FMGE 2023 - Pediatrics PYQs Practice Questions

Q: Following urine microscopy and examination, a child is found to have hematuria and RBC casts in the urine. What is the probable cause for this?

Post-streptococcal glomerulonephritis (PSGN). ***Post-streptococcal glomerulonephritis (PSGN)***- RBC casts are highly indicative of **active glomerulonephritis**, demonstrating that red blood cells have leaked through damaged glomeruli and aggregated in the renal tubules.- **PSGN** is the most common cause of acute nephritic syndrome in children, typically following a *Streptococcal* infection, characterized by **hematuria**, hypertension, and mild proteinuria.*Focal segmental glomerulosclerosis (FSGS)*- FSGS almost universally presents as **nephrotic syndrome**, characterized by heavy **proteinuria**, profound edema, and hypoalbuminemia.- While microscopic hematuria may be present, the finding of **RBC casts** is highly uncommon and points away from a primary diagnosis of FSGS.*Membranoproliferative glomerulonephritis (MPGN)*- MPGN often presents with a **mixed nephrotic and nephritic picture**, including hematuria, but is less common acutely than PSGN in children.- PSGN presents with a very typical acute onset of **nephritic features** (hematuria, casts, hypertension) following infection, making it the more probable cause.*Minimal change disease*- This is the leading cause of **nephrotic syndrome** in children, defined by massive **proteinuria** with minimal to no damage visible on light microscopy.- **Minimal change disease** classically presents without significant hematuria and **RBC casts** are virtually absent. [Practice more Pediatrics PYQs on OnCourse]

Q: A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?

Within 1 hour. ***Within 1 hour***- The World Health Organization (WHO) and UNICEF strongly recommend initiating breastfeeding within the **first hour** of birth, often termed **early initiation**.- This practice stimulates early **suckling reflexes**, encourages bonding, and ensures the baby receives **colostrum**, which is rich in antibodies.*After 1 hour*- While better than waiting several hours, delaying beyond the first hour can miss the infant's period of **quiet alertness** immediately post-delivery, when they are most receptive to suckling.- The first hour is critical for the establishment of a successful maternal-infant bond and **optimal milk production signaling**.*After 4-6 hours*- Delaying breastfeeding significantly reduces the likelihood of successful **exclusive breastfeeding** later on, as the infant may become sleepy or less keen to latch.- Waiting this long deprives the newborn of the crucial **colostrum** and its protective immunological and nutritional benefits during a vulnerable period.*After 24 hours*- This is considered a significant and unnecessary delay, which greatly increases the risk of **neonatal hypothermia, hypoglycemia**, and poor feeding outcomes.- It is strictly against standard guidelines and often necessitates artificial formula supplementation, undermining the goal of achieving **exclusive breastfeeding**. [Practice more Pediatrics PYQs on OnCourse]

Q: An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

100,000 IU. ***100,000 IU*** - This is the correct **single dose per day** of Vitamin A for infants aged 6 to 11 months in the therapeutic regimen for Vitamin A deficiency or measles. - According to **WHO guidelines**, the therapeutic protocol for this age group involves administering **100,000 IU on Day 1** and **100,000 IU on Day 2** (and a third dose on Day 14 for severe deficiency). - This dose is both safe and effective for treating deficiency in this specific age group. *25,000 IU* - This dose is significantly lower than the recommended therapeutic level for infants 6-11 months and would be **ineffective** for treating Vitamin A deficiency. - Doses of this magnitude are not part of standardized WHO supplementation protocols for this age group. *50,000 IU* - This is the standard single dose recommended for **infants under 6 months** of age (1-5 months) for both prophylactic and therapeutic purposes. - For an 8-month-old infant (6–11 months age group), 50,000 IU is **insufficient** for effective therapeutic intervention. *200,000 IU* - This is the standard single dose for **children aged 12 months to 5 years** for routine supplementation. - Giving 200,000 IU as a single dose to an 8-month-old infant carries significant risk of **acute hypervitaminosis A toxicity** including symptoms such as bulging fontanelle, nausea, vomiting, and headache. [Practice more Pediatrics PYQs on OnCourse]

Q: Which of the following is not true about CHPS? CHPS - Congenital hypertrophic pyloric stenosis

b.Caused by hypertrophy of longitudinal muscles. ***b.Caused by hypertrophy of longitudinal muscles***- The defining pathology of congenital hypertrophic pyloric stenosis involves hypertrophy and hyperplasia of the **circular muscle layer** of the pylorus, not the longitudinal muscle layer.- This thickening of the circular muscle narrows the pyloric canal lumen, leading to gastric outlet obstruction.*a.Presents with non-bilious vomiting*- This is a true statement; vomiting is typically **non-bilious** because the obstruction is proximal to the **ampulla of Vater** (where bile enters the duodenum).- The vomiting is often projectile, feeding soon after a meal, and progresses from occasional to nearly every feed.*c.USG is very sensitive in diagnosing this condition*- This is a true statement; ultrasonography is the diagnostic modality of choice due to its high sensitivity and specificity, avoiding radiation exposure.- Diagnosis is confirmed when the **pyloric muscle wall thickness** is >4 mm or the **pyloric channel length** is >16 mm.*d.Hypokalemic metabolic alkalosis seen*- This is a true statement; persistent, massive vomiting leads to the loss of gastric **hydrochloric acid (HCl)**.- The resulting primary loss of H+ ions leads to **metabolic alkalosis**, which is compensated by renal excretion of K+ and retention of HCO3- (leading to secondary **hypokalemia**). [Practice more Pediatrics PYQs on OnCourse]

Q: How much oxygen is given to a term infant with respiratory distress during resuscitation?

21%. ***Correct: 21% (Room Air)*** - **Current NRP and WHO guidelines** recommend starting resuscitation of **term infants with 21% oxygen (room air)** - Evidence shows room air is **equally effective** as 100% oxygen for initial resuscitation - Reduces **oxidative stress and potential harm** from hyperoxia - Oxygen can be **titrated up** if preductal SpO2 targets are not achieved within expected timeframes - This applies specifically to **term infants (≥37 weeks gestation)** *Incorrect: 70%* - Not a standard concentration used in neonatal resuscitation - Would expose infant to unnecessarily high oxygen levels without clear benefit *Incorrect: 100%* - **Outdated practice** - previously used but no longer recommended for term infants - Associated with increased **oxidative stress** and potential harm - May still be considered for **preterm infants <35 weeks** (start with 21-30% and titrate) *Incorrect: 50%* - Not the recommended starting concentration for term infants - May be used as an **intermediate step** when titrating oxygen if initial room air is insufficient **Key Point:** For term infants, always start with room air (21%) during resuscitation and titrate based on SpO2 targets. [Practice more Pediatrics PYQs on OnCourse]

Question 1

Following urine microscopy and examination, a child is found to have hematuria and RBC casts in the urine. What is the probable cause for this?

Accepted Answer

Post-streptococcal glomerulonephritis (PSGN)

Answer

Focal segmental glomerulosclerosis (FSGS)

Answer

Membranoproliferative glomerulonephritis (MPGN)

Answer

Minimal change disease

Question 2

A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?

Accepted Answer

Within 1 hour

Answer

After 24 hours

Answer

After 4-6 hours

Answer

After 1 hour

Question 3

An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

Accepted Answer

100,000 IU

Answer

25,000 IU

Answer

50,000 IU

Answer

200,000 IU

Question 4

Which of the following is not true about CHPS? CHPS - Congenital hypertrophic pyloric stenosis

Accepted Answer

b.Caused by hypertrophy of longitudinal muscles

Answer

a.Presents with non-bilious vomiting

Answer

c.USG is very sensitive in diagnosing this condition

Answer

d.Hypokalemic metabolic alkalosis seen

Question 5

How much oxygen is given to a term infant with respiratory distress during resuscitation?

Accepted Answer

21%

Answer

70%

Answer

100%

Answer

50%

Question 6

Which of the following is an absolute contraindication for breastfeeding?

Accepted Answer

Galactosemia in infant

Answer

HIV positive mother

Answer

Tuberculosis in mother

Answer

Hepatitis C in mother

Question 7

An 8-year-old child presented with a sudden onset of high-grade fever, seizures, and loss of consciousness. On examination, the child had anemia, hypoglycemia, and no focal neurological deficits. What is the probable diagnosis?

Accepted Answer

Cerebral malaria

Answer

Tubercular meningitis

Answer

Viral meningitis

Answer

Fungal meningitis

Question 8

Gonadal growth corresponds with _____.

Accepted Answer

Skeletal system

Answer

Dental growth

Answer

Lymphoid growth

Answer

Brain

Question 9

A 6-year-old child is brought for complaints of short stature. His height is comparable with his parent's height and his bone age corresponds to his chronological age. What is the likely diagnosis?

Accepted Answer

Familial short stature

Answer

Constitutional delay

Answer

Undernutrition

Answer

Growth hormone deficiency

Question 10

Which of the following is the most common cause of mortality in diabetic ketoacidosis?

Accepted Answer

Cerebral edema

Answer

Cardiac arrhythmia

Answer

Acute kidney injury

Answer

Acute respiratory distress syndrome

FMGE 2023 — Pediatrics