Question: A child draws circle at

<p>. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning.copies circle. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}


Question: Birth length is double at the age of

D. i.e. (4 years) (4 Ghai 6th) (6 - Ghai 7th)WeightLength or heightHead circumference*birth - about =3 kg*birth50 cm*Birth34 cm5 month(Doubles)6 kg1 years75 cm1 years45 cm1 years9 kg2years85 cm2years47 cm2 years12 kg3 years95 cm 3 years14 kg4 years(doubles)100 cm3 years49 cm4 years16 kg 4 years50 cm* A useful guide for normal range is target height + 7 cm for girls and target height + 8.5 cm for boys


Question: Most common indication of liver transplant in children is

Biliary atresia is the most common indication for liver transplantation in India, followed by metabolic and inborn disorders.


Question: Most common gene involved in Noonan syndrome

NOONAN SYNDROME: - Autosomal dominant, Normal karyotype - MC gene involved --> PTPN 11 - Seen in both boys & girls --> FEILE - FEATURES: Sho stature webbed neck Anti-mongoloid slant eyes (Opposite of Down syndrome) Cubitus valgus Clinodactyly, Cryptorchidism cardiac anomalies: Supra valvular Pulmonary Stenosis -->, HOCM, ASD Presence of Intellectual disability


Question: The dose of betamethasone in prenatal to prevent respiratory distress syndrome is

Betamethasone is the antenatal coicosteroid of choice and the recommendation is to give 2 doses of 12mg intramuscularly 24 hrs apa to all pregnant women in preterm labour between 24 and 35 wks irrespective of whether the membranes are intact or not. This is to reduce the rate of respiratory distress syndrome and intraventricular hemorrhage. The other option is dexamethasone 6mg every 12hrs for 4 doses. Reference : page 194 Textbook of Obstetrics Sheila Balakrishnan 2nd edition


Question: Neonatal sepsis is commonly caused by

(E. coli) (161-G) (136-Ghai 7th)* Neonatal sepsis is the single most important cause of neonatal deaths in the community accounting for over half of them.* Most cases of neonatal sepsis in the community are caused by Escherichia-coli and staphylococcus aureus. In hospitals, Klebsiella pneumonia is also a common organism


Question: Severe Acute Malnutrition is defined as

Severe acute malnutition in children of 6 months - 5 year is defined as
a) Weight / Height < - 3SD
b) Mid - upper arm circumference < 11.5 cm
c) Presence of bipedal edema


Question: Ω Omega shaped epiglottis is seen in

On Laryngoscopy, Omega shaped epiglottis is seen in laryngomalacia.


Question: Auer rods are specific for

-Auer rods are Needle-like azurophilic fusiform inclusions in cytoplasm of myeloblasts -Auer rods are most reliable morphological feature of AML -Myeloblasts Stain +ve with MPO and Sudan Black B


Question: EMG is least useful for diagnosis of

EMG is leastly used in cerebral palsy since the cause is in the brain and not in the muscles


Question: The most common cause of severe obstructive uropathy in children is

Posterior Urethral ValvesThe most common cause of severe obstructive uropathy in children is posterior urethral valves, affecting 1 in 8,000 boys. The urethral valves are tissue leaflets fanning distally from the prostatic urethra to the external urinary sphincter.Valves are of unclear embryologic origin and cause varying degrees of obstruction. Ref: Nelson Textbook of Pediatrics; 20th edition; Page no: 2574


Question: Preventable causes of Mental Retardation are

Cretinism is congenital iron deficiency syndrome which can be preventable by intake in required amounts. Reference: GHAI Essential pediatrics, 8th edition


Question:
NOT a feature of Atrial Septal defect among the
following

Left Atrial hypertrophy is never seen in ASD.

Complications include Left Atrial hypertrophy

Complications due to ASD are of late onset

Most Common Congenital heart disease presenting in Adult age


Question: Treatment of multiple carboxylase deficiency

Treatment of multiple carboxylase or biotinidase deficiency is biotin.Oral dose is 10-40 mg/kg/day Reference:Essential pediatrics-Ghai,8th edition,page no:650


Question: The best indicator of acute malnutrition is

Severe acute malnutrition is defined by a very low weight for height (below-3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional edema.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 301)


Question: Skin change in newborn that disappear spontaneously

.Harlequin color change is a cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body&;s midline. This transient change occurs in approximately 10% of healthy newborns. It is seen usually between two and five days of bih. Reference: GHAI Essential pediatrics, 8th edition


Question: Hutchisons traid is seen

* Hutchinson&;s triad is seen in congenital syphilis. *it includes interstitial keratitis, deafness and Hutchinson&;s teeth ( central incissors with peg shaped, notched appearance ). Reference : IADVL&;s concise textbook of dermatology, first edition, pg no: 126


Question: Enzyme deficient is Von Gierke disease is

Enzyme deficient in Von Gierke disease is Glucose 6 - phosphatase.


Question: Recent marker for Downs syndrome is

Inhibin A is a protein secreted by the ovary, and is designed to inhibit the production of the hormone FSH by the pituitary gland. The level of inhibin A is increased in the blood of mothers of fetuses with Down syndrome. Reference: GHAI Essential pediatrics, 8th edition


Question: Between 3 to 4months of age, Infant weight increases approximately around

Between 3 and 4 months of age, the rate of growth slows to approximately 20 g/day.By age 4 months, bih weight is doubled.(Refer: Nelson; Chapter 10; pg no. 69)


Question: Most common cardiac anomoly associated with Turner's syndrome among the following is

Most common cardiac anomoly associated with Turner's syndrome is Bicuspid Aortic valve > Coarctation of Aorta.


Question: A most common cause of Neonatal Hypothyroidism is

Iodine deficiency is the commonest cause of congenital hypothyroidism in certain parts of India, while thyroid dysgenesis is the most common aetiology in non-endemic areas (75% of all cases).

Transplacental maternal thyroid antibodies


Question: Select the most common clinical sign or symptom for diagnosis Tuberous sclerosis

Tuberous sclerosis, an autosomal dominant condition, can result in severe mental retardation and seizures. Infantile spasms, a hypsarrhythmic EEG pattern, hypopigmented lesions (ash-leaf spots), cardiac tumors, sebaceous adenomas, a shagreen patch (a roughened, raised lesion over the sacrum), and calcifications on the CT scan are all features of this condition. No specific treatment is available.

A 6-month-old child with blindness on the same side as a large facial lesion

An infant with infantile spasms, a hypsarrhythmic EEG pattern, and ash-leaf depigmentation on her back

An 18-year-old patient with a history of fractures and optic gliomas, who now has developed a malignant schwannoma

A 2-year-old child with multiple episodes of skin infection and failure to thrive


Question: Amount of Protein present in 100ml of breast milk is

Amount of Protein present in 100ml of breast milk is: 1.1 g/dl


Question: A five year old child presents to the emergency depament with burns. The burn area corresponding to the size of his palm is equal to

Ans is 'a' i.e., 1% BSA Estimation of body surface area (BSA) of burn o Rough estimate of body surface area of burn can be estimated by following rules. Rule of Palm (Palmar method) o It can be used in Children as well as in adults. o It is used for small burns ( o The palm of patients hand represents I% of BSA. Palm is the area of hand from wrist crease to the finger crease. o Entire burned hand represents 2.5% of BSA: 1 /% for palm; 1% for dors um of the hand (excluding fingers);0. 5% for the fingers. Rule of 9 o It can be used in adults and children older than 14 years. o It is used for larger surface area burns. o Estimates the body surface area of an adult in multiples of 9. o An adult who has been burned, the percent of the body involved can be calculated as follows: Head and Neck = 9% Anterior chest = 9% Anterior abdomen =9% Upper back = 9% Lower back = 9% Right upper extremity (Anterior + Posterior) = 9% Left upper extremity (Anterior + Posterior) = 9% Right lower extermity, Anterior = 9% Right lower extremity, Posterior = 9% Left lower extremity, anterior = 9% Left lower extremity, Posterior = 9% Perenium = 1% o Percent of the burn in a child can be calculated as follows: Head and neck = 9% Anterior trunk = 18% Posterior trunk = 18% Upper extremity (Right) = 9% Upper extremity (Left) = 9% Lower extremity (Right) = 18% Lower extremity (Left) = 18% Perenium = 1%


Question: 3 months old child with typical mewing cry and congenital hea disease, chromosome abnormality

Ans. is 'b' i.e., 5p Cri-du-chat syndrome. A high-pitched cry like a cat, giving the syndrome its name. Genetic studies have confirmed that this characteristic cry results from the deletion at 5p15 The main features are hypotonia, sho stature, characteristic cry, microcephaly with protruding metopic suture, moonlike face, hypeelorism, bilateral epicanthic folds, high arched palate, wide and flat nasal bridge, and mental retardation. Cardiac abnormalities including ventricular septal defect, atrial septal defect, patent ductus aeriosus and Fallot's tetralogy.


Question: Most common cause of lower respiratory tract infection in 3 year old child is

Ans. is 'c' i.e., Streptococcal pneumonia


Question: A 5 year lod child is assessed to have developmental age of one year. His developmental patient would be


Question: Most common cause of ESRD in children

This is why kidney failure is also called end-stage renal disease, or ESRD for sho. Diabetes is the most common cause of ESRD. Common causes of acute renal failure include: Hea attack. Illegal drug use and drug abuse. Not enough blood flowing to the kidneys. Urinary tract problems Reference: GHAI Essential pediatrics, 8th edition


Question: Most common organism causing meningitis in a 1 year old child

Streptococcus pneumonia is the most common organism causes meningitis even in the 1 year old child. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common cause of hea failure in infancy is

Most common cause of hea failure in infancy is CHD. Ref : Ghai essential of pediatrics, eighth edition, p.no:397


Question: The karyotype of a patient with androgen insensitivity Syndrome is

Karyotype-46 ,XY. Normal genitK appearance -SRY deletion ,SF1 defect,Gonadal dysgenesis ,Severe StAR defect ,Complete androgen insensitivity syndrome. Genital ambiguity -Testicular dysgenesis ,Steroidogenic defects,Paial androgen insensitivity syndrome ,Aromatase deficiency. * Chromosomal study: Karyotype is 46, XY. * In infants and children, stimulation by hCG before measurement of hormones needed. * Serum testosterone is normal (or higher) * Serum E2 level is high normal for males * Serum LH level is normal or slightly elevated * FSH is normal. * USG: --Ovaries, uterus, upper 2/3rd of vagina and tubes are absent Reference: OP Ghai ,essential.paediatrics ,8 th edition, page no- 538,table 17.32 .


Question: Automatism is seen in

A complex paial seizure is a type of seizure that arises in one lobe of the brain, rather than the whole brain. The seizure affects people&;s awareness and may cause them to lose consciousness . A complex paial seizure stas focally within the brain and causes impairment of consciousness. This definition is based on both clinical and electroencephalographic (EEG) data. A complex paial seizure is most commonly a manifestation of temporal lobe epilepsy, but the term is so broadly defined (le, as any focal seizure with Impairment of consciousness) that it is very nonspecific. For this reason, many clinicians make a point of distinguishing between temporal and extratemporal complex paial seizures. Complex paial seizures are paial seizures that are associated with an alteration of consciousness ( Complex-Paial Seizures with Automatisms). The term psychomotor describes a paicular semiology characterized by automatisms and impairment of consciousness, usually of temporal lobe origin. Automatisms: Automatisms are nonpurposeful, stereotyped, and repetitive behaviors that commonly accompany complex paial seizures (In the sem lologic classification, they define automotor seizures). The behavior Is Inappropriate for the situation. Verbal automatisms range from simple vocalizations, such as moaning, to more complex, comprehensible, stereotyped speech. The most common automatisms, at least In temporal lobe epilepsy, are oral (eg, lip smacking, chewing, swallowing) and manual (eg, picking. fumbling, patting). Unilateral manual automatisms accompanied by contralateral arm dystonia usually Indicates seizure onset from the cerebral hemisphere !psilateral to the manual automatisms. Automatisms can also be more elaborate, coordinated movements Involving bilateral extremities. Bizarre automatisms, such as alternating limb movements, right-to-left head rolling, or sexual automatisms, may occur with frontal lobe seizures. Reference: GHAI Essential pediatrics, 8th edition


Question: 3 months old baby with fever and respiratory rate 60, irritable, and well feed, no stridor, no chest indrawing, no convulsions. Diagnosis

The above given history is suggestive of pneumonia as there is increased respiratory rate. New ARI classification (2014) by WHO: Diagnosis Clinical features Pneumonia Fast breathing and/or chest indrawing Severe pneumonia or Very severe disease General danger signs present If the child Is: Fast breathing Is: 2 months up to 12 months 50 breaths per minute or more 12 months up to 5 years 40 breaths per minute or more


Question: A child is brought by mother with HO massive hemetemesis with HO drug intake previously with NSAIDS and on Rx.Associated with moderate splenomegaly diagnosis is

Massive hematemesis,moderate splenomegaly are features of oesophageal varices Ref : ESSENTIAL PEDIATRICS,O.P.GHAI.,PG NO:290, 7th edition


Question: Flag hair sign is seen in

Ans. (a) KwashiorkorRef: Nelson's Pedia, 19th ed. Ch 670# kwashiorkorDisease due to decreased protein and caloric intake.Clinical Features are:# Hypoalbuminemia which leads to pedal edema# Hepatomegaly- Hallmark feature of kwashiorkor# Skin: Sun-exposed skin is relatively spared, as are the feet and dorsal aspects of the hands; Hypo pigmentation# Hair and Nail: Nails are thin and soft, and hair is sparse, thin, and depigmented, sometimes displaying a flag sign of alternating light and dark bands that reflect alternating periods of adequate and inadequate nutrition.# Apathy# Lack of appetite* PELLAGRA:This presents with edema, erythema, and burning of sun-exposed skin on the face, neck, and dorsal aspects of the hands, forearms, and feet* SCURVY (VITAMIN C OR ASCORBIC ACID DEFICIENCY): This presents initially with follicular hyperkeratosis and coiling of hair on the upper arms, back, buttocks, and lower extremities. Perifollicular erythema and hemorrhage, swollen, erythematous gums; stomatitis; and subperiosteal hematomas are also seen.


Question: Most common benign tumours during infancy is

An infantile hemangioma is one of the most common benign tumors of infancy and occurs in approximately 5-10% of infants.They occur more frequently in females,premature and low bih weight infants. Reference: GHAI Essential pediatrics, 8th edition


Question: A new bom presented with Jaundice. Most diagnostic investigation of choice is

(Total and Direct bilirubin) (171 - Ghair 6th)* Unconjugated Hyperbilirubinemia1. Clinical Jaundice appearing in the first 24 hours2. Increase in level of total bilirubin by more than 0.5 mg/dL /hour or 5mg/dL /24 hours3. Total bilirubin >15mg/dL (hyper bilirubinemia)4. Direct bilirubin >2.0mg /dL* Conjugated hyperbilirubinemia - is rare in newborn, conjugated hyper bilirubinemia is defined as a direct reacting fraction of >2mg/dL or >15% of the total bilirubin


Question: Brain abscess in Cyanotic hea disease is commonly located in

Brain abscess in CHD is located mainly in frontal lobe. Ghai essential of pediatrics, eighth edition, p.no:411


Question: Commonest cause of short stature in children


Question: Minimal interval between two live vaccines administered by the oral route is

Live vaccines administered by the oral route (Oral Polio vaccine-OPV; oral typhoid and Rota virus) are not believed to interfere with each other if not given simultaneously. These vaccines may be given at any time before or after each other. Live parenteral (injected) vaccines and live intranasal influenza vaccine should either be administered at the same visit or they should be seperated by atleast 4 weeks. Ref: Ghai essentials 9th edition Pgno: 190


Question: Investigation of choice in VUR

c. Voiding cystourethrogram(Ref: Nelson's 20/e p 2562-2567, Ghai 8/e p 485-486)The most useful process for conclusive diagnosis of VUR is micturating cystourethrogram (MCU)MCU demonstrates the grade of reflux as well as urethral anatomy.Radionuclide imaging is sensitive at detecting reflux but does not demonstrate anatomic details


Question: Chromosomal anomalies more than 20% is associated with aEUR'

Omphalocele "Chromosomal abnormalities have been repoed in as many as 43% fetuses with omphalocele. The most common being 13, 18, 21 and Turner's syndrome". Omphalocele Omphalocele is a midline defect of the anterior abdominal wall characterized by herniation of the abdominal visceral in to the base of the umbilical cord. Omphalocele is a defect of the umbilical ring which results from a failure of the two lateral abdominal wall folds to migrate and. fuse normally in the midline around the 3rd or 4th week of intrauterine life. The defect is characteristically located at the base of the umbilical cord and may contain abdominal and thoracic structures. The herniated visceral are included in a sac which is .formed internally by the peritoneum and externally by Whaon's jelly and the amnion. Omphalocele is associated with number of congenital anomalies Anomalies Gastroschisis Gastroschisis is a herniation of the abdominal viscera through a paraumibilical defect of the anterior abdominal wall. The defect is usually located at the right side of the cord inseion and comprises full thickness of the abdominal wall. The herniated organ is usually bowel and very rarely other structures are involved. In contrast to omphalocele - "Gastrochisis is rarely associated with other congenital anomalies". The most frequent associated anomalies are gastrointestinal in origin and are related to the same vascular embryologic problem that originates the gastrochisis. - Intestinal atresia or stenosis (7-30%) cardiac malformation seen in 8% cases. It is also associated with I.U.G.R.


Question: Low bih weight is defined as

Low bih weight (LBW) neonate- A neonate weighing less than 2500g at bih irrespective of the gestational age. Very low bihweight (VLBW) neonate- A neonate weighing leas than 1500g at bih irrespective of the gestational age. Extremely low bih weight (ELBW) neonate- A neonate weighing leas than 1000g at bih irrespective of the gestational age. Reference : page 125 Ghai Essential Pediatrics 8th edition

Weight < 10 percentile for their gastational age


Question: Umbilical cord becomes black in

The cord becomes brownish black within 2 or 3 days after bihIt falls off in about 10-14 days(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 811)


Question: As per as latest resuscitation guidelines Umbilical cord clamping must be delayed for atleast ( in preterm )

Umbilical cord clamping must be delayed for atleast 30 seconds (in term + preterm babies) Benefits of delayed cord clamping | Total body iron stores Expand blood volume | Incidence of anemia in neonates Note - If case of Bih asphyxia, cord should be clamped immediately NELSON states 30-60 seconds so, better response is 30 seconds as the value is common to our 2 references and the question mentions ''ATLEAST''.


Question: Most common Enzyme Deficiency leading to childhood hypeension is

Most common enzyme deficiency causing hypeension in pediatric child group is APPARENTMINERALOCOICOID EXCESS. Apparent mineralocoicoid excess (AME) is an autosomal recessive disorder caused by deficiency of 11 beta hydroxysteroid dehydrogenase 2 (11-beta HSD 2) enzyme which is encoded by a gene in chromosome 16q22. Congenital adrenal hyperplasia due to 11b-hydroxylase deficiency is a form of congenital adrenal hyperplasia (CAH) which produces a higher than normal amount of androgen,resulting from a defect in the gene encoding the enzyme steroid 11b-hydroxylase (11b-OH) which mediates the final step of coisol synthesis in the adrenal. 11b-OH CAH results in hypeension due to excessive mineralocoicoid effects. It also causes excessive androgen production both before and after bih and can virilize a genetically female fetus or a child of either sex. Reference: GHAI Essential pediatrics, 8th edition


Question: One month old baby is referred for failure to thrive. On examination there are features of congestive cardiac failure. Femoral pulses are feeble compared to brachial pulses. The likely diagnosis is

In coarctation of aoa there will be radiofemoral delay. Ghai essential of pediatrics, eighth edition, p.no:432


Question: ASD patient with murmur similar to MR and left axis detion of 40 degrees is having

Floppy mitral valve REF: Pediatrics: A Concise Text - Text - SK Kabra, RN Srivastava Page 135 Repeat in December 2011 The murmur is the clinching point here as the patient is having ostium primum type of ASD with MR and Ostium primum defect alone cannot produce such murmur and in question it is already mentioned that the patient is having ASD, Floppy mitral valve should be the answer. "Presence of pansystolic murmur of mitral regurgitation (MR) in a patient with ASD suggests the presence of ostium primum defect with cleft mitral laeflet or floppy mitral valve with mitral valve prolapsed" "ECG shows right axis detion in ostium secundum ASD and extreme left axis detion in ostium primum ASD" "Clinical presentation of ostium primum is similar to ostium secundum except that there may be a mitral systolic murmur due to MR and ECG shows left axis detion"


Question: Drug of choice for Prophylaxis of Bronchialitis in a child with heart disease

Treatment for Bronchiolitis in a child with co-morbidities is inhaled Ribavirin.
Drug of choice for prophylaxis of Bronchialitis in a child with co-morbidities is Palivizumab.


Question: Earliest sign of Rickets is

A. i.e. (Craniotabes) (82- Ghai 7th) (128 - Ghai 6th)RICKETSSCURVY* Craniotabes* is the earliest manifestations (felt like a ping pong ball)* Anterior fontanel is large and its closure is delayed beyond 18 months* Bossing of frontal and parietal bones* Rachitic rosaiy (costochondral junction become prominent dome shaped and semicircular)* Pigeon breast - sternum projects forward* Harrison's groove (Horizontal depression)* Eruption of primary teeth delayed* Moderate degree of scoliosis kyphosis or lordosis* Epiphysis of long bones are widened and broadening of wrists* Long bones of legs get deformed when the child starts bearing weight* Anterior bowing of legs, knock knee and coxa vera*** Pot- belly (Abdomen become protuberant)* Visceroptosis and lumber lordosis* Child is listless, anorexic, fretful and cries onbeing handled* Bones are tender* Hemorrhages occur under the periosteum of long bones* Gum bleeds are common* Petechiae may be seen over the skin* Costochondral junction is prominent and appears sharp and angular* Scorbutic rosary is attributed to separation of epiphysis of ribs and backward displacement of sternum* Wound healing is delayed* Anemia may co- exist* Metaphyseal flaring of the anterior ends of the ribs is characteristically seen in rickets*** **First change to appear is "loss of normal zone ofprovisional calcification" adjacent to metaphysis


Question: Most common cause of Congenital hypothyroidism is

Most common cause of congenital hypothyroidism is thyroid dygenesis > thyroid dysharmonogenesis.


Question: Cause of "bloody" vomitus in a neonate

Meckel&;s dieiculum may cause severe hemorrhage due to peptic ulceration. The blood is usually passed per rectum and is maroon in colour. it may cause bloody vomitus. Ref : BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,24 TH EDITION PG NO:1159


Question: Surfactant deficiency occurs in

Fetal lung maturation in diabetic pregnancy. The increased incidence of the idiopathic respiratory distress syndrome (IRDS) in infants of diabetic mothers may be explained by preterm delivery and asphyxia but the metabolic derangement per se may also be responsible for the inadequate production of surfactant Reference: GHAI Essential pediatrics, 8th edition


Question: After 3 days of bih, the base of the umbilical cord is red and swollen. It indicates

Redness or edema at the base of umbilical cord indicate inflammatory changes and infectionIt is called as omphalitis(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 890, 811)


Question: Diagnostic Criteria of JRA

It is defined as ahritis of one or more joints with onset below 16 yr age and persisting for atleast 6 weeks Ref Ghai pediatrics eighth edition pg no 625


Question: OATP 1B1/2 gene mutation is seen in

OATP 1B1/2 gene mutation - Rotor syndrome
ABCCA gene mutation - Dubin johnson syndrome


Question: Persistence of Moro's reflex is abnormal beyond the age of

3rd month According to Ghai 6th/e p. 146 "Moro's reflex disappear at three month of age and persistence of this reflex beyond three months is abnormal." According to Ghai 7m/e p. 114 "Moro's reflex disappear by six months in normal infant" We have done an extensive search for this one. We are sure of one point. Persistence of Moro's reflex beyond 6 months of age indicates neurological abnormality "In the normal infant the 17101-0' s reflex begins to fade at three months of age and gradually disappear at 4-6 months of age. When it persist beyond 6 months of age it indicates delay in CNS development such as cerebral palsy." (Tachdjian clinical paediatric ohopaedic p. 371) But still we are not sure what would be the answer for Moro's reflex disappear at ??


Question: Neonatal hepatitis, cholestasis, triangle shaped face, pulmonary stenosis is seen in

The above clinical features seen in Alagille syndrome.


Question: In a neonate, Jaundice appears for the first time in the 2nd week. The following is not a cause

In case of rh incompatibility the baby may have jaundice within 24 hrs and not late. Reference: GHAI Essential pediatrics, 8th edition


Question: After premature delivery, mother's milk is low in

Ans. a (Lactose) (Ref OP Ghai 6th/ p. 158; 7th/p. 131, 134)After premature delivery, mother's milk is low in:# Calcium # Phosphates # LactoseADVANTAGES OF BREAST MILK# Docosahexanoic acid (DHA, W3, 2:3) present in breast milk helps in brain development.# Maximum synthesis of breast milk occurs at 12 months.# Has better calcium than cow milk for baby to absorb.# Iron in breast has 70% availablity. # Prevents against infections by:- Human milk contains bacterial and viral antibodies, including secretory IgA. They probably account for the lower incidence of diarrhea, otitis media, pneumonia, bacteremia, and meningitis during the 1st yr of life.e- Macrophages in human milk may synthesize complement, lysozyme, and lactoferrin.- Lactoferrin has an inhibitory effect on the growth of Escherichia coli in the intestine.- The lower pH of the stool of breast-fed infants is thought to contribute to the favorable intestinal flora of infants fed human milk vs. formula (i.e., more bifidobacteria and lactobacilli; fewer E. coli), which also helps protect against infections caused by some species of E. coli.- Human milk also contains bile salt-stimulated lipase, which kills Giardia lamblia and Entamoeba histolytica.DISADVANTAGES OF BREAST MILK# Breast milk is balanced, will supply all the necessary nutrients except, perhaps, fluoride and, after several months, vitamin D.# The iron content of human milk is somewhat low. However, most normal infants have sufficient iron stores for the first 6 mo of life. Moreover, human milk iron is well absorbed.# The vitamin K content of human milk also is low and may contribute to hemorrhagic disease of the newborn. Parenteral administration of 1 mg of vitamin K, at birth is recommended for all infants, edpecially for those who will be breast- fed.# Cytomegalovirus (CMV), human T-cell lymphotropic virus type 1, rubella virus, hepatitis B virus, and herpes simplex virus also have been demonstrated in breast milk. Of these, the presence of CMV is the most troublesome.Nutritive value of milk compared BuffaloCowGoatHuman1Fat (g)6.54.14.53.42Protein (g)4.33.23.31.13Lactose (g)5.14.44.67.1Q4Calcium (mg)210120170285Iron (mg)0.20.20.3--6Vitamin C (mg)12137Minerals (g)0.80.80.80.18Water (g)81.08786.888


Question: Myelodysplasia in fetus can be best diagnosed by

Ans. a (AFP); (Ref. Robbins, Pathologic Basis of Disease, 6th/pg.325)Maternal serum AFP (MSAFP)# It is a oncofoetal protein# Highest level of which in foetal serum and amniotic fluid, it reaches around 13 weeks and decreases thereafter.# It reaches a peak around 32 weeks.# It decreases in Down's syndrome.# Its increased levels are seen in (Mnemonic = WORMIAN)- Wrong gestational age,- Open neural tube defects,- Renal anomalies,- Multiple pregnancy,- IUD,- Anterior abdominal wall defects,- Nephrotic syndrome (Congenital).# Ach esterase has better diagnostic value than AFP in open neural tube defects. (AI 2005)# Normal levels of AFP in liquor at 16th week = 20 mg/dL.# AFP is tumor marker for HCC, Non-seminomatous GCTs and ovarian sexcord tumors like Sertoli-Leydig tumors.


Question: A Full Term Baby, exclusively breast fed, at the end of 1 week was passing Golden yellow stools and was found to have adequate hydration with normal systemic examination. The weight of the baby was just same as it was at bih. The pediatrician should now advice

Sometimes the physiological changes may vary from different children,proper reassurance to mother is very impoant. Reference: GHAI Essential pediatrics, 8th edition

Reassure the mother that nothing is abnormal


Question: Central bronchiectasis is seen with

The distribution . bronchiectasis mar be impoant diagnostically A central - Perihilar allergic bronchopulmonary aspergillosis. Predominant upper lobe o Middle and lower lobe - Cystic fibrosis or one of its variants. Distribution is consistent with PCD Lower lobe involvement is - Middle lobe and lingular segment of the LUL involvement is characteristic of non tuberculous mycobacteria (NTM). Idiopathic bronchiectasis REF : OP-GHAI 9th edition


Question: ECG new born child with Down syndrome

Ans. is 'a' i.e., Normal Neonatal ECG screening for congenital hea disease in Down syndrome. Narchi HI He studied the value of routine neonatal electrocardiography (ECG) in the 1st 48 hours of life to diagnose congenital hea disease in 37 neonates with Down syndrome. 60% infants had no clinical evidence of congenital hea disease, had normal ECGs and normal cardiac anatomy on echocardiography. About 40% children with down syndrome have congenital hea disease. Endocardial cushion defect (ASD with ostium primum) account for 40-60% of cases.


Question: The cardiac silhouette can have an "egg on side" appearance in

Transposition of great vessels (TGA) is defined as aoa arising from the right ventricle and pulmonary aery from the left ventricle. In patients with TGA, the oxygenated pulmonary venous blood recirculates in the lungs whereas the systemic venous blood recirculates in the systemic circulation. The pulmonary aery saturation is thus always higher than the aoic saturation. Survival depends on the mixing available between the two circulations. Patients of complete TGA with intact ventricular septum are cyanotic at bih. Since the interatrial communication results in poor mixing, the neonates present with rapid breathing and congestive failure secondary to hypoxemia within the first week of life. Physical examination shows severe cyanosis, congestive failure, normal first sound, single second sound and an insignificant grade one to two ejection systolic murmur. The electrocardiogram shows right axis detion and right ventricular hyperophy. The thoracic roentgenogram shows cardiomegaly with a narrow base and plethoric lung fields. The cardiac silhouette can have an "egg on side" appearance: The right upper lung fields appear more plethoric than other areas. The thymic shadow is often absent. Patients of TGA with VSD have increased pulmonary blood flow; mixing at the ventricular level determines the severity of cyanosis. They develop congestive failure around 4-10 weeks of age. Physical findings consist of cyanosis, cardiomegaly, congestive failure, normal first sound, single or normally split second sound and grade II-IV ejection systolic murmur. Apical third sound gallop or a mid-diastolic rumble may be present. Electrocardiogram shows right axis detion with biventricular, right ventricular or left ventricular hyperophy. Chest X-ray shows cardiomegaly, plethoric lung fields and features of pulmonary venous hypeension. The aerial switch operation is now established as the treatment of choice for TGA, Prostaglandin El can help reduce cyanosis in selected cases by keeping the PDA open. Interim palliation can be accomplished through a balloon atrial septostomy. Reference: Essential Paediatrics; O.P. Ghai; Page no: 425


Question: Confirmatory test for cushing's disease is

High dose dexamethasone suppression test

Overnight dexamethasone suppression test

Bilateral inferior petrous sinus sampling


Question: Chromosome associated with autosomal dominant PCKD

PKD1 gene → Chromosome 16.
PKD2 gene → Chromosome 4.


Question: Hyperbilirubinemia in a child can be due to

Breast milk jaundice - bilirubin in excess of 10mg/dl. Seen beyond 3rd-4th weeks of life. A diagnosis of breast milk jaundice should be considered if this is unconjugated (not staining nappies) and other causes for prolongation such as inadequate feeding, continuing hemolysis, extravasated blood, G6PD deficiency and hypothyroidism have been ruled out. Cystic fibrosis is an autosomal recessive disorder caused by mutation in the gene encoding the chloride conductance channel, CF transmembrane conductance regulator(CFTR). The failure of chloride conductance by epithelial cells leads to dehydration of secretions that are too viscid and difficult to clear. Fanconi syndrome is characterised by tubular proteinuria and aminoaciduria and variable degrees of bicarbonaturia, phosphaturia, electrolyte wasting and glucosuria. Alpha1-antitrypsin deficiency (AATD) is a genetic inherited autosomal-codominant condition. People with AATD are predisposed to obstructive pulmonary disease and liver disease (eg, cirrhosis and hepatocellular carcinoma in children and adults). Reference : page 172,499, 393 Ghai Essential Pediatrics 8th edition


Question: Profuse watery diarrhoea in an immune compromised child is due to

Giardiasis caused by Giardia lamblia is a major cause of diarrhoea in children and travellers. Individuals with malnutrition,humoral immunodefeciencies,and cystic fibrosis are particularly susceptible.
Features: acute diarrhoea with sudden onset of explosive, watery foul smelling stools, along with nausea and anorexia,abdominal distension,flatulence,epigastric camps and mild fever.


Question: Early eiphyseal closure is seen with

(Estrogens): Ref: 1859-Nelson 17thEstrogen has direct result of the known on promoting epiphyseal fusion and therapy must begin before the bone age has reached 12 years (Marfan's syndrome)* Recent studies have demonstrated that is estrogen that mediates epiphyseal fusion in both girls and boys* Androgens also accelerates skeletal maturation, presumably via aromatization to estrogens, but at the price of rapid virilization.


Question: Trisomy 13 is seen in

Trisomy 13 is seen in Patau syndrome Edward syndrome is trisomy 18 Down syndrome trisomy 21 and turner syndrome is due to 45 XO . Reference : Nelson TB of pediatrics 19th edition.


Question: A 9 months old girl is presented with PR bleed, vomiting, mass & colicky pain in Rt lumbar region with masked liver dullness. She is in shocklike condition. Management should includes

.Intussusception Mostly between 6-11 months of age Features:intermittent colicky abdominal pain,vomiting,bloody mucous stools(current jelly) History of recent change of milk formula,upper respiratory tract infection,vaccination may be present. Sausage shaped mass maybe palpable on right quadrant of abdomen...iliac fossa may appear empty it is a surgical emergency but aim is reduction of the obstructed bowel.in intussusception of sho duration hydrostatic pressure of the barium enema or saline enema usually relieve it. ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:259,7 th edition


Question: Expressed breast milk can be stored at room temperature for

Expressed Breast Milk (EBM) If a mother is not in a position to feed her baby (e.g. ill mother, preterm baby, working mother, etc.), she should express her milk in a clean wide-mouthed container and this milk should be fed to her baby. EBM can be stored at room temperature for 6-8 hr, in a refrigerator for 24 hr and a freezer at -20degC for 3 months. Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 155


Question: Wilson disease is caused by defect in

ATP 7B gene on chromosome 13 is mutated in Wilson disease.


Question: A 3 year old child comes with complaint of limp diagnosis is

.Septic ahritis, also known as jointinfection or infectious ahritis, is the invasion of a joint by an infectious agent resulting in joint inflammation. Symptoms typically include redness, heat and pain in a single jointassociated with a decreased ability to move the joint.


Question: Mousy odor of urine is seen in

Children with classic phenyl ketonuria have an unpleasant odour of urine due to presence of phenylacetic acid,which is often described as musty or mousey. Phenylketonuria is due to deficiency of enzyme phenylalanine hydroxylase or of its cofactor tetra hydro biopterin. Reference: Nelson TB of pediatrics pg 418 edit


Question: Most common GI malignancy of childhood

Ans. is 'b' i.e., Lymphoma Over all hemangioma is most common Tumor in infant. Hemangioma is usually benign in Nature. Leukemia is most common malignancy in pediatric age gyp. 2"' most common is CNS Tumor = Lymphoma is the most common malignancy of the gastrointestinal tract in children. About 30% of children with non-Hodgkin lymphoma present with abdominal tumors.


Question: The test is done to diagnose syphilis in a newborn if the mother is syphilitic is

Diagnosis of congenital syphilisIt involves Dark ground Microscopy and VDRL.As IgM does not cross the placenta, its presence in neonatal serum confirms congenital syphilis and helps to differentiate it from seropositivity due to passively transferred maternal antibodies. The tests to detect IgM are-FTA-ABS (19S IgM FTA-ABS)Syphilis Capita M test(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1475-1477)


Question: A newborn baby presented with profuse bleeding from umbilical stump after birth. Probable diagnosis is

Ans. is 'a' i.e. Factor XIII deficiency Bleeding from umbilical stump suggests Factor XIII deficiency.Neonates with a positive bleeding history, particularly with features such as delayed bleeding, umbilical stump bleeding or miscarriages and in whom the initial panel of screening test is negative should be tested for factor XIII deficiency.The normal screening tests such as PT and PTT are normal in factor XIII deficiency because factor XIII is needed to stabilize the clot after a fibrin clot has formed, so tests used for evaluating the extrinsic or intrinsic pathways are not affected. (Note, that factor XIII is used, once the clot has formed.)Test used for evaluation of factor XIIITest used in qualitative evaluation of factor XIII is evaluation of clot stability in 5M urea.Clots formed from normal individuals remain stable in 5M urea, while clots from factor XIII deficient patient dissolve in urea.This assay detects only the most severely affected patients with 1% to 2% factor XIII deficiency or tests.A quantitative chromogenic assay has been developed but is not yet readily available.In addition to hemorrhages these patients may have poor wound healing a high incidence of infertility among males and abortion among affected females and a high incidence of intracerebral hemorrhage.About other options:Von Willebrand diseasePatients with Von-Willebrand disease rarely presents in the neonatal period because plasma concentration of Von Willebrand factor is high in neonatal period.Platelet function disordersGenetic disorders that result in deficient platelet function are rare causes of bleeding in infants.Most patients with these platelet disorders do not present in neonatal period but rather later in life. They are not recognized as a problem during the neonatal period.Glanzman's thromboastheniaThis is an extremely rare disorder of the blood in which the platelets lack the glycoprotein IIb/HIa.Hence platelet aggregation cannot occur and bleeding time is significantly prolonged and there is increased bleeding.Bernard Soulier syndromeIt is an autosomal recessive disorder characterized by thrombocytopenia and large platelets (giant platelets)There is absence of the platelet membrane GpIb/IX complex.Symptoms are consistent with low or dysfunctional platelets and include easy bruising, nosebleeds, mucosal bleeding, menorrhagia and occasionally G.I. bleedingFactor XII deficiency * It is not associated with clinical bleeding.


Question: Best indicator of growth monitoring in children aEUR'

Rate of increase in height & weight Midarm circumference, Body weight and chest circumference are one time point estimates therefore they are not adequate to provide information about long term nutritional stats of the child. A measurement which shows the time trends like rate of increase in height or weight with passage of time would be more useful. - The growth chas demonstrate progressive change in the height and weight of child as age advances therefore they are the best indicator of long term nutritional status. "The growth cha has been described as passpo to child health care. It has won international recognition and is now a standard method of monitoring children's health and nutritional status". Uses of growth cha - For growth monitoring - Diagnostic tool for identifying "high risk" children - Planning and policy making - Education tool - Tool.for action - Evaluation - Tool for teaching


Question: Expressed Breast milk can be stored in refrigerator up to

(24 hours) (151-Ghai 6th) (127-Ghai 7th)Expressed breast milk can be stored at room temperature for 6-8 hours* In refrigerator - 24 hours* In freezer at - 20deg for 3 months


Question: Acquired megacolon can be due to

Acquired megacolon may occur at any age as a result of Chagas disease (Trypanosoma cruzi), obstruction by a neoplasm or inflammatory stricture, toxic megacolon complicating ulcerative colitis, visceral myopathy, or in association with functional psychosomatic disorders (poor toilet training during infancy). Ref : Bailey and Love 26e pg: 1177


Question: A3 year old girl has problems with writing and spelling. Other intelligence is normal

Dyslexia

Dyslexia - problem in reading, spelling and written expression
Intelligence is normal
Dyslexia is the most common type of learning disability.
Children with dyslexia have problem in reading, spelling and written expression.
The important clues to dyslexia in school age children include delayed language, trouble rhymic words, mispronunciation, hesitation,
work-finding difficulties and poor spellings with presence of letter reversal. Reading is slow, inaccurated and labored.


Question: A 3 day child vomits everything he feeds, has a distended abdomen & diarrhoea. The urine is positive for benedicts test for reducing substance. The substance in urine is aEUR'

Galactose Characteristic symptom i.e., vomiting, distended abdomen and diarrhea along with the presence of reducing substance in the urine suggests the diagnosis of galactosemia Benedict's Test Benedict's test is a biochemical test to detect reducing sugars. -Benedicts test detects the presence of aldehydes except (aromatic ones) and alpha hydroxyketones in a compound. All monosaccharides are reducing sugars i.e., they all have a free reactive aldehyde group and are positive on Benedicts. Some disaccharides such as fructose have alpha hydroxyl ketones and can reduce sugars. All other disaccharides are non reducing sugars and will not react with Benedict's solution Galactosemia Galactosemia is a group of inherited metabotic disorders in which an enzyme deficiency affects the normal metabolism of the sugar galactose Galactose is a monosaccharide Most of the galactose originates from the dairy products that contain lactose or milk sugar Lactose is a disaccharide that is catalyzed by the enzyme lactase into two monosaccharides i.e. lactose and glucose From the intestine the galactose is transpoed to liver where it is conveed to glucose phosphate, which can be used in several metabolic pathway. Conversion of Galactose to Gulose I phosphate occurs in several successive steps. A specific enzyme is required at each step Galactosemia occurs because of the deficiency of any of the enzymes involved in the metabolism of Galactose. The most common enzyme associated with galactosemia is the deficiency of the enzyme galactose -1- phosphate uridyl trans-ferase. The deficiency of the enzyme or the defect in the metabolism results in an accumulation of galactose -1- PO4 and galacticol that are thought to have direct toxic effect on the liver and other organs. Clinical features Infants with galactosemia appear normal at bih, however symptomsusually appear a few days to weeks after initiating galactose containing .feeds The early clinical features of severe galactosemia include liver dysfunction, manifested by jaundice and hypoglycemia, The accompanying gastrointestinal.findings are poor feeding, vomiting and diarrhoea. Due to the effect of galacticol toxicity on brain it may cause C.N.S symptoms to predominate which are irritability and seizures Diagnosis If galactosemia is suspected, urine should be tested simultaneously with Benedicts reagent and with Glucose oxidase method. - The Glucose oxidase method is specific for glucose, whereas - Benedict's reagent can detect any reducing substance -A negative glucose oxidase test with positive benedicts test suggests that a non glucose reducing substance is present. - With appropriate clinical findings this is most likely to be galactose Confirmatory diagnosis The confirmatory diagnosis is made by the enzyme assay.


Question: Commonest cause of hypothyroidism is

(Thyroid dysgenesis) (1872-73-Nelson 17th) (481-Ghai 7th)HYPOTHYROIDISM results from deficient production of thyroid hormone or a defect in thyroid hormone or a defect in thyroid hormonal receptor activity* Someform of thyroid dysgenesis (aplasia, hypoplasia or an ectopic gland) is the most common cause of congenital hypothyroidism, accounting for 85% of cases, 10% are caused by an in bom error of thyroxine synthjesis and 5% are the result of transplacental maternal thyrotropin receptor blocking antibody.* Pendred syndrome - congenital hypothyroidism with sensorineural deafness and goiter, also have a positive perchlorate discharge.* ** Sodium L-thyroxine given orally is the treatment of choices (side effects are - craniosynostosis and temperature problems pseudotumour cerebri)* Acquired hypothyroidism - is most commonly caused by auto immune destruction of thyroid as a part of Chronic lymphocytic thyroidits (Hashimoto's thyroiditis


Question: Investigation of choice for confirming Henoch Schonlein Purpura is

Biopsy of the kidney may be performed both to establish the diagnosis or to assess the severity of already suspected kidney disease. The main findings on kidney biopsy are increased cells and IgA deposition in the mesangium (pa of the glomerulus, where blood is filtered), white blood cells, and the development of crescents.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1217 - 1218)


Question: The poor indicator of response during treatment of malnutrition includes

Primary failure to respond may be characterized by:1. Failure to regain appetite by day 42. Failure to sta losing edema by day 43. Failure of the disappearance of edema by day 104. Failure to gain weight at least by 5g/kg/day by day 10 of therapyRef: Nelson Paediatrics; 20th edition

Failure to gain at least 5 g/kg/day by day 4

Failure to gain at least 2 g/kg/day by day 10


Question: Endemic cardiomyopathy in children is linked to the deficiency of

Deficiency of selenium has resulted in Keshan disease, a form of cardiomyopathy endemic in China. Other dietary factors such as low intake of vitamin E, protein, and methionine are also considered relevant to the causation of the disease. Selenium deficiency is usually associated with vitamin E deficiency. Ref: Page 131; Ghai essential pediatrics; 6th edition


Question: In pediatric advanced life suppo intraosseous access for drug/fluid administration is recommended for

Intraosseous infusion (IO) is the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system. This technique is used in emergency situations to provide fluids and medication when intravenous access is not available or not feasible. A comparison of intravenous (IV), intramuscular (IM), and intraosseous (IO) routes of administration concluded that the intraosseous route is demonstrably superior to intramuscular and comparable to intravenous administration (in delivering paediatric anesthetic drugs). Due to the rapid advance and adoption of superior intraosseous access technology, IO access has now become the preferred method of establishing vascular access for patients in whom traditional access is difficult or impossible. Reference: GHAI Essential pediatrics, 8th edition


Question: The gene for Wilson&;s disease is on

In Wilson&;s disease,the underlying defect lies in the long arm of chromosome 13 where there is a mutation in ATP7B gene,the normal hepatic copper- excreting gene.Eventually,capacity of hepatocytes to store copper is exceeded and copper is released into circulation which then gets deposited in extrahepatic tissues such as the brain eyes, and others. Reference:Textbook of pathology-Harsh Mohan,6th edition,page no:628


Question: Hematopoisis in first month of life is

After bih, and during early childhood, hematopoiesis occurs in the red marrow of the bone. With age, hematopoiesis becomes restricted to the skull, sternum, ribs, veebrae, and pelvis. Yellow marrow, comprised of fat cells, replaces the red marrow and limits its potential for hematopoiesis. Reference: GHAI Essential pediatrics, 8th edition


Question: Moderate Hypothermia in a neonate is defined as an axillary temperature

Classification of Neonatal hypothermia: Cold stress: 36.0 - 36.4oC Moderate hypothermia: 32 - 35.9oC Severe hypothermia: < 32oC.


Question: Enzyme replacement therapy is most commonly used for

Gaucher disease is a multisystemuc lipidosis characterized by hematological abnormalities,organomegaly and,skeletal involvement.It has 3 clinical subtypes . It occurs due to the deficient activity of acid beta glucosidase . Thus glucosylceramide accumulate in reticule end I the loam cells. Treatment is mainly enzyme replacement therapy with recombinant acid beta glucosidase.Most extra skeletal symptoms are reversed by 60 IU/kg enzyme iv infusion every other week. Monthly maintenance improves skeletal manifestations. Reference: Nelsons TB of pediatrics 19th edit,pg 487


Question: The Blood sugar in a neonate sholy after bih reaches the lowest level of 30 mg/dl at the age of

Hypoglycemia is a condition in which the level of glucose in the blood is lower than normal. A baby is at risk if he or she has a mother with diabetes, is preterm, or is large. If your baby has signs of hypoglycemia, give him or her formula or glucose and water mixture. Reference: GHAI Essential pediatrics, 8th edition


Question: Best method of estimation of amount of proteinuria in a 2 year child with nephrotic syndrome is

c. Spot urine sample for protein/creatinine ratio(Ref: Nelson 20/e 2518)Though 24 hr urine for protein and creatinine, is more accurate, but due to difficulty in collecting 24 hour urinary sample in children, Spot urine sample for protein/creatinine ratio is preferred.


Question: Most common cause of acquired hea disease in children

Ans. is 'a' i.e., Acute Rheumatic fever Acute rheumatic fever Most common cause of acquired hea disease in children. Caused by group A f3 hemolytic streptococci Usually seen in school going children Jones criteria = very impotrant Mitral valve most common followed by aoic valve In acute phase - MR seen In RI-ID MS seen


Question: In Sickel cell disease, aplastic crisis is due to

In Sickel cell disease, due to infection of red cell progenitors by ParvoVirus B19 infection aplastic crisis occurs.


Question: In child, foreign body in lung

The children are treated by removal of foreign body through a rigid bronchoscope.Bronchoscopy should be undeaken if the clinical and radiological picture suggests the diagnosis even when the history of foreign body aspiration is not fohcoming. Ref : Essential Paediatrics,O.P.Ghai,7th edition,Pg No:368


Question: A 4 year baby is having large face, large jaw, large ear and macro orchidism is

A child with large face large ears large jaw and macro orchidism has fragile X syndrome It is due to a fragile site in one of the distal long arm of chromosome Xq27.3 Reference: Nelson TB of pediatrics pg 411 edition 19.


Question: Calculate the silverman score for a neonate with paradoxical breathing, mild lower chest retraction, marked xiphoid retraction, minimal nasal flare and expiratory grunt audible without stethoscope

Score for Paradoxical breathing
2

Mild lower chest retraction
1

Marked xiphoid retraction
2

Minimal nasal flare
1

Expiratory grunt audible without stethoscope
2

Total score
8


Question: Macrosomia is a

Macrosomia:- A condition where a baby is large before bihFactors causing macrosomia:Mother having diabetesMother having gestational diabetesObese mother(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 777, 897 - 899)


Question: Characteristic feature of Systemic Juvenile Idiopathic Arthritis is

Systemic Juvenile Idiopathic Arthritis

It begins at below 16 years of age
NSAIDs are given
Ra factor is negative
Uveitus is seen in oligoarticular JIA


Question: Initial drug of choice in a child with status epilepticus

Prompt treatment with benzodiazepines is the first-line treatment of status epilepticus, but many patients will need additional treatment with additional medications including phenytoin, valproic acid, phenobarbital, or levetiracetam. The Neurocritical Care Society's guideline states that benzodiazepines remain the "emergent initial therapy" of choice based both on available evidence and expe consensus. When possible, intravenous benzodiazepine administration is preferred. However, formulations exist for buccal, intranasal, intramuscular, and rectal administration, and these should be administered if intravenous access cannot be rapidly established. The American Epilepsy Society's guideline concludes that intravenous lorazepam and diazepam are efficacious at stopping seizures lasting at least five min and that rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective at terminating seizures lasting at least five minutes . Reference: GHAI Essential pediatrics, 8th edition


Question: Exclusive breast feeding means

(D) Breast feeding only > Exclusive Breastfeeding. Only breastmilk is given. No other food or drink, not even water, is given. Medicines, vitamins or mineral drops are permitted if indicated. An infant should be exclusively breastfed for first 6 months of life.

Breast feeding on demand only + solid foods at other times


Question: Vision is tested in the newborn by

Methods of assessing vision in infants:Papillary light reflexRed reflexOptokinetic nystagmus (using nystagmus drum)Visual evoked potentialsAbility to follow a target(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2802)


Question: 2 year old baby having testicular lump. Increased AFP diagnosis

Yolk sac tumor is the most common characteristic testicular tumor of infants and young children up to the age of 4 years.Alphafetoprotein levels are elevated in 100% cases of yolk sac tumors. Germ cell tumours unrelated to germ cell neoplasia in situ (non-GCNIS) Spermatocytic tumour Yolk sac tumour, prepubeal type Teratoma, prepubeal type - Dermoid cyst - Epidermoid cyst - Differentiated neuroendocrine tumours Mixed teratoma and yolk sac tumour, prepubeal type Germ cell tumours derived from germ cell neoplasia in situ (GCNIS) Seminoma Embryonal carcinoma Yolk sac tumour, postpuberal type Choriocarcinoma Teratoma, postpuberal type Mixed germ cell tumours Regressed germ cell tumours Sex cord-stromal tumours Leydig cell tumour Seoli cell tumour Granulosa cell tumour Tumour containing both germ cell and sex cord-stromal elements Gonadoblastoma Haematolymphoid tumours Tumours of collecting duct and rete testis Miscellaneous Reference:Textbook of pathology-Harsh Mohan,6th edition,page no:711.


Question: Drugs that can be used in Kernicterus

Barbiturates can be used in Kernicterus . Reference: GHAI Essential pediatrics, 8th edition


Question: The most common manifestation of congenital toxoplasmosis

*Congenital toxoplasmosis is caused by toxoplasma gondi .The transmissibility increases but the risk of feral disease decreases with advancing pregnancy * The classical triad of toxoplasmosis includes intracranial calcification, hydrocephalus and chorioretinitis. Diagnosis is confirmed by demonstrating IgM in serum of the baby Image : Severe, active retinochoroiditis. Reference : Ghai essential pediatrics, 9 th edition, pgno :264


Question: A 5 year old boy comes with overnight petechial spots 2 weeks back he had history of abdominal pain and no hepatosplenomegaly. Diagnosis is

most probable diagnosis here is ITP. in ALL there will be hepatosplenomegaly of a plastic anemia infection Symptoms Immune thrombocytopenia may have no signs and symptoms. When they do occur, they may include: Easy or excessive bruising Superficial bleeding into the skin that appears as pinpoint-sized reddish-purple spots (petechiae) that look like a rash, usually on the lower legs Bleeding from the gums or nose Blood in urine or stools Unusually heavy menstrual flow Reference: GHAI Essential pediatrics, 8th edition


Question: The most common congenital cardiac abnormality associated with the maternal rubella infection during pregnancy is

Congenital rubella syndrome characterized by PDA,PS,VSD. Ref : Ghai essential of pediatrics, eighth edition ,p.no:401


Question: A Child with increased Ca++ & hyperphosphatemia is seen in

Ans. c (Renal osteodystrophy). (Ref. Harrison Medicine, 18th/Ch.44, 279, Nelson, Paediatrics, 17th/223)# The principal clinical consequences of hyperphosphatemia are hypocalcemia and systemic calcification.# Ectopic calcification occurs in untreated, chronic renal failure with severe hypercalcemia and in vitamin D intoxication.# Tumor calcinosis is rare inherited disorder in which hyperphosphatemia is associated with ectopic calcification.# Vitamin D intoxication causes excessive gastrointestinal absorption of both Ca++ and Ph++ and suppression of PTH by hypercalcemia causes decrease in renal phosphorous excretion.# Hyperphosphatemia in hyperthyroidism or acromegaly is also associated with hypercalcemia.


Question: The risk of intraventricular hemorrhage (IVH) can be reduced by using

Ans. a (Vitamin K) (Ref. Williams Obstetrics 22nd/Ch. 29)INTRAVENTRICULAR HEMORRHAGEThere are four major categories of neonatal intracranial hemorrhage: subdural hemorrhage is usually the result of trauma. Subarachnoid hemorrhage and intracerebellar hemorrhage usually result from trauma in term infants but in preterm infants are commonly due to hypoxia. Periventricular-intraventricular hemorrhage results from either trauma or asphyxia in half of term infants but has no discernible cause in 25 percent of cases. In preterm neonates, the pathogenesis of periventricular hemorrhage is multifactorial and includes hypoxic-ischemic events, anatomical factors, coagulopathy, and many others.The severity of intraventricular hemorrhage can be assessed by ultrasound and computed tomography. Papile and colleagues (1978) devised the most widely used grading scheme to quantify the extent of the lesion and estimate prognosis.# Grade I--hemorrhage limited to the germinal matrix.# Grade II--intraventricular hemorrhage.# Grade III--hemorrhage with ventricular dilatation.# Grade IV--parenchymal extension of hemorrhage.Prevention and Treatment# Administration of corticosteroids at least 24 hours before delivery appears to prevent or reduce the incidence and severity of intraventricular hemorrhage.# The type of corticosteroid administered may be important. Although both betamethasone and dexamethasone cross the placenta in their active form, betamethasone has a longer half-life. This is because it has a larger volume of distribution and is cleared more slowly than dexamethasone# The efficacy of phenobarbital, vitamin K, vitamin E, or indomethacin in diminishing the frequency and severity of intracranial hemorrhage, when administered either to the neonate or to the mother during labor, remains controversial.# Magnesium sulfate may prevent the sequelae of periventricular hemorrhage.# It is generally agreed that avoiding significant hypoxia both before and after preterm delivery is of paramount importance. There is presently no convincing evidence, however, that routine cesarean delivery for the preterm fetus presenting cephalic will decrease the incidence of periventricular hemorrhage.


Question: This clinical condition is seen in


Question: Treatment of choice for stage 4S neuroblastoma is

The usual treatment for children with low-risk neuroblastoma is surgery for stages 1 and 2 Observation for stage 4S with cure rates generally >90% without fuher therapy. Treatment with chemotherapy or radiation for the rare child with local recurrence can still be curative. Reference: Nelson; Neuroblastoma; Page no: 2463


Question: NOT a feature of Turner's syndrome

Cubitus valgus is seen in Turner's syndrome.


Question: Most common cause of persistent hypeension in child with Intrinsic Renal disease is

ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Bedtime dosing of at least one antihypeensive medication improves BP control in patients with CKD. Reference: GHAI Essential pediatrics, 8th edition


Question: Sign of pubey in girl is needed to change

In girls, the first visible sign of pubey is the appearance of breast buds (Thelarche), between 8-12 years of ageIn boys the first visible sign of pubey is testicular enlargement, beginning as early as 9 1/2yr(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 926)


Question: The most potent form of vitamin D is

1,25 dihydroxy cholecalciferol is the metabolically active form of vitamin D. It helps in the absorption of calcium and phosphorus in the gut, and promotes bone dissolution and mineralization, thereby increasing serum calcium and alkaline phosphatase activity. Ref: Page 127; Ghai essential pediatrics; 6th edition


Question: The best indicator of nutritional status for a child is

The best indicator of nutritional status of a child is the rate of increase in height & weight. Rest of them are age independent indices. Ref: Page 64, Ghai Essential Pediatrics; 7th edition


Question: Most common complication of mumps in children is

(B) Aseptic meningitis > In adult males, mumps can cause bilateral orchitis and sterility, Meningitis usually follow parotitis and acute pancreatitis occurs in 2nd week, may result in diabetes mellitus.> Meningo encephalitis results 3-10 days after onset of glandular swelling.> Incubation period of mumps is 12-21 days (Mean 17 days)> COMPLICATIONS OF MUMPS: Epididymo-orchitis is a complication seen in about a third of postpubertal male patients. The testis becomes swollen and acutely painful, with accompanying fever and chills. Orchitis is usually unilateral but when it is bilateral and followed by testicular atrophy, sterility or low sperm counts may result. The central nervous system is involved in about 60 per cent of cases, as indicated by pleocytosis in the CSF but only about 10 per cent show symptoms of meningitis.> Mumps has been reported to cause about 10-15 per cent of cases of aseptic meningitis'. Mumps meningitis and meningoencephalitis usually resolve without sequelae but deafness may sometimes result. Munps meningitis may occasionally occur in the absence of parotitis, when diagnosis rests solely on laboratory evidence. The virus can be grown readily from the CSF in the early phase of meningitis.> Other less common complications are arthritis, oophoritis, nephritis, pancreatitis, thyroiditis and myocarditis. Most common complication of mumps in children is aseptic meningitis.


Question: Most common hea lesion in down syndrome

Ans. is 'a' i.e., ASD with ostium primum About 40% children with down syndrome have congenital hea disease. Endocardial cushion defect (ASD with ostium primum) account for 40-60% of cases.


Question: Felty syndrome is characterised by A/E

Ans. is 'd' i.e., Thrombocytopenia Felty's syndrome is characterized by the combination of rheumatoid ahritis, splenomegaly and neutropenia. The condition is more common in those aged 50-70 years, and is more prevalent in females than males


Question: Straining and Dribbling of urine in a male infant with recurrent urinary infection should lead to the suspicious of

Posterior urethral valves are a problem with the urethra in a boy. The urethra is the tube that drains urine from the bladder to the outside of the body. These valves are small leaflets of tissue in the urethra. They paly block urine flow because not enough urine can get through them to leave the body. Reference: GHAI Essential pediatrics, 8th edition


Question: Darkening of urine on standing is associated with

Alkaptonuria is caused by defect of the enzyme homogentisate 1,2-dioxygenase(homogentisic acid oxidase).The disorder comes to attention due to change in colour of urine to brownish black/ staining of diapers.The urine becomes dark on standing,especially if the pH of urine is alkaline,due to the presence of homogentisic acid.Excessive urine homogentisate results in positive reducing substances. Reference:Essential pediatrics-Ghai,8th edition,page no:653.


Question: One year old male child with sparse blond hair, developmental delay and tremors, diagnosis

Phenylketonuria is due to deficiency of enzyme phenylalanine hydroxylase or of its cofactor tetrahydrobiopterin ;leads to accumulation of phenylalanine in body fluids and brain. It is mainly characterized by profound mental retardation ,lighter complexion and neurologic symptoms like tremors,hyperreflexia and spasticity. Reference: Nelson TB of pediatrics 19th edition, pg 418


Question: Most common cause of infectious croup is

Ans. is 'b' i.e., Parainfluenza type I Infectious croup (Laryngitis & laryngotracheobronchitis)o Nearly always caused by viral infectiono Usually by parainfluenza type I.o Other-RSVParainfluenza 2,3InfluenzaAdenoviruso TreatmentHumidified oxygenIntravenous fluid for adequate hydrationAntibiotic (ampicillin ceftriaxone) if suspecting epiglottitis.


Question: Most common cardiac anamoly associated with Noonan 's syndrome is

Most common cardiac anamoly associated with Noonan's syndrome is pulmonary stenosis.


Question: Most common cause of neonatal meningitis is

The most common bacterial causes of neonatal meningitis are GBS(S.agalactiae), E.coli, and L.monocytogenes Most common cause of neonatal sepsis in hospitals in India is - KLEBSIELLAMost common cause of neonatal sepsis in hospitals across the world is - E.COLI


Question: A 6 months old baby was brought do difficulty in feeding. '' The child was found to be hypotonic with a weak gag. The child is on breast milk and mother also gives honey to the child during periods of excessive crying. The causative agent is

Infant botulism is associated with intake of honey, breastmilk etc. The child presents with generalized weakness and hypotonia in addition to bulbar palsies with symptoms like poor feeding, feeble cry,weak suck,drooling and obstructive apnea. Reference: Nelson textbook of pediatrics 19th edition Page 988

Gram positive anaerobic spre-suffering bacillus

Toxin produced by gram positive anaerobic bacillus


Question: Attention deficit hyperactivity disorder is seen in

ADHD:

Attention Deficit Hyperactivity Disorder.
Difficulty in paying attention, difficulty in controlling behavior and hyperactivity.
Etiology- both genetic and environmental factors. Abnormality in dopamine transporter and thyroid receptor beta genes in some patients.

Three subtypes are known:

Predominantly hyperactive-impulsive
Predominantly inattentive
Combined hyperactive-impulsive and inattentive.

Diagnosis is primarily clinical, using thorough clinical interview of parents and use of behavior rating scales. Physical examination includes direct observation of the child and ruling out chronic systemic illnesses that affect child's attention span.


Question: Sodium content in normal saline and Ringer lactate respectively are

Sodium Content in
a) Normal saline = 154 meq / L
b) Ringer lactate = 130 meq / L


Question: The commonest cause of intestinal obstruction in children between 3 months to 6 years of age

Ans. a (Intussusception) (Ref. Nelson paediatrics, p. 1569)INTUSSUSCEPTION# Intussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment. It is the most common cause of intestinal obstruction between 3 mo and 5 yr of age.# Sixty percent of patients are younger than 1 yr, and 80% of the cases occur before 24 mo: it is rare in neonates.# The incidence varies from 1 to 4/1,000 live births.# The male:female ratio is 4:1. A few intussusceptions reduce spontaneously, but if left untreated, most will lead to intestinal infarction, perforation, peritonitis, and death.Etiology and Epidemiology# The cause of most intussusceptions is unknown.# The seasonal incidence has peaks in spring and autumn.# Correlation with prior or concurrent respiratory adenovirus (type C) infection has been noted, and the condition may complicate otitis media, gastroenteritis, Henoch-Schonlein purpura.# The risk of intussusceptions in infants <1 yr of age after receiving a no longer available tetravalent rhesus-human reassortant rotavirus vaccine within 2 wk of immunization was increased.# Lymphoid nodular hyperplasia is another related risk factor. Prominent mounds of lymph tissue lead to mucosal prolapse of the ileum into the colon, thus causing an intussusception.# In 2-8% of patients, recognizable lead points for the intussusception are found, such as a Meckel diverticulum, intestinal polyp, neurofibroma, intestinal duplication, hemangioma, or malignant conditions such as lymphoma. Intussusception can complicate mucosal hemorrhage, as in Henoch-Schonlein purpura or hemophilia.# Cystic fibrosis is another risk factor.# Postoperative intussusception is ileoileal and usually occurs within 5 days of an abdominal operation.# Lead points are more common in children >2 yr of age.Pathology# Intussusceptions are most often ileocolic, less commonly cecocolic, and rarely exclusively ileal.Clinical manifestations# Spasmodic intermittent abdominal pain;# "Red currant" jelly stools# Palpable lump.# Dance sign, n "Empty RIF" signDiagnosis# Ultrasound is investigation of choice.# Ba enema is now 2nd line investigation# USG signs:- "Doughnut or target" appearance in transverse images.- "Sandwich or hamburger" sign in longitudinal images- Pseudokidney sign# Ba emema signs:- "Claw"sign- "Coiled-spring" signRx# Hydrostatic reduction# Air reduction is associated with fewer complications and lower radiation exposure than traditional contrast hydrostatic techniques.# The success rate of radiologic hydrostatic reduction under fluoroscopic or ultrasonic guidance is =50% if symptoms are present longer than 48 hr and 70-90% if reduction is done in the 1st 48 hr.# If manual operative reduction is impossible or the bowel is not viable, resection of the intussusceptions is necessary with end-to-end anastomosis.# Corticosteroids may reduce the frequency of recurrent intussusception.


Question: Baby is not at risk for hypoglycemia

newborns are at risk for hypoglycemia : Babies born to mothers with diabetes. Babies who are small for gestational age or growth-restricted. Preterm babies, especially those with low bih weights. Babies born under significant stress. Babies with mothers treated with ceain medicines such as terbutaline. Reference: GHAI Essential pediatrics, 8th edition


Question: Child begins to sit with suppo, able to transfer objects from one hand to another hand and speak monosyllabic babbles at the age of

<p>. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand).transfer object from one hand to other. 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}


Question: The likely diagnosis in a child with limb pain and pancytopenia is

Child with acute lymphocytic leukemia presents with pallor, petechiae, infection(pancytopenia),. Reference: GHAI Essential pediatrics, 8th edition


Question: Ponds fracture is most common in

.The Ping-Pong skull fracture or a pond skullfracture refers to a depressed skull fracture of the infant skull caused by inner buckling of the calvarium.


Question: DPT is contraindicated in

C. i.e. (Progressive neurological illness) (191 - Ghai 6th) (168- 69- Ghai 7th)Following are NOT contraindication for administration of vaccine1. Mild acute illness2. Low grade fever3. Mild diarrheal4. Current antibiotic therapy5. Prematurity6. Recent exposure to an infectious disease7. History of allergies8. Allergy to penicillin9. Malnutrition* Children suffering from progressive neurological disorders or with history of convulsions to a previous dose are at a higher risk of adverse reactions following whole cell pertuessis vaccine* The vaccine is relatively contraindicated in children with progressive neurological disease, but children with stable neurological disease like developmental delay cerebral palsy and idiopathic epilepsy may be vaccinated (169 - Ghai 7th)


Question: Membraneous gap seen between fetal skull bone is known as

Ans) a (Fontanelle) Ref D.C. Dutta p84,Nehon 18th ed p 677Flat bones of the vault are united together by nonossified membranes attached to the margin of the bone.These are called sutures and fontanelles.Wide gap in the suture line is called fontanelleCraniosynostosis is defined as premature closure of the cranial suturesDisorders Associated with a Large Anterior FontanelAchondroplisinIntrauterine growth retardationApert syndromeKenny syndromeAthyrotic hypothyroidismOsteogenesis imperfectnCleidocrininl dysostosisPrematurityCongenital rubella syndromePylenodysctslosisHallermantl-Sucill syndromeRussell-Silver syndromeHydrocephaly13-, 18-, 21-trisoniesHypophospnatasiaVitamin D deficiency ricketsPersistently small fontanels suggest microcephaly, craniosynostosis, con-genital hyperthyroidism, or wormian bones. A 3rd fontanel suggests trisomy 21 but is seen in preterm infants. Soft areas in the occipital region suggest the irregular calcification and wonnian bone formation.Important causes of wonnian bones Hypothyroidism/ cretinismHypophosphatasia RcketsCliedocraniodysostosis / pyknodysostosis Osteogenesis imperfecta


Question: Non immune hydrops fetalis is caused by

Primary fetal infection is associated with nonimmune fetal hydrops and intrauterine fetal demise,with the risk for fetal loss after infection estimated at <5%. The mechanism of fetal disease appears to be a viral-induced RBC aplasia at a time when the fetal erythroid fraction is rapidly expanding ,leading to profound anemia, high-output cardiac failure, and fetal hydrops. Nonimmune type * Three major causes -- parvovirus B 19 -- alfa-thalassemia -- cardiovascular defects, chromosomal anomalies, and fetal anemia Reference: Nelson textbook of pediatrics 19th edition, Page 1096


Question: A 4 year child presents with a history of hoarseness, croupy cough and aphonia, the child has dyspnoea with wheezing. The most probable diagnosis is

The given symptoms points to laryngeal foreign body. the course of illness depends on the nature of foreign body,its size,extent,and site of lodgement. Ref : Essential pediatrics,O.P.Ghai,7 th edition,pg no:367


Question: A neonate is suspected to be suffering from necrotizing entercolitis (NEC). On fuhur examination and investigation, he is diagnosed to be Bell&;s stage INEC. The management of choice would be

.Abdomen radiographs may show pneumatosis intestinalis,or free intraperitoneal air. management consists of agressive resuscitation and intravenous feeding.The optimal time for surgery is not in the acute phase as the baby can withstand the pressure of necrosis better than an adult,but not in the stress laprotomy. BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,PG NO:1200, 24th edition

Conservative management with IV fluids and antibiotics

Initial conservative management and laparotomy after 24 hours


Question: Apnea of prematurity is defined as sudden stoppage of breathing that lasts for

Apnea of prematurity defined as sudden stoppage of breathing that lasts for 20 sec or is associated with bradycardia or cyanosisApnea of prematurity should be different from periodic breathing which is normal phenomenon is preterm neonate.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 832, 849 - 850)


Question: Sodium content of ReSoMal is

Fish are naturally low in sodium and even those species with the highest sodium levels contain less than 100 milligrams per 3 ounce cooked poion. Most shellfish generally have more sodium, ranging from 100 to 500 milligrams per 3 ounce cooked serving. Reference: GHAI Essential pediatrics, 8th edition


Question: A five year old child presents to the emergency department with burns. The burn area corresponding to the size of his palm is equal to

Estimation of body surface area (BSA) of burn
Rough estimate of body surface area of bum can be estimated by following rules.
Rule of Palm (Palmar method)

It can be used in Children as well as in adults.
It is used for small burns (<10% of BSA)
The palm of patients hand represents I% of BSA. Palm is the area of hand from wrist crease to the finger crease.
Entire burned hand represents 2.5% of BSA: 1/% for palm; 1% for dorsum of the hand (excluding fingers);0. 5% for the fingers

Rule of 9

It can be used in adults and children older than 14 years.
It is used for larger surface area burns.
Estimates the body surface area of an adult in multiples of 9.
An adult who has been burned, the percent of the body involved can be calculated as follows:
Head and Neck = 9%
Anterior chest = 9%
Anterior abdomen =9%
Upper back = 9%
Lower back = 9%
Right upper extremity (Anterior + Posterior) = 9%
Left upper extremity (Anterior + Posterior) = 9%
Right lower extensity, Anterior = 9%
Right lower extremity, Posterior = 9%
Left lower extremity, anterior = 9%
Left lower extremity, Posterior = 9%
Perenium= 1%
Percent of the burn in a child can be calculated as follows:
Head and neck = 9%
Anterior trunk =18%
Posterior trunk =18%
Upper extremity (Right) = 9%
Upper extremity (Left) = 9%
Lower extremity (Right) = 18%
Lower extremity (Left) =18%
Perenium = 1%


Question: The most common symptom of AIDS in an infant is

Clinical features in an HIV infected infant is:Recurrent GI infection and oral thrush is commonly foundClinical features in older children:Growth failureFeverDiarrheaSecondary infection(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 202)


Question: A child presented with fever for 2 days, altered sensorium and purpuric rashes. His blood pressure is 90/60 mmHg. Treatment of choice is>

Ans. is 'c' i.e. Penicillin .The clinical presentation of fever, altered sensorium and purpuric rashes, is highly suggestive of meningococcal meningitis.Purpuric rash in quite characteristic of meningococcemia.I. V. Penicillin is the treatment of choice for meningoccal inf. among the given options.The DOC for meningococcal infection is -IIIrd generation cephalosporin e.g. Cefotaxime, Ceftriaxone.Also RememberWaterhouse Friderichsen syndromeSeen in fulminant meningococcemiaadrenal insufficiency occurs* due Haemorrhage and necrosis in the adrenal glandsClinical presentation isprostrationhypotensionshock andUltimately coma and death.


Question: Pneumatoceles on chest radiograms in a child with pneumonia are seen in infection

staphylococcal pneumonia : pneumonic process is diffuse but soon lesions suppurate and cause bronchoalveolar destruction multiple microabscesses erode the bronchial wall and discharge their contents in bronchi. several pneumatocoeles form and they fluctuate in size over time ultimately resolving and disappearing in few weeks to months in Xray pneumatocoeles persist as thin walled cysts.they are also seen in klebsiella pneumonia Ref : ESSENTIAL PEDIATRICS,O.P.GHAI, PG NO:353,7thedition


Question: The ratio of ICF volume to Extracellular fluid volume reaches adult values at the age of

Total body water is divided between 2 main compaments: intracellular fluid (ICF) and extracellular fluid (ECF). In the fetus and newborn, the ECF volume is larger than the ICF volume. The normal postnatal diuresis causes an immediate decrease in the ECF volume. This is followed by continued expansion of the ICF volume, which results from cellular growth. By 1year of age, the ratio of the ICF volume to the ECF volume approaches adult levels.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 55; Electrolyte and Acid-Base Disorders


Question: The pediatric disease that most closely resembles amyotrophic lateral sclerosis (ALS) is

Werdnig-Hoffmann disease most closely resembles amyotrophic lateral sclerosis (ALS). Both of these diseases involve the degeneration of motor neurons. Presentation Symptoms symmetric flaccid paralysis most affected infants are hypotonic at bih proximal muscle involvement lower extremity greater than upper extremity sparing of upper cranial nerves e.g., normal eye movements Physical exam absent or decreased deep tendon reflexes tongue and finger fasciculatons infants have flaccid "frog-like" posture restrictive respiratory insufficiency ALS appears to be increasing in incidence. In 5% to 10% of cases, there is an autosomal dominant pattern with strong age-dependent penetrance. Proposed etiologies include oxidative stress, viral infection, immunologic disease, or some unknown environmental factor. Currently, the oxidative stress theory is ored because a defect in the zinc-copper binding superoxide dismutase (5001) coded on chromosome 21 was discovered. Because SO 01 is an antioxidant that conves the superoxide free radical into peroxide and oxygen, reduced activity causes apoptosis (individual cell necrosis) of spinal motor neurons. Inhibition of glutamate transpo potentiates the toxicity associated with the reduced SODllevels. ALS most commonly presents with both upper motor neuron signs (e.g., spastic paralysis) and, eventually, lower motor neuron signs (e.g., muscle atrophy, fasciculations). Atrophy of the intrinsic muscles of the hand and forearms with hand weakness and spastic changes in the lower legs are early signs. Antioxidant cocktails have now been developed, which offer some symptomatic improvement. Werdnig- Hoffmann disease is a progressive muscular atrophy noted in infants. It often presents as the floppy child syndrome. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common type of Atrial septal defect is

The atrial septal defect can occur in any poion of the atrial septum(secundum, primum or sinus venosus)OSTIUM SECUNDUM:Most common type of ASD accounts for 7% of al congenital hea disease.Defect situated at fossa ovalis.Associated with structurally normal atrioventricular (AV)valves.OSTIUM PRIMUM/ ENDOCARDIAL CUSHION DEFECT:Defect situated inferior to fossa ovalis.Associated with the cleft in AV valves.Most common cardiac lesion in Down&;s syndrome is endocardial cushion defect.


Question: Bart's hydrops fetalis is lethal because

Bart hydrops fetalis is a lethal complication of alpha thalassemia trait where oxygen can't release from hemoglobin

Hb Bart's cannot release oxygen to fetal tissues

Microcytic red cells become trapped in the placental

The excess a - globin form insoluble precipitates


Question: The development of septal defects in the fetal hea occurs at

Fetal hea septal defect develop by 6-8 weeks. Ref : Ghai essential of pediatrics, eighth edition, p.no: 402


Question:
NOT an indication for surgery in Ventricular septal
defect

Eisenmenger's Syndrome is an absolute contraindication for Surgery in Ventricular septal defect.


Question: Most common lobe involved in congenital lobar emphysema

Congenital lobar emphysema present with respiratory distress. Most common lobe involved is Left upper lobe. X-ray shows shift of mediastinum to Right side.


Question: Most common cause of Acute epiglottis is

Most common cause of Acute epiglottis is Hemophilius influenza B


Question: Sign of pubey in boys is

In girls, the first visible sign of pubey is the appearance of breast buds (Thelarche), between 8-12 years of ageIn boys the first visible sign of pubey is testicular enlargement, beginning as early as 9 1/2 yr.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 926)


Question: Most common delivery room emergency in newborns

Ans. d (Failure to initiate efficient respiration) (Ref. Nelson textbook of paediatrics, p. 723)The most common delivery room emergency for neonates is secondary to failure to initiate and maintain effective respirations. Less frequently, but of major importance are shock, severe anemia, plethora, convulsions and management of life-threatening congenital malformation.Educational Points:# NEC is the most common life-threatening emergency of the gastrointestinal tract in the newborn period.# ABO incompatibility is the most common cause of hemolytic disease of the newborn.

Life threatening congenital malformations


Question: Para amino benzoic acid in breast milk prevents the infection of

Para-amino-benzoic acid(PABA) of breast milk provides protection against malaria.Ref: Page 97; Ghai essential pediatrics; 6th edition


Question: In neonatal cholestasis, if the serum gammaglutamyl transpeptidase is more than 600IU/L the most likely diagnosis is.

Ans. is 'd' i.e., Biliary atresia Most of the books are of the opinion that alkaline phosphatase and gamma glutamyl transpeptidase are two enzymes that are associated with biliary tract disease.Serum levels of these enzymes are usually increased in cholestasis or bile duct obstruction.But the problem in that, all of these books also add that they may also be increased in parenchymal disease or infiltrative or mass lesions of the liverIn the question only the value of Gamma glutamyl transpeptidase is given. Nothing is mentioned about the value of other enzymes.We cannot come to a conclusive diagnosis only by the level of Gamma glutamyl transpeptidaseBut still such a considerable elevation in the serum level of Gamma glutamyl transpeptidase i.e., 10 to 12 times its normal value points towards the diagnosis of biliary tract diseaseNote:- Normal value of serum Gamma glutamyl transpeptidase is - 10-40IU/L


Question: A single umbilical aery in newborn increases the risk of

The umbilical cord should have 2 aeries and 1 vein. A single umbilical aery is associated with an increased risk for an occult renal anomaly.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 94; The Newborn Infant


Question: Hetch Giant cell pneumonia is caused by

Hetch Giant cell pneumonia is caused by Rubeola or Measles virus.


Question: Thrombocytopenia, macerated skin lesions, rash and periostitis in a new born are seen in

In Syphilis, thrombocytopenia is often associated with platelet trapping in an enlarged spleen. Characteristic osteochondritis and periostitis and a mucocutaneous rash manifesting with erythematous maculopapular or vesiculobullous lesions followed by desquamation involving hands and feet are common. Reference : Nelson textbook of pediatrics 19th edition Page 1017 & 1018


Question: Most common enzyme deficiency in congenital adrenal hyperplasia is

congenital adrenal hyperplasia is a group of autosomal recessive defects in steroid synthesis characterised by deficiency of adrenocoical hormones The commonest form of congenital adrenal hyperplasia accounting for about 90% of cases is due to deficiency of 21-alpha hydroxylase It is associated with diminished synthesis of coisol and aldosterone Reference: Ghai TB of pediatrics 8th edition pg 526


Question: The most common etiological agent for acute bronchiolitis in infancy is

Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by the age of 2. Outbreaks of the RSV infection occur every winter. Bronchiolitis can also be caused by other viruses, including those thatcause the flu or the common cold. Bronchiolitis Lower respiratory tract (bronchioles) Microbiology : * Respiratory syncytial virus (RSV) * Rhinovirus. Parainfluenza virus, Human metapneumovirus * Influenza virus Clinical * Occurs primarily in children s 2-years-old * Often preceded by a 1 to 3 day URI prodrome * Fever. Cough * Respiratory distress (tachypnea, retractions, wheezing, crackles) Complications * Dehydration * Apnea (premature and < 2 months old) * Aspiration pneumonia, Respiratory failure Management Nonsevere bronchiolitis * Anticipatory guidance, nasal suctioning, hydration Severe bronchiolitis * Trial of inhaled bronchodilator (controversial) * Heated humidified high-flow nasal cannula * Continuous positive airway pressure * Endotracheal intubation Reference: GHAI Essential pediatrics, 8th edition


Question: Macrosomia is

The term "macrosomia" is used to describe a newborn who&;s significantly larger than average ( large size baby ). A baby diagnosed with fetal macrosomia has a bih weight of more than 4,000 grams (8 pounds 13 ounces), regardless of his or her gestational age. Another definition of macrosomia is a bih weight above the 90th percentile, corrected for gestational age and sex. Factors associated with fetal macrosomia include high blood sugar levels from gestational diabetes or diabetes mellitus, ethnicity (Hispanic women are more at risk), obesity, gaining extra weight during the pregnancy, carrying baby past term, gender of fetus (males are more prone to macrosomia), history of a previous large baby. Reference : page 137 Ghai Essential Pediatrics 8th edition