UPSC-CMS 2025 - Pediatrics Practice Questions

Q: For a sick child aged 4 years, which of the following are signs of "severe pneumonia or very severe disease", as per IMNCI (Integrated Management of Neonatal and Childhood Illness) Program? I. Fast breathing (Greater than or equal to 40 breaths per minute) II. Child vomits everything III. Stridor in a calm child IV. Chest indrawing: Select the correct answer using the code given below :

III and IV. ***III and IV*** - **Stridor in a calm child** is a critical sign indicating severe upper airway obstruction, classified as "very severe disease" in IMNCI. This is a general danger sign requiring urgent referral. - **Chest indrawing** (severe lower chest wall indrawing) signifies increased work of breathing and severe respiratory distress, categorizing it under "severe pneumonia" in IMNCI and requiring urgent referral. - These two signs represent the most specific respiratory indicators of severe pneumonia or very severe disease. *I and II* - **Fast breathing** for a 4-year-old (age 12 months to 5 years) is correctly defined as ≥40 breaths per minute per IMNCI. However, fast breathing alone indicates **pneumonia** (not severe pneumonia), which can be managed as outpatient with oral antibiotics. - **Child vomits everything** is indeed a general danger sign indicating "very severe disease" in IMNCI, but when combined with fast breathing (which indicates only simple pneumonia), this combination is less specific than III and IV. *II and III* - **Child vomits everything** is a general danger sign for "very severe disease" requiring urgent referral. - **Stridor in a calm child** is also a sign of "very severe disease." - While both are valid signs, this combination misses **chest indrawing**, which is the primary respiratory-specific sign of severe pneumonia and more directly answers the question about severe pneumonia classification. *II and IV* - **Child vomits everything** is a general danger sign for "very severe disease." - **Chest indrawing** is the key sign of "severe pneumonia." - While both are valid signs of severe pneumonia or very severe disease, the combination of **stridor and chest indrawing (III and IV)** represents the two most specific respiratory signs and is the preferred answer for this classification.

Q: In a child aged 3-12 years with an ear problem, which one of these situations merits urgent referral to hospital?

Tender swelling behind the ear. ***Tender swelling behind the ear*** - A **tender swelling behind the ear**, particularly in a child with an ear problem, is a classic sign of **mastoiditis**, which is a serious complication requiring urgent medical attention due to the risk of intracranial spread. - **Mastoiditis** often presents with fever, pain, and a prominent, pushed-out auricle. *Pus seen draining from the ear, and discharge reported for more than or equal to 14 days* - This suggests **chronic suppurative otitis media (CSOM)**, which typically requires a referral to ENT for assessment and management but is not usually an *urgent* referral unless there are signs of complications. - While concerning, the chronicity itself doesn't immediately indicate an acute emergency in the absence of other symptoms like fever or severe pain. *Pus seen draining from the ear, and discharge reported for less than 14 days* - This indicates acute otitis media (AOM) with perforation, which is very common in children. - It usually resolves with antibiotics and local care, and while a follow-up is important, it doesn't typically require urgent hospital referral. *Pus seen draining from both ears, irrespective of duration* - Bilateral ear discharge suggests bilateral acute or chronic otitis media, but does not inherently imply an acute emergency that requires urgent hospital referral. - The key factor for urgency would be signs of complications, such as mastoiditis or intracranial involvement, rather than the bilaterality of discharge alone.

Q: Which of the following are characteristic features of cerebral palsy? I. Disorder of movement II. Permanent nature III. Progressive course IV. Disorder of posture Select the correct answer using the code given below :

I, II and IV. ***Correct: I, II and IV*** - Cerebral palsy is defined as a group of **permanent disorders** that affect the development of **movement and posture**, causing activity limitations. - It is attributed to **non-progressive disturbances** that occurred in the developing fetal or infant brain. - Key characteristics: **Disorder of movement (I)** + **Permanent nature (II)** + **Disorder of posture (IV)** + Non-progressive course. *Incorrect: I, II and III* - While cerebral palsy is a **disorder of movement** and **permanent**, it is explicitly characterized by its **non-progressive** nature. - The underlying brain lesion does not worsen over time, though clinical manifestations may change as the child develops. - Statement III (Progressive course) is incorrect. *Incorrect: I, III and IV* - Cerebral palsy is fundamentally a **disorder of movement** and **posture**. - However, a key distinguishing characteristic is its **non-progressive** nature; the brain injury itself does not advance or worsen. - Statement III (Progressive course) contradicts the definition of cerebral palsy. *Incorrect: II, III and IV* - Cerebral palsy is **permanent** and affects **posture**, but it has a **non-progressive** course, not progressive. - It is also fundamentally a **disorder of movement**, which is a primary manifestation. - Statement III (Progressive course) is incorrect, making this combination wrong.

Q: Which of the following are tools commonly used in the evaluation of children with cerebral palsy for motor function and spasticity assessment? I. Gross Motor Function Classification System II. Medical Research Council System III. Modified Connors Scale (Connors-II) IV. Modified Ashworth Scale Select the correct answer using the code given below:

I and IV. ***Correct: I and IV*** - The **Gross Motor Function Classification System (GMFCS)** is the gold standard tool to classify gross motor function in children with **cerebral palsy** based on self-initiated movement and functional limitations across five levels (I-V). - The **Modified Ashworth Scale** is the most widely used clinical tool for assessing **spasticity** and muscle tone in cerebral palsy, grading resistance to passive movement on a 0-4 scale. - These two tools directly address **motor function classification** and **spasticity assessment** as required in the question. *Incorrect: III and IV* - While the **Modified Ashworth Scale (IV)** is correctly identified for spasticity assessment, the **Modified Connors Scale (Connors-II)** is used exclusively for evaluating **Attention-Deficit/Hyperactivity Disorder (ADHD)**, not motor function or spasticity in cerebral palsy. *Incorrect: I and II* - The **GMFCS (I)** is correctly identified for motor function classification in cerebral palsy. - However, the **Medical Research Council (MRC) System** is primarily used for **muscle strength grading** (0-5 scale) in conditions like peripheral neuropathy, stroke, or myopathy—not for motor function classification or spasticity assessment specific to cerebral palsy. *Incorrect: II and III* - Both tools are inappropriate for the stated purpose: the **MRC System** assesses muscle strength (not CP-specific motor function classification), and the **Modified Connors Scale** evaluates ADHD symptoms. - Neither tool is standard for evaluating motor function or spasticity in cerebral palsy.

Q: Which of the following are causes of secondary immunodeficiency in children? I. Diphenylhydantoin II. Severe malnutrition III. Post-varicella state IV. Nephrotic syndrome Select the correct answer using the code given below :

I, II and IV. ***I, II and IV*** - **Diphenylhydantoin (phenytoin)**, an anticonvulsant, causes immunosuppression through multiple mechanisms including IgA deficiency, hypogammaglobulinemia, and impaired T-cell function, making it a well-documented cause of drug-induced secondary immunodeficiency. - **Severe malnutrition** is one of the most common causes of secondary immunodeficiency worldwide, significantly impairing both cellular and humoral immunity by affecting T cells, B cells, and phagocytic function. - **Nephrotic syndrome** causes loss of immunoglobulins (particularly IgG) in the urine due to increased glomerular permeability, directly resulting in hypogammaglobulinemia and increased susceptibility to encapsulated bacterial infections (especially *Streptococcus pneumoniae*). *II, III and IV* - While **severe malnutrition**, **post-varicella state**, and **nephrotic syndrome** are all causes of immunodeficiency, this option incorrectly excludes diphenylhydantoin. - **Diphenylhydantoin** is a well-established cause of secondary immunodeficiency, not a minor or questionable cause. *I, III and IV* - This option incorrectly excludes **severe malnutrition**, which is one of the most important and prevalent causes of secondary immunodeficiency in children globally. - Severe malnutrition affects multiple components of the immune system and is considered a primary cause in pediatric populations. *I, II and III* - While **diphenylhydantoin**, **severe malnutrition**, and **post-varicella state** can all affect immunity, this option incorrectly excludes **nephrotic syndrome**. - The **post-varicella state** causes transient T-cell lymphopenia, but this is typically temporary and self-limited compared to the sustained immunoglobulin loss in nephrotic syndrome. - **Nephrotic syndrome** represents a more consistent and clinically significant cause of secondary immunodeficiency with a clear mechanism (protein loss in urine).

Q: Which of the following statements are correct regarding vaccination routes for children? I. Hepatitis B vaccine given in deltoid region has reduced efficacy II. Two vaccines may be given in the same thigh, but separated by 1 inch III. Separate sites are used when administering a vaccine and an immunoglobulin IV. Two intramuscular vaccines should never be given on the same day Select the answer using the code given below:

II and III. ***II and III*** - Hepatitis B vaccine can be given in the **deltoid region** for older children and adults with good efficacy; reduced efficacy primarily occurs if administered in the gluteal region due to high fat content, not the deltoid. Administering two vaccines in the same thigh, separated by 1 inch, is a recognized practice when multiple injections are needed and separate limbs are not feasible. - Administering a vaccine and an immunoglobulin at **separate sites** is crucial to prevent the immunoglobulin from neutralizing the live attenuated vaccine, thereby reducing its efficacy. *I and III* - Statement I is incorrect because the **deltoid region** is an appropriate and effective site for Hepatitis B vaccine administration in older children and adults. - Statement III is correct, as separating the sites for vaccine and immunoglobulin prevents **immune interference**. *III only* - While statement III is correct regarding the separation of vaccine and immunoglobulin administration, statement II is also correct, making this option incomplete. - **Multiple injections** on the same limb with adequate spacing are acceptable under certain guidelines. *II, III, and IV* - Statement IV is incorrect; multiple **intramuscular vaccines** *can* be given on the same day if clinically indicated and the child is due for them, often in different limbs or at appropriately spaced sites on the same limb. - Statements II and III are correct, but the inclusion of the incorrect statement IV makes this option invalid.

Q: "Small for Date" (SFD) babies, also known as "small for gestational age" babies, weigh less than what percentile for the gestational age?

10^th percentile. ***10^th percentile*** - A baby is classified as **small for gestational age (SGA)** when their birth weight is below the **10th percentile** for their gestational age. - This definition helps identify infants who may be at increased risk for **perinatal morbidity and mortality** due to restricted growth. *20^th percentile* - A cutoff of the 20th percentile is generally considered within the **normal range** for birth weight. - Using this percentile would lead to an **overestimation** of infants experiencing growth restriction. *2^nd percentile* - While babies below the 2nd percentile are also considered SGA, this is a more **severe category** of growth restriction. - The standard definition for SGA encompasses all infants below the **10th percentile**, not just those with extreme growth deficits. *5^th percentile* - Similar to the 2nd percentile, the 5th percentile represents a subset of SGA babies with more **pronounced growth restriction**. - However, the universally accepted definition for **small for gestational age** uses the 10th percentile as the threshold.

Question 1

For a sick child aged 4 years, which of the following are signs of "severe pneumonia or very severe disease", as per IMNCI (Integrated Management of Neonatal and Childhood Illness) Program?
I. Fast breathing (Greater than or equal to 40 breaths per minute)
II. Child vomits everything
III. Stridor in a calm child
IV. Chest indrawing:

Select the correct answer using the code given below :

Accepted Answer

III and IV

Answer

I and II

Answer

II and III

Answer

II and IV

Question 2

In a child aged 3-12 years with an ear problem, which one of these situations merits urgent referral to hospital?

Accepted Answer

Tender swelling behind the ear

Answer

Pus seen draining from the ear, and discharge reported for more than or equal to 14 days

Answer

Pus seen draining from the ear, and discharge reported for less than 14 days

Answer

Pus seen draining from both ears, irrespective of duration

Question 3

Which of the following are characteristic features of cerebral palsy?
I. Disorder of movement
II. Permanent nature
III. Progressive course
IV. Disorder of posture

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

I, III and IV

Answer

II, III and IV

Question 4

Which of the following are tools commonly used in the evaluation of children with cerebral palsy for motor function and spasticity assessment?
I. Gross Motor Function Classification System
II. Medical Research Council System
III. Modified Connors Scale (Connors-II)
IV. Modified Ashworth Scale

Select the correct answer using the code given below:

Accepted Answer

I and IV

Answer

III and IV

Answer

I and II

Answer

II and III

Question 5

Which of the following are causes of secondary immunodeficiency in children?
I. Diphenylhydantoin
II. Severe malnutrition
III. Post-varicella state
IV. Nephrotic syndrome

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Answer

I, II and III

Question 6

Which of the following statements are correct regarding vaccination routes for children?
I. Hepatitis B vaccine given in deltoid region has reduced efficacy
II. Two vaccines may be given in the same thigh, but separated by 1 inch
III. Separate sites are used when administering a vaccine and an immunoglobulin
IV. Two intramuscular vaccines should never be given on the same day

Select the answer using the code given below:

Accepted Answer

II and III

Answer

I and III

Answer

III only

Answer

II, III, and IV

Question 7

Which of the following are neonatal complications of maternal diabetes during pregnancy?
I. Hyperbilirubinemia
II. Hypocalcemia
III. Cardiomyopathy
IV. Hypoglycemia

Select the correct answer using the code given below :

Accepted Answer

I, II and IV

Answer

I, II and III

Answer

II, III and IV

Answer

I, III and IV

Question 8

"Small for Date" (SFD) babies, also known as "small for gestational age" babies, weigh less than what percentile for the gestational age?

Accepted Answer

10^th percentile

Answer

20^th percentile

Answer

2^nd percentile

Answer

5^th percentile

UPSC-CMS 2025 — Pediatrics