Question: Most common cause of fresh bleeding per rectum in a 5 years old child is

(D) (Juvenile rectal polyp)* Fresh bleeding indicates bleeding from anal canal or rectum.* Whenever a child comes with bleeding per anum, a diagnosis of rectal polyp should be made until it is excludes by rectal examination.* According to C.P.P.T. common causes of bright red bleeding in a children 2-12 year old in decreasing order frequency are-- Anal fissure- Solitary rectal ulcer- Juvenile polyp- Lymphonodular hyperplasia.Differential diagnosis of bright red bleeding from rectum InfantChild (2-12 yrs)Adolescent >12Hematochezia with diarrhea and crampy abdominal painInfectious colitisPseudomembranous colitisEosinophilic coliisHirschsprung's entrocolitisInfectious colitis pseudomembranous colitisHemolytic uremic syndromeH.S. purpuraLymphonodular hyperplasiaInfectious colitisPseudomembranouscolitisGranulomatous colitisH.U.SH.S.P.Hematochezia without diarrhoea and abdominal painAnal fissure Eosinophilic colitis Rectal gastric mucosa, heterotropiaColonic hemangiomasAnal fissureSolitary rectal ulcerJuvenile polypLymphonodular hyperplasiaAnal fissure HemorrhoidSolitary rectal ulcerColonic A-V malformationThe aetiology and man and management of rectal bleeding depends on the age of the child, the type and quantity of bleeding and the associated symptoms. Unlike adults malignancy is exceptionally rare. In infants an anal fissure, necrotizing enterocolitis, intussusceptions and allergic enterocolitis are possible causes. In older children, more common causes includes an anal fissure, a juvenile polyp and certain gastroenteritides (e.g. Campylobacter infection); Meckel's diverticulum, duplication cyst and inflammatory bowel disease are less common. - Bailey and Love.Juvenile polyps are the most common type of childhood polyp, occurring in up to 1% of preschool children. The solitary polyps found in the rectum which most commonly present with rectal bleeding.These are hamartomatous polyps, which are usually pedunculated but can be sessile. The typical child with a juvenile polyp is 4 to 6 years of age, presents with intermittent painless rectal bleeding with bowel movements. - Rudolph's PediatricsJuvenile polyps are usually are not premalignant. Because the gross appearance of these polyps is identical to adenomatous polyps, these lesions should also be treated by polypectomy.Juvenile polyposis is a term used when more 5 to 10 juvenile polyps develop.Juvenile polyposis coli applies if the polyps are limited to the colon, whereas generalzed juvenile polyposis describes the presence of polyps throughout the GI tract, both have a significant malignant potential.Mentioned options are rare in childrenFamilial adenomatous polyposis (FAP) patients present in 2nd to 3rd decade.Rectal ulcer (solitary rectal ulcer) is commonly seen in 20 to 40 yrs age group.Piles are rare in children. (Ref: Rudolp'spediatrics, 21/e chapter 17.22)* MC solid tumor in childhood- Brain tumors* MC extracranial solid tumor in childhood - Neuroblastoma* MC intraabdominal solid tumor in childhood - NeuroblastomaCauses of Recurrent Gross Haematuria (2169-Nelson '8th)1. IgA Nephropathy - (MC cause)2. Alport's syndrome3. Thin glomerular basement membrane disease4. Hypercalciuria5. Urolithiasis* MCC of vasculitis in children is Henoch- schonlein prupura (HSP)* MC tumors in children are Leukaemia* MC solid tumors in children are CNS tumors* MC site of brain tumors in children is Infratentorial (cerebellar)* MC site of brain tumors in neonates is supratentorialMC posterior fossa tumour in children is cerebellar Astrocytoma* The Leukemias (ALL) are the most common malignant neoplasms in childhood


Question: Drug of choice for Absence attacks is

- DOC for Absent seizures: Typical - Ethosuximide Atypical & in India - Sodium valproate If nothing is mentioned in question then DOC is Ethosuximide Drug of choice for: Focal seizures : oxcarbamazepine and carbamazepine; Juvenile myoclonic epilepsy: valproate and lamotrigine; Lennox-Gastaut syndrome: clobazam, valproate, topiramate, lamotrigine, and, most recently, as add on, rufinamide Infantile spasms: adrenocoicotropic hormone (ACTH).


Question: A neonate is suspected to be suffering from necrotizing enterocolitis (NEC). On fuher examination and investigation, he is diagnosed to be Bell's stage I NEC. The management of choice would be

Ans. c. Conservative management with IV fluids and antibiotics The management of choice for Bell's Stage I necrotizing enterocolitis is conservative management with IV fluids and antibiotics. Treatment of Bell's Stage I Necrotizing Enterocolitis: NPO, II/fluids and Antibiotics for 3 days

Initial conservative management and laparotomy after 24 hours


Question: Commonest cause of obstructive hydrocephalus in children

Aqueducts stenosis is most common cause of obstructive hydrocephalus in children. Reference: GHAI Essential pediatrics, 8th edition


Question: Commonest type of seizure in newborn

Hypoxic-ischemic encephalopathy : It is an impoant cause of neonatal seizures. Seizures resulting from hypoxic-ischemic encephalopathy may be seen in term and prematureinfants. They frequently present within the first 72 hours of life.Seizures may include subtle, clonic, or generalized seizures. These are subtle seizure . There are 4 major types of seizures in neonates: Subtle seizures are relatively common in the neonatal period and are more often encountered in the preterm than full term infant. Such seizures include oral-buccal-lingual movements, ceain ocular phenomena, peculiar limb movements, autonomic alterations and apnea. Clonic seizures include focal and multifocal varieties which may migrate to another pa of the body in a non-ordered fashion. Tonic seizures include focal episodes (less common) and generalized episodes (more common). Generalized tonic seizures may mimic decerebrate and decoicate posturing. Myclonic seizures may be focal, multifocal or generalized and are the least common of the four varieties during the neonatal period. Reference: GHAI Essential pediatrics, 8th edition


Question: Manifestations of vitamin C deficiency are

In Vitamin C deficiency, bones are tender and the infant is reluctant to move his limbs, which are kept in a frog-like position. This may be mistaken for paralysis. Page 127, Ghai essential pediatrics; 6th edition


Question: A premature infant born at 34 weeks presented with acute onset lethargy and cessation of feeding. The imaging modality of choice to screen for intraventricular haemorrhage is

Intraventricular hemorrhage (IVH) is a major complication of prematurity. IVH typically initiates in the germinal matrix, which is a richly vascularized collection of neuronal-glial precursor cells in the developing brain. The etiology of IVH is multifactorial and is primarily attributed to the intrinsic fragility of the germinal matrix vasculature and the disturbance in the cerebral blood flow. While this review broadly describes the mechanism underlying IVH, the main focus is on the recent development in molecular mechanisms that elucidates the fragility of the germinal matrix vasculature. The microvasculature of the germinal matrix is frail because of an abundance of angiogenic blood vessels that exhibit paucity of pericytes, immaturity of basal lamina and deficiency of glial fibrillary acidic protein (GFAP) in the ensheathing astrocytes-endfeet. High VEGF and angiopoietin-2 levels activate a rapid angiogenesis in the germinal matrix. The elevation of these growth factors may be ascribed to a relative hypoxia of the germinal matrix perhaps resulting from high metabolic activity and oxygen consumption of the neural-progenitor cells. Hence, the rapid stabilization of the angiogenic vessels and the restoration of normal cerebral blood flow on the first day of life are potential strategies to prevent IVH in premature infants. Reference: GHAI Essential pediatrics, 8th edition


Question: Male pseudohermaphroditism is seen in

5 alpha reductase conve testosterone to dihydrotestosterone,which is required for external genital devolopment in male.deficiency of it leads to development of mullerian duct into fallopian tube,Uterus and upper third of vagina. Reference : Ghai essential of pediatrics, eighth edition, p.no:538


Question: Most common soft tissue sarcoma in children is

Rhabdomyosarcoma is the Most common Pediatric soft tissue sarcoma.


Question: Maple syrup urine is due to defective decarboxylation of


Question: A 10 months old baby boy presented with inability to feed since 1 day. He had a prior history of cough, fever and hurried breathing since 3 days. On examination the child had a Respiratory rate of 56/min. The line of management is

Inability to feed is one of the danger signs of pneumonia.
Hence the child can be categorised as Severe pneumonia and needs hospital admission and treatment with injectable antibiotics.


Question: A 2 year old child presents with scattered lesions in the skull. Biopsy revealed Langerhans giant cells. The most commonly associated is marker with this candition will be

In Langerhans cell histiocytosis,the hallmark feature is the presence of Birbeck granules on electron microscopy and positivity for S-100 protein and CD 1a. Reference:Essential pediatrics-Ghai,8th edition,page no:620.


Question: Bart hemoglobin consist of

Bart hemoglobin is tetramer of four γ chains.


Question: The most characteristic radiographic sign in a child with leukemia is

The most characteristic radiological signs in a child with leukemia are metaphyseal lucent band,reduced bone density,lytic bone lesions,metaphyseal coical bone erosions,collapsed veebrae,widening of sutures,and periosteal reactions. Reference: GHAI Essential pediatrics, 8th edition


Question: Malformations of the following organ system of the fetus are found to be most commonly associated with Single umbilical aery .

Malformation of the genitourinary system is generally associated with the single umbilical aery. Paediatric complications associated with single umbilical aery include: An isolated SUA is associated with renal malformations in 7-9 per cent of infants. Vesicoureteric reflux (VUR) is the most common abnormality occurring in 4 per cent of infants with an isolated SUA. In a meta analysis of 26 studies the incidence of any renal abnormality associated with isolated SUA was 8 per cent, with only 4 per cent requiring treatment of the abnormality. From this meta analysis the investigation of 14 cases of isolated SUA would yield one patient requiring treatment. In another study VUR was also the most common abnormality requiring treatment and three out of five of their patients had a urinary tract infection (UTI) before the age of three months. Reference: GHAI Essential pediatrics, 8th edition


Question: The gold standard lab test for diagnosis of paroxysmal nocturnal Hemoglobinuria is

Flow cytometry

It is gold standard test for diagnosis of PNW
It shows absence of CD55 and CD59 on RBC


Question: The normal resting hea rate for a newborn is

The normal resting hea rate in the newborn is 110-140bpm but may vary from 90 beats /min in a relaxed state to 180 bpm during activity.


Question: Early onset sepsis in a neonate occurs within

Early-onset sepsis (EOS) (less than 72 hr) infections are caused by organisms prevalent in the maternal genital tract or in the delivery area.Late-onset sepsis (LOS) (72 hr or later) infections are caused by the organisms thriving in the external environment of the home or the hospital. The infection is often transmitted through the hands of the care providers.Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 163


Question: Best indicator of acute malnutrition

Ans. is 'a' i.e., Weight for height 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 oedema.


Question: Differential cyanosis occurs in

Differential cyanosis is present when the preductal (right upper extremity) oxygen saturation is higher than the postductal(lower extremity) saturation.ETIOLOGY:- PDA with reversal of shunt.- Persistent pulmonary hypeension of the newborn.Reverse differential cyanosis:In this condition only the upper pa of the body is cyanosed and the lower pa is pink.ETIOLOGY:PDA +TGV+severe pulmonary hypeensionPDA+TGV+preductal coarctation of the aoa


Question: Iron supplementation in a healthy term breastfed baby should be staed at the age of

.However, human milk contains littleiron, so infants who are exclusively breastfed are at increased risk ofiron deficiency after 4 months of age. The clinical repo recommends giving breastfed infants 1 mg/kg/day of a liquid iron supplement until solid foods, such as iron-foified cereals, are introduced.


Question: Edema in nephrotic syndrome is due to

NEPHROTIC SYNDROME:- Characterised by massive proteinuria, hypoalbuminemua and edema, hyperlipidemia is often associated. Some patients show hematuria and hypeension. Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl). The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin angiotensin aldosterone axis and ADH secretion that enhances sodium and water retention. Hypoalbuminemia also induces hepatic synthesis of beta lipoproteins resulting in hypercholesterolemia. Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy. Steroid sensitive nephrotic syndrome:- MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non specific obliteration of epithelial foot processes. Immunofluorescence studies shows deposits of occassional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia impa a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated. Low serum calcium level. Steroid resistant nephrotic syndrome:- Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and wilms tumor(WT1) genes. Reference: GHAI essential Paediatrics


Question: ACTH secretion is highest during

High levels of ACTH are detected by the adrenal gland receptors which stimulate the secretion of coisol, causing blood levels of coisol to rise. As the coisol levels rise, they sta to slow down the release of coicotrophin-releasing hormone from the hypothalamus and ACTH from the pituitary gland. Ref : Nelson


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

The best indicator of the nutritional status of a child is the rate of increase in height & weight. Rest of them are age independent indices.


Question: Amount of ORS given in 5kg child with diarrhoea with some dehydration

For some dehydration, amount of ORS given is 75ml/kg over 4 hours, hence 75×5 = 375 ml over 4 hours.


Question: In newborn, cold stress implies

Classification of Neonatal hypothermia
Cold stress 36 - 36.4o C
Moderate hypothermia 32 - 35.9o C
Severe hypothermia < 32o C


Question: Chemotherapy agents used for Retinoblastoma includes

Vincristine, Etoposide, Carboplatin are used to treat Retinoblastoma.


Question: A child admitted to emergency with urinary incontinence, miosis, sweating, salivation.... poisoning likely by

(A) Carbamates > Diagnosis of organic insecticide (Carbamate) poisoning was made on the basis of definite clinical picture such as bradycardia, rhinorrhea, vomiting, diarrhoea, urinary incontinence, miosis, sweating, muscle fasciculations, altered neurological status and a typical smell of insecticide.


Question: Febrile convulsions

(B) Show an increase in familial incidence # Characteristics of simple benign febrile convulsions:> Fits occurs within 24 hour of the onset of fever, last less than 10 minutes, usually single per febrile episode.> Convulsions are generalized, a small proportion (4-18%) of case may show focal convulsions.> There is no postictal neurological deficit and electroencephalogram a few days after the seizure is normal.> There may be a family history of febrile convulsions in the sibling.> Febrile convulsions are unusual before the age of six months and after 5 years.> Vast majority of patients do not require treatment for either their acute presentation with a seizure or for recurrences.>Best way to manage is to control the temperature with acetaminophen (Paracetamol) or by sponging. When anticonvulsant therapy is judged by a doctor to be indicated, anticonvulsants can be prescribed.> Sodium valproate or clonazepam are active against febrile seizures, with sodium valproate showing superiority over clonazepam.


Question: The Sodium content of ReSoMal (rehydration solution for malnourished children) is

The sodium content in ResOMal is 45 mmol/l. Therapeutic action - Oral rehydration salts with high potassium and low sodium contents Indications - Prevention and treatment of dehydration, in patients suffering from complicated acute malnutrition only Forms and strengths - Sachet containing 84 g of powder, to be diluted in 2 litres of clean, boiled and cooled water. Dosage and duration - Prevention of dehydration Child under 2 years: 50 to 100 ml after each loose stool as long as diarrhoea persists Child over 2 years: 100 to 200 ml after each loose stool as long as diarrhoea persists Adult: 200 to 400 ml after each loose stool as long as diarrhoea persists - Treatment of dehydration Child and adult: 5 ml/kg every 30 minutes over the first 2 hours, then 5 to 10 ml/kg/hour for the next 4 to 10 hours, until dehydration is corrected. Contra-indications, adverse effects, precautions - Do not administer to patients with cholera or uncomplicated acute malnutrition: use standard ORS instead. - May cause: hea failure when administered too rapidly. During treatment, closely monitor the rate of administration in order to avoid overhydration. Increase in respiratory and pulse rates and appearance or increase of oedema are signs of over rapid rehydration. In this event, stop ReSoMal for one hour then reassess the patient's condition. Reference: GHAI Essential pediatrics, 8th edition


Question: Amount of ORS to be given in the first 4 hours to a child with some dehydration is

Treatment plan B: in case of some dehydration 75 ml/kg of ORS in the first 4 hours.use child&;s age when you donot know the weight. The signs of dehydration disappears in 4 hours.after this maintainance fluid therapy can be done. Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:265,7 th edition


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

Preterm milk contains more energy, protein, fat, sodium, zinc, anti-infective factors, and macrophages and has a lower content of lactose, calcium, and phosphorus. Ref: Page 98; Ghai essential pediatrics; 6th edition


Question: Congenital hea lesion (s) in rubella are

Cardiac abnormalities occur in half of the children infected during the 1st 8 wk of gestation. Patent ductus aeriosus is the most frequently repoed cardiac defect followed by lesions of the pulmonary aeries and valvular disease. Reference: Nelson textbook of pediatrics 19th edition Page 1077


Question: Primary cause of hyaline membrane disease is

Ans. d (Surfactant deficiency). (Ref. Nelson, Textbook of Paediatrics, 18th/731)HYALINE MEMBRANE DISEASE# Common in premature, IDM and infants delivered by caesarean section.# Clinically manifests shortly after birth (dyspnoea and cyanotic attacks).# X-ray chest shows "ground glass" mottling.# As HMD progresses, influx of plasma renders the lungs more radio-opaque, reticulogranular shadowing becomes more confluent & ground glass haziness is seen with loss of clarity of diaphragm & heart.# Mortality 33%# Hyaline membrane is a homogenous eosinophilic membrane plastering the alveolar ducts and terminal bronchiole in HMD.# Rx .-Timely steroids, exogenous surfactant therapy and oxygen (not 100 %) are useful in treatment.


Question: A 2 year old male baby presents with cough, high grade fever, fast breathing since 7 days. On examination respiratory rate is 50/min and visible chest indrawing present. Next line of management is

Diagnosis can be made as Pneumonia. Pneumonia without any danger sign can be treated at home with Oral antibiotic. In case of presence of any danger signs, the patient has to admitted to the hospital or to be referred to higher center.


Question: Second most common neoplasm seen in children is

Also called low-grade gliomas, these are the most common brain tumors in children. Medulloblastomas are the most common type of childhood brain cancer. Most medulloblastomas occur before age 10. Ependymomas are a type of childhood brain tumor that can be benign (noncancerous) or malignant (cancerous). The most common cancers of children are: Leukemia. Brain and spinal cord tumors. Neuroblastoma. Wilms tumor. Lymphoma (including both Hodgkin and non-Hodgkin) Rhabdomyosarcoma. Retinoblastoma. Bone cancer (including osteosarcoma and Ewing sarcoma) Reference: GHAI Essential pediatrics, 8th edition


Question: For the prevention of parent to child transmission of HIV, the NACO's recommendation is to give

Single dose nevirapine,given once to the mother in labor and once to the newborn infant during 48-72 hrs of life reduces perinatal transmission by 50%. A sho term regime consisting of 300 mg BD zidovudine from 36 weeks of pregnancy and 300 mg every 3 hourly during delivery also offers a 50% reduction in transmission. Reference: Ghai essential pediatrics 9 th edition Page 230

Nevirapine 200 mg in active labour to mother

Nevirapine 200 mg, four hours after rupture to membranes, to mother

Nevirapine 200 mg in active about to mother and syrup nevirapine 2 mg/kg body weight to newborn with 72 hours of delivery

Syrup nevirapine 2 mg/kg body weight to newborn within 72 hours of bih


Question: Sweaty feet odor is seen in

Sweaty feat odor - Isovaleric AcidemiaSmoky sweat - MSUDMousy or Musty - PhenylketonuriaBoiled cabbage - TyrosinemiaIn alkaptonuria - urine becomes darkish brown when exposed to air while purplish brown in porphyria(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 651)


Question: Bronchitis in children is caused by

Breathing tubes (bronchi) in the lungs. In children, the most common cause of acutebronchitis is a virus. A cough, fever, runny nose, and body aches are common symptoms. Reference: GHAI Essential pediatrics, 8th edition


Question: Commonest feature of hypothyroidism in children is

Ans. is 'c' i.e., Cold extremities o Amongst the given options cold extremities is the best answer. o Prolongation of physiological jaundice is the earliest sign.


Question: Breast milk at room temperature is stored for

Expressed Breast milk (EBM) can be stored at room temperature for 6-8 hrs. Ref: Page 155, Ghai essential pediatrics; 8th edition


Question: Breast feeding is contraindicated in

Contraindications to breastfeeding are those conditions that could compromise the health of the infant if breast milk from their mother is consumed. One example of this is galactosemia. This is. If the mother has HIVor antiviral therapy, untreated active tuberculosis, Human T-lymphotropic virus 1or II, uses illicit drugs, or mothers undergoing chemotherapy or radiation treatment. Breastfeeding contraindication are situations where the mother has conditions such as an addiction or disease that would make it harmful to the baby, should the baby be breastfed. Breast milk contains many nutrients that formulas in store shelves do not have which makes breast feeding a healthier and ideal way to feed an infant. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common cause of Seizures during Neonatal Period includes

(A) Hypoxic Ischemic Encephalopathy # HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE) It is a type of brain damage that occurs when an infant's brain doesn't receive enough oxygen and blood. It is a dangerous condition that requires immediate medical intervention. HIE affects 20 out of every 1000 full term births; the incidence rate in premature babies is 60% of all live births.# Causes of Neonatal Seizures:> Seizures resulting from hypoxic-ischemic encephalopathy Seen in both term and premature infants. Present within the first 72 hours of life. Seizures may include subtle, clonic, or generalized seizures.> Intracranial hemorrhage: Occurs more frequently in premature than in term infants. Distinguishing infants with pure hypoxic-ischemic encephalopathy from those with intracranial hemorrhage often is difficult.> Subarachnoid hemorrhage: More common in term infants. Type of hemorrhage occurs frequently and is not clinically significant. Typically, infants with subarachnoid hemorrhage appear remarkably well.> Germinal matrix-intraventricular hemorrhage: Is seen more frequently in premature than in term infants, particularly in infants born prior to 34 weeks' gestation. Subtle seizures are seen frequently with this type of hemorrhage.> Subdural hemorrhage: Is seen in association with cerebral contusion. It is more common in term infants.> Metabolic disturbances: Include Hypoglycemia, Hypocalcemia, & Hypomagnesemia. Less frequent metabolic disorders, such as inborn errors of metabolism, are seen more commonly in infants who are older than 72 hours. Typically, they may be seen after the infant starts feeding.> Intracranial infections (which should be ruled out vigorously) that are important causes of neonatal seizures include Meningitis, Encephalitis (including herpes encephalitis), Toxoplasmosis, and Cytomegalovirus (CMV) infections. Most common bacterial pathogens include Escherichia coli and Streptococcus pneumoniae.> Most cerebral malformations present with seizures at a later age, major malformation syndromes are important to consider.> Lissencephaly, pachygyria, polymicrogyria, and linear sebaceous nevus syndrome can present with seizures in the neonatal period.


Question: Handedness develops by age of

Handedness is usually established by the 3rd year. Frustration may result from attempts to change children's hand preference, Variations in fine motor development reflect both individual proclivities and different oppounities for learning. Children who are seldom allowed to use crayons, for example, develop a mature pencil grasp later.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 77)


Question: Mean head circumference at birth is

Head circumference:-

 Measured with a nonstretchable tape passing through the maximum point of occipital protuberance posteriorly and at a point just above the glabella anteriorly.

Head circumference must be compared with that of mother to know any familial variations.
If the head circumference is more than expected, always measure the both parents' head circumference, for benign familial megalencephaly is common.
At birth , it is around 34 cm.HC increases 2cm/ month for the first 3 months, 1cm/month for next three months and 0.5 cm per month for next 6 months.


Question: Subluxated lens, thin elongated, hyperextensible extremities and aortic aneurysm are the characteristic clinical features of

(A) Marfan's syndrome # MARFAN'S SYNDROME is a disorder of connective tissue (elastin). The gene called fibrillin is on chromosome 15. Inheritance is autosomal ominant. Sporadic cases may occur. The patients are tall and slender. Extremities especially the fingers and toes are long and thin. The muscles are markedly hypotonic and joints are hyperextendible. At times the disorder may be associated with arthrogryposis (contraction of joints in flexion due to fibrous ankylosis). There may be subluxation of the lens and other ocular abnormalities e.g., cataract, coloboma, squint, nystagmus and megalocornea. Deformities of the chest and spine may be present. Other associated anomalies include aortic cystic medionecrosis leading to aortic dilatation and other valvular deformities. Intelligence is normal. It should be distinguished from cases of homocystinuria, which also may present with ectopia lentis and similar bone changes, but has associated mental retardation. The basic manifestations are joint hypermobility, skin hyperextensibility, dystrophic scarring of the skin and easy bruising, and connective tissue fragility. Wound healing is delayed and there are freely movable subcutaneous nodules. Molecular genetics has helped to characterize 11 different types of Ehlers-Danlos syndrome. Homocystinuria is a relatively common metabolic error with autosomal recessive inheritance. In the most common situation, Type 1, cystathionine is not synthesized from homocysteine and serine because the enzyme cystathionine synthetase in the liver is deficient. Although the precursor, homocysteine accumulates in the tissues, it is rapidly oxidized to homocystine. The usual age of presentation is 3-4 years. The patients develop subluxation of the lens, recurrent thromboembolic episodes and have marfanoid features. Klinefelter syndrome is characterized by tall thin stature, small testes and small phallus, with the chromosomal karyotype of 47 XXY. Behavioral and psychiatric disorders and mental retardation are common.


Question: Penile growth occurs during SMR stage

In males, the first visible sign of pubey and the hallmark of SMR2 is the testicular enlargement. Penile growth occurs during stage 3.Reference: Nelson Textbook of Paediatrics; 20th edition


Question: The most common site of brain metastasis is

MC site of brain metastases (85%) CEREBRUM2nd MC site of brain metastases- CEREBELLUM LUNG, BREAST, MELANOMA (SKIN CANCER), COLON AND KIDNEY cancers commonly spread to the brain.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2460)


Question: Major criteria for jones classification is

i.e. (Chorea): (380 - Ghai 7th)JONES CRITERIA FOR RHEUMATIC FEVERMajor Criteria Minor Criteria* Carditis* Arthritis* Subcutaneous nodule* Chorea* Erythema marginatumA. Clinicali. Feverii. Arthralgiaiii. Previous rheumatic fever rheumatic heart diseaseB. Laboratoryi. Acute phase reactants leukocytosis, elevated ESR and CRPii. Prolonged PR interval on ECGEssential criteriaEvidence for recent streptococcal infection as evidenced bya. Increased antistreptolycin 'O' titerb. Positive throat culturec. Recent scarlet feverTwo major qr one major and two minor criteria are required in the presence of essential criteria to diagnose acute rheumatic feverAssessment for Presence of Heart DiseaseNadas' CriteriaMajor Minor* Systolic murmur* Systolic murmur less than grade III* Grade III or more* Abnormal second sound* Diastolic murmur* Abnormal ECG* Cyanosis* Abnormal X-ray* CHF* Abnormal blood pressurePresence of one major or two minor criteria indicate heart disease (399- Ghai 7th)


Question: Common presentations of juvenile Hypothyroidism

Most common presentation of juvenile hypothyroidism is growth retardation. others include delayed skeletal maturation,delayed dental development,delayed pubey, myopathy and pseudohyperophy,enlarged sella,pseudomotor cerebri. Usually due to hormonal synthesis defect such as TPO or to c -erb A mutation PE : goiter, delayed maturation, testicular enlargement/precocious menarche NOT usually MR- recovery is general rule with thyroxine Reference: OP Ghai ,essential paediatrics ,8 th edition.page no 517


Question: An infant should be exclusively breastfed till

An infant should be exclusively breastfed till six months of age Cardinal principles of breastfeeding practice Initiation of breastfeeding within an hour after bih Exclusive breastfeeding up to 6 months of age Continuation of breastfeeding along with complementary feeding for up to 2 yr of age Reference: Paediatrics; O.P Ghai; 8th edition; Page no: 90


Question: In a 3 year old most common cause of Hepatitis B is

*HBV is transmitted through contact with blood and body fluids of an infected person . *In highly endemic areas , HBV infections occur mainly due to perinatal transmission resulting from carrier mothers to their infants during first 5 years of life. * It may also occur through horizontal transmission from casual contact . * HBV is not transmitted by breastfeeding Reference : OP Ghai pgno 217 9th edition.


Question: Most common cause of Nephrotic Syndrome in Children

NEPHROTIC SYNDROME:- Characterised by massive proteinuria, hypoalbuminemua and edema, hyperlipidemia is often associated. Some patients show hematuria and hypeension. Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl). The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin angiotensin aldosterone axis and ADH secretion that enhances sodium and water retention. Hypoalbuminemia also induces hepatic synthesis of beta lipoproteins resulting in hypercholesterolemia. Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy. Steroid sensitive nephrotic syndrome:- MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non specific obliteration of epithelial foot processes. Immunofluorescence studies shows deposits of occassional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia impa a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated. Low serum calcium level. Steroid resistant nephrotic stndrome:- Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and wilms tumor(WT1) genes. Reference: GHAI essential Paediatrics


Question: In the management of severe acute malnutrition (SAM) child, iron should be started

Do not given Iron is Stabilization Phase. If given Iron releases free radical, causing injury to GIT.
Iron should be started in Rehabilitation Phase (after day 7)

In Rehabilitation Phase, after fever subside


Question: A solid renal mass detected during prenatal ultrasound is most likely a

Mesoblastic nephroma is the most common solid renal tumor identified in the neonatal period and the most frequent benign renal tumor in childhood. It represents 3-10% of all pediatric renal tumors. Many cases are diagnosed with prenatal ultrasound and can manifest as polyhydramnios, hydrops, and premature delivery. Most of the patients are diagnosed before 3 mo of age, whereas WT is rarely diagnosed before 6 mo of age. Radical nephrectomy is the treatment of choice and may be sufficient by itself. Local recurrence is uncommon. Reference: Nelson; Neuroblastoma; Page no: 2467


Question: In breastfeeding, hindmilk poion is richer in

Hind milk is rich in fat and provides more energy and satisfies the hunger of the baby. It comes towards the end of the feed.


Question: Drug of choice for pertussis in children is


Question: The most common etiology of short stature is

Short Stature
Defined as height below the third centile or more than 2 standard deviations below the median height for age and gender according to the population standard. Children whose statures more than 3 SD below the population mean for age and gender are more likely to be suffering from pathological short stature as compared to those with stature between -2 and -3SD, who are more likely to be affected by familial or constitutional short stature.
CAUSES:-

The most common cause is constitutional.
Familial
Pathological causes include:
	Undernutrition
	Chronic systemic illness
	Cerebral palsy
	Congenital heart disease
	Cystic fibrosis, asthma
	Malabsorption
	Acquired immunodeficiency syndrome
Endocrine causes include:
 Psychosocial dwarfism.
Children born small for gestational age.
Skeletal dysplasia; achondroplasia, rickets.
Genetic syndrome; Turner, Down syndrome.


Question: Most common urinary tumour in children is

(Wilm's tumour) (2143 -Nelson 18th) (591-Ghai 7th)1. Rhabdomyosarcoma is the most common soft tissue sarcoma in children 15 years (MC site head & neck region)2. Wilm s tumor or nephroblastoma is the most common malignant tumour of the kidney (Under 5years of age)3. Neuroblastoma is the most common intra- abdominal solid tumor in childhood (Before 6 years of age)4. Retinoblastoma is the most common primary ocular tumor of childhood (White reflex is MC sign)* Wilms tumour associated with syndrome - WAGR, Denys- Drash, Backwith - Wiedemann syndrome others hemihypertrophy sporadic aniridia, neurofibromatosis (Von Recklinghausen disease) and Von Wille brand diseaseGenitourinary anomalies most commonly associated Wilms tumour are hypoplasia, fusion and ectopia of the kidney, duplications of collecting systems, hypospadias and cryptorchildism


Question: Ba&;s hydrops fetalis is lethal because

Ba hydrops fetalis is a lethal complication of alpha thalassemia trait where oxygen can&;t release from hemoglobin. Hb Bas is formed of 4 gamma chains. The oxygen affinity is so high that it releases very little oxygen into the fetal tissues. Reference: Ghai essential of pediatrics, eighth edition, p.no:342

The excess a - globin form insoluble precipitates

Hb Ba's cannot release oxygen to fetal tissues

Microcytic red cells become trapped in the placental


Question: A patient with VSD develops pulmonary hypeension, the characterstic feature will be

Pulmonary hypeension in VSD lead to cyanosis. Ref : Ghai essential of pediatrics, eighth edition, p.no: 417


Question: Anterior fontanelle is closed at

[Cl (12-18 months) Ref: 525, 1974-Nelson 17,h1. Anterior fontanelle: Formed by joining of four sutures in the midline, Diamond shape, 2 by 2 cm measurements* The floor is formed by membranous and it becomes ossified 18 month after birth. It becomes pathological, if it fails to ossify even after 24 months (84 - Dutta 6th)* The average time of closure is 18 months but the fontanel may normally close as early as 9 months. The fontanele is normally slightly depressed and pulsatile and is best evaluated when an infant is held upright while asleep or feeding (1974-Nelson 17th)Disorders associated with a large anterior fontanel* Achondroplasia* IUGR* Apert syndrome* Kenny syndrome* Athyrotic hypothyroidism* Osteogenesis imperfecta* Cleidocranial dysostosis* Prematurity* Congenital rubella syndrome* Pyknodysostosis* Hallermann-Streiff syndrome* Russell - Silver syndrome* Hydrocephaly* 13 - 18, 21 trisomies* Hypophosphatasia* Vitamin D deficiency ricketsPersistently small fontanels suggest microcephaly, cranio synostosis congenital hyperthyroidism or wormian bones2. Posterior fontanelle: between the intersection of the occipital and parietal bones that may be closed at birth or at the most admit the tip of finger. The posterior fontanele is usually closed and nonpalpable after the first 6- 8 weeks of life.Its persistence suggests underlying hydrocephalus or possibility of congenital hypothyroidism


Question: A 1 & 1/2 yr child can do

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. 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. 15months : vocabulary of 6 words 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, 8th edition


Question: Profuse watery diarrhea 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 paicularly 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. ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:244,7th edition


Question: A child presents with sho episodes of vacant stare several times a day. The vacant episode begins abruptly and the child remains unresponsive during the episode. There is no associated history of aura or postictal confusion and the child is otherwise normal. The likely diagnosis is

Answer is B (Absence seizures): Presence of multiple sho episodes of vacant stare (absence) in an otherwise normal child with no history of aura or postictal confusion suggests the diagnosis of typical absence seizures. Absence seizures versus Dav dreaming Absence seizures can easily be confused with episodes day dreaming however there are ceain clues that can help differentiate these two conditions Day dreaming is usually not associated with automatism while automatism is common in seizures. Day dreaming can often be 'broken' with stimulation while seizures can usually not be 'broken'. Day dreaming usually occurs when child is tired /bored or involved in a monotonous activity but seizures can sta abruptly at any time (for example in the middle of a sentence). Abrupt onset of vacant episodes and the fact that the child remains unresponsive during the episode (cannot be broken) ours a diagnosis of absence seizures in this child. Absence seizures versus complex paial seizures Complex paial seizures are frequently associated with aura and postictal confusion. Absence of these features ours a diagnosis of 'Absence seizures' Absence seizures must primarily be differentiated from complex paial seizures and Day dreaming Clinical data Absence Complex paial Daydreaming Frequency/day Multiple Rarely over 1-2 Mutiple; situation-dependent Duration Frequently < 10 sec (Rarely longer than 30 sec) Average duration ober 1 min, 10 sec Seconds to minutes; rarely more rarely less Aura Never Frequently' No Eye blinking Common Occasionally No Automatism Common Frequently No Postictal impairment None Frequently No Seizures activated by 1-11p er yen ti la tio n Very frequently Occassionallv No Photic Frequently Rarely No EEG ktul Generalized spike and wave Usually unilateral or bilateral temporal frontal discharges Normal Interictal Usually normal Variable; may be spikes or sharp waves in frontal or temporal lobes Normal


Question: Features of cystic fibrosis

The sweat chloride is high(>60 mEq/L) Defect in long arm of chromosome 7 Autosomal recessive condition. Ref : Essential pediatrics,O.P.Ghai,7 th edition,pg no:369


Question: In a fetus highest O2 concentration found in

Highest o2 concentration umblical vien > ivc > svc> =ra=rv > umblical aery Reference: GHAI Essential pediatrics, 8th edition


Question: 6 months old baby brought to OPD with complaitns of loud, noisy breathing since birth after feeding on supine position. Baby birth history is insignificant. Treatment for the condition is

The given case scenario is laryngomalacia. It is the most common anamoly of Larynx. The baby presents with stridor in supine position and relieved on prone position. The condition is self resolving by 1 year.


Question: 6 years old drowsy child is brought to emergency with a history of vomitings and loose motion for 3 days. On examination, he had sunken eyes, hypothermia, skin on pinching taken very long time to reve. Diagnosis is

A child with severe dehydration will have at least two of the following four signs: sensorium is abnormally sleepy or lethargic, sunken eyes, drinking poorly or not at all, and a very slow skin pinchA child with some signs of dehydration will have two of the following: restlessness or irritability, sunken eyes, drinking eagerly or slow skin pinchA child with either one or none of these signs is classified as having dehydration.(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 265)


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

Spot urine sample for Protein/ Creatinine ratio


Question: 10 days old baby develops swelling left in posterior cervical area, bluish in appearance, increase in size on crying and brilliently transilluminant

Ans. is 'c' i.e., Cystic hygroma Cystic hygroma Usually present in neonate or early infancy. Filled with lymph Commonly present in posterior cervical area, axilla, mediastinum, parotid, floor of mouth. Soft & paially compressible Size increase during crying, coughing Brilliently transilluminant Sometimes size increase with age or during infection. Treatment is complete excision.


Question: Chest radiographs of children with foreign body aspiration

In foreign body aspiration a radiograph is vital as the object may be radio opaque. often its not radio opaque or is obscured by the cardiac shadow or the inflammatory response. over inflation of affectedlung due to inflammatory response. Ref : BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,24 th edition ,PG NO:852

May show over inflation of the involved lung


Question: A child is having nocturnal asthmatic attacks 2 times in a week and day time attacks 3 times or more. This child is categorized to be having

.intermittent :<1 time a week ,asymptomatic,normal PEFR between attack,nocturnal attack less than or equal to 2 per month mild persistant :>1 time a week but less than 1 time a day,noctunal attack>2 /month moderate persistant :daily use beta 2 agonist, attack affect activity,nocturnal attack>1/week severe persistant :continuous, limited physical activity,nocturnal attack frequent Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:363, 7th edition


Question: Feature of Down syndrome is

Ans) c (Trisomy 21) Ref Nelson 18th ed p 508Down syndrome is the most common chromosome disorder and the single most common genetic cause of moderate mental retardation. The incidence of Down syndrome in live births is approximately 1 in 750. The occurrence of trisomy 21 as well as other autosomal trisomies increases with advanced maternal age (> 35 yr)In approximately 95% of the cases of Down syndrome there are 3 copies of chromosome 21. The parental origin of the supernumerary chromosome 21 is maternal in 97% of the cases. Approximately 1 % of individuals are mosaics with some cells having 46 chromosomes, while another 4% of individuals have a translocation that involves chromosome 21.The majority of translocations in Down syndrome are fusions at the centromere between chromosomes 13, 14, 15, or 21, known as Robertsonian translocations. The translocations can be de novo or inherited.Down syndrome patients without a visible chromosome abnonnality are the least common.It is not possible to distinguish the phenotypes of individuals with full trisomy 21 and those with a translocation.Patients who are mosaic tend to have a milder phenotype.


Question: Commonest cardiac lesion in tuberous sclerosis is

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome with a high incidence of sporadic cases and variable clinical expression. It has an estimated frequency of 1/6000. Major manifestations of TSC include skin lesions in more than 95%, autism and seizures in 85%, kidney disease in 60%, mental retardation in 50%, and cardiac rhabdomyoma in 50%.Mental retardation and autism are more in TSC patients who presents with generalized seizures including infantile spasms in the first 2 years of life. Reference: GHAI Essential pediatrics, 8th edition


Question: Most commonly, ductus aeriosus is

Most commonly, the ductus aeriosus is just distal to the subclan, and the ductus enters the pulmonary aery at its bifurcation. Ref: Nelson textbook of pediatrics 21st edition Pgno: 2344

Just proximal to the left common carotid


Question: Congenital wilson&;s disease is characterized by

Wilson disease is an inborn error of metabolism due to toxic accumulation of copper in liver,brain,cornea and other tissues.Manifestations are more likely to be hepatic in early childhood & neurological in adolescents or adults.The spectrum of hepatic manifestations include all forms of acute or chronic liver disease,i.e.,&;viral hepatitis&; like illness,acute liver failure,chronic hepatitis,poal hypeension,cirrhosis or asymptomatic hepatomegaly.KF (Kayser-Fleischer)/rings are most common in children with neurological(96%) than hepatic(60%) Wilson disease. Wilson disease is characterised by decreased serum ceruloplasmin & increased urinary copper excretion with increased hepatic copper stores. Reference:Essential pediatrics-Ghai,8th edition,page no:320,321


Question: Single gene defect causing multiple unrelated problems

Pleiotropism : A gene that has multiple phenotypic effects It is a special interest because it helps in understanding the relationships between different organisms of the same individuals Examples: I. Drosophila bar eyed individuals may be significantly altered by the wing nature II. Seed coat colour gene of sweet pea controls flower colour and also red spot in leaf axils II. Sickle cell anemia in human . Reference: GHAI Essential pediatrics, 8th edition


Question: A child has presented with a BP of 190/110, pedal edema++, facial edema, gross hematuria and absent ascites, The most probable diagnosis is

Glomerulonephritis signs and symptoms include: Pink or cola-colored urine from red blood cells in your urine (hematuria) Foamy urine due to excess protein (proteinuria) High blood pressure (hypeension) Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen. Causes of Acute Glomerulonephritis 1.Non-infectious 2.Infectious # Numerous infectious organisms, include fungi, bacteria, rickettsia, virus, especially influenza, and parasites could induce PAGN. # However, APSGN accounts for 80 to 90% of such cases and is used as the prototype for this group of disorder. # APSGN is a classic example of the acute nephritic syndrome Reference: GHAI Essential pediatrics, 8th edition


Question: Periventricular Leukomalacia most commonly causes

Pathology
Cerebral Palsy subtype

Periventricular
				Leukomalacia

Spastic diplegia

Parasaggital brain injury

Spastic quadriparesis

Middle cerebral artery (MCA) teritory infarction

Spastic hemiplegia

Basal ganglia

Dyskinetic cerebral palsy


Question: Concentration of epinephrine used in neonatal resuscitation is

Medications: indication, dosage and effects MedicationIndicationEffectsConcentration administeredDose of prepared solutionRouteEpinephrine (1:1000)HR <60 / min after 30 sec of effective PPV and chest compressions Inotropic; chronotropic; peripheral vasoconstrictor 1:100000.1-0.3 ml/kgIV; through umbilical vein (endotracheal route if no IV access) Normal salineRinger lactateAcute bleeding with hypovolemia Increased intravascular volume improves perfusion 10 ml/kgUmbilical vein Naloxone (0.4 mg/ml) Respiratory depression with maternal history of narcotic use within 4 hr of bihNarcotic antagonist 0.4 mg/ml 0.25 ml/kgIV preferred; delayed onset of action with intramuscular use; administer only after restoring ventilationSodium bicarbonate is administered only if prolonged asphyxia is associated with metabolic acidosis despite use of epinephrine and volume expanders.IV intravenous; PPV positive pressure ventilation Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 132


Question: Split skin grafts in children should be harvested from

A split-thickness skin graft(STSG) is a skin graft including the epidermis and pa of the dermis. Its thickness depends on the donor site and the needs of the person receiving the graft.A full-thickness skin graft consists of the epidermis and the entire thickness of the dermis. Split skin grafts in children should be harvested from Buttocks. Reference: GHAI Essential pediatrics, 8th edition


Question: Number of primary teeth;

there are total of 20 primary teeth PRIMARY/ MILK/ TEMPORARY TEETH SECONDARY/ PERMANENT TEETH BEGIN AT 6-7 months 6 years 1st tooth to erupt Lower central incisor 1st molar Last tooth Second molar 3rd molar or wisdom tooth Completes at 2 and half - 3 years 12 years except the 3rd molar Total no. of teeth 20 28-32


Question: Screening of neonatal thyroid disease is done by

Since the neonates are asymptomatic at bih all newborns are screened for neonatal hypothyroidism. TSH is estimated either in cord blood at the time of bih (preferred) or blood obtained from heel prick after 2 days of bih.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2669 - 2773)


Question: Sho stature, secondary to growth hormone deficiency is associated with

sho stature : Defined as height below third centile or more than 2 standard detions below the median height for age and gender according to the population standard. Children whose stature s more than 3 SD below the population mean for age and gender are more likely to be suffering from pathological sho stature as compared to those with stature between -2 and -3SD , who are more likely to be affected by familial or constitutional sho stature. CAUSES:- 1. Most common cause is constitutional. 2. Familial 3. Pathological causes include: Undernutrition Chronic systemic illness Cerebral palsy Congenital hea disease Cystic fibrosis,asthma Malabsorption Acquired immunodeficiency syndrome 4. Endocrine causes include: Growth hormone deficiency Hypothyroidism Cushing syndrome Pseudohypoparathyroidism Precocious or delayed pubey 5. Psychosocial dwarfism 6. Children born small for gestational age. 7. Skeletal dysplasia; achondroplasia, rickets. 8. Genetic syndrome; Turner, Down syndrome. Growth hormone deficiency:- Growth hormone deficiency may be caused by congenital CNS malformations, genetic defects or acquired neurological insults. These children have normal growth at bih. Growth retardation become apparent around 1 year of age. Midfacial crowding, round facies, mild obesity,depressed nasal bridge,single central incisor tooth and micropenis are common. Body propoions are normal. Development of tooth delayed.Facial appearance is doll like. These children look much younger than their actual age. Bone age is delayed. Newborns may present with severe hypoglycemic seizures due to concomitant ACTH deficiency. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common cause of Neonatal Hypothyroidism is

Iodine deficiency is the commonest cause of congenital hypothyroidism in ceain pas of India, while thyroid dysgenesis is the most common aetiology in non-endemic areas (75% of all cases). Thyroid scan pictures showing different types of thyroid dysgenesis. At upper panel hypoplasia (A), hemiagenesis (B), ectopia (C), double ectopia (D), and athyreosis (E) compared with normal thyroid (G) shown at lower panel. Panel F showing scintigraphy performed at the time of diagnosis (F1 and F2) repoed as hemiagenesis while repeated scintigraphy at the time of the study (at 12 years age) showed ectopia (F3). Radiopharmaceutical uptake by thyroid tissue is shown by black arrows and salivary glands by empty arrows. Reference: Ghai essential of paediatrics, eighth edition, p.no:516

Transplacental maternal thyroid antibodies


Question: Transient myleoproliferative disorder of the newborn is seen in association with

Approximately 10% of children with Down syndrome develop a preleukemic clone,transient myeloproliferative disorder,with somatic mutations in hematopoietic transcription factor GATA1.These children have a high leukocyte count,circulating blasts in peripheral blood,hepatosplenomegaly,effusions,anemia and thrombocytopenia in the neonatal period,which resolves by 3 months.About 20% of children with transient myeloproliferative disorder develop AML. Reference:Essential pediatrics-Ghai,8th edition,page no:605.


Question: Chromosome involved in Wilm's tumor is

WTl is the best characterized Wilms tumor gene. It is located at chromosome llp13 and encodes for a transcription factor that is critical for normal development of kidneys and gonads. WT2 is localized to a cluster of genes at llpl5. Reference: Essential paediatrics; O.P.Ghai; Childhood Malignancies; Page no: 617


Question: Maximum growth spu is seen in girls at time of

Adolescence: Stage of transmission from childhood to adulthood. During this stage, there will be an appearance of sexual characters with changes in cognition and psychology. Adolescence refers to this entire process, pubey refers to the physical aspect. Age 10-19 year is considered a period of adolescence and pubey marks the early half of adolescence. Pubey in girls stas with breast development( thelarche) anytime between 8-13 years. This is followed by an appearance of pubic hair ( pubarche) and subsequently, menstruation ( menarche), occurring at an average of 12.6 years. Menarche occurs after 2-21/2 years of thelarche. In boys, the earliest change is an increase in testicular size( testicular volume reaching 4 ml) and this occurs between 9-14 years. This is followed by an appearance of pubic hair and lengthening of the penis. Spermarche( sperm production) stas during mid-adolescence. Laryngeal growth, manifesting as cracking of voice, begins in boys in mid-pubey, deepening of voice is complete by end of pubey. During pubey, boys gain 20-30 cm and girls 16-28 cm of height. Peak growth velocity in girls occurs before attainment of menarche. Boys have their peak growth in later stages of pubey. Reference: GHAI Essential pediatrics, 8th edition


Question: The commonest cardiac lesion in Tuberous sclerosis is

MAJOR FEATURES OF TUBEROUS SCLEROSIS COMPLEX:Coical tubersSubependymal noduleSubependymal giant cell astrocytomaFacial angiofibroma Periungual fibromaHypomelanotic macules (>3) Shagreen patchMultiple retinal hamaomasCardiac rhabdomyomaRenal angiomyolipomaPulmonary lymphangioleiomyomatosisApproximately 50% of children with tuberous sclerosis have cardiac rhabdomyoma.Most common cardiac lesion: cardiac rhabdomyomaMost common renal lesion: angiomyolipomaMost common skin lesion: hypomelanotic maculeMost common CNS lesion: coical tubersMost common pulmonary lesion: lymphangiomyomatosis


Question: In newborn, the aery used for palpation of the pulse is

Radial, brachial and carotid aeries are difficult to palpate in a newborn baby.The femoral aery is easily palpable in the newborn.Bilateral femoral pulse should be palpated and indicates the degree of volume status in newborn.In coarctation of the aoa, the femoral pulse will be absent.


Question: Edward syndrome is

Edward syndrome is trisomy 18 . It is due to non dysfunction of chromosomes during meiosis Trisomy 21 is down symdrome and trisomy 13 is patau syndrome. Reference: Nelson TB of pediatrics pg 404 edi 19.


Question: Conjugated hyperbilirubinemia

Ans. is 'a' i.e., Dubin johnson syndrome Breast milk jaundice - Decrease bilirubin uptake across hepathocyte membrane. Entero-hepatic recirculation. Leads to indirect hyperbilirubinemia. Crigler naj jar & Gilbe syndrome (deficiency of glucuronyl transferase) <Type I - Complete deficiency Type II - Paial deficiency Decrease conjugation leads to Indirect hyperbilirubinemia. Defect in hepatocyte secretion of conjugated bilirubin. Leads to direct hyperbilirubinemia


Question: Sinus bradycardia in neonates is considered if sinus rate is

Sinus bradycardia is a result of slow discharge of impulses from the sinus node, the hea's natural pacemaker. A sinus rate <90 beats/min in neonates and <60 beats/min in older children is considered to be sinus bradycardia. It is commonly seen in well-trained athletes; in healthy individuals, it is generally without significance. Sinus bradycardia may occur in systemic disease (hypothyroidism or anorexia nervosa), and it resolves when the disorder is under control. It may also be seen in association with conditions in which there is high vagal tone, such as gastrointestinal obstruction or intracranial processes. Reference: Nelson; 20th edition; Page no: 435


Question: Neonatal meningitis is caused by

The most common causes ofneonatal meningitis is bacterialinfection of the blood, known as bacteremia (specifically group B streptococci (Streptococcus agalactiae), Escherichia coli, and Listeria monocytogenes). Reference: GHAI Essential pediatrics, 8th edition


Question: Large tongue is common in

Oral manifestations of hypothyroidism : Childhood hypothyroidism known as cretinisim is characterized by thick lips, large protruding tongue (macroglossia), malocclusion and delayed eruption of teeth. Thickening of the lips and macroglossia is due to increased accumulation of subcutaneous mucopolysaccharides i.e., glycosaminoglycans due to decrease in the degradation of these substances. The long-term effects of severe hypothyroidism on craniofacial growth and dental development have also included impaction of the mandibular second molars. This seems to be caused by a dissociation of ramus growth and failure of normal resorption of the internal aspect of the ramus, resulting in insufficient space for proper eruption of these teeth. The common oral findings in hypothyroidism include the characteristic macroglossia, dysgeusia, delayed eruption, poor periodontal health, altered tooth morphology and delayed wound healing.Before treating a patient who has a history of thyroid disease, the dentist should obtain the correct diagnosis and etiology for the thyroid disorder, as well as past medical complications and medical therapy. Reference: GHAI Essential pediatrics, 8th edition


Question: Compared with Cow&;s milk, mothers milk has more

Lactose is in a high concentration(6-7 g/dl) in breast milk. Lactose helps in absorption of calcium and enhances the growth of lactobacilli. Ref: Page 150, Ghai essential pediatrics; 8th edition


Question: A 6 year old boy presenting with palpable abdominal mass in the epigastrium. The clinical diagnosis is (There is no bile in vomitus).

Ans. is 'c' Pyloric stenosis Clinical features which suggests the diagnosis of Pyloric stenosisVomitting without bileMass palpable in epigastriumOther options can be easily ruled outCholedochal cystIt can also present as mass in abdomen but the mass is usually present in right upper Quadrant.Jaundice will be a prominent symptom andUsually there is no vomitingDuodenal Atresia #Mass (Peristaltic wave) is usually present in the left upper quadrant and the vomiting is bile stained*.Child vomits from birth*Esophageal atresia -There is excessive drooling, saliva is frothy and there is choking and cyanosis with 1st feed.No mass in abdomen, no vomiting.So the boy is having pyloric stenosis. The only problem is age of boy i.e. 6 yrs. The hypertrophic pyloric stenosis which we know of, makes its clinical presentation in early infancy (3rd to 6th weeks of life*)But the problem in solved once you know that there is a similar disease in adults - Hypertrophic pyloric stenosis of adults. (Bailey & Love, 22/e, p 675).


Question: The pattern of inheritance in the give pedigree chart

Every affected male inherits the disease to his male child only.
No female is affected. Hence it is inherited by Y chromosome also known as Holandric inheritance.


Question: Energy requirement in a 15kg normal body weight child is

In case of energy, advising intakes in excess or below the actual requirements is not safe. Calculation of energy requirement should account for the level of physical activity and the energy required to allow for optimal growth. For children with normal body weights, the energy requirements are calculating roughly as 100 kcal/ kg for the first 10 kg of body weight; between 10 and 20 kg, the requirement is 1000 kcal plus 50 kcal/kg added for weight above 10 kg (e.g. for a 15 kg child, the requirement will be 1250 kcal); and for weight more than 20 kg, 20 kcal/kg is added to 1500 kcal to estimate the requirements (e.g. for a 30 kg child the requirement is approximately 1700 kcal). Reference: Paediatrics; O.P Ghai; 8th edition; Page no: 90


Question: Stillborn child is defined by

The definition recommended by WHO is a baby born with no signs of life at or after 28 weeks&; gestation. The major causes of stillbih include: childbih complications post-term pregnancy maternal infections in pregnancy (malaria, syphilis and HIV) maternal disorders (especially hypeension, obesity and diabetes) fetal growth restriction congenital abnormalities. Reference: GHAI. Essential paediatrics , 8 th edition


Question: Most common site of metastases in neuroblastoma

metastases in neuroblastoma :
 Most commonly involved organs are lymph nodes, long bones, skull, bone marrow, liver.


Question: The Finnish type of Congenital Nephritic syndrome occurs due to Gene mutation affecting the following protein

It occurs due to gene mutation NPHS 1 which encodes nephron and the protein is affected and results in massive protein loss , edema. Congenital nephrotic syndrome Finnish type is a genetic condition of the kidney that begins early in development during pregnancy or within the first three months of life. The syndrome is characterized by a group of symptoms, including protein in the urine (proteinuria), low blood protein levels, high cholesterol levels, and swelling (nephrotic syndrome), which progresses rapidly to end-stage kidney disease. Infants with congenital nephrotic syndrome may have failure to thrive and frequent infections. Although more commonly seen in individuals of Finnish descent, congenital nephrotic syndrome Finnish type has been repoed worldwide. Congenital nephrotic syndrome Finnish type is caused by mutations in the NPHS1 gene and is inherited in an autosomal recessive manner. At this time, kidney transplantation seems to be the only treatment available for this condition. Reference: GHAI Essential pediatrics, 8th edition


Question: Hilar dance on fluoroscopy is seen in

. Ghai essential of pediatrics, eighth edition p.no:413 hilar dance on fluoroscopy due to vigorous pulmonary aery pulsations seen in ASD


Question: First line ATT in children

*The first line drugs in ATT are effective with minimal toxicity and include isoniazid,rifampicin,ethambutol,streptomycin and pyrazinamide.Ethionamide is a second line drug. * In a view of increasing INH resistance, use of three drugs (INH, Rifamipicin , and ethambutol) instead of two (INH and rifampicin) is suggested during the continuous phase . Reference : Ghai essential pediatrics 9 th edition Page 249


Question: Vaccine not given in Adolescents

Adolescence ranges from 10 to 19 yrs Early ( 10-13yrs); Mid(. 14-16yrs); Late( 17-19yrs) DPT vaccine is given at 10-12 yrs, once every 10 yrs thereafter. HPV vaccine - 2 doses( if 9-14 yrs). 3 doses( if beyond 15 yrs) Influenza vaccine- Annually Rota virus vaccine presently is given in 4 states (AP, HP, Haryana, Odisha).It is given to prevent diarrhoea caused by rota virus. Three kinds of live attenuated oral vaccines ; Rotatrix( monovalent ) 2 doses:10 &14 wks Rotateq( pentavalent)3doses:6,10,14 wks Rotovac( monovalent recombinant )3doses Immunization of rotavirus vaccine should be completed by 8 months of age. Adolescents affected with rotavirus show mild symptoms in comparison to infants and toddlers Ref: Ghai, 9th edition, Chap 5 & 10.


Question: NOT a feature of Fragile X syndrome

Fragile X syndrome follows X-linked dominant inheritance Clinical features are

Elongated face
Increased risk of ADHD and Autism
Large gonads
Intellectual disability
Large ears (not low set ears)


Question: Commonest cause of congenital adrenal hyperplasia is

(21 hydroxylase) (489-90-G) (492-Ghai 7th)* 21 hydroxylase & 11-b hydroxylase deficiency are common varieties21 hydroxylase11-b hydroxylase deficiency* May present as salt-wasting form of CAH, due to the associated aldosterone deficiency resulting in life threatening emergencies in the early postnatal life* These may present with severe vomiting and vascular collapse* Boys with CAH do not have anomaly of the external genitals at birth* Results in accumulation of deoxycortisol (DOC) because enzymatic block is beyond this stage* These children develop hypertension of varying severity due to excessive DOC


Question: A foreign body is commonly responsible for vaginal bleeding in pediatric patients.

Ans. is 'a' i.e., Congenital malformation o Smoking during pregnancy causes --> o IUGR (Low bih weight) Fetal death Sudden infant death syndrome May horm the child's mental development and behavior.


Question: Neptrotic syndrome is claracterised by


Question: For karyotyping, the dividing cells are arrested by the addition of colchicines in the following mitotic phase

b. Metaphase(Ref: Nelson's 20/e p 605-606, Ghai 8/e p 645)Chromosomes are examined after arresting dividing cells in metaphase with mitotic spindle inhibitors (e.g., N-diacetyl- N-methylcolchicine), followed by staining.


Question: The floor of the nasal cavity in children is made of

"The floor of the nasal cavities, which also form the roof of the mouth, is made up by the bones of the hard palate: the horizontal plate of the palatine bone posteriorly and the palatine process of the maxilla anteriorly".(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2007)


Question: Dosage of drug in child is calculated based on March 2013

Ans. B i.e. Weight Drug dosage for children is calculated based on age and weight of the child.


Question: The metabolic dearrangement in congenital pyloric stenosis is

The classical presentation is non bilious vomiting begining at 3-6 weeks of age Severity and frequency of vomiting increases gradually Persistant vomiting leads to malnutrition,dehydration and hypochloremic alkalosis. constipation is usual Diagnosis is based on history and palpability of mass. Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:253,7 th edition


Question: Select the most common clinical sign or symptom for diagnosis PHACE syndrome

The child with a unilateral facial lesion and blindness suggests either Sturge-Webber or PHACE syndrome (posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta or other cardiac defects, and eye abnormalities). These patients can have seizures, hemiparesis, intracranial calcifications, and mental retardation.

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: A patient of moderate VSD in chronic CCF develops clubbing with no cyanosis. Diagnosis is

SHUNT REVERSAL / EISENMENGER SYNDROME: Refers to patients with the septal defect in which blood is shunted paially or completely from right to left as a result of the development of pulmonary vascular disease resulting in apparent cyanosis.Long-standing pulmonary edema is characterized by cyanosis, dyspnea.New onset clubbing without cyanosis in a patient with congenital hea defects indicates the development of SABE .Pulmonary aerial hypeension commonly occurs in large non-restrictive VSD and is unlikely in moderate VSD.


Question: Most common Cardiac anomoly associated with Turner's syndrome

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


Question: Perinatal period corresponds to

Peaining to the period immediately before and after bih. The perinatal period is defined in diverse ways. Depending on the definition, it stas at the 20th to 28th week of gestation and ends 1 to 4 weeks after bih. Ref : Nelson paediatrics chapter : Growth and develop

28 weeks of gestation to 7 days after bih

Third trimester of pregnancy to newborn period

36 weeks of gestation to 3 days after bih


Question: Kleiner syndrome is diagnosed by

Klinefelter syndrome

Extra x chromosome (47 XXY) karyotype
Small testes with hyalinised seminiferous tubules
Delayed puberty
Delayed secondary sexual characters Small penis
Tall & underweight
Mental retardation
Gynaecomastia


Question: A child is brought to the paediatric OPD with fever of 24 hours furation. History reveals 3 episodes of chest infection and passage of foul smelling stools. The most probable diagnosis is

The symptoms are suggestive of cystic fibrosis. Ref : Essential paediatrics,O.P.Ghai,7 th edition,pg no:369


Question: Most common presentation of Down syndrome is

Down syndrome:- Trisomy 21 Patients with down syndrome have mental and physical retardation, flat facial profile, an upward slant of eyes and epicanthic folds. Oblique palpebral fissure seen. Nose is small with flat nasal bridge. Mouth shows narrow sho palate with small teeth and furrowed protruding tongue. There is significant hypotonia. Skull appears small and brachycephalic with flat occiput . Ears are small and dysplastic. Characteristic facial grimace on crying. Hands are sho and broad. Clinodactyly( hypoplasia of middle phalanx of fifth finger) and simian crease are usual. There is wide gap between the first and second toe( Sandle gap). Associated anomalies:- 1. Congenital hea disease- ventricular septal defect. 2. Gastrointestinal - atresia, annular pancreas and Hirschsprung disease. 3. Ophthalmic- cararact, nystagmus, squint. 4. Thyroid dysfunction 5. Conductive hearing loss Best serological marker for down syndrome is Beta HCG. Reference: GHAI Essential pediatrics, eighth edition


Question: Breast milk at room temperature stored for

Breast milkCan be stored at room temperature for 8-10 hoursIn a refrigerator for 24 hoursIn a freezer for 3 months(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 286 - 290)


Question: The drug of choice in treatment of inflantile spasms is

Infantile spasms:-

West syndrome
Onset : 3-8 months of life
Characterised by combination of salaam spells( sudden dropping of the head and flexion of arms), developmental retardation, hypsarrythmia on ECG.

Causes-

Hypoxic ischemic encephalopathy
Neurocutaneous syndromes
Perinatal infections
Hemorrhage
Injury
Metabolic disorders
Localized structural malformations
The spasms occur in clusters usually on waking

Drug therapy-

Intramuscular ACTH 40-60 unit per day may be given 4-6 weeks and tgen tapered off.
On the other hand oral prednisolone at 2 mg/ kg / day in divided doses may also be used.
These agents abolish spasms and may result in resolution of hypsarrythmia.


Question: Residual auditory defect is a common complication in meningitis caused by

Residual auditory defect is caused by Haemophilus meningitis .so BERA is the investigation of choice done in them. Reference: GHAI Essential pediatrics, 8th edition


Question: The definition of hypeension in children is

The definition of hypeension in adults is BP >=140/90 mm Hg, regardless of body size, sex, or age. This is a functional definition that relates level of BP elevation with the likelihood of subsequent cardiovascular events. Because hypeension-associated cardiovascular events, such as myocardial infarction or stroke, usually do not occur in childhood, the definition of hypeension in children is statistical rather than functional. The National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents published the Fouh Repo on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (Fouh Repo) in 2004. This repo established normal values based on the normative distribution of BP in healthy children and included tables with systolic and diastolic values for the 50th, 90th, 95th, and 99th percentile by age, sex, and height percentile. The Fouh Repo defined hypeension as average systolic blood pressure (SBP) and/or diastolic BP that is >=95th percentile for age, sex, and height on >=3 occasions. Prehypeension was defined as average SBP or diastolic BP that is >=90th percentile but <95th percentile. In adolescents beginning at age 12 yr, prehypeension is defined as BP between 120/80 mm Hg and the 95th percentile. A child with BP levels >=95th percentile in a medical setting but normal BP outside of the office has white coat hypeension. The Fouh Repo fuher recommended that if BP is >=95th percentile, then hypeension should be staged. Children with BP between the 95th and 99th percentile plus 5 mm Hg are categorized as stage 1 hypeension, and children with BP above the 99th percentile plus 5 mm Hg have stage 2 hypeension. Stage 1 hypeension, if asymptomatic and without target organ damage, allows time for evaluation before staing treatment, whereas stage 2 hypeension calls for more prompt evaluation and pharmacologic therapy. Reference: Nelson; 20th edition; Page no: 2294

Average systolic blood pressure (SBP) and/or diastolic BP that is >=95th percentile for age, sex, and height on >=2 occasions

Average systolic blood pressure (SBP) and/or diastolic BP that is >=95th percentile for age, sex, and height on >=3 occasions

Average systolic blood pressure (SBP) and/or diastolic BP that is >=90th percentile for age, sex, and height on >=2 occasions

Average systolic blood pressure (SBP) and/or diastolic BP that is >=90th percentile for age, sex, and height on >=3 occasions


Question: Most common malignant tumour in childhood

Leukemia is the most common malignancy of childhood.There are two main subtypes,the commoner acute lymohoblastic leukemia(ALL) & acute myeloid leukemia(AML).A small propoion may have chronic myeloid leukemia(CML) and juvenile myelomonocytic leukemia(JMML).ALL is the most common childhood malignancy accounting for one-fouh of all childhood cancers. Reference:Essential pediatrics-Ghai,8th edition,page no:599.


Question: Definitive treatment of choice for Transposition of great vessels (TGA) is

The aerial switch operation is now established as the treatment of choice for TGA and most centers endeavour to offer this procedure for all infants with TGA. In this operation, the pulmonary aery and aoa are transected. The distal aoa is anastomosed to the proximal pulmonary stump (neo-aoic root) and the pulmonary aery to the proximal aoic stump (neopulmonary aery). The coronary aeries are moved along to the neo-aoic root along with a cuff of aoic tissue to allow suturing without compromise of coronary blood flow. There is a limited window of time for performing the aerial switch for TGA. Infants with TGA and intact septum should ideally undergo this procedure within the first 2-4 weeks of life. As pulmonary vascular resistance falls after bih the left ventricle regresses rapidly. In 1-2 months the left ventricle has the ability to adjust to the elevated systemic vascular resistance after the aerial switch through hyperplasia of the available muscle. After this, it is difficult for the left ventricle to adapt to an aerial switch. Later in infancy, the atrial switch operation (Senning operation) is the only option for TGA with intact ventricular septum. This is not an ideal long-term option because the right ventricle remains as the systemic ventricle for life. Over time, right ventricle dysfunction and severe tricuspid regurgitation sets in. Additionally, extensive restructuring of atria predisposes to atrial rhythm disturbances. Reference: Essential Paediatrics; O.P. Ghai; Page no: 426


Question: Juene syndrome is

Juene syndrome : Autosomal recessive disorder. Characterised by typical skeletal dysplasia such as narrow thorax and micromelia with respiratory and renal manifestations. Classic manifestations in infancy include dwarfism with sho ribs, sho limbs and characteristic radiographic changes in limbs. All patients have small chest but presentation varies. Patients who survive newborn period may later develop pancreatic and renal insufficiency. FIGURE 1 Characteristics of Jeune syndrome. A. Neonate with a bell-shaped chest, protuberant appearing abdomen, and mild shoening of the limbs. B. Radiograph of a neonate poraying the characteristic sho, horizontal ribs, costochondral flaring, and handlebar-shaped clavicles associated with Jeune syndrome. Reference: GHAI Essential pediatrics, 8th edition


Question: The initial fluid of choice of the treatment of hypernatremic dehydration is

The initial resuscitation of hypernatremic dehydration requires restoration of the intravascular volume with NS. RL and other fluids should not be used because they are hypotonic fluids.Seizures are the most common manifestation of cerebral edema from an overly rapid decrease of the serum sodium concentration during correction of hypernatremic dehydration. Signs of increased intracranial pressure or impending herniation may develop quite rapidly (see Chapter 68). Acutely, increasing the serum concentration an infusion of 3% sodium chloride can reverse the cerebral edema. Each 1 mL/kg of 3% sodium chloride increases the serum sodium concentration by approximately 1 mEq/L. An infusion of 4 mL/kg often results in resolution of the symptoms. This strategy is similar to that used for treating symptomatic hyponatremia Ref.nelson 20th edition 390 page


Question: Caorctation of aoa is most commonly seen with

Coarctation of aoa is associated with bicuspid aoic valve. Ref : Ghai essential of pediatrics, eighth edition, p.no:431


Question: Bovine cough is characteristic of

In bovine cough glottis cant be completely closed. Aphonic cough seen usually in vocal cord paralysis. it is one which doesn&;t have an explosive nature. Ref : PAEDIATRIC CLINICAL EXAMINATION BY A.SANTHOSH KUMAR,4 TH EDITION, PG NO:141


Question: The mode of inheritance of Duchenne muscular dystrophy is

Duchene muscular dystrophy is a X linked recessive disorder. Gait disturbances is commonly seen and calf muscle pseudo hyperophy is also seen


Question: Risk of endocarditis among the following is highest in

Risk of endocarditis - Ventricular septal defect > patent ductus arteriosus > Atrial septal defect.


Question: A 3 year old boy with normal developmental milestones with delayed speech and difficulty in communication and concentration. He is not making friends. Most probable diagnosis is

Ans. is 'a' Autism "Difficulty in concentration and communication, delayed speech and problems in forming social relationship in early childhood suggests the diagnosis of Autism"Essentials of Diagnosis and Typical Features of AutismOnset in infancy or early childhood (before age of 3 years)Abnormal language and speech development (Abnormal communication)Inability to develop normal social skill (lack of eye contact gestures and facial expression)Understand little or no language (therefore fail to acquire speech)Deficient comprehension and communicative use of speech and gesture.Behavioural peculiarities such as ritualized repetitive or stereotyped behaviour and rigidity.Difficulty in concentrationSevere deficit in social responsiveness and interpersonal skillsIntrusive stereotypes (Repetitive behaviour) together with inability to concentrate may prevent children from engaging in meaningful activity or social interaction (difficulty in making friends)Do not engage in pretended play (which starts before age of 2 in normal children)Also knowAbout 75% of children with autism are mentally retardedEpilepsy develops in one fifth to one third of autistic individuals.EEG abnormalities are noted in half of the patients.

Developmental-Behavioral Screening and Surveillance


Question: An indicator of inadequate breast feeding in an infant is

Weight loss of >7-10% of bih weight is an indicator of inadequate breastfeeding in an infant. Indicators of inadequate breastfeeding in an infant: Weight loss >7-10% of bih weight Lethargy (sleeping longer than 2-3 hours) Delayed stooling (Less than 4 times/day) Decreased urine output (urinating less than 5-7 times/day) Hypernatremic dehydration Inconsolable crying and increased hunger Insufficient milk intake may be caused by insufficient milk production, failure of established breastfeeding, and health conditions in the infant that prevent proper breast stimulation. Breastfed neonates usually feed 8-12 times a day, with a minimum of 8 times per day. However, the neonate should be breastfed on demand. Ref: Nelson textbook of pediatrics 21st edition Chapter : 56


Question: NOT a feature of Holt Oram Syndrome is

Holt Oram Syndrome Patient have normal blood picture.


Question: Bilabial consonants are

Pronounced or aiculated with both lips, as the consonants b, p, m, and wBaby stas producing bilabial words by the 4th month of age(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 32)


Question: Maternal Antibody responsible for heartblock in a baby born to mother suffering from SLE

Anti-Ro antibody crosses placenta and affects conducting system of fetal heart leading to Heart block.


Question: Pseudohermaphroditism in a female child is most commonly due to

Excess androgen production is the most common cause of disorder of sexual differentiation (pseudohermaphroditism) mainly 21- hydroxylase deficiency. Others are 11- beta-hydroxylase and 3 beta-hydroxysteroid dehydrogenase deficiency Image : Female pseudohermaphroditism with normal uterus. A, Sonographic view of the external genitalia; note the enlarged clitoris (C) with fused prominent labia (L). B, The corresponding postnatal disposition verifying enlarged clitoris and fused labia. Reference: Ghai essential of paediatrics, eighth edition, p.no:538


Question: A 14 year old boy has difficulty in expressing himself in writing and making frequent spelling mistakes, does not follow instruction and cannot wait for his turn while playing a game. He is likely to be suffering from

The Child may suffer from Specific learning disability If one find difficulty in expressing himself in writing and making frequent spelling mistakes, does not follow instruction and cannot wait for his turn while playing a game. Reference: GHAI Essential pediatrics, 8th edition


Question: The most impoant determinant of prognosis in Wilms tumor

The most impoant prognostic factors in Wilms tumor is its histopathology.3% of tumors show ourable pathology(focal anaplasia)for which only surgical excision is needed.Another 6% have unourable pathology(diffuse analplasia);these tumors are pleomorphic and ruptured and show early metastasis to bones. Other prognostic factors are Stage of the disease,Ploidy(diploid tumors have better prognosis than hyperdiploid tumors).Young age,low stage and low tumor weight(<550 g) are ourable prognostic factors.Presence of anaplasia and loss of heterozygosity of 1p or 16q increase risk recurrence. Reference:Essential pediatrics-Ghai,8th edition,page no:618

Loss of heterozygosity of chromosome I p


Question: Bone age is advanced in

An advanced or delayed bone age does not always indicate disease or "pathologic" growth. Conversely, the bone age may be normal in some conditions of abnormal growth. Children do not mature at exactly the same time. Just as there is wide variation among the normal population in age of losing teeth or experiencing the first menstrual period, the bone age of a healthy child may be a year or two advanced or delayed. Those with an advanced bone age typically hit a growth spu early on but stop growing at an earlier age. Consequently, when a naturally sho child has an advanced bone age, it stunts their growth at an early age leaving them even shoer than they would have been. Because of this, those who are sho with an advanced bone age, need medical attention before their bones fully fuse. An advanced bone age is common when a child has had prolonged elevation of sex steroid levels, as in precocious pubey or congenital adrenal hyperplasia. The bone age is often marginally advanced with premature adrenarche, when a child is overweight from a young age or when a child has lipodystrophy. Those with an advanced bone age typically hit a growth spu early on but stop growing at an earlier age. Bone age may be significantly advanced in genetic overgrowth syndromes, such as Sotos syndrome, Beckwith-Wiedemann syndrome and Marshall-Smith syndrome. Bone maturation is delayed with the variation of normal development termed Constitutional delay of growth and pubey, but delay also accompanies growth failure due to growth hormone deficiency and hypothyroidism. Reference: GHAI Essential pediatrics, 8th edition


Question: Child with PDA will not have aEUR'

CO. washout During intrauterine life the fetus does not breathe. The .fetus does not require .functioning lung to oxygenate its blood. The fetus receives oxygenated blood from the mother through the umbilical vein. The lungs remains collapsed during the fetal life and the pulmonary circulation is a high pressure circuit. So, the fetal blood does not pass through the lungs. Instead, it requires a duct that can bypass the lung and can carry the blood straight way to systemic circulation i.e., Aoa. This function is carried out by ductus aeriosus. During intrauterine life only 10% of the cardiac output passes through the lungs the remaining 90% is shunted through the ductus aeriosus to the Aoa and the systemic circulation. After bih, the umbilical vein is cut off The blood must now pass through the lungs for oxygenation.Soon, after bih fetus stas breathing, the lung is filled with air and it expands. The pulmonary vasculature changes from high pressure circuit to low pressure circuit.Now, the fetal blood must pass through the lungs to facilitate proper gas exchange. In order to make this possible, the ductus aeriosus undergoes constriction, and functional closure occur soon after bih in term neonates. Eighty percent of the ductus aeriosus in term infants close by 48 hours and nearly 100% by 96 hours. Oxygen and endothelins are very strong vasoconstrictors and pro- staglandins E2 and 12 are strong vasodilator of the ductus aeriosus. During fetal life, the 02 concentration is Low and PGE2 and PGI2 level in high. This keeps the ductus aeriosus patent. Soon after bih there is sudden elevation in circulating oxygen tension and fall in prostaglandin levels. This results in strong vasoconstriction and functional closure of the ductus aeriosus soon after the delivery. The functional closure is followed by anatomic closure in the next 1-3 months.But in ceain infants the ductus aeriosus does not close after the bih it remains open and is called patent ductus aeriosus. Since after bih the systemic circulation has higher pressure than the pulmonary circulation the blood flows from Aoa to the pulmonary aery through the patent ductus aeriosus. Hemodynamic consequences of the PDA Shunting of blood from the systemic circulation to the pulmonary circulation results in congestive cardiac failure, which manifests clinically "with wide pulse pressure" and "bounding pulses". Overloading of the pulmonary vasculature leads to pulmonary edema/hemorrhage which predisposes the neonate to "chronic lung" disease (CO2 retention may occur). Blood flow to the kidney and gastrointestinal tract is compromised due to shunting of blood front systemic circulation, predisposing to acute renal failure (ARE) and "necrotizing enterocolitis (NEC) and metabolic acidosis". Hypoperfusion followed by reperfusion increases the risk of "Intraventricular hemorrhage" (1VH). Clinical features :- Hyperdynamic circulation A wide pulse pressure (> 25 mm Hg), prominent precordial pulsations and "bounding pulses"Q. An ejection systolic murmurQ heard best at the 2nd left parasternal area. Metabolic acidosis not attributable to hypoperfusion and sepsis. Deteriorating respiratory status on day 3-4 after a period of relative stability. Increasing ventilator requirements and recurrent apneas. Unexplained CO2 retention, fluctuating F102 requirements.


Question: Phocomelia is

Phocomelia is absence of long bones It occurs due to thalidomide consumption during pregnancy


Question: Nephrotic range of proteinuria is

Nephrotic range of proteinuria is > 40 mg/m2/hr or  > 1 gm/m2/24hrs.


Question: Grisel&;s syndrome is

Grisel's syndromeSpontaneous subluxation of the atlantoaxial joint following peri-pharyngeal inflammation is known as Grisel's syndrome Children are most frequently affected and classically have toicollis associated with neck stiffness or pain upon neck movement(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 3297, 3298)


Question: Very low birth weight child weights


Question: Not a feature of Cystic fibrosis among the following is

Azoospermia is seen in Cystic fibrosis, not Oligospermia.


Question: Treatment of choice in 11 years old children with hepatitic C infections

(Interferon) (216- Ghai 6th) (574- CMDT-8) (195-Ghai 7th)* Combined therapy with interferon a2 and ribavirin have yielded better results* Treatment of acute hepatitis C with peg interferon or interferon a for 6-24 weeks appreciably decreases the risk of chronic hepatitis* Ribavirin may be added if HCV DNA fails to clear after 3months of peg interferon or interferone a


Question: MCV (fl) in infant of 1 month of age is

MCV at bih will be about 100-110 will reduce to 80-100 by 5 years. MCV. 0-1 month 1-3 months 3-6 months 6 months-1 year. 88-123 91-112 74-108 70-85. femtoliters Reference: GHAI Essential pediatrics, 8th edition


Question: Sapropterin is used in the treatment of

Sapropterin, a synthetic form of tetrahydrobiopterin, which acts as a cofactor in patients with residual PAH activity, is approved by FDA to reduce phenylalanine levels in PKU. Galactosemia- Avoid milk & milk products. Hereditary Fructose Intolerance- Complete elimination of sucrose & fructose drom diet. Gaucher's disease- Enzyme replacement therapy.


Question: Treatment for childhood hypothyroidism is with

Levothyroxine is used for the treatment of childhood hypothyroidism.In case of congenital hypothyroidism,treatment should be staed immediately after diagnosis.The initiation dose is 10-15 microgram/kg/day.T4 & TSH are expected to normalise over one week and one month,respectively,with this treatment.Lifelong thyroid replacement is required for most cases. In acquired hypothyroidism,treatment should be gradual.A dose of 100 microgram/m2/day is recommended.Levothyroxine should be given empty stomach in the morning.Followup should be done every 3 months during the first 2 years of therapy and six monthly thereafter.Most children require lifelong therapy. Reference:Essential pediatrics-Ghai,8th edition,page no:517,518.


Question: Commonest location for Craniopharyngioma is

Commonest site of craniopharyngioma is Supra sellar region . Craniopharyngiomas are primarily suprasellar tumors (75%) while a small intrasellar component is present in 20-25% of cases . Purely intrasellar location is quite uncommon (<5%), and may be associated with the expansion of the pituitary fossa . Larger tumors can extend in all directions, frequently distoing the <a href=" chiasm or compressing the . Occasionally, craniopharyngiomas appear as intraventricular, homogeneous, soft-tissue masses without calcification (papillary subtype). The third ventricle is a paicularly common location. Reference: GHAI Essential pediatrics, 8th edition