NEET-PG 2013 — Pediatrics
34 Previous Year Questions with Answers & Explanations
At what age does the tonic neck reflex typically disappear?
What is the significance of the persistence of the asymmetric tonic neck reflex in a 9-month-old infant?
2 months old child having birth weight 2kg, with poor feeding, very sleepy and wheezing. The diagnosis is?
At what age does clinically significant IgG production begin?
Which immunization is typically given at 6 months of age?
A 3-month-old infant with no chest indrawing and a respiratory rate of 52/minute. The diagnosis is:
Ideal temperature for DPT storage?
The most common cause of meningitis in children aged 5 yrs is-
In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?
At what age (year) do arm span and height become the same?
NEET-PG 2013 - Pediatrics NEET-PG Practice Questions and MCQs
Question 1: At what age does the tonic neck reflex typically disappear?
- A. 1 month
- B. 2 months
- C. 3 months
- D. 4 months (Correct Answer)
Explanation: ***Correct Answer: 4 months*** - The **tonic neck reflex**, also known as the **asymmetrical tonic neck reflex (ATNR)**, typically disappears around **4 to 6 months of age**. - Persistence beyond this age can be a sign of **neurological dysfunction** and may interfere with motor development such as rolling or bringing hands to midline. *Incorrect: 1 month* - While the tonic neck reflex is present at 1 month, it does not typically disappear at this early stage. - At 1 month, infants are still relying on a variety of **primitive reflexes** for survival and early motor patterns. *Incorrect: 2 months* - The tonic neck reflex is still usually clearly present at 2 months of age. - This reflex contributes to early **eye-hand coordination** and helps develop unilateral body movements. *Incorrect: 3 months* - While starting to integrate, the tonic neck reflex is not fully integrated or gone by 3 months. - Its presence is normal at this age, and its integration is a gradual process as **voluntary motor control** emerges.
Question 2: What is the significance of the persistence of the asymmetric tonic neck reflex in a 9-month-old infant?
- A. Decreased muscle tone
- B. Increased muscle tone (Correct Answer)
- C. Normal phenomenon
- D. None of the options
Explanation: ***Increased muscle tone*** - The **asymmetric tonic neck reflex (ATNR)** should integrate by **6 months of age**, and its persistence beyond this period is a sign of **neurological dysfunction**. - Persistent primitive reflexes, including ATNR, are often associated with **upper motor neuron lesions** and can manifest as increased muscle tone or **spasticity**. *Decreased muscle tone* - **Decreased muscle tone**, or **hypotonia**, is typically associated with **lower motor neuron lesions** or certain genetic conditions, not the persistence of primitive reflexes. - While some neurological conditions can cause hypotonia, persistent ATNR is a hallmark of problems leading to **hypertonia**. *Normal phenomenon* - The persistence of the ATNR beyond **6 months of age** is considered abnormal and indicates a potential developmental delay or neurological issue. - In a **9-month-old**, the reflex should have fully integrated, and its presence warrants further investigation. *None of the options* - As the persistence of the ATNR is indeed a significant finding, associated with increased muscle tone, this option is incorrect.
Question 3: 2 months old child having birth weight 2kg, with poor feeding, very sleepy and wheezing. The diagnosis is?
- A. Very severe disease (Correct Answer)
- B. No evidence of pneumonia
- C. Severe respiratory infection
- D. No diagnosis
Explanation: ***Very severe disease*** - According to **WHO/IMNCI (Integrated Management of Neonatal and Childhood Illness) classification** for young infants (0-2 months), the presence of **danger signs** automatically classifies the condition as "Very severe disease" - This infant presents with two critical danger signs: **poor feeding** and **lethargy (very sleepy)**, along with respiratory symptoms (wheezing) - In young infants, any danger sign (poor feeding, lethargic/unconscious, convulsions, severe chest indrawing, central cyanosis) requires immediate classification as "Very severe disease" and **urgent referral** to higher center - This is a specific diagnostic classification used in pediatric emergency protocols, not a general term *Severe respiratory infection* - While the child has respiratory symptoms (wheezing), this classification would only be appropriate if respiratory distress was present **without danger signs** - The presence of danger signs (poor feeding, lethargy) escalates the classification to "Very severe disease" in the WHO/IMNCI protocol - In young infants (0-2 months), the classification system prioritizes danger signs over organ-specific diagnoses *No evidence of pneumonia* - This is incorrect as the infant clearly presents with respiratory symptoms (wheezing) and systemic signs of illness - The presence of wheezing, poor feeding, and lethargy indicates serious illness requiring urgent evaluation and treatment - This option contradicts the clinical presentation *No diagnosis* - This is incorrect as the WHO/IMNCI classification provides a clear diagnostic framework - The presence of danger signs in a young infant mandates classification as "Very severe disease" - A working diagnosis is essential for guiding appropriate management and urgent referral
Question 4: At what age does clinically significant IgG production begin?
- A. Around 6 months (Correct Answer)
- B. Around 1 year
- C. Around 2 years
- D. Around 3 years
Explanation: ***Around 6 months*** - Maternal IgG levels, which provide **passive immunity**, decrease significantly by 3-6 months of age. - Infants begin to produce their own **clinically significant** levels of IgG around this time, coinciding with the "physiologic nadir" of IgG. *Around 1 year* - While IgG production continues to mature, significant production has already begun by 6 months to replace declining maternal antibodies. - By 1 year, the immune system is more robust, but the initial critical transition occurs earlier. *Around 2 years* - By this age, children generally have a robust adaptive immune response, and the period of vulnerability due to low IgG has passed. - This option is too late for the beginning of clinically significant IgG production. *Around 3 years* - This age is far past the point where children start producing their own significant levels of IgG. - The immune system is well-developed by 3 years, and initial IgG production started much earlier.
Question 5: Which immunization is typically given at 6 months of age?
- A. Measles vaccine
- B. DPT vaccine (Correct Answer)
- C. BCG vaccine
- D. None of the options
Explanation: **DPT vaccine** - The DPT (diphtheria, pertussis, and tetanus) vaccine is administered in multiple doses during infancy as part of the primary immunization series. - At **6 months of age**, the **third dose of DPT** is typically given (following doses at 6 weeks, 10 weeks, and 14 weeks according to the Indian immunization schedule). - Among the options provided, DPT is the only vaccine routinely administered at 6 months of age. - This vaccine protects against three serious bacterial infections: **diphtheria**, which can cause breathing problems; **pertussis (whooping cough)**, a severe respiratory illness; and **tetanus**, which causes painful muscle spasms. *Measles vaccine* - The measles vaccine (given as part of the **MMR vaccine** or as MR vaccine in India) is typically administered at **9 to 12 months of age** for the first dose, and a second dose between 15-18 months or 4-6 years. - It is not routinely given at 6 months, as maternal antibodies can interfere with its effectiveness at this younger age. *BCG vaccine* - The BCG (Bacillus Calmette-Guérin) vaccine protects against **tuberculosis** and is given at **birth** or in early infancy as a single dose. - It is not administered at 6 months of age. *None of the options* - This option is incorrect because the **DPT vaccine** (third dose) is a standard immunization given at 6 months of age according to the Indian immunization schedule. - Multiple vaccines are actually given at 6 months (including OPV, Hepatitis B, Hib, PCV), but among the listed options, only DPT is correct.
Question 6: A 3-month-old infant with no chest indrawing and a respiratory rate of 52/minute. The diagnosis is:
- A. Severe pneumonia
- B. Pneumonia (Correct Answer)
- C. No pneumonia
- D. Very severe disease
Explanation: ***Pneumonia*** - A respiratory rate of 52/minute in a 3-month-old infant **meets the age-specific threshold for tachypnea** (respiratory rate ≥ 50 breaths/minute for infants 2-12 months according to IMCI guidelines). - In the **absence of chest indrawing**, the presence of fast breathing (tachypnea) alone classifies this as **pneumonia** per IMCI classification. - This requires **outpatient management with oral antibiotics** and close follow-up. *No pneumonia* - This diagnosis would apply if the respiratory rate was **< 50 breaths/minute** for this age group with no chest indrawing. - Since the respiratory rate is 52/minute (≥ 50/minute), this rules out "no pneumonia." *Severe pneumonia* - This diagnosis requires the presence of **chest indrawing** in addition to fast breathing. - The question explicitly states **"no chest indrawing,"** which excludes severe pneumonia. - Severe pneumonia would require **hospitalization and parenteral antibiotics**. *Very severe disease* - This diagnosis involves **danger signs** such as inability to drink or breastfeed, persistent vomiting, convulsions, lethargy, unconsciousness, or severe malnutrition. - None of these critical signs are mentioned in the clinical scenario. - Very severe disease requires **urgent hospitalization and injectable antibiotics**.
Question 7: Ideal temperature for DPT storage?
- A. Room temperature
- B. 4 to 8°C (Correct Answer)
- C. 0 to - 20°C
- D. None of the options
Explanation: ***4 to 8°C*** - The ideal temperature for DPT (diphtheria, pertussis, tetanus) vaccine storage is between **+2°C and +8°C** (or 35°F and 46°F), which is the standard refrigerator temperature range. - This temperature range is crucial for maintaining the **potency** and **efficacy** of the vaccine, preventing **degradation** due to excessive heat or cold. *Room temperature* - Storing DPT vaccines at **room temperature** (typically 20-25°C or 68-77°F) for extended periods can lead to a **loss of potency** as heat can degrade vaccine components. - While short-term excursions within this range might be permissible under specific conditions (e.g., during transport), it is not the ideal long-term storage solution. *0 to - 20°C* - DPT vaccines, particularly the **whole-cell pertussis (wP)** component, can be **damaged by freezing**. - Temperatures below 0°C can cause the **adjuvant** (usually aluminum salt) to separate, leading to a loss of efficacy and potential local reactions at the injection site. *None of the options* - This option is incorrect because **4 to 8°C** is indeed the established and recommended ideal storage temperature for DPT vaccines.
Question 8: The most common cause of meningitis in children aged 5 yrs is-
- A. Staphylococcus
- B. E.coli
- C. H. influenzae
- D. S. pneumoniae (Correct Answer)
Explanation: ***S. pneumoniae*** - **_Streptococcus pneumoniae_** (Pneumococcus) is the **most common cause of bacterial meningitis** in children aged 5 years and older, as well as in adults. - Widespread vaccination has reduced its incidence but it remains a significant pathogen. *H. influenzae* - **_Haemophilus influenzae_ type b (Hib)** was a major cause of meningitis in young children, but its incidence has **drastically decreased** due to the routine **Hib vaccine**. - Without vaccination, it would still be a significant cause in this age group, but with high vaccine coverage, it is less common than _S. pneumoniae_. *Staphylococcus* - **_Staphylococcus aureus_** and other staphylococcal species are **less common causes of meningitis** in otherwise healthy children. - They are more typically associated with meningitis following **neurosurgery**, trauma, or in immunocompromised patients. *E.coli* - **_Escherichia coli_** is a common cause of **neonatal meningitis** (in infants less than 3 months old), often acquired during passage through the birth canal. - It is **rarely a cause of meningitis** in children aged 5 years.
Question 9: In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?
- A. Acrodermatitis enteropathica (Correct Answer)
- B. Pellagra
- C. Riboflavin deficiency
- D. Kwashiorkor
Explanation: ***Acrodermatitis enteropathica*** - This condition is a **zinc deficiency** syndrome, which can be either inherited or acquired. - It presents with a classic triad of **diarrhoea**, **dermatitis** (often periorificial and acral with moist, crusted lesions), and **alopecia**. - The **perianal moist crust** is a characteristic finding of the periorificial dermatitis seen in this condition. *Pellagra* - Pellagra is caused by **niacin (Vitamin B3) deficiency** and is characterized by the "4 D's": **dermatitis** (often sun-exposed areas), **diarrhoea**, **dementia**, and eventually death. - The dermatitis of pellagra is typically **symmetrical, hyperpigmented, and photosensitive**, not moist perianal crusts, differentiating it from the presented case. *Riboflavin deficiency* - **Riboflavin deficiency** typically manifests as **cheilosis**, angular stomatitis, glossitis, and seborrheic dermatitis, but not specifically perianal moist crusts with diarrhoea. - While it can affect mucous membranes, the specific perianal presentation with diarrhoea points away from this diagnosis. *Kwashiorkor* - **Kwashiorkor** is a form of protein-energy malnutrition that can present with **diarrhoea** and skin changes (flaky paint dermatosis, hypopigmentation). - However, the skin changes are typically **desquamating** and affect dependent areas, not the characteristic **moist, crusted periorificial lesions** seen in zinc deficiency. - Kwashiorkor also typically presents with **edema**, which is not mentioned in this case.
Question 10: At what age (year) do arm span and height become the same?
- A. 9
- B. 11 (Correct Answer)
- C. 13
- D. 15
Explanation: ***11*** - At approximately **11 years of age**, the arm span and height of an average individual become equal. - This equality is a **developmental milestone** often observed during childhood growth. *9* - At **9 years of age**, an individual's **arm span** is typically **less than their height**, as the extremities are still growing in proportion to the trunk. - The limbs are still developing, and the ratio of limb length to trunk length hasn't yet reached parity. *13* - By **13 years of age**, in most individuals, the **arm span generally exceeds the height**, especially during the adolescent growth spurt. - This is often a period of rapid growth where the limbs may grow faster than the trunk, leading to disproportion. *15* - At **15 years of age**, the **arm span typically continues to be greater than the height**, reflecting the fully developed adult proportions for most individuals. - Adult proportions, where arm span often slightly exceeds height, are typically established by this age.