NEET-PG 2017 - Pediatrics Practice Questions

Q: A Lethargic hypoglycemic girl neonate has the following genital appearance. What is the probable cause? (Recent Neet Pattern 2016-17)

Congenital adrenal hyperplasia. ***Congenital adrenal hyperplasia*** - The image shows **ambiguous genitalia (clitoromegaly/phallic structure with fused labia)** in a neonate presenting with **lethargy and hypoglycemia**, which are symptoms of **salt-wasting crisis**. - This clinical picture in a presumed genetic female is highly suggestive of **21-hydroxylase deficiency**, the most common form of CAH, leading to excess adrenal androgens and mineralocorticoid deficiency. *Ovotesticular disorder of sexual differentiation* - This condition involves the presence of both **ovarian and testicular tissue**, leading to ambiguous genitalia. - While it can cause ambiguous genitalia, it does not typically present with the acute metabolic crisis (hypoglycemia, lethargy) seen in this neonate, which points to a hormonal deficiency. *Turner syndrome* - **Turner syndrome (45, XO)** affects genetic females and is characterized by the absence of one X chromosome, typically resulting in **female external genitalia** that are usually normal or immature. - It does not cause ambiguous genitalia or the metabolic derangements (hypoglycemia) characteristic of adrenal insufficiency. *Klinefelter syndrome* - **Klinefelter syndrome (47, XXY)** affects genetic males and typically presents with **normal male external genitalia** at birth. - Features like hypogonadism and gynecomastia become apparent later in puberty, and it is not associated with ambiguous genitalia or neonatal metabolic crises.

Q: A 6-year-old child from Kashmir is brought to New Delhi hospital in a delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Probable diagnosis is:

Rickettsia. ***Rickettsia*** - The combination of **high-grade fever**, **delirium**, **non-blanching rash** on palms and soles, and **splenohepatomegaly** is highly suggestive of severe rickettsial infection, especially with the child being from Kashmir where rickettsial diseases like Indian Tick Typhus are endemic. - The **non-blanching rash** (petechial/purpuric) on palms and soles is a classic, though not universally present, sign of severe rickettsial infection, reflecting vascular damage. *Cerebral malaria* - While cerebral malaria can cause **delirium**, **high fever**, and **splenohepatomegaly**, it typically does not present with a prominent **blanching rash** on the palms and soles. - Malaria is often endemic in Kashmir, but the rash pattern described is less typical for it. *Dengue hemorrhagic fever* - Dengue hemorrhagic fever can cause high fever, rash, and in severe cases, neurological symptoms due to shock or encephalopathy. However, the rash is typically **maculopapular** or **petechial**, and while it can involve extremities, the prominent *blanching* nature and distribution solely on **palms and soles** are less characteristic. - While splenomegaly can occur, prominent **splenohepatomegaly** in conjunction with this specific rash and neurological status points away from uncomplicated or even severe dengue as the primary diagnosis. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a chronic, progressive, and fatal neurodegenerative disease that usually develops several years after measles infection. - It presents with progressive neurological deterioration, including **cognitive decline**, **myoclonus**, and **seizures**, but does not typically involve acute high fever or a rash like the one described.

Q: A 5-year-old child in a village went for open air defecation when he was attacked by a dog. He has been admitted in your hospital, all are correct about the condition except: (Recent NEET Pattern 2016-17)

Virus infects pyramidal cells leading to cytolysis. ***Virus infects pyramidal cells leading to cytolysis*** - The **rabies virus** primarily infects neurons and causes neuronal dysfunction rather than **cytolysis** (cell death and lysis), particularly in the early stages. - The characteristic pathological finding in rabies is the presence of **Negri bodies** (intracytoplasmic inclusions) which represent viral aggregates within unaffected neurons, not cytolytic destruction. *Category 3 bite* - A **Category 3 bite** involves single or multiple transdermal bites or scratches, licks on broken skin, or contamination of mucous membranes with saliva, especially if involving the head, neck, or digits, which appears to be the case given the severe facial injuries depicted with a dog bite. - Due to the high risk of rabies transmission in such severe wounds, Category 3 requires both **rabies vaccine** and **rabies immunoglobulin (RIG)** administration. *Wash with povidone-iodine* - Immediate and thorough **wound washing** with soap and water for at least 15 minutes is crucial for all animal bites, as it significantly reduces the viral load. - **Antiseptics** like povidone-iodine or alcohol can be used after washing to further disinfect the wound. *Administer vero cell vaccine with immunoglobulin* - For a **Category 3 rabies exposure**, both **rabies vaccine** (e.g., Vero cell vaccine) and **rabies immunoglobulin (RIG)** are indicated for post-exposure prophylaxis. - The vaccine provides active immunity, while the immunoglobulin provides immediate passive immunity, critical for high-risk exposures.

Q: A child presents with the ocular findings shown in the image below. Identify the most likely underlying illness:

Pertussis. ***Pertussis (Whooping Cough)*** - The image shows **subconjunctival hemorrhage**, which is a **classic complication** of pertussis in children - Pertussis causes severe **paroxysmal coughing fits** that dramatically increase intrathoracic and intravascular pressure - This elevated pressure leads to rupture of conjunctival blood vessels, resulting in subconjunctival hemorrhages and facial petechiae - These hemorrhages are well-recognized **diagnostic clues** for pertussis, especially when accompanied by the characteristic whooping cough - This is a **primary manifestation** of the disease process, not merely an incidental finding *Trachoma* - Trachoma, caused by *Chlamydia trachomatis*, presents with **chronic follicular conjunctivitis** and progressive scarring - Classic features include follicles on upper tarsal conjunctiva, conjunctival scarring, trichiasis, and pannus formation - While it causes conjunctival inflammation, **acute subconjunctival hemorrhage is NOT a typical feature** of trachoma - Trachoma is a chronic, scarring disease rather than an acute hemorrhagic condition *Tetanus* - Tetanus is a neurological disorder characterized by **muscle rigidity** and **spasms**, beginning with trismus (lockjaw) - Ocular manifestations are limited to **risus sardonicus** (facial muscle spasm) and potential ophthalmoplegia - Does NOT cause subconjunctival hemorrhage as a direct manifestation *Measles* - Measles presents with **maculopapular rash**, fever, the three C's (cough, coryza, conjunctivitis), and **Koplik spots** - The conjunctivitis in measles is typically a **bilateral, non-hemorrhagic inflammation** with watery discharge - Does NOT typically cause prominent subconjunctival hemorrhage as shown in the image

Q: A neonate presents with a congenital heart disease as shown below. Which drug should be started immediately? (Recent NEET Pattern 2016-17)

Alprostadil. ***Alprostadil*** - The image shows a **transposition of the great arteries (TGA)** with the aorta originating from the right ventricle and the pulmonary artery from the left ventricle. In this condition, a patent ductus arteriosus (PDA) is crucial to maintain mixing of oxygenated and deoxygenated blood to ensure systemic circulation. - **Alprostadil (prostaglandin E1 analog)** is used to keep the **ductus arteriosus patent**, allowing for mixing of blood and improving systemic oxygenation in neonates with ductal-dependent congenital heart defects like severe TGA. *Digoxin* - **Digoxin** is a cardiac glycoside used to improve **cardiac contractility** and control heart rate in certain heart conditions, but it is not the immediate drug of choice for maintaining patency of the ductus arteriosus in TGA. - Its primary role is in managing heart failure symptoms or arrhythmias, not directly addressing the immediate ductal dependency of TGA. *Ivabradine* - **Ivabradine** is a hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker that selectively reduces heart rate by acting on the **sinoatrial node**. - It is used in adults with chronic heart failure or stable angina, and is not indicated for the acute management of congenital heart defects like TGA in neonates. *Propranolol* - **Propranolol** is a non-selective beta-blocker used to reduce heart rate and blood pressure, or to manage conditions like **tetralogy of Fallot spells**. - It does not have any role in maintaining the patency of the ductus arteriosus, which is critical for survival in ductal-dependent congenital heart lesions like TGA.

Q: What ventilation modality is shown below?

Nasal CPAP. ***Nasal CPAP*** - The image shows a device applied to the nose of an infant, providing a continuous flow of air which is characteristic of **Nasal Continuous Positive Airway Pressure (nCPAP)**. - This modality helps maintain lung volume, improve oxygenation, and reduce the work of breathing in neonates with respiratory distress. *High frequency jet ventilation* - This modality involves delivering small tidal volumes at very **high frequencies** (hundreds of breaths per minute) through a specialized ventilator and endotracheal tube. - The image does not depict an **endotracheal tube** or the rapid, small tidal volume delivery characteristic of jet ventilation. *Inverse ratio ventilation* - This is a mode of **mechanical ventilation** where the inspiratory time is longer than the expiratory time (I:E ratio > 1:1), typically used in intubated patients. - The image shows a non-invasive nasal device, not an **intubated patient** on a mechanical ventilator. *Intermittent positive pressure ventilation* - This refers to delivering breaths with positive pressure, either invasively (via endotracheal tube) or non-invasively (via mask), to assist or control breathing. - While CPAP provides positive pressure, "intermittent positive pressure ventilation" implies cyclical breaths, which is not the primary defining feature shown, and CPAP (continuous pressure) is a more specific and accurate description for the depicted setup.

Question 1

A Lethargic hypoglycemic girl neonate has the following genital appearance. What is the probable cause? (Recent Neet Pattern 2016-17)

Accepted Answer

Congenital adrenal hyperplasia

Answer

Ovotesticular disorder of sexual differentiation

Answer

Turner syndrome

Answer

Klinefelter syndrome

Question 2

A 6-year-old child from Kashmir is brought to New Delhi hospital in a delirious condition with history of high grade fever for last 10 days. He is nonresponsive to commands and blanching rash is noted all over the body especially soles and palms. Per abdomen examination shows splenohepatomegaly. Probable diagnosis is:

Accepted Answer

Rickettsia

Answer

Cerebral malaria

Answer

Dengue hemorrhagic fever

Answer

SSPE

Question 3

A 5-year-old child in a village went for open air defecation when he was attacked by a dog. He has been admitted in your hospital, all are correct about the condition except: (Recent NEET Pattern 2016-17)

Accepted Answer

Virus infects pyramidal cells leading to cytolysis

Answer

Category 3 bite

Answer

Wash with povidone-iodine

Answer

Administer vero cell vaccine with immunoglobulin

Question 4

A child presents with the ocular findings shown in the image below. Identify the most likely underlying illness:

Accepted Answer

Pertussis

Answer

Tetanus

Answer

Measles

Answer

Trachoma

Question 5

A neonate presents with a congenital heart disease as shown below. Which drug should be started immediately? (Recent NEET Pattern 2016-17)

Accepted Answer

Alprostadil

Answer

Digoxin

Answer

Ivabradine

Answer

Propranolol

Question 6

What ventilation modality is shown below?

Accepted Answer

Nasal CPAP

Answer

High frequency jet ventilation

Answer

Inverse ratio ventilation

Answer

Intermittent positive pressure ventilation

NEET-PG 2017 — Pediatrics