NEET-PG 2012 - Pediatrics Practice Questions

Q: Treatment of simple febrile convulsion is based on

Control of fever. ***Control of fever*** - Among the given options, **control of fever** is the most appropriate answer as it represents the **immediate supportive care** for a child with a simple febrile seizure. - Management includes using antipyretics like **paracetamol** or **ibuprofen** to reduce fever and improve comfort. - **Important note:** While fever control is good supportive care, evidence shows that antipyretics do **NOT prevent recurrence** of febrile seizures. The actual cornerstone of management is **reassurance and parental education**. - According to AAP guidelines, simple febrile seizures are benign, self-limited events that require no specific anticonvulsant treatment. *Rectal diazepam* - **Rectal diazepam** is used for **acute termination** of prolonged seizures (>5 minutes) or as rescue therapy for recurrent episodes. - It is NOT indicated for routine management of simple febrile seizures, which typically last <15 minutes and resolve spontaneously. - May be prescribed for home use in select cases with recurrent seizures. *CSF finding* - **CSF analysis** is a **diagnostic procedure**, not a treatment basis. - It is indicated only when there is clinical suspicion of meningitis or meningoencephalitis (e.g., altered sensorium, meningeal signs, complex seizure features). - NOT routinely required for simple febrile seizures in well-appearing children. *Blood reports* - **Blood investigations** are diagnostic, not treatment-guiding for simple febrile seizures. - They may be considered to identify the source of fever or rule out electrolyte abnormalities, but are not the basis of seizure management itself. - Simple febrile seizures do not require routine laboratory workup.

Q: What is the threshold for hyperglycemia in neonates?

150 mg/dl. ***150 mg/dl*** - A blood glucose level greater than **150 mg/dL** is the **standard threshold** most commonly taught and used for defining **hyperglycemia** in neonates. - This value is widely accepted in clinical practice and guides decisions regarding **glucose management** and potential **insulin therapy** in this population. - This threshold is particularly relevant for term and late preterm neonates. *125 mg/dl* - While **125 mg/dL** represents an elevated glucose level and some newer guidelines consider this as a threshold (especially >7 mmol/L), it is **not the standard taught threshold** of 150 mg/dL. - For examination purposes, **150 mg/dL** remains the recognized standard definition. *180 mg/dl* - A blood glucose level of **180 mg/dL** indicates **severe hyperglycemia** rather than the initial threshold for defining hyperglycemia. - While some protocols for extremely preterm infants may use higher cutoffs, this exceeds the standard diagnostic threshold. - Intervention is typically initiated well before reaching this level to prevent complications. *100 mg/dl* - A blood glucose level of **100 mg/dL** in a neonate falls within the **normal range**, not hyperglycemia. - This level is desirable for proper brain development and metabolic function. - Normal neonatal glucose ranges from approximately **40-100 mg/dL** in the first days of life.

Q: What is the most common complication of a large Patent Ductus Arteriosus (PDA)?

Congestive Heart Failure (CHF). ***Congestive Heart Failure (CHF)*** - A large PDA results in a significant **left-to-right shunt**, increasing pulmonary blood flow and leading to **pulmonary overcirculation**. [1] - This increased workload on the heart, particularly the left atrium and ventricle, can lead to **ventricular dysfunction** and ultimately CHF. [1] *Eisenmenger syndrome* - While a severe complication of an untreated large PDA, it represents a **late stage** where the left-to-right shunt has reversed due to **pulmonary hypertension**. [1] - It is not the *most common* initial complication, as CHF often develops earlier in the disease progression. *Infective endocarditis* - This is a potential long-term complication of a PDA, especially if untreated, due to the **turbulent blood flow** across the ductus. - However, it is less common than CHF, which results directly from the hemodynamic burden imposed by a large shunt. *None of the options* - This option is incorrect because **Congestive Heart Failure** is indeed a very common and significant complication of a large Patent Ductus Arteriosus.

Q: What is the most common cause of conjugated hyperbilirubinemia in infants?

Biliary atresia. ***Rotor syndrome*** - Characterized by **conjugated hyperbilirubinemia** due to a defect in hepatic uptake and storage of bilirubin [1]. - This condition can lead to elevated levels of **direct (conjugated) bilirubin** without significant liver damage. *Crigler Najjar* - This condition primarily causes **unconjugated hyperbilirubinemia** due to a deficiency of the enzyme **uridine diphosphate glucuronyl transferase** [1]. - It typically presents with **kernicterus** in newborns rather than conjugated bilirubin elevation. *Breast milk jaundice* - Mainly leads to **unconjugated hyperbilirubinemia** due to substances in breast milk that inhibit bilirubin conjugation. - Generally occurs in **breastfed infants** after the first week of life, not presenting with increased conjugated bilirubin. *Gilbert syndrome* - This syndrome is associated with **unconjugated hyperbilirubinemia** due to a genetic defect in bilirubin conjugation [1]. - Typically benign, it does not cause **increased conjugated bilirubin** levels as seen in Rotor syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 860.

Q: Which of the following cancers has the highest cure rate?

Retinoblastoma. ***Retinoblastoma*** - This **childhood eye cancer** has an excellent prognosis, with a reported cure rate of **over 95%** when diagnosed early and treated promptly. - Treatment options like **chemotherapy**, **radiation**, **laser therapy**, and **enucleation** contribute to its high survival rate. *Wilm's Tumor* - While **Wilm's tumor** (nephroblastoma) also has a high cure rate in children, typically **around 90%**, it is slightly lower than that of retinoblastoma. - It is a **kidney cancer** primarily affecting children and is highly responsive to treatment. *Rhabdomyosarcoma* - The cure rate for **rhabdomyosarcoma**, a rare and aggressive cancer of the soft tissues, varies significantly based on factors like **tumor location**, **stage**, and **histology**. - Overall survival rates are generally lower than for retinoblastoma and Wilm's tumor, often ranging from **60-70%**. *All of the options* - This option is incorrect because while all three cancers listed have good prognoses, **retinoblastoma** specifically stands out with the highest cure rate among them. - The cure rates for Wilm's tumor and rhabdomyosarcoma, while good, are not as high as that for retinoblastoma.

Q: Upper segment to lower segment ratio in a 3-year-old child is:

1.3:1. ***1.3:1*** - At birth, the upper segment to lower segment ratio is around **1.7:1**, indicating proportionally longer trunks. - By the age of **3 years**, this ratio typically decreases to approximately **1.3:1** as the lower limbs grow more rapidly. *1.2:1* - This ratio is typically observed in **older children** or young adults, as lower limb growth catches up further. - A ratio of 1.2:1 would suggest more **proportional body segments** than expected for a 3-year-old child. *1.4:1* - This ratio is closer to that of a **younger infant** or toddler, as the lower segments are still relatively shorter. - A 3-year-old would generally have experienced more **lower limb growth**, reducing this ratio further. *1.6:1* - This ratio is characteristic of a **newborn or very young infant**, where the upper body and head are significantly larger relative to the legs. - It would be **abnormal** for a 3-year-old to still have such a high ratio, indicating a disproportional growth pattern.

Q: What is the recommended rate for blood transfusion in neonates?

1-5 ml/min. ***1-5 ml/min*** - The recommended rate for blood transfusion in neonates is **1-5 ml/min** to prevent **circulatory overload** and other complications. - Slower rates are crucial for neonates due to their limited cardiovascular reserves and smaller blood volume. *5-10 ml/min* - This rate is generally **too fast** for routine neonatal blood transfusions, increasing the risk of **fluid overload** and **cardiac strain**. - Rapid administration can lead to complications such as **necrotizing enterocolitis (NEC)** or **respiratory distress**. *10-15 ml/min* - Administering blood at this rate in neonates is **contraindicated** due to the high risk of **cardiovascular compromise**. - It could quickly overwhelm the neonate's circulatory system, leading to severe adverse events. *15-20 ml/min* - This rate is significantly **too rapid** for any neonatal blood transfusion and would almost certainly result in **severe volume overload** and potential cardiac arrest. - Such high rates are only rarely considered in extreme emergency situations, like massive hemorrhage with specific considerations and monitoring.

Q: Double aortic arch is associated with which syndrome?

DiGeorge syndrome. ***DiGeorge syndrome*** - **DiGeorge syndrome** is caused by a **22q11.2 deletion** affecting the development of the third and fourth pharyngeal pouches, leading to **thymic hypoplasia**, **parathyroid hypoplasia**, and **cardiac anomalies**. - Common cardiac defects include **interrupted aortic arch type B**, **truncus arteriosus**, **tetralogy of Fallot**, and **VSD**. - **Double aortic arch** can occur in 22q11.2 deletion syndrome, though it is less common than other cardiac anomalies; however, among the syndromes listed, this represents the most appropriate association. - The question tests recognition that various cardiac arch anomalies, including double aortic arch, may be seen in this genetic syndrome. *CATCH 22 syndrome* - This is an **acronym** for DiGeorge syndrome: **C**ardiac defects, **A**bnormal facies, **T**hymic hypoplasia, **C**left palate, **H**ypocalcemia, and **22q11 deletion**. - It is **essentially the same condition** as DiGeorge syndrome, just using different nomenclature. - While technically correct, "DiGeorge syndrome" is the more standard medical terminology currently used. *Shprintzen syndrome* - **Shprintzen syndrome** (also called **velocardiofacial syndrome or VCFS**) is caused by the **same 22q11.2 deletion** as DiGeorge syndrome. - It represents a **phenotypic variant within the 22q11.2 deletion syndrome spectrum**, with more emphasis on palatal and facial features. - Since it shares the same genetic basis, it can also present with similar cardiac anomalies, but "DiGeorge syndrome" is the more commonly recognized term for this genetic disorder. *None of the options* - This is incorrect because the three syndromes listed above (DiGeorge, CATCH 22, and Shprintzen) all refer to **22q11.2 deletion syndrome** or its variants, which can be associated with various cardiac anomalies including double aortic arch. - Among the listed options, **DiGeorge syndrome** is the most appropriate and widely recognized answer.

Q: A 3-month-old infant presents with an abdominal palpable mass and non-bilious vomiting. What is the most likely diagnosis?

Hypertrophic pyloric stenosis. ***Hypertrophic pyloric stenosis*** - The classic presentation includes **projectile non-bilious vomiting** and a palpable **olive-shaped mass** in the epigastrium of an infant typically between 3 weeks and 6 months of age. - The vomiting is non-bilious because the obstruction is proximal to the ampulla of Vater. *Intussusception* - While it can present with an **abdominal mass** and vomiting, the vomiting is often **bilious** and the classic stool is **'currant jelly'**, which is not mentioned here. - It usually presents with sudden onset of severe, **colicky abdominal pain** and occurs more commonly in slightly older infants (6-12 months). *Tracheoesophageal fistula* - This condition presents at birth with symptoms such as **choking, coughing**, and **cyanosis** during feeding. - It usually causes respiratory distress and feeding difficulties from the first days of life, not a palpable abdominal mass and non-bilious vomiting at 3 months. *Duodenal atresia* - This is a congenital obstruction that typically presents with **bilious vomiting** (as the obstruction is distal to the ampulla of Vater) within the first 24-48 hours of life. - Imaging usually shows a **“double bubble” sign** on abdominal X-ray, and an abdominal mass is not typically palpable.

Question 1

Treatment of simple febrile convulsion is based on

Accepted Answer

Control of fever

Answer

Rectal diazepam

Answer

CSF finding

Answer

Blood reports

Question 2

What is the threshold for hyperglycemia in neonates?

Accepted Answer

150 mg/dl

Answer

180 mg/dl

Answer

100 mg/dl

Answer

125 mg/dl

Question 3

What is the most common complication of a large Patent Ductus Arteriosus (PDA)?

Accepted Answer

Congestive Heart Failure (CHF)

Answer

Eisenmenger syndrome

Answer

Infective endocarditis

Answer

None of the options

Question 4

What is the most common cause of conjugated hyperbilirubinemia in infants?

Accepted Answer

Biliary atresia

Answer

Rotor syndrome

Answer

Crigler Najjar syndrome

Answer

Dubin-Johnson syndrome

Question 5

Which of the following cancers has the highest cure rate?

Accepted Answer

Retinoblastoma

Answer

Wilm's Tumor

Answer

Rhabdomyosarcoma

Answer

All of the options

Question 6

Upper segment to lower segment ratio in a 3-year-old child is:

Accepted Answer

1.3:1

Answer

1.2:1

Answer

1.4:1

Answer

1.6:1

Question 7

What is the recommended rate for blood transfusion in neonates?

Accepted Answer

1-5 ml/min

Answer

10-15 ml/min

Answer

15-20 ml/min

Answer

5-10 ml/min

Question 8

Double aortic arch is associated with which syndrome?

Accepted Answer

DiGeorge syndrome

Answer

CATCH 22 syndrome

Answer

Shprintzen syndrome

Answer

None of the options

Question 9

A 3-month-old infant presents with an abdominal palpable mass and non-bilious vomiting. What is the most likely diagnosis?

Accepted Answer

Hypertrophic pyloric stenosis

Answer

Tracheoesophageal fistula

Answer

Duodenal atresia

Answer

Intussusception

Question 10

What is the PRIMARY pathophysiological mechanism underlying the most common cause of neonatal hyperbilirubinemia?

Accepted Answer

Immature liver enzyme

Answer

Inefficient erythropoiesis

Answer

RBC hemolysis

Answer

Decreased bilirubin excretion

NEET-PG 2012 — Pediatrics