NEET-PG 2020 - Pediatrics PYQs Practice Questions

Q: A patient presents with clustered, white lesions on the buccal mucosa, typically near the upper molars. These lesions are pathognomonic for measles. What are these lesions called?

Koplik spots. ***Koplik spots*** - These are pathognomonic for **measles (rubeola)** and appear as small, **white or bluish-white lesions** on an erythematous base on the buccal mucosa. - They typically precede the characteristic rash of measles by 1-2 days, making them a crucial early diagnostic sign. *Leukoplakia* - Refers to **thickened, white patches** on the mucous membranes that cannot be scraped off and are often precancerous. - These lesions are usually associated with chronic irritation (e.g., tobacco use) and are not a feature of viral infections like measles. *Kaposi spots* - This term is **not typically used** to describe oral lesions, particularly in the context of measles. - Kaposi sarcoma involves **purple or brown skin lesions** associated with HHV-8 infection, commonly seen in immunocompromised individuals. *None of the options* - This option is incorrect because **Koplik spots** accurately describe the buccal mucosal lesions pathognomonic for measles. [Practice more Pediatrics PYQs on OnCourse]

Q: Most common cause of death in SLE in children

Anemia and infections. ***Anemia and infections*** - **Infections** are a leading cause of death in pediatric SLE patients, often due to immunosuppression from the disease itself or its treatment. Although pediatric Systemic Lupus Erythematosus (SLE) is not a primary immune deficiency, the susceptibility to encapsulated bacteria and recurrent infections seen in primary B- and T-lymphocyte deficiencies mirrors the infection risks managed in these patients [1]. - **Anemia** can contribute to overall morbidity and mortality, although it is less directly a cause of death than severe infections or organ failure. *Lupus nephritis* - While **lupus nephritis** is a common and severe manifestation of SLE in children and a major cause of morbidity, particularly long-term kidney failure, it is not the most frequent immediate cause of death. - Advancements in treatment for nephritis have improved prognosis, shifting the leading cause of mortality to other factors. *Lupus cerebritis* - **Lupus cerebritis** (neuropsychiatric SLE) can be life-threatening, causing seizures, stroke, or psychosis, but it is less common as the primary cause of death compared to infections. - Its presence usually indicates severe disease requiring intensive treatment, but not the most common direct cause of death. *Libman sacks endocarditis* - **Libman-Sacks endocarditis** involves sterile vegetations on heart valves and is a known complication of SLE, but it rarely causes acute mortality in children. - It is more often associated with chronic complications like valvular dysfunction or a source of emboli rather than being the most common cause of death. [Practice more Pediatrics PYQs on OnCourse]

Q: Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?

Kawasaki syndrome. ***Kawasaki syndrome*** - **Kawasaki syndrome** is characterized by a constellation of symptoms including **conjunctival injection**, **pharyngeal injection**, a **polymorphic rash**, and **cervical lymphadenopathy**, often described as the CRASH and burn criteria (Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/foot changes, and Fever). - It is an acute systemic vasculitis, primarily affecting young children, and without treatment, it can lead to **coronary artery aneurysms**. *Measles* - Measles is characterized by a maculopapular rash that typically starts on the face and spreads downwards (cephalocaudal), along with the presence of **Koplik spots** on the buccal mucosa. - While it presents with conjunctivitis and rash, the rash is not polymorphic in the same way as Kawasaki, and cervical lymphadenopathy is less prominent. *Scarlet fever* - **Scarlet fever** is caused by Group A Streptococcus and presents with pharyngitis, fever, and a characteristic **sandpaper-like erythematous rash** with circumoral pallor. - While it has pharyngeal involvement and rash, it lacks the **conjunctival injection** and **polymorphic nature of the rash** seen in Kawasaki syndrome. The rash is typically fine and blanching. - Cervical lymphadenopathy may be present but the overall constellation differs from Kawasaki. *Mumps* - Mumps is an acute viral infection primarily characterized by the swelling of the **parotid glands** (parotitis), often accompanied by fever, headache, and malaise. - It does not typically present with conjunctival injection, a polymorphic rash, or prominent cervical lymphadenopathy as seen in Kawasaki syndrome. [Practice more Pediatrics PYQs on OnCourse]

Q: What is the most serious complication of measles?

Pneumonia. ***Pneumonia*** - **Pneumonia**, particularly **giant cell pneumonia**, is the most common cause of **measles-related deaths** in young children. - It results from the **direct viral infection** of the lungs or a **secondary bacterial superinfection**. *Croup* - **Croup (laryngotracheobronchitis)** can be a complication of measles, but it is typically **less severe** and **less life-threatening** than pneumonia. - It primarily affects the **upper airways**, causing a barking cough and stridor. *Meningo-encephalitis* - **Meningo-encephalitis** is a serious, albeit **less common**, complication of measles, occurring in approximately 1 in 1,000 cases. - While potentially fatal or leading to neurological sequelae, it is **outranked by pneumonia** in terms of overall mortality attributed to measles. *Otitis media* - **Otitis media** (middle ear infection) is a common complication of measles, but it is generally **not life-threatening**. - It usually responds well to **antibiotic treatment** and rarely leads to severe outcomes. [Practice more Pediatrics PYQs on OnCourse]

Q: In a term baby who is 72 hours old, breastfeeding well, and has a bilirubin level of 14 mg/dL, which of the following statements is true?

Continue to breastfeed. ***Continue to breastfeed*** - A bilirubin level of **14 mg/dL at 72 hours of age** in a healthy, full-term, breastfeeding baby is usually within the range considered **physiological jaundice** and does not warrant stopping breastfeeding. - **Breastfeeding should continue** regardless of jaundice management, as interruption can cause a **decrease in milk supply** and may worsen jaundice by reducing bilirubin excretion through stool. - Continued breastfeeding (8-12 times per day) helps promote bilirubin clearance. *Exchange transfusion* - This is an **invasive procedure** reserved for very high bilirubin levels (typically **>20-25 mg/dL** in full-term infants depending on age and risk factors) or in cases of **acute bilirubin encephalopathy**. - A bilirubin level of 14 mg/dL is **well below the threshold** for exchange transfusion in a healthy term infant. *Phototherapy* - According to **AAP guidelines**, phototherapy thresholds are age-dependent: - At **72 hours of age**, phototherapy is typically considered at bilirubin levels **>15-18 mg/dL** in low-risk term infants. - At 14 mg/dL, **close monitoring** with repeat bilirubin measurement is appropriate, but phototherapy is generally **not yet indicated** for a healthy term infant without risk factors. *None of the options* - This option is incorrect because **continuing to breastfeed** is the appropriate and evidence-based management for this clinical scenario. - The other interventions (exchange transfusion, phototherapy) are **not indicated** at this bilirubin level and age in a healthy term infant. [Practice more Pediatrics PYQs on OnCourse]

Question 1

A patient presents with clustered, white lesions on the buccal mucosa, typically near the upper molars. These lesions are pathognomonic for measles. What are these lesions called?

Accepted Answer

Koplik spots

Answer

Leukoplakia

Answer

Kaposi spots

Answer

None of the options

Question 2

Most common cause of death in SLE in children

Accepted Answer

Anemia and infections

Answer

Libman sacks endocarditis

Answer

Lupus cerebritis

Answer

Lupus nephritis

Question 3

Which condition is characterized by conjunctival injection, pharyngeal injection, polymorphic rash, and cervical lymphadenopathy?

Accepted Answer

Kawasaki syndrome

Answer

Measles

Answer

Scarlet fever

Answer

Mumps

Question 4

What is the most serious complication of measles?

Accepted Answer

Pneumonia

Answer

Croup

Answer

Otitis media

Answer

Meningo-encephalitis

Question 5

In a term baby who is 72 hours old, breastfeeding well, and has a bilirubin level of 14 mg/dL, which of the following statements is true?

Accepted Answer

Continue to breastfeed

Answer

Exchange transfusion

Answer

Phototherapy

Answer

None of the options

Question 6

A 5 yr old male child presented with H/O recurrent infection. O/E the child has rashes as shown below. Routine blood investigation reveal patient has low platelets. Which of the following diagnosis is possible?

Accepted Answer

Wiskott Aldrich syndrome

Answer

Henoch Schoenlein purpura

Answer

Job syndrome

Answer

Measles

Question 7

A 4-year-old male child presents with muscle weakness. His mother reports that her child has difficulty in climbing stairs and getting up from the floor. On muscle biopsy, small degenerated muscle fibers and absence of dystrophin were found. What is the diagnosis?

Accepted Answer

Duchenne muscular dystrophy

Answer

Myotonic dystrophy

Answer

Becker's muscle dystrophy

Answer

Limb-girdle muscular dystrophy

Question 8

A 2 years old child presents to PHC with fever and cough. He has chest in-drawing and respiratory rate of 38 per minute, weight 11 kg. The next step in management according to IMNCI is:

Accepted Answer

Give antibiotics and refer to tertiary centre

Answer

Give antibiotics and re-assess in 3 days

Answer

Refer to tertiary care

Answer

Only antipyretics are given

Question 9

A term neonate, with a birth weight of 2700 g, who is otherwise well, and is exclusively breastfed, presents for routine evaluation. His total serum bilirubin is found to be 14mg/dl on day 5. What is the management?

Accepted Answer

No active treatment required

Answer

Stop breastfeeding for 2 days

Answer

Phototherapy

Answer

Exchange transfusion

Question 10

A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Accepted Answer

Acute Laryngotracheobronchitis

Answer

Acute Bacterial Tracheitis

Answer

Acute Epiglottitis

Answer

Foreign Body aspiration

NEET-PG 2020 — Pediatrics