NEET-PG 2020 - Pediatrics Practice Questions

Q: Which of the following, if normal, would be most significant in making PEM unlikely?

Lean body mass. ***Lean body mass*** - A normal **lean body mass** indicates adequate muscle and organ tissue, which is the primary component affected by **Protein-Energy Malnutrition (PEM)**. - Maintaining normal lean body mass despite potential weight loss makes significant PEM, especially the **marasmic type**, less likely. *Extracellular fluid (ECF)* - **Extracellular fluid (ECF)** can be normal or even increased in cases of **edematous PEM** (kwashiorkor) due to decreased oncotic pressure, making it an unreliable indicator for excluding PEM. - Normal ECF does not rule out the depletion of protein, fat, and muscle mass that characterizes PEM. *Serum Potassium* - **Serum potassium** levels can be normal or abnormal (low or high) in PEM depending on hydration status, renal function, and refeeding syndrome, making it a non-specific indicator for excluding the condition. - It does not directly reflect the overall **nutritional status** or body composition changes seen in PEM. *Skin fold thickness* - **Skin fold thickness** measures subcutaneous fat stores, which can be normal or even preserved in some forms of PEM, particularly **kwashiorkor**, even when severe protein deficiency exists. - While reduced skin fold thickness suggests **marasmus**, a normal value does not conclusively rule out **protein deficiency** or other forms of PEM.

Q: A 5-year-old boy has recurrent infections, low platelet count, and rash as shown below. What is the likely diagnosis?

Wiskott Aldrich Syndrome. ***Wiskott Aldrich Syndrome*** - **Wiskott-Aldrich Syndrome (WAS)** is an X-linked recessive disorder characterized by the triad of **thrombocytopenia (low platelets)**, **eczema (rash)**, and **recurrent infections**. - The classic presentation in a young boy with these three features is highly indicative of WAS due to a mutation in the **WAS gene**, which affects immune cell and platelet function. *Bruton's Agammaglobulinemia* - This disorder primarily involves a defect in **B cell development**, leading to a severe deficiency of immunoglobulins and recurrent bacterial infections. - It is not typically associated with **thrombocytopenia** or **eczema** as defining features. *Severe Combined Immunodeficiency* - **SCID** is characterized by a severe defect in both T-cell and B-cell immunity, leading to profound immunodeficiency and recurrent, severe opportunistic infections. - While it causes recurrent infections, it does not typically present with the specific combination of **thrombocytopenia** and **eczema** seen in WAS. *Job Syndrome* - **Job Syndrome (Hyper-IgE Syndrome)** is characterized by very high IgE levels, recurrent skin abscesses, eczema, and coarse facial features. - While **eczema** and **recurrent infections** are present, **thrombocytopenia** is not a characteristic feature of Job Syndrome.

Q: A 5-year-old unvaccinated child presents to the OPD with fever, red eyes, and a maculopapular rash. What is the most likely complication associated with this condition?

Pneumonia. ***Pneumonia*** - **Pneumonia** is the **most common and most likely complication of measles**, occurring in approximately **1-6% of measles cases** - The clinical presentation of **fever, red eyes (conjunctivitis), and maculopapular rash** in an **unvaccinated child** is classic for **measles (rubeola)** - Pneumonia may be due to **direct viral pneumonitis** from measles virus or **secondary bacterial infection** (most commonly *Streptococcus pneumoniae*, *Staphylococcus aureus*, or *Haemophilus influenzae*) - It is a major cause of **measles-related mortality**, particularly in young children and immunocompromised individuals *Acute myocarditis* - **Acute myocarditis** is an extremely rare complication of measles - While myocardial involvement can theoretically occur with severe viral infections, it is **not a recognized characteristic or common complication** of measles - This is not the most likely complication when compared to pneumonia, otitis media, or diarrhea *Acute nephritis* - **Acute nephritis** is not a characteristic complication of measles - It is more commonly associated with **post-streptococcal glomerulonephritis** following Group A Streptococcus infection - Kidney involvement in measles is not a well-documented or common complication *Acute orchitis* - **Acute orchitis** is a recognized complication of **mumps** virus infection, particularly in post-pubertal males (occurring in 20-30% of infected males) - It is **not associated with measles infection** - This is a classic distractor testing knowledge of viral exanthems and their specific complications

Q: A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Give antibiotics. ***Give antibiotics*** - The child presents with **chest indrawing** along with cough and fever, which according to **IMNCI guidelines** classifies as **pneumonia**. - Note: RR of 38/min is **within normal limits** for a 24-month-old child (fast breathing threshold is ≥40/min for 12-59 months age group). - The diagnosis of pneumonia is based on the presence of **chest indrawing**, not fast breathing in this case. - According to **IMNCI**, pneumonia (without danger signs) should be treated with **oral antibiotics** (amoxicillin 250 mg twice daily for 5 days) at the primary care level. - The child should be followed up in 2 days and the mother advised on when to return immediately. *Refer to a higher-level health facility for further management.* - Referral is indicated for **severe pneumonia**, which requires presence of any **general danger sign** (inability to drink/breastfeed, persistent vomiting, convulsions, lethargy/unconsciousness, or stridor in calm child). - This child has **pneumonia** (not severe), so outpatient treatment with oral antibiotics is appropriate. *Monitor at home without medical treatment.* - This would be inappropriate as the child has **pneumonia** requiring antibiotic treatment. - Untreated pneumonia can rapidly progress to severe disease and is a **leading cause of child mortality** in developing countries. *Provide symptomatic treatment with antipyretics only.* - While antipyretics (paracetamol) can be given for fever, they do not treat the underlying **bacterial infection**. - Antibiotics are essential to treat pneumonia and prevent complications and mortality.

Q: A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?

Age < 11 years. ***Age < 11 years*** - Age is **NOT included** in the original King's College criteria for acute liver failure - King's College criteria are based on **biochemical parameters** (INR, bilirubin, pH, creatinine) and **clinical factors** (encephalopathy grade, jaundice-to-encephalopathy interval), not patient age - While **younger age may be a prognostic factor** in pediatric liver failure, it is not part of the formal King's College criteria used to predict poor prognosis or need for transplantation *INR > 6.5* - An **elevated INR > 6.5** (or PT > 100 seconds) is a **key criterion** in King's College criteria for non-paracetamol acute liver failure - Indicates severe **coagulopathy** and hepatic synthetic dysfunction - One of the most important predictors of poor outcome *Jaundice 7 days = subacute (worse prognosis, indicates need for transplant) - This temporal relationship is a **critical prognostic indicator** *Bilirubin > 300 mmol/L* - **Serum bilirubin > 300 μmol/L** (17.5 mg/dL) is explicitly included in King's College criteria for non-paracetamol ALF - Indicates severe **cholestasis** and hepatocellular dysfunction - Part of the multi-parameter assessment for transplant listing

Q: A 2-year-old child presented with the following x-ray finding. What is the most likely diagnosis?

Acute laryngotracheobronchitis. ***Acute laryngotracheobronchitis*** - The x-ray finding of a **steeple sign** (subglottic narrowing) is a classic radiographic feature of **croup**, also known as acute laryngotracheobronchitis. - Croup is characterized by a **barking cough**, hoarseness, and inspiratory stridor, primarily affecting the **larynx** and **trachea**. *Acute pharyngitis* - Acute pharyngitis is an **inflammation of the pharynx** and does not typically involve the subglottic region or cause the characteristic steeple sign on radiographs. - It presents with symptoms like **sore throat**, fever, and difficulty swallowing, without the prominent stridor or barking cough of croup. *Acute epiglottitis* - Acute epiglottitis, though a serious airway emergency, typically shows a **thumb sign** on a lateral neck x-ray due to a swollen epiglottis, not a steeple sign. - It presents with rapid onset of **high fever**, **dysphagia**, drooling, and muffled voice, often without a cough. *Parapharyngeal abscess* - A parapharyngeal abscess is a deep neck infection that would likely present with a **mass effect**, **displacement of airway structures**, and **soft tissue swelling** on imaging, not subglottic narrowing. - Symptoms include severe **sore throat**, **fever**, **trismus**, and neck swelling, with potential airway compromise from external compression.

Q: Pulmonary plethora in a child presenting with cyanosis, is seen in?

Total Anomalous Pulmonary Venous Connection (TAPVC). ***Total Anomalous Pulmonary Venous Connection (TAPVC)*** - In **non-obstructed TAPVC**, all pulmonary veins drain anomalously into the right atrium (or its tributaries) instead of the left atrium. - This causes **complete mixing of oxygenated pulmonary venous blood with deoxygenated systemic venous blood** in the right atrium → **cyanosis**. - Since an obligatory **atrial septal defect (ASD)** allows blood to reach the left heart, and there is **increased volume load on the right heart**, there is **increased pulmonary blood flow → pulmonary plethora** on chest X-ray. - Key point: **Obstructed TAPVC** causes pulmonary venous congestion and oligemia, NOT plethora. *Coarctation of the aorta* - **Coarctation of the aorta** is an **acyanotic** congenital heart disease involving systemic outflow obstruction. - It does **not cause cyanosis** unless there is differential cyanosis (lower body only) with a PDA and pulmonary hypertension causing right-to-left shunt. - Does not cause pulmonary plethora. *Tetralogy of Fallot (TOF)* - **Tetralogy of Fallot** presents with **cyanosis** due to right-to-left shunting through a VSD. - However, it has **pulmonary oligemia (decreased pulmonary blood flow)** due to right ventricular outflow tract obstruction and pulmonary stenosis. - Chest X-ray shows **boot-shaped heart** with decreased pulmonary vascular markings, NOT plethora. *Tricuspid Atresia (TA)* - **Tricuspid atresia** causes **cyanosis** due to obligatory right-to-left shunting at the atrial level. - Pulmonary blood flow is typically **decreased or normal** (depending on presence of VSD/PDA), NOT increased. - Does not typically cause pulmonary plethora.

Q: A boy after playing football complaining fatigue and abdominal pain. He also had a history of hand swelling in past. On ultrasonography, he has shrunken spleen. What is the likely diagnosis of this patient?

Sickle cell anemia. ### Sickle cell anemia - This patient's history of **hand swelling** (dactylitis), current **fatigue**, and **abdominal pain** are classic symptoms of sickle cell crises in **sickle cell anemia**. - The finding of a **shrunken spleen** on ultrasonography is consistent with **autosplenectomy**, a common complication of sickle cell disease due to repeated infarctions [1]. *Acute pancreatitis* - While acute pancreatitis can cause **severe abdominal pain**, it typically presents with elevated amylase/lipase, and does not explain the history of **hand swelling** or **shrunken spleen**. - There is no specific connection between playing football and developing acute pancreatitis in this context. *Iron deficiency anemia* - **Iron deficiency anemia** can cause **fatigue**, but it does not typically cause **abdominal pain**, **hand swelling**, or **autosplenectomy**. - A definitive diagnosis would require iron studies, which are not mentioned here. *Intermittent porphyria* - **Intermittent porphyria** can cause **abdominal pain** and neurological symptoms, but it does not manifest with **hand swelling** or **splenic atrophy**. - Its clinical presentation is distinctly different from the symptoms described.

Question 1

Which of the following, if normal, would be most significant in making PEM unlikely?

Accepted Answer

Lean body mass

Answer

Serum Potassium

Answer

Skin fold thickness

Answer

Extracellular fluid (ECF)

Question 2

A 5-year-old boy has recurrent infections, low platelet count, and rash as shown below. What is the likely diagnosis?

Accepted Answer

Wiskott Aldrich Syndrome

Answer

Bruton's Agammaglobulinemia

Answer

Severe Combined Immunodeficiency

Answer

Job Syndrome

Question 3

A 5-year-old unvaccinated child presents to the OPD with fever, red eyes, and a maculopapular rash. What is the most likely complication associated with this condition?

Accepted Answer

Pneumonia

Answer

Acute myocarditis

Answer

Acute nephritis

Answer

Acute orchitis

Question 4

A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Accepted Answer

Give antibiotics

Answer

Refer to a higher-level health facility for further management.

Answer

Monitor at home without medical treatment.

Answer

Provide symptomatic treatment with antipyretics only.

Question 5

A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?

Accepted Answer

Age < 11 years

Answer

INR > 6.5

Answer

Jaundice < 7 days before development of encephalopathy

Answer

Bilirubin > 300 mmol/L

Question 6

A 2-year-old child presented with the following x-ray finding. What is the most likely diagnosis?

Accepted Answer

Acute laryngotracheobronchitis

Answer

Acute pharyngitis

Answer

Acute epiglottitis

Answer

Parapharyngeal abscess

Question 7

Pulmonary plethora in a child presenting with cyanosis, is seen in?

Accepted Answer

Total Anomalous Pulmonary Venous Connection (TAPVC)

Answer

Coarctation of the aorta

Answer

Tetralogy of Fallot (TOF)

Answer

Tricuspid Atresia (TA)

Question 8

A boy after playing football complaining fatigue and abdominal pain. He also had a history of hand swelling in past. On ultrasonography, he has shrunken spleen. What is the likely diagnosis of this patient?

Accepted Answer

Sickle cell anemia

Answer

Acute pancreatitis

Answer

Iron deficiency anemia

Answer

Intermittent porphyria

NEET-PG 2020 — Pediatrics