacentalaromatasedeficiency,andWNT-4genemutation.
373.Whichofthefontanelleisthelastto close? a)Anterolateral b)Anterior c)Lateral d)Occipital CorrectAnswer-BAns.B.AnteriorTheposteriorfontanellenormallycloses2to3monthsafterbirthThesphenoidalfontanelleisthenexttoclosearound6monthsafterbirthThemastoidfontanelleclosesnextfrom6to18monthsafterbirth;Theanteriorfontanelleisgenerallythelasttoclosebetween18?24months.
374.WhichenzymedeficiencycausesLesch? Nyhansyndrome? a)Hypoxanthine-guaninephosphoribosyltransferase(HGPRT) b)Xanthineoxidase c)Adeninephosphoribosyltransferase(APRT) d)AMPdeaminase CorrectAnswer-AAns.A.Hypoxanthine-guaninephosphoribosyltransferase(HGPRT)Lesch?Nyhansyndrome(LNS),alsoknownasjuvenilegout,isarareinheriteddisordercausedbyadeficiencyoftheenzymehypoxanthine-guaninephosphoribosyltransferase(HGPRT),producedbymutationsintheHPRTgenelocatedontheXchromosome
375.Whichvaccineisnotincludein indradhanushmission? a)Tuberculosis b)Measles c)JapaneseEncephalitis d)Diphtheria CorrectAnswer-CAns.C.JapaneseEncephalitisTheMissionIndradhanush,depictingsevencoloursoftherainbow,targetstoimmunizeallchildrenagainstsevenvaccinepreventablediseasesnamely:DiphtheriaPertussisTetanusChildhoodTuberculosisPolioHepatitisBMeasles.
376.WhichamongthefollowingistheMost commoncauseforneonatalblindness? a)Neisseriagonorrhoeae b)Chlamydiatrachomatis c)Klebsiella d)Enterobacter CorrectAnswer-AAns.A.NeisseriagonorrhoeaeOphthalmianeonatorum(ON)isdefinedasapurulentconjunctivitisoccurringduringthefirstfourweeksoflife.ThetwomostcommoncausativeagentsareNeisseriagonorrhoeaeandChlamydiatrachomatis,theformerbeingofmoreconcernherebecauseofitspropensitytocauseblindness.
377.Truehermaphroditismkaryotype: a)45X0streakedgonads b)46XXOvotestis c)47XY+9 d)47XX CorrectAnswer-BAns.B.46XXOvotestisTruehermaphroditeorovotesticulardisorderofsexualdifferentiation(OVO-DSD)isoneoftherarestvarietyofallintersexanomalies.Inabout90%ofcases,patientshave46XXkaryotype.Rarely,46XY/46XXmosaicismmayoccur.
378.Whencanonediagnoseacute respiratorydistressinachild? a)Within7daysofknownclinicalinsult b)Respiratoryfailurenotfullyexplained c)Leftventriculardysfunction d)Alloftheabove CorrectAnswer-DAns:D.Alloftheabove PediatricCriticalCareMedicine2015 Excludepatientswith1:m11-natalrelatedlung Age disease Iiming Within7daysofknownclinicalInsult originof Respiratoryfailurenotfullyexplainedbycardiacfailure Edema orfluidoverloadChest Chest imagingfindingsofnewinfiltrate(siconsigentwithacute Imaging pulmonaryNoninvasivemechanical lovasivemechanicalventilation ventilation- PARRS(Noseverity Mild Moderate Severe gratification) Oxygenation Fullface-maskbi-level EK01< O1t16 ventilationor 4501c8 16 CiSt CPAPz5crnHAa Ss09.c7.51 7.5OSI 1233 PFratios300 <12.31 SFratio52E4I Specia-lPopulations tandardCriteriaaboveforage,timing,originofedema Cyanotic
Cyanotic andchestimagingwithanacutedeteriorationIn Heart oxygenationnotexplainedbyunderlyingcardiac Disease disease.standardCriteriaaboveforage,timing,andoriginof Chronic edemawithchestimagingconsistentwithnewinfiltrate Lung andacutedeteriorationinoxygenationfrom Disease baselinewhichmeetoxygenationcriteriaabove_StandardCriteriaforage,timingandoriginofedema Left withchestimagingchangesconsistentwithnew Ventricular infiltrateandacutedeteriorationinoxygenationwhichdysfunction meetcriteriaabovenotexplainedbyleftventricular dysfunction.
379.Newbornbabywithheartratelessthan 60beatsperminutecanberesuscitatedbyallexcept a)chestcompression b)oxygentherapy c)tactilestimulation d)slappingtheback CorrectAnswer-DAns:D.slappingthebackThefirstthreesareindicatedwhileslappingthebackisnotrecommendedinanewbornwhohasHeartratelessthan60beatsperminute.
380.Whichconditionisassociatedwith Congenitaladrenalhypoplasia? a)Malepseudohermaphroditism b)Femalepseudohermaphroditism c)Truepseudohermaphroditism d)Sequentialpseudohermaphroditism CorrectAnswer-BAnswer-B-CongenitalAdrenalHyperplasia:Thisisthemostcommoncauseofandrogenicexcessinfetuseswithfemalepseudohermaphroditism.Thehyperplasticglandssynthesizedefectiveenzymesthatcauseimpairedcortisolsynthesis.ThisleadstoexcessivepituitaryACTHthesecretionofthefetaladrenalglandswithsecretionoflargeamountsofcortisolprecursors,includingandrogenicprehormones.Theseprehormones,forexample,androstenedione,areconvertedtotestosteroneinfetalextra-adrenaltissues.
381.1yrchildweighing6kgissufferingfrom AcuteGastroenteritisalongwithsignsofsunkeneyes&skinpinchgoingbacktonormalveryrapidly.Whatwillbeyourmanagement? a)RLinfusion120mlinthefirsthourfollowedby360mlinthe next5hours b)RLINFUSION180mlinthefirsthourfollowedby420mlinthe next5hours c)RLINFUSION180MLINthefirsthourfollowedby480mlinthe next5hours d)RLINFUSION240mlinthefirsthourfollowedby360mlinthe next5hours CorrectAnswer-BAns.B.RLINFUSION180mlinthefirsthourfollowedby420mlinthenext5hoursSeveredehydrationconstitutesamedicalemergencyrequiringimmediateresuscitationwithintravenousfluids.Intravenousaccessshouldbeobtained,andpatientsshouldbeadministeredabolusof20-30mL/kglactatedRinger's(LR)ornormalsaline(NS).Ifpulse,perfusion,and/ormentalstatusdonotimprove,asecondbolusshouldbeadministered.Afterthis,thepatientshouldbegivenaninfusionof70mL/kgLRorNSover5hours(children<12months)or2.5hours(olderchildren).Ifnoperipheralveinsareavailable,anintraosseouslineshouldbeplaced.Serumelectrolytes,bicarbonate,urea/creatinine,and
placed.Serumelectrolytes,bicarbonate,urea/creatinine,andglucoselevelsshouldbesent.
382.Whichparameterconclusivelyrulesout malnutrition? a)Edema b)Leanbodymass c)Skinfoldthickness d)NormalECFvolume CorrectAnswer-BAns.B.LeanbodymassMeasuringweightandheightisthemostcommonwayofassessingmalnutritioninagivenpopulation.Suchuseofmeasurementsofdimensionsofthehumanbodyisknownasanthropometry.Anthropometryisawidelyused,inexpensiveandnoninvasivemeasureofthegeneralnutritionalstatusofanindividualorapopulationgroup.Thethreecommonlyusedanthropometricindicesare:-Weight-for-Age{WFA).-Length-for-AgeorHeight-For-Age(HFA).-Weight-for-LengthorWeight-for-Height{WFH).PEMreducesgrowthinchildrenEnergyexpenditureinexcessofconsumptionleadstometabolizingnutritionreservesintheformofstoredbodyfat.LeanbodymassintheformofmuscleandevenorgantissuewillalsobeconsumedifPEMpersists.itservesasareliableindicatorforPEMWeightlossaccompaniestheinitialstagesofinadequateenergyintakebut,ifprolonged,isfollowedbywasting,calledinitssevereclinicalform,marasmus.Inchildren,PEMdelaysorpermanentlystuntsgrowthandincreases
morbidityandmortality.Ref.ParkPSMed.24thPageno.677
383.A2yearsbabywith6.7kg,Hb%-6mg/dl totalprotein3mg/dL,lowalbuminwithdistendedstomachbutnoproteinuria.Whatwillbethediagnosis? a)Marasmus b)Kwashiorkor c)Indianchildhoodcirrhosis d)None CorrectAnswer-BAns.B.KwashiorkorKwashiorkorisaformofsevereacutemalnutrition(SAM)characterizedbyedemaandapathy.Edemaismostlikelytoappearfirstonthefeetandtheninthelowerlegs.Itcandevelopintogeneralizededemaaffectingthehands,arms,andface.MoonfaceSkinchangesincludedepigmentationofskin,dermatoses,dark,crackedpeelingpatches(flakypaintdermatosis)withpaleskinunderneaththatiseasilyinfected.Hairissparse,easilypulledout,andmayturnreddish.Flagsign:alternatingbandsofhypopigmentedandnormalpigmentedareasonthehairstrandTheliverisoftenenlargedwithfat(fattyLiver).Thechildrenaremiserableandapatheticandoftenrefusetoeat.Musclewastingandgrowthfailureareseen.Villousatrophyofsmallintestineanddiarrhea.
NelsonTextbookofPediatrics20thEditionPage:301
384.InRDSinachild,whichcellsarefound defective? a)Type1pneumocytes b)Type2pneumocytes c)Bronchialepithelium d)None CorrectAnswer-BAns.B.Type2pneumocytesTypeIcellsformthealveolarwallwhiletheTypeIIcellssynthesizeandsecretesurfactantDPCC.ThedefectinthebiosynthesisofDipalmitoylphosphatidylcholine(DPPC),alsoknownasdipalmitoyllecithinleadstoRespiratorydistresssyndrome.Ref.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880575/
385.Causeofgreenish-blackstoolina neonate- a)Meconium b)Biliverdin c)Bilirubin d)Urochrome CorrectAnswer-BAns.B.BiliverdinFetalbowelcontentsconsistofvariousproductsofsecretion,suchasglycerophospholipidsfromthelung,desquamatedfetalcells,lanugo,scalphair,andvernix.Italsocontainsundigesteddebrisfromtheswallowedamnionicfluid.Thedarkgreenish-blackiscausedbypigments,especiallybiliverdin.Ref.WilliamsObstetricsEd.24thPageno.141
386.Atermbabyonbreastfeedingwith bilirubin14mg/dLwhichofthefollowingistrue? a)Exchangetransfusion b)Continuetobreastfeed c)Phototherapy d)None CorrectAnswer-BAns.B.ContinuetobreastfeedComparedwithformula-fednewborns,breastfedinfantsarethreetosixtimesmorelikelytoexperiencemoderatejaundice(totalserumbilirubinlevelabove12mgperdL)orseverejaundice(totalserumbilirubinlevelabove15mgperdL.Inabreastfednewbornwithearly-onsethyperbilirubinemia,thefrequencyoffeedingsneedstobeincreasedtomorethan10perday.Iftheinfanthasadeclineinweightgain,delayedstooling,andcontinuedpoorcaloricintake,formulasupplementationmaybenecessary,butbreastfeedingshouldbecontinuedtomaintainbreastmilkproduction.Phototherapyusuallynotrecommendedwhenthetotalserumbilirubinlevelisbelow15mgperdL.Ref:https://www.aafp.org/afp/2002/0215/p599.html
This post was last modified on 23 November 2021