Question: Breast milk is known to transmit

CMV has been demonstrated in breast milk. Approximately 2/3 of CMV-seronegative breast-fed infants may become infected with CMV. The risk is more in a preterm infant. Thus the use of fresh donor milk for feeding a preterm infant is contraindicated unless the milk is known to be CMV-negative.Ref: Page 215; Nelson textbook of pediatrics; 18th edition


Question: A child is below the third percentile for height. His growth velocity is normal, but chronologic age is more than skeletal age. The most likely diagnosis is

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. Constitutional growth delay:- These children are born with a normal length and weight and grow normally for first 6-12 months of life. Their growth then shows a decelration so that the height and weight fall below third centile. By 3 yr of age, normal height velocity is resumed abd they continue to grow just below and parallel to tge 3rd centile with a normal height velocity. Bone age is lower than chronological age and corresponds to the height age. History of delayed pubey and delayed height spu is usually present in one or both parents. Reference: GHAI Essential pediatrics, 8th edition


Question: The most common cause of Renal scarring in a 3 year old child is

vesicoureteral reflux (VUR) has been considered the most impoant risk factor for post-UTI renal scar formation in children. VUR predisposes children with UTI to pyelonephritis, and both are associated with renal scarring. Reference: GHAI Essential pediatrics, 8th edition

Vesicoureteral reflux induced pyelonephritis


Question: The site of occurrence of Subependymal Giant Cell Astrocytoma is

Subependymal Giant Cell Astrocytoma occurs in foramen of monro.


Question: H. influenzae has been isolated from the CSF of a 2 year old boy suffering from meningitis. The strain is beta lactamase producing and resistant to chloramphenicol, The most appropriate antimicrobial is

HI Inlluenzae type b produces J3 lactamases and therefore are resistant to ampicillin. These 3 lactamase producing strains remain sensitive to the extended spectrum cephalosporins * Ceftriaxone or cefotaxime IV are used as a single agents * Infections caused by ampicillin - resistant strains can be treated with 1. Trimethoprim - sulfamethoxazole 2. Amoxicillin I clavulanic acid 3. Extended spectrum cephalosporins 4. Azithromycin and clarithromycin * F'loraquin lones are highly active against H. influenzae but are not currently recommended for the treatment of children or pregnailt women because of possible effects on aicular cailage

Trimethoprim -- suiphamethoxazole combination


Question: Rose spot is associated with

a. Typhoid fever(Ref: Nelson's 20/e p 1390)Skin rash in Enteric fever:In 25% of cases, a macular or maculopapular rash (rose spots) may be visible around the 7th-10th day of the illnessLesions may appear in crops of 10-15 on the lower chest and abdomen and last 2-3 daysThese lesions may be difficult to see in dark-skinned children.

General Considerations - Infectious Diseases


Question: In morbus caeruleus foramen ovole closes after

In few cases, foramen ovale remains patent throughout life and gives rise to cyanosis, a condition called as Morbus caeruleus.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2162)


Question: Most common cause of abdominal mass in neonates is

Multicystic dysplastic kidney(MCDK) is a condition that results from the malformation of the kidney during fetal development. The kidneyconsists of irregular cysts of varying sizes. Multicystic dysplastic kidney is a common type of renal cystic disease, and it is a cause of an abdominal mass in infants. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common cause of hydronephrosis is children

In children Most common cause of hydrophosis is Pelvi Ureteric junction obstruction.


Question: During neonatal resuscitation, the chest compression to ventilation ratio is

It is important to ventilate in between chest compressions. A positive breath should follow every third chest compression(chest compression to ventilation ratio is 3:1).
In one minute, 90 chest compressions and 30 breaths are administered(120 events).
To obtain this, the chest should be compressed 3 times in 1.5 seconds leaving out approx. 0.5 second for ventilation.


Question: Not a feature of Hartnup's disease

In hartnup's disease, mental development is normal.


Question: The most common anomaly of the upper urogenital tract is

UPJ stenosis is the most common abnormality in childhood and is more frequent in male children, characterized by narrowing usually on the left sideOverall, position & shape of the kidney being most common oneHorseshoe kidney is the most common and most frequently found renal abnormality among men.(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 470)


Question: The umbilical cord is shed off by

The umbilical cord stump usually dries and shrivels up and is shed off by 1-2 weeksThe parents must look out for signs of redness, swelling, and edema with pus discharge around the stump. These might indicate infection-Omphalitis(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 890, 811)


Question: Pediatric airway differs from adult by

Airway: Pediatric Obligate nasal breatherLarge tongueLarynx & trachea are funnel-shapedThe narrowest pa is cricoid (glottis in adults)(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2036 - 2037)


Question: Most common cause of congenital hypothyroidism in

Congenital hypothyroidism:- The disorder encompasses a spectrum ranging from complete agenesis, paial agenesis to ectopic thyroid. Iodine deficiency is the commonest cause in endemic pas and thyroid dysgenesis is the most common etiology in non endemic areas. Clinical manifestations include hoarse cry, facial puffiness, umbilical hernia, hypotonia, mottling of skin and lethargy. Prolonged jaundice, constipation, and unexplained hypothermia may also indicate hypothyroidism. Open posterior fontanelle is an impoant indicator. History of maternal thyroid disease or ingestion of antithyroid medications enquired. Reference: GHAI essential Paediatrics


Question: Nephrotic syndrome in children is caused by

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: Not a criteria of J.R.A (Juvenile Rheumatoid Ahritis)

. juvenile Rheumatoid ahritis : age should be below 16 yrs Ref : Ghai pediatrics eighth edition pg no 625


Question: Hereditary spherocytosis is best tretaed with

Treatment of choice for hereditary spherocytosis is splenectomy especially in case of severe hemolysis,done after 6 years of age. The treatment of hereditary spherosytosis (HS) is dependent on the severity of the condition and recommendations vary a bit in the medical literature. In general, folate therapy (a type of vitamin B to suppo red blood cell production) is recommended for those with moderate to severe anemia, although some doctors may also recommend it for those with mild anemia. Red blood cell transfusions may be required in severe cases of anemia, paicularly in the first years of life or during infections and pregnancy. If red blood cell transfusions are needed repeatedly, iron chelating therapy may be required to reduce iron overload. Regular monitoring for anemia and gallstones is advised. Removal of the spleen (splenectomy) is usually only performed in severe HS or in moderate to severe cases with significant anemia and gallstone complications. Splenectomy is not recommended in cases of mild HS except in specific cases. The majority of medical researchers no longer recommend that the spleen be removed during gallbladder removal (cholecystectomy), unless there are other reasons to do so. In some cases only removing of pa of the spleen is advised. Expe evaluation is recommended in order to avoid unnecessary spleen removal. Reference: GHAI Essential pediatrics, 8th edition


Question: The amount of calories required at 1 year of age are


Question: Following is not a cause of stridor in infants


Question: % of children with Simple Febrile seizure developing Epilepsy is

Only 1-2% of children are developing simple febrile seizures The Risks For Developing Epilepsy : Problems with the child&;s development before the febrile seizure Having <a href=" or complicated febrile seizures that last longer than 15 minutes, more than one seizure in 24 hours, or seizures in which only one side of the body is affected Seizures without fever in a parent or a brother or sister If the child has none of these risk factors, the chances of epilepsy developing later are only 1% to 2% (1 or 2 out of 100). This is very similar to the risk of developing epilepsy in any other child. Children with 1 of these risk factors have a 2.5% (1 in 40) chance of later epilepsy. For children with 2 or 3 risk factors, their chance of developing epilepsy later ranges from 5% (1 in 20) to over 10% (greater than 1 in 10). In rare cases, febrile seizures that last more than 30 minutes may cause scar tissue in the temporal lobe of the brain. In some of these children, chronic epilepsy develops. Reference: GHAI Essential pediatrics, 8th edition


Question: Vaccine with maximum efficacy

b. Measles(Ref: Nelson's 20/e p 1546, Ghai 8/e p 145; IAP guidebook of Immunization 2013-14, p 222-223)Seroconversion rates after measles vaccination are around 60% at the age of 6 months, 80-85% at the age of 9 months and beyond 95% at the age of 12-15 months.


Question: Holt Oram syndrome is characterized by

Holt Oram syndrome:Hypoplastic or absent radii1st-degree hea blockASD(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 401)


Question: Type 1 diabetes in children is most commonly associated with

The estimated prevalence of celiac disease in patients with type 1 diabetes is approximately 6%, and about 1% in the general population. Type 2 diabetes does have genetic components, but they are not associated with celiac disease genes like type 1 diabetes&; . Reference: GHAI Essential pediatrics, 8th edition


Question: In Kawasaki disease, desquamation and denudation of skin from fingers and toes occurs in

The cause of Kawasaki disease isn&;t known. The body&;s response to a virus or infection combined with genetic factors may cause the disease. However, no specific virus or infection has been found, and the role of genetics isn&;t known. Kawasaki disease can&;t be passed from one child to another. Swelling and redness in hands and bottoms of feet, followed by sloughing of skin of hands and feet Redness in the eyes Enlarged glands, especially in the neck Irritated throat, inner mouth, and lips Swollen, bright red "strawberry tongue" <a href=" pain Stomach trouble, with diarrhea and vomiting Reference: GHAI Essential pediatrics, 8th edition


Question: Drug of choice for Infantile Spasm

Drug of choice for infantile spasm is ACTH. Infantile spasms (also called West syndrome) can be caused by brain malformations, infections, brain injury, or abnormal blood vessels in the brain. IS also can happen in babies with ceain metabolic and genetic disorders. In rare cases, a baby&;s infantile spasms are caused by vitamin B6 deficiency. Infantile spasms (IS) is a seizure disorder in babies. The Spasms sta suddenly and last a second or two. They often come one after another in a cluster that lasts several minutes. They happen most often just after waking. They&;re often mistaken for A baby having a spasm might have: the head bent forward with arms flung out and the knees pulled into the body (described as "jackknife") the head bent back with the arms and legs straightened small movements in the neck or other pas of the body The most common drugs used to treat West syndrome are: Adrenocoicotropic hormone (ACTH) Prednisone Vigabatrin Pyridoxine Reference: GHAI Essential pediatrics, 8th edition


Question: Commonest type of cong. cyanotic hea disease is

Most common cyanotic hea disease is tetrology of fallot encountered beyond the age of 1 yr constituting almost 75% of all blue patient. Ref : Ghai essential pediatrics,eighth edition, P.no:420


Question: 4 years old child having palpable abdominal mass & hypeension with sweating & diarrhea is due to

Neuroblastoma is a malignant tumor of autonomic nervous system.Clinical features are related to the localisation of the sympathetic nervous system and site of metastasis.The most common site is adrenal medulla.The patient can present with a localised abdominal mass ,sweating and hypeension due to the hyperstimulation of sympathetic nervous system.It is also characterised by watery diarrhea associated with VIP(vasoactive intestinal polypeptide) secretion by the tumor. Reference:Essential pediatrics-Ghai,8th edition,page no:616,617.


Question: Anatomical closure of Ductus Arteriosus takes place at

Functional closure happens 10-12 hours after birth. Anatomical closure takes place at 2-3weeks after birth.


Question: 11 hydroxylase deficiency leads to

Seen in Newborns and infants, Virilization and the presence of both hypeension and hypokalemia. 11 -deoxycoisol, 17a-hydroxyprogesterone, urinary 17- ketosteroids, and 17-hydroxycoicosteroids are increased. Blood levels and production rates of coisol are usually within normal limits. Physiologic replacement doses of glucocoicoid, such as hydrocoisone or dexamethasone, restores blood pressure to normal levels, corrects K+ depletion, Addition of estrogen-progestogen combined cyclic therapy may be necessary in the adult patient with 17a- hydroxylase deficiency. Reference: GHAI Essential pediatrics, 8th edition


Question: The ratio of chest compressions to ventilation in a newborn is

If the hea rate does not improve after 30 sec with bag-and-mask (or endotracheal) ventilation and remains below 100 beats/min, ventilation is continued and chest compression should be initiated over the lower third of the sternum at a rate of 90 compressions/min. The ratio of compressions to ventilation is 3 : 1 (90 compressions:30 breaths). If the hea rate remains <60 beats/min despite effective compressions and ventilation, administration of epinephrine should be considered.Ref: Nelson; 20th edition; Page no: 845


Question: In AML best prognosis is seen with

- Acute Promyelocytic Leukemia (APML): characterized by a gene rearrangement involving retinoic acid receptor It is very responsive to all-trans retinoic acid (ATRA, tretinoin) combined with anthracyclines and cytarabine. The success of this therapy makes Bone marrow transplantation unnecessary in 1st remission. Arsenic trioxide is also an effective non-cytotoxic therapy for APML


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

Galactosemia caused by the deficiency of enzyme GALT(galactose-1-phosphate uridyl transferase).Patients appear normal at bih,but by 3-4 days of breast milk,/formula feeding,show life threatening disease with vomiting,diarrhoea,poor weight gain,hepatic and renal manifestations and cataract.In case if suspected galactosemia,the urine should be tested simultaneously with Benedict reagent and by glucose-oxidase method.A negative dipstick by glucose oxidase method with positive Benedict reaction indicates nonglucose reducing substances,like galactose. Reference:Essential pediatrics-Ghai,8th edition,page no:657.


Question: For severe malnutrition MAC will be less than

For severe malnutrition, MAC is < 11.5 cm Severe acute malnutrition In a child between 6 months to 5 years of age, presence of any1 or more of- Weight for height < -3 Z score or < 70% of expected Mid arm circumference - < 11.5 cm Symmetric bipedal edema of nutritional origin Visible severe wasting;


Question: The recommended room temperature for maintaining warmth for neonates is

The recommended room temperature for maintaining warmth for neonates: 25 degree C.


Question: A child presented with cola coloured urine, proteinuria 2+ & h/o rash 2 week ago. Probable Dx

Ans: B (HSP) Gross hematuria (cola coloured urine) after upper respiratory tract infection; Time of latencyIgA nephropathy 1-2 days (Nelson 18th/2171)PSGN (After Pharyngitis or impetigo): 7-21 days (Nelson 18th/ 2171)HSP: 1-3 wk upto 12 wks (Nelson 18th/2179); also presents with systemic feature like rashHenoch-Schonlein Purpura (HSP); Short reviewIt is a systemic vasculitis that causes the blood vessels in the skin to become inflamed, causing red spots. When the blood vessels in the skin get inflamed, they can bleed, causing a rash that is called Purpura. This rash is typically seen on the lower legs or arms. The specific skin lesion is characterized by the tissue deposition of an immune system product, called IgA immunoglobulin, which is also found in kidneysof patients with a renal disease, called IgA nephropathy.HSP occurs more often in children than in adults, and many cases follow an upper respiratory tract infection (infection in your sinuses and /or lungs). Halfof affected children are under age five, although kidney involvement is more likely to be severe in older children. Compared to children, adults had more severe and frequent kidney involvement.Symptoms occur over a period of days to several weeks: Skin rash, joint aches and pains, usually in knees and ankles, occasional swelling, abdominal pain and renal disease manifesting mostly as hematuria (blood in your urine), proteinuria (abnormal excretion of proteins in urine), edema (swelling) or alteration in the volume of urine. The hematuria may be noticed as red or tea-colored or cola-colored urine or the amount may be so small that it can only be seen under a microscope. The brain or the lung may also be involved in HSP.Even though the symptoms of HSP make it easier to diagnose in children, confirmation of the diagnosis of HSP requires evidence of tissue deposition in the skin or kidney of IgA immunoglobulin. Renal biopsy is another method to establish the diagnosis, but is reserved for patients in whom the diagnosis is uncertain or in whom there is evidence of more severe renal involvement.


Question: In congenital adrenal hyperplasia most common deficiency

Ans) a (21- alpha ) Ref Nelson 18'h ed p 2360More than 90% of CAH cases are caused by 21 -hydroxylase deficiency.


Question: Most common cause of Hemolytic Uremic Syndrome is

Hemolytic-uremic syndrome (HUS) often occurs after a gastrointestinal infection with E coli bacteria (Escherichia coli O157:H7). However, the condition has also been linked to other gastrointestinal infections, including shigella and salmonella Causes Hemolytic-uremic syndrome (HUS) often occurs after a gastrointestinal infection with E coli bacteria (Escherichia coliO157:H7). However, the condition has also been linked to other gastrointestinal infections, including HUS is most common in children. It is the most common cause of acute kidney failure in children. Several large outbreaks have been linked to undercooked hamburger meat contaminated with E coli. E coli can be transmitted through: Contact from one person to another Consuming uncooked food, such as milk products or beef STEC-HUS is not to be confused with atypical HUS (aHUS) which is not infection-related. It is similar to another disease called <a href=" thrombocytopenic purpura (TTP). Reference: GHAI Essential pediatrics, 8th edition


Question: Hutchinson's teeth are seen in

It is a common pattern of presentation for congenital syphilis, and consists of three phenomena aka Hutchinson triad:

Interstitial keratitis
Hutchinson incisors
Eighth nerve deafness.


Question: In Glanzman's thrombasthenia, there is a defect of

Glanzman's thrombasthenia

Platelet aggregation defect
IIb / IIIa Gp deficient


Question: The most common paediatric cardiac tumour among the following is

The vast majority of tumours originating from the hea are benign. Rhabdomyomas are the most common pediatric cardiac tumours and are associated with tuberous sclerosis in 70-95% of cases. Rhabdomyomas may occur at any age, from fetal life through late adolescence. They are often multiple, can occur in any cardiac chamber, and originate within the myocardium extending, often, into the atrial or ventricular cavities. Depending on their location and size, they can result in inflow or outflow obstruction leading to cyanosis or cardiac failure; many are asymptomatic. Atrial and ventricular arrhythmias have been repoed with rhabdomyomas, and on occasion, ventricular pre-excitation (Wolff-Parkinson-White) is present on electrocardiogram. Reference: Nelson; 20th edition; Page no: 2281


Question: Edema of hands & feet in infants is characterised

Edema of hands and feet is associated with turner syndrome. Turner syndrome is identifiable at bih by presence of LYMPHEDEMA ,cystic hygroma and left sided obstructive cardiac lesions. Reference : Ghai TB of pediatrics 8th edition pg 537.


Question: The given clinical condition may present with

This is Vein of Galen Malfomation:
Anamolous Vein of Galen ⇒ No Capillaries Blood flow directly from artery to vein
↓
Heart is subjected to hight pressure leading to congestive cardiac failure.


Question: Risk of Down's syndrome in Elderly (>35 years)

Risk of Down's syndrome in Elderly (>35 Years) is 1% - 4%.


Question: Risk of congenital heart disease in first degree relative is

Ans. b (2 to 6%). (Ref. Nelson, Textbook of Paediatrics, 18th/pg. 1878)Congenital heart disease occurs in# 0.5 to 0.8% of live births.# 3 to 4 % of stillboms.# 10 to 25% of abortuses.# 2% of premature infants (except PDA)# 0.8% of normal population.# 2-6% after birth of a child with CHD or if parent affected.# 20-30% when 2 first-degree relatives have congenital heart disease.NOTE: Most congenital defects are well tolerated in the fetus because of the parallel nature of the fetal circulation. Even the most severe cardiac defects (hypoplastic left heart syndrome) can usually be well compensated for by the fetal circulation. It is only after birth when the fetal pathways (ductus arteriosus and foramen ovale) are closed that the full hemodynamic impact of an anatomic abnormality becomes apparent. One notable exception is the case of severe regurgitant lesions, most commonly of the tricuspid valve. In these lesions (Ebstein anomaly), the parallel fetal circulation cannot compensate for the volume load imposed on the right side of the heart. In utero heart failure, often with fetal pleural and pericardial effusions, and generalized ascites (nonimmune hydrops fetalis) may occur.


Question: Least common valve involved in rheumatic fever is

Endocarditis in rheumatic feverMitral valve involved almost all the cases of Acute Rheumatic FeverAlmost 25% of MR is associated with aoic regurgitationTricuspid regurgitation is seen in 10-30% of casesPulmonary valve involvement is never seen(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1333 - 1335)


Question: Coaaction of aoa is associated with

Coarctation of aoa is association with bicuspid aoic valve. Ref : Ghai essential of pediatrics, eighth edition, p.no:432


Question: In full term neonates, the ductus aeriosus closure is due to

High pressure O2 can cause the closure of ductus aeriosus. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common vasculitis in children

UPDATE- Most common vasculitis in children Kawasaki Disease.


Question: Traetment of choice in brochiolitis in

Antibiotics have no role. Ribavirin an antiviral agent has no role in treatment of infants who were previously healthy.It shoens the course of illness in infants with underlying congenital hea disease, chronic lung diseases,and immunodeficiency.Ribavirin is delivered by a nebulizer 16 hours a day for 3-5 days in such cases. Ref : Essential Pediatrics,O.P.Ghai,7t edition,pg no:358


Question: A 5 year old child presents with perivascular IgA deposition and neutrophilic collection. There is erythematous rash on the lower limb and nonblanching purpura. Probable diagnosis is

Henoch schonlein purpura : It is one of the most common vasculitic disorder of childhood. Characterised by the presence of nonthrombocytopenic , palpable purpura, transient ahralgia and abdominal symptoms. The illness begins with a rash more prominent over the extensor aspects of lower extremities and buttocks. It may be macular, maculopapular or even uicarial to begin with . Glomerulonephritis seen in one third of cases. Gastrointestinal manifestations usually occur in first 7-10 days if illness. Abdominal pain is intermittent, colicky and periumbilical.vomitingseen , whereas melena and hemetemesis are less common. Rare manifestations include CNS vasculitis, coma, Guillain Barre syndrome, pulmonary hemorrhage, carditis and orchitis. Criteria for childhood HSP:- Palpable purpura in the presence of at least one of the following 4 features: 1. Diffuse abdominal pain. 2. Any deposit showing IgA deposition. 3. Ahritis/Ahralgia. 4. Renal involvement. Investigation: Nonspecific rise in total serum IgA levels. Skin biopsy shows leukocytoclastic vasculitis. On indirect immunofluorescence there are mesangial deposits of IgA andC3 in skin and renal biopsy. Reference: GHAI essential Paediatrics


Question: The following rashes seen in a previously well 5 month old child can be treated by administration of

Deficiency of zinc leads to Acrodermatitis enteropathica -rashes seen especially around the orifices. Acrodermatitis enteropathica is a genetic AR disorder Characterized by periorificial dermatitis, alopecia, and diarrhea. Caused by mutations in the gene that encodes a membrane protein that binds zinc in the intestine. Treatment - Oral zinc supplementation


Question: Best indicator of growth monitoring in children

Rate of increase in height or weight as age advances- Best indicator of growth monitoring in children Uses of growth cha:- 1) For growth monitoring 2) Diagnostic tool for identifying "high risk" children 3) Planning and policy making 4) Education tool 5) Tool for action Mid arm circumference, Body weight and chest circumference are one time point estimates therefore they are not adequate to provide information about long term nutritional status of the child.


Question: Neonate with retrolental fibroplasia is associated with

Retrolental fibroplasia- Abnormal proliferation of fibrous tissue immediately behind the lens of the eye, leading to blindness. This is mostly due to excessive administration of oxygen in premature babies. Image : Retrolental fibroplasia or Retinopathy of prematurity Reference: GHAI Essential pediatrics, 8th edition


Question: Most common cause of cushings syndrome is

Most common cause of Cushing's syndrome is prolonged administration of glucocorticoid harmones.


Question: A 10 year old boy presents with mucosal bleeding of 1 week duration. The investigation of choice that will be most useful in him is

In case of platelate disorder site of bleeding is usually skin and mucous membrane. where as in coagulation disorder bleeding will be from soft tissue,muscle,joint and deep sites. Platelet count is the investigation of choice in this case . Reference: GHAI Essential pediatrics, 8th edition


Question: The most sensitive Indicator of Depletion of intravascular volume in infant is

The most sensitive indicator of depletion of intravascular volume in infant is Hea rate. Reference: GHAI Essential pediatrics, 8th edition


Question: A child is hepatitis B immunized the marker for seroconversion is

i.e. (Anti HBs Ag): (193- Ghai 7th)Common sero pattern of hepatitis B infectionHBsAgAnti HBsAnti HBcHBeAgAnti HBeInterpretation+-IgM+-Acute infection--IgM+/-+/-Acute infection anti HBC window+-IgG+/--Chronic infection; high infectivity+-IgG-+Chronic infection; low infectivity+-+ /---Precore/ Cor mutant infection-+IgG-+/-Recovery from infection-+ --Immunization; false positive; infection in remote past


Question: The most common congenital cardiac lesion identified at bih is

Ventricular Septal Defect (VSD) This is the most common congenital cardiac lesion identified at bih accounting for one-quaer of all CHD. VSD is a communication between the two ventricles. 90% are located in the membranous pa of the ventricular septum with variable extension into the muscular septum. Others are located in the muscular septum and can be multiple. Reference: Essential Paediatrics; O.P. Ghai; Page no: 414


Question: Most common type of AML in Down's syndrome

- Megakaryocytic maturation AML - Most common AML in Down's syndrome. - Blast cells in these patients are highly sensitive to medications - show better outcome than AML in those without Trisomy 21.


Question: The features of Hemolytic Uremic Syndrome in children include

Hemolytic-uremic syndrome (HUS) is a group of blood disorders characterized by low red blood cells, acute kidney failure, and low platelets. Initial symptoms typically include bloody diarrhea, fever, vomiting, and weakness.Kidney problems and low platelets then occur as the diarrhea is improving.While children are more commonly affected, adults may have worse outcomes.Complications may include neurological problems and hea failure. Reference: GHAI Essential pediatrics, 8th edition

"Helmet cells" in peripheral blood smear


Question: Hutchinson teeth are seen in

(Congenital syphilis) (1265- Nelson 18th)HUTCHINSON TEETH - which arc the peg or barrel shaped upper central incisors that erupt during the 6th year of life: abnormal enamel, which results in a notch along the biting surface, seen in Late manifestation of congenital syphilisEarly manifestations of congenital syphilis* Approximately 66% of infected ifants are asymptomatic* Hepatosplenomegaly jaundice, elevated liver enzymes are common* Lymphadenopathy to be diffuse, shotty nodes may persist* Coombs negative hemolytic anemia, Thrombocytopenia* Osteochondritis, periostitis* Limbs are held immobile due to excruciating pain (pseudo paralysis of parrot)*** Mucous patches, rhinitis (snuffles)* and condylomatous lesions are highly characteristic* CNS abnormalities, failure to thrive, chorioretinitis, nephritis and nephritic syndrome* Renal involvement include - hypertension, hematuria, proteinuria, hypoproteinemia, hypercholesterolemia, and hypocomplementemia* Less common clinical manifestations - gastroenteritis, peritonitis, pancreatitis, pneumonia, eye involvement glaucoma and chorioretinitis) nonimmune hydrops and testicular masses.Late manifestations of congenital syphilis* Frontal bossing, a bony prominence of the forehead (Olympian brow), unilateral or bilateral thickening of the sternoclavicular third of clavicle (Clavicular or Higoumenaki'sign)* Saber shins, scaphoid scapula, Hutchinson teeth, mulbeny molars* Saddle nose, Rhagedes, Juvenile paresis - Juvenile tables* Hypersensitivity phenomenon - interstitial keratitis, blindness less common ocular manifestations include - choroiditis, retinitis, vascular occlusion and optic atrophy, eighth nerve deafness* Clutton joint - U/L or B/L synovitis usually in the knee painless, soft tissue gammas, paroxysmal cold hemoglobinuria (rare)Hunterian chancre single painless, regular indurated reddish brown plaque seen in primary syphilis* Congenital varicella syndrome is characteristically associated with limb reduction defects and scarring of skin* Classical Tetrad of congenital Toxoplasmosis* Hydrocephalus or Microcephaly*** Chorioretinitis* Convulsions (seizures)* Cerebral calcifcations*RUBELLA - is a teratogenic virus* can be transmitted from fetus to mother. The rate of transmission and congenital defects maximum in first trimester infections (hearing loss) * Under eradication of congenital rubella syndrome programme the first priorty group of rubella vaccination is- All non pregnant women of age 15 to 34 years*** Most common congenital defects are deafness, cardiac malformations and cataractsOther resulting from defects include - glaucoma, retinopathy microcephalus, cerebral palsy, IUGR, hepatosplenomegaly mental and motor retardation"Chancre- redux" is a clinical feature of early relapsing syphilis at the site of the healed lesionTerm "Viable not cultivable" (VNC) is used for T.pallidum. M. leprae


Question: Most common cause of seizure in newborn is

Most common cause of seizure in first day of new born baby is anoxia ,hypoxia induced ischemic Symptomatic neonatal seizures may be caused by: lack of oxygen before or during bih because of problems such as placental abruption (premature detachment of the placenta from the uterus), a difficult or prolonged labour, or compression of the umbilical cord infection acquired before or after bih, such as bacterial (a blood clot in the brain) bleeding in the brain congenital brain abnormalities, either genetic or acquired during fetal development, such as tuberous sclerosis blood sugar or electrolyte imbalances, including hypoglycemia (low blood sugar), hypocalcemia (low calcium), hyponatremia (low sodium), or hypernatremia (high sodium) metabolic problems, such as maple syrup urine disease, pyridoxine dependency, or <a href=" (PKU) drug withdrawal, which may be seen in infants born to mothers addicted to barbiturates, alcohol, heroin, cocaine or methadone Reference: GHAI Essential pediatrics, 8th edition


Question: Drug dosage best decided in child by


Question: Fluid of choice in child with burn < 24 hour is

Ans. is 'c' i.e., Ringer lactate Fluid resuscitation in burn injury Parkland formulaa a. Initial 24 hours: Ringer's lactated (RL) solution 4 ml/kg/% burn for adults and 3 ml/kg/% burn for children. RL solution is added for maintenance for children: 4 ml/kg/hour for children weighing 0-10 kg 40 ml/hour +2 ml/hour for children weighing 10-20 kg 60 ml/hour + 1 ml/kg/hour for children weighing 20 kg or higher This formula recommends no colloid in the initial 24 hours. b Next 24 hours: Colloids given as 20-60% of calculated plasma volume. No crystalloids. Glucose in water is added in amounts required to maintain a urinary output of 0.5-1 ml/hour in adults and 1 ml/hour in children.


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

Autistic disorder:- Pervasive developmental disorders. Also called autistic spectrum disorders, cluster of syndromes that share marked abnormalities in the development of social and communicative skills. Symptoms: Qualitative impairment in social interaction as manifested by two of the following- impairment in use of multiple non verbal behaviors( eye gaze, facial expression, body postures) , failure to develop peer relationships, lack of sharing of enjoyment, lack of social or emotional reciprocity. Qualitative impairment in communication in at least one of the following areas- delay or total lack of spoken languages, marked impairment in the ability to initiate or sustain a conversation with others, stereotyped or repetitive use if languages and lack of varied spontaneous play. Restricted repetitive and stereotyped patterns of behaviors, interests, and activities as manifested by preoccupation with one or more restricted patterns of interests; inflexible adherence to nonfunctional routines or rituals ; repetitive motor mannerisms( such as rocking, hand flipping, finger flicking) and preoccupation with pas of objects. Intelligence is variable. Reference: GHAI Essential pediatrics, 8th edition


Question: Hypoglycemia is defined as a blood glucose value of less than

Hypoglycemia is defined as a blood glucose value of less than 40 mg/ dl (plasma glucose of less than 45 mg/ dl). These babies should be screened for hypoglycemia at 2, 6, 12, 24, 48 and 72 hr after bih with reagent strips (dextrostix).Babies showing blood sugar value of less than 40 mg/ dl on reagent strip should be treated for hypoglycemia but should have confirmation of hypoglycemia by a lab test Appropriate for gestational age babies who are breastfeeding adequately do not require any screening for hypoglycemia.Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 179


Question: A child , Names 4 colours by the age of

Emerging patterns for language behaviour from 1-5years of age 15months Jargon Follows simple commands May name a familiar object (e.g., ball) Responds to his/her name 18months 10 words (average) Names pictures Identifies 1 or more pas of the body 24months Puts 3 words together (subject, verb, object) 30months Refers to self by the pronoun "I" Knows full name 36months Knows age and sex Counts 3 objects correctly Repeats 3 numbers or a sentence of 6 syllables Most of the speech intelligible to strangers 48months Counts 4 pennies accurately Tells story 60months Names 4 colours Repeats sentence of 10 syllables Counts 10 pennies correctly Ref: Nelson paediatrics; Table 11-1


Question: Neonatal period extends upto

Neonatal period extends from bih to <28 days (under 4 wks) of age. First week of life(<7days or <168 hrs) is known as early neonatal period. Late neonatal period extends from 7th day to <28th day. Reference : page 124 Ghai Essential Pediatrics 8th edition


Question: Aneurysm of anterior Cerebral circulation is associated with

Saccular Aneurysm of anterior Cerebral circulation, Valvular abnormalities are seen in Autosomal dominant PCKD.


Question: Pastia's lines are seen in

Pastia's lines :

Rash gets concentration in axilla and grain.
It is seen in Scarlet fever.


Question: Treatment of TOF

Ans. is 'a' i.e., Modified BT shunt Tetrology of fallot Cyanonic hea disease (MC). Defect in infundibular septum leads to : Pulmonary stenosis. VSD (Not ASD) Dextroposition and overriding of aoa. Right ventricular hyperophy (NOT LVH). Pink TOF (Acyanotic TOF) when PS is mild to moderate, balanced shunt across the VSD, pt does not have cyanosis. The modified Blalock-Taussig shunt is currently the most common aoopulmonary shunt procedure and consists of a Gore-Tex conduit anastomosed side to side from the subclan aery to the homolateral branch of the pulmonary aery Fontan procedure - Pulmonary ateria with intact uentricular septum. Glenn shunt - Anastomosis between SVC and pulmonary aery (tricuspid atresia) Rastelli operation - Double outlet right ventricle with pulmonary stenosis


Question: Measles virus is

Measles (rubeola) is caused by an RNA virus belonging to the Paromyxovirus family. The virus is transmitted by droplet spread from the secretions of the nose and throat usually 4 days before and 5days after the rash. Virus multiplies in the respiratory epithelium. Reference: Essential pediatrics,op ghai,9 th edition, pg no:209


Question: Frequent relapse in Nephrotic syndrome implies

Frequent relapse : 2 or more relapse in 6 months of initial response  , 4 or more relapse in any 12 month period.


Question: 5 years old child presented with generalised edema and ascites there was no hypertension or hematuria Renal function tests were normal . Urinalysis revealed massive proteinuria . Most probable diagnosis is

All the above features suggest Nephrotic syndrome Most common cause is Minimal Change disease.


Question: In TGA, position of aoa is

Ans. is 'd' i.e., Anterior and right to pulmonary aery o In TGA aoa lies anterior and to the right of pulmonary aery.

Anterior and right to pulmonary aeryTA PVC


Question: Hyalin emembrane disease presents as

In hyaline membrane disease the basic pathology is surfactant defeciency.surfactant is a lipoprotein containing phospholipids like phosphatydylcholine and phosphatydylglycerol. Surfactant is produced by type ll alveolar cells of lungs which helps to reduce surface tension in alveoli,in its absence surface tension increases and alveoli tend to collapse during expiration.During inspiration more negative pressure is needed to keep alveoli patent.There is inadequate oxygenation and increased work for breathing. Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:143, 7th edition


Question: Most dangerous Osteogenesis Imperfecta (OI) in utero foetus

(C) Type 3 OI# Osteogenesis Imperfecta (OI): 4 different genes responsible for collagen production, and any combination, or all, of them can be affected. These combinations produce eight types of brittle bone disease, labeled as type 1 OI through type 8 OI. The first four types are the most common. Last 4 types are extremely rare and most are subtypes of type 4 OI.> Type 1 OI is the mildest and most common form of brittle bone disease your baby can have. With this type, your child's body produces normal quality collagen, but just not enough of it.> Type 2 OV, the most severe form of brittle bone disease, is fatal. In type 2 OI, your child's body either produces poor-quality collagen or not enough of it. Type 2 OV can produce bone deformities.> Type 3 OI is a severe form of brittle bone disease that also causes bones to break easily. In Type 3 OI, your child's body procuces enough collagen, but it is of poor quality. A baby's bones can even begin to break before birth.> Type 4 OI is the most variable form of brittle bone disease because its symptoms range from mild to severe


Question: In wood lamp examination,Tinea versicolor looks like

Tinea versicolor is caused by Malassezia furfur. examination shows a golden yellow fluorescence under ultraviolet light of Wood&;s lamp. Reference : Anathanarayan & paniker&;s 9th edition, pg no:615


Question: Hindmilk is richer in

Hindmilk comes later towards the end of the feed and is richer in fat that provides more energy and gives a sense of satiety.Ref: Page 153; Ghai Essential Pediatrics; 8th edition


Question: Most common extracranial solid tumor in children is

Neuroblastoma is the most common extracranial solid tumor in children and the most commonly diagnosed malignancy in infants. Reference: Nelson; Neuroblastoma; Page no: 2461


Question: Perifascicular Atrophy is seen in

.It acts mostly like an autoimmune disorder. That means your body mistakes its own tissues as the enemy and attacks itself. When you have dermatomyositis, yourimmune system goes after the blood vessels inside your muscles and the connective tissues in your skin. The pathology of dermatomyositisincludes inflammation, vasculitis, and perifascicular atrophy. ... A distinctive feature ofdermatomyositis is atrophy and degeneration of myofibers at the periphery of fascicles (perifascicular atrophy-PFA), which occurs even in absence of inflammation


Question: Meningomyelocele with progressive hydrocephalus is commonly seen in

Hydrocephalus + Meningomyelocele ⇒ Seen in Arnold chiari II


Question: Klinefelter syndrome is diagnosed by

Persons with Klinefelter syndrome are identified with the help of karyotyping. 80% of children with klinefelter syndrome have a male karyotype of X-47,XXY,while the remaining 20% have multiple sex mosaicism or structurally abnormal X chromosome Reference: (Nelson TB of pediatrics pg 410 edition 19.


Question: 24 hour normal fluid requirement for a one year old child weighing 8 kg is

Ans: (b) 800 mlRef : OP Ghai 8th ed./73f 293The fluid requirement of children less than 10 kg is 100ml per kg of body weight. The preffered fluid shall be N/5 in 5% dextrose with added potassium for daily requirements.


Question: APGAR score include A/E

Apgar score is an objective method of evaluating the newborn&;s condition. It includes Hea rate, Respiratory effo, Muscle tone, Reflex irritability and Color. It is generally performed at 1min and again at 5 min after bih. Reference : page 126 Ghai Essential Pediatrics 8th edition


Question: The most common presentation of hypoparathyroidism beyond the neonatal period is

In postnatal period hypoparathyroidism presents with tetany of hands and feet,resulting in carpopedal spasm. Hyperreflexia due to hypocalcemia is common. Trousseau sign is a carpopedal spasm that occurs after a blood pressure cuff around the arm is inflated above the systolic blood pressure for several minutes. Chvostek sign (ie, twitching of ipsilateral facial muscles with tapping on the facial nerve in front of the ear and just below the zygomatic bone) is a manifestation of neuromuscular excitability. Chvostek sign is present in 25% of healthy adults and in even higher rates in children. Thus, its presence or absence should be documented prior to thyroidectomy. Reference: Ghai essential of pediatrics, eighth edition, p.no:521.

Syncope secondary to prolonged QT intervals


Question: Most common organism associated with cystic fibrosis

Pseudomonas may colonise s of patients with cystic fibrosis and causes recurrent pulmonary exacerbations. Ref : Essential pediatrics,O.P.Ghai,7 th edition,pg no:355


Question: Down&;s syndrome most commonly occurs due to

Down syndrome occurs due to trisomy 21. In 97% of cases it occurs as result of non dysfunction of chromosome during maternal meiosis. Reference : Nelson TB of pediatrics 19th edition pg 402.


Question: Most commonly associated disorder with Down's syndrome among the following is

Among the following options, Early onset Alzheimer's disease is most appropriate.

AML & ALL have equal incidence
Duodenal atresia is most Common GI disorder associated with Down's syndrome.
Early onset Alzheimer's disease (Pre-senile Alzheimer's in associated with Down's syndrome.


Question: Most common inherited cause of Intellectual disability

Most common inherited caused of Intellectual disability is Fragile X syndrome.


Question: Congenital dislocations


Question: Most common cause of convulsion on the First day of life in a newborn is

Most common cause of seizure in first day of new born baby is anoxia ,hypoxia induced ischemic. Symptomatic neonatal seizures may be caused by: lack of oxygen before or during bih because of problems such as placental abruption (premature detachment of the placenta from the uterus), a difficult or prolonged labour, or compression of the umbilical cord infection acquired before or after bih, such as bacterial (a blood clot in the brain) bleeding in the brain congenital brain abnormalities, either genetic or acquired during fetal development, such as tuberous sclerosis blood sugar or electrolyte imbalances, including hypoglycemia (low blood sugar), hypocalcemia (low calcium), hyponatremia (low sodium), or hypernatremia (high sodium) metabolic problems, such as maple syrup urine disease, pyridoxine dependency, or <a href=" (PKU) drug withdrawal, which may be seen in infants born to mothers addicted to barbiturates, alcohol, heroin, cocaine or methadone Reference: GHAI Essential pediatrics, 8th edition


Question: Holt oram syndrome is characterised by

Holt or am syndrome characterized by ASD. Ghai essential of pediatrics, eighth edition, p.no:401,table 15.7


Question: Pneumatoceles often develop in children after pneumonia due to the following organism

Radiological signs are extensive in a form of massive consolidation.E.coli,Klebsiella ,staphylococcus pneumonia have pneumatoceles. Ref : Essential pediatrics,O.P.Ghai,7 th edition,pgno:355


Question: 1st Visible sign of puberty in males is

Tanner's staging in Males
Stage I :
Testicular size < 4ml
Stage II :
Sparse hair growth
Scrotum and testis (>4ml) enlarge
Stage III :
Hair growth darkens
Penis grows in lenght
Stage IV :
Hair growth becomes dense and coarse
Scrotum and penis continues to grow
Growth spurt occurs
Stage V :
Hair growth extend to inner thigh
Genitalia reaches adult size

Testicular enlargement > 3ml in Stage III

Testicular enlargement > 4ml in Stage II


Question: 5 year old child with pseudomembrane in throat, fever, sore throat, the organism causing is

Corynebacterium diphtheriaNon-motile, non-capsulated, club-shaped gram-positive bacillusInfect nasopharynx & release exotoxin which cause local inflammation of epithelial surface, the formation of a membrane (pseudomembrane) and toxemia.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1345 - 1348)


Question: Wimberger sign of Scurvy is defined as

Sclerotic rim around epiphyseal centre of Ossification


Question: Calorie requirement per a day of a child weighing 15 kg would be

We draw the energy from our food: The nutrients are transpoed to the body cells in the digestive tract after splitting up and are broken down there. This releases the required energy. They are measured in kilojoule (kJ) or kilocalories (kcal). One kilocalorie corresponds to 4,184 kilojoules. The calorie though is an outdated unit of measurement and was replaced in scientific use by the joule. In common parlance, calories are still often used. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common cause of Pyogenic Meningitis in 6 month to 2 years of age is

Bacterial meningitis is caused by several different types of bacteria, including: Streptococcus pneumoniae, also called pneumococcus. Neisseria meningitidis, also called meningococcus. Haemophilus influenzae, also called Hib. Listeria monocytogenes. group B strep E. coli. Reference: GHAI Essential pediatrics, 8th edition


Question: Treatment of Rolandic epilepsy is

Rolandic epilepsy otherwise called as benign childhood epilepsy with centrotemporal spikes.It typically stas during childhood and is outgrown in adolescence.The child typically wakes up at night due to focal seizures causing throat tingling and tonic/clonic contractions of one side of the face with preserved consciousness.Seizure syndromesDrug of choiceROLANDIC EPILEPSYCARBAMAZEPINEWEST SYNDROME/ INFANTILE SPASMSACTH(FIRST CHOICE)VIGABATRIN(SECOND CHOICE)VALPROATE/CLONAZEPAMDRAVET SYNDROMEVALPROATE/CLONAZEPAM


Question: Treatment in days for meningitis caused by Streptococcus pneumonia in children is

The child with bacterial meningitis shows improvement in 10 days and rarely necessary beyond 14 daysStaph meningitis and gram-negative infection require treatment for 21-28 daysN.meningitis- Penicillin for 5-7 daysH. Influenza- for 7-10 days(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1317)


Question: In Kawasaki disease, desquamation and denudation of skin from fingers and toes occur at

Kawasaki disease can be divided into 3 clinical phases:Clinical phasedurationClinical featuresAcute febrile phase1-2 weeksfeverSubacute2-3 weeksDesquamation and peeling of fingers and toesCoronary aery aneurysmHigh risk of sudden deathConvalescence6-8weeksrecoveryKawasaki disease- Clinical Criteria1. Fever persisting at least for 5 days2. Presence of at least 4 of the following features. a) Changes in extremities:Acute: erythema of palms, soles, edema of hands and feetsSubacute: periungual peeling of fingers, toesb) Polymorphous exanthemac) Bilateral nonexudative bulbar conjunctival injectiond) Changes in lips and oral cavity(erythema, strawberry tongue)e) Cervical lymphadenopathy( unilateral and >1.5cm diameter)Other Features:GIANT CORONARY AERY ANEURYSMS (>8mm internal diameter)Thrombocytosis after 1st weekInduration of BCG inoculation site


Question: In developmental milestones of children, first draws

(A) Zero > Scribbling on paper with a crayon or pencil. The child scribbles spontaneously by 12-24 months, copies arid draws a horizontal or vertical line at 2 years; a circle by 3 years, a cross (plus sign) by 4 years and tilted cross (multiplication sign) by 5 years. He can draw a rectangle by the age of 4 years and a triangle by 5 years.


Question: Deep white matter lesion with bilateral deep bright thalamic appearance is suggestive of

Ans. is 'c' i.e. Krabbe's disease Deep white matter lesion along with the involvement of thalamus suggests Krabbe's disease.Krabbe's disease is a leukodystrophy.LeukodystrophyIt is a term commonly used to refer to demyelination disorders.They are mainly due to genetic defects in the formation and maintenance of myelin.They usually present in infants and children with increasing development delay, progressive dementia and neurological deficit.These disorders are inherited as autosomal recessive trait and are associated with lysosomal enzyme deficiencies.They include the following disorders:-Metachromatic leukodystrophyGloboid leukodystrophy (Krabbe's disease)Spongiform degeneration (Canavan's disease)T. scan of leukodystrophies:-C. T. scan of the leukodystrophies shows low density areas in the white matter which are bilateral but not necessary symmetric and becomes more extensive as the disease process progresses.Krabbe's diseaseIt occurs due to deficiency of the enzyme P-galactocerebroside.It presents in infancy with retardation and spasticity.CT scan appearance of Krabbe's diseaseB/L symmetrical hypodensities in both frontoparietal and occipital regions in the white matter zone.Both thalamus and basai ganglia are hyperdenseCerebellum unaffected, ventricles normal, septum midlineMetachromatic leukodystrophyIt is a common leukodystrophy which commences in infancy.It occurs due to deficiency of the enzyme Arylsulphatase A.C. T. shows diffuse symmetric attenuation of the cerebellar and cerebral white matter.Alexander's diseaseIt is one of the few leukodystrophies that occurs sporadically and is characterized histopathologically by the abundant presence of Rosenthal fibres in the affected brain.Definitive diagnosis thus depends on brain biopsy.It occurs due to mutation in glial fibrillary acidic protein (GFAP).C. T. scan demonstrates degeneration of the white matter most prominent in the frontal lobes.Canavan's diseaseIt occurs due to deficiency of the enzyme aspart acylase leading to accumulation of N-Acetyl aspartic acid in the brain.C. T. scan shows diffuse white matter degeneration primarily in the cerebral hemispheres with less involvement in the cerebellum and brainstem.


Question: Only congenital cyanotic heart disease with Left Ventricular hypertrophy and Left atrial enlargement

Tricuspid atresia→blood from Right atrium to Left atrium→more blood to Left atrium leading to Left atrial enlargement→more blood to left Ventricle leads to left ventricular hypertrophy.


Question: Liver and spleen produce RBC's for

Ans. a (Prenatal life). (Ref. Nelson, Paediatrics, 17th/pg.l599; Dutta, Obst., 4th/pg.42)DEVELOPMENTAL HEMATOPOIESIS OCCURS IN ANATOMICAL STAGESMesoblasticHepaticMyeloidYolk sacLiverBone marrow10-14th day to 10-12 weeks6-8 weeks to throughout the gestation5th month to throughout life long


Question: Patau syndrome feature include A/E

Patau syndrome is due to trisomy 13. It is characterised by holoprosencephaly,hypotelorism and cleft lip. Rocker bottom feet is a feature of Edward syndrome or trisomy 18. Reference: Nelson TB of pediatrics pg 404 19th edition.


Question: NOT a feature of Digeorge Syndrome

Features of Digeorage Syndrome include parathyroid gland hypoplasia leading to Hypocalcemia, not Hypercalcaemia.

Caused due to deletion of long arm of Chromosome 22


Question: Breast milk is deficient in the following vitamins

Breast milk is rich in all Vitamins except Vitamin D, K and B12 (in strict vegetarain Mother)


Question: Pulmonary hypoplasia with urinary problems is associated with

Potter syndromePotter syndrome refers to the typical physical appearance and associated pulmonary hypoplasia of a neonate as a direct result of oligohydramnios and compression while in utero.In Potter syndrome, the primary problem is kidney failure mostly due to renal agenesis. The kidneys fail to develop properly as the baby is growing in the womb.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2554)


Question: The most appropriate treatment for Homocystinuria is

Treatment with high doses of vitamin B6 (200-1,000 mg/24 hr) causes a dramatic improvement in most patients who are responsive to this therapy. The degree of response to vitamin B6 treatment may be different in different families. Some patients may not respond because of folate depletion; a patient should not be considered unresponsive to vitamin B6 until folic acid (1-5 mg/24 hr) has been added to the treatment regimen. Restriction of methionine intake in conjunction with cysteine supplementation is recommended for patients who are unresponsive to vitamin B6.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 85; Defects in Metabolism of Amino Acids


Question: Drug of choice for the treatment of Kawasaki disease is

Drug of choice for the treatment of Kawasaki disease is lintravenous Immunoglobulin.
Asprin is also used as anti-inflammatory drug.


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

Mild to moderate VSD there are minimal symptoms . VSD is the commonest congenital lesion complicated by infective endocarditis. Ref :pg 417 Ghai pediatrics. Eighth edition


Question: Most common antigen involved in erythroblastosis fetalis is

Erythroblastosis fetalis (Hemolytic Disease of the newborn)
Erythroblastosis fetalis is caused by the transplacental passage of maternal antibody active against paternal RBC antigens of the infant and is characterized by an increased rate of RBC destruction  Although more than 60 different RBC antigens are capable of eliciting an antibody response, the significant disease is associated primarily D antigen of Rh group and with ABO incompatibility.

Other rare antigens involved are -

C or E antigen of Rh group o RBC antigens - Cw, Cx, Cu, K (kell), M, Duffy, S, P, MNS, Xg, Lutheran, Diego and Kidd
Anti-Lewis antibodies do not cause disease.


Question: Conjugated hyperbiliubinemia in infancy is seen

Dubin Johnson syndrome is an autosomal recessive disorder resulting from impaired hepatic excretion of bilirubin and thus causes conjugated hyperbilirubinemia(2-6 mg/dl). Gilbe syndrome, Crigler- Najjar syndrome and breast milk jaundice are causes of unconjugated hyperbilirubinemia. Reference : page 312 Ghai Essential Pediatrics 8th edition


Question: A 5 year old child presents with mental retardation, seizures, with lighter skin complexion. The diagnosis is

(C) Phenylketonuria# Phenylketonuria: Phenylketonuria (PKU) is a disorder that causes a buildup of the amino acid phenylalanine, which is an essential amino acid that cannot be synthesized in the body but is present in food.> Most affected newborns are detected during routine screening tests. Newborns with PKU rarely have symptoms right away, although sometimes an infant is sleepy or eats poorly.> If not treated, affected infants progressively develop mental retardation over the first few years of life, which eventually becomes severe.> Other symptoms include seizures, nausea and vomiting, an eczema-like rash, lighter skin and hair than their family members, aggressive or self-injurious behavior, hyperactivity, and sometimes psychiatric symptoms.> Untreated children often give off a "mousy" body and urine odor as a result of a by-product of phenylalanine (phenylacetic acid) in their urine and sweat.


Question: Newborn infant prevents hypothermia by

Normally, Oxidation occurs
↓
Energy generated in used for ATP production by phosphorylation
This is known as Coupling of oxidation with phosphorylation.
In Newborn: Due to Brown fat,
Energy generated from oxidation is used for heat production not ATP production to prevent hypothermia.
This Mechanism is Non - shivering thermogenesis or Uncoupling of oxidation with phosphorylation.

Coupling of oxidation with phosphorylration

Uncoupling of oxygenation with phosphorylation


Question: Developmental milestone attained at 9 months of age is

Developmental milestones:-
GROSS MOTOR DEVELOPMENT:
2 months: Holds head in the plane of rest of the body when held in ventral suspension. In the prone position in bed, the chin lifts momentarily.
3 months: lift head above the plane of the body. Head control starts by 3 months and fully developed by 5 months.
4 months: Remain on forearm support if put in prone position, lifting the upper part of the body off the bed.
5 months: Rolls over.
6 months: sit in a tripod fashion.
8 months: sits without support., 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 support.
15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs.
18 months: Runs, walks upstairs 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 start to develop. Turns to sound above the level of ear.
9 months- immature pincer grasp, probes with the 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, vertical 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 the mirror, shows displeasure when toy pulled off.
9 months: waves bye bye.
12 months: comes when called, plays a simple ball game. kisses the parent on request. Makes postural adjustments for dressing.
15 months: jargon, starts imitating mother.
18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three parts of the body on request.
2 years: ask for food, drink, toilet, pulls people to show toys.
3 years: shares toys, know full name and gender, dry by night.
4 years: Plays cooperatively in a group, goes to the toilet alone, washes face, brushes teeth. Role play.
5 years helps in the household task, dresses and undresses.
LANGUAGE MILESTONES:
1 month: alerts to sound.
2 month: respond to sound by startle or quietening to a smooth voice.
3 months: babbles when spoken to. Makes sounds (ahh, coos, ) laughs.
4 months: laughs aloud.
6 months: monosyllables
9 months: understands spoken words, bisyllables.
12 months: 1-2 words with meaning.
18 months: a vocabulary of 10 words. Can name one part of the body.
2 years: 3-word simple sentences.
3 years: asks questions, knows full name and gender.
4 years: says songs or poem, tells a story, knows three colors.
5 years: ask the meaning of words.


Question: Most common presentation of Wilm&;s tumor is

The most common initial clinical presentation for Wilm's tumor is the incidental discovery of an asymptomatic abdominal mass by parents while bathing or clothing an affected child or by a physician during a routine physical examination. Hypeension is present in approximately 25% of tumors at presentation and has been attributed to increased renin activity. Abdominal pain, gross painless hematuria, and fever are other frequent findings in diagnosis. Occasionally, rapid abdominal enlargement and anemia occur as a result of bleeding into the renal parenchyma or pelvis. WT thrombus extends into the inferior vena cava in 4-10% of patients, and rarely into the right atrium. Patients might also have microcytic anemia from iron deficiency or anemia of chronic disease, polycythemia, elevated platelet count, and acquired deficiency of von Willebrand factor or factor VII deficiency. Reference: Nelson; Neuroblastoma; Page no: 2466


Question: The risk of recurrence of congenital hea disease

Only 2-8 % of congenital hea diseases recur Ref : page no 412 ghai pediatrics eighth edition


Question: Early closure of sagittal suture leads to

Scaphalophegaly : Early closure of saggital suture. In this compensatory skull grows parallel to the affected suture in order to accommodate the growing brain Ref Ghai pediatrics eighth edition pg no 41


Question: Most common mode of treatment of a 1 year old child with asthma is

The pharmacological therapy of bronchial asthma involves use of drugs that relax smooth muscle and dilates the airways and drugs that decrease inflammation and there by prevent exacerbations. The commonly used bronchodilators are adrenaline,terbutaline and salbutamol.Terbutaline and salbutamol are specific beta 2 agonists and therefore less cardiac side effects. Ref : Essential paediatrics,O.P.Ghai,7 th edition ,pg no:361


Question: Neonatal sepsis is not caused by

.Neonatal sepsis can be caused by bacteria such as Escherichia coli (E coli), Listeria, and some strains of streptococcus. Group B streptococcus (GBS) has been a major cause of neonatal sepsis. However, this problem has become less common because women are screened during pregnancy. Ref ghai 9e


Question: Ideal time gap between 2 live vaccinations is about

(B) 4 weeksGUIDELINES FOR SPACING OF LIVE & INACTIVATED ANTIGENSAntigen CombinationRecommended minimum interval between doses>= InactivatedNone; can be administered simultaneously or at any interval between dosesInactivated & LiveNone; can be administered simultaneously or at any interval between doses>=2 live parenteral*4-week minimum interval, if not administered simultaneously * Live oral vaccines (E.g., Ty21a typhoid vaccine, oral polio vaccine) can be administered simultaneously or at any interval before after inactivated or live parenteral vaccines.If live parenteral (injected) vaccines (MMR, MMRV, Varicella zoster, and yellow fever) and live intranasal influenza vaccine (LAIV) are not administered at the same visit, they should be separated by at least 4 weeks.VACCINATION CHART FOR BABIES IN INDIABCGNewborn*. Bacilli Calmette-Guerin (BCG):*. Vaccination is given to combat Tuberculosis & prevent TB Meningitis in child.*. Vaccine contains live culture of the bacterium that causes TB in humans, but in a weakened form, which triggers the immune system of the child, preventing TB to attack the body. It is given at birth.Hep BNew born 1st6th week 2nd6th month 3rd*. Hepatitis B vaccination:*. It is given to prevent liver diseases caused by the Hepatitis B virus, which can cause liver cancer, liver failure and in some cases, death.*. The first dose of vaccination is given at birth.*. RECOMBIVAX HB Hepatitis B vaccine is non- infectious and is created out of a genetic recombination.*. It is made with the help of yeast.OPV6th month 1st9th month 2nd4-6 years 3rd*. Oral Polio Vaccine (OPV):*. It is given to prevent the polio disease. It can be given orally (OPV) or via injection (IPV). OPV is a polio vaccine, It is made up of an inactivated non-wild strain of the virus which helps produce antibodies within the body.IPV6th week 1st10th week 2nd14th week 3rd16th-18th month B1*. Inactivated Polio Vaccine (IPV):*. It is given to prevent polio disease in child. It is a mandatory vaccine for all children.*. It contains a wild strain of inactivated polio virus.*. It is usually given along with the DTP vaccine.DTP6th Week 1st10th week 2nd14th week 3rd16th-18th month B1 4-6 years B2*. Diphtheria, Tetanus, & Pertussis (DTP):*. Commonly known as a whooping cough, this vaccination is mandatory.*. Vaccine is a combination of three antigens-Diphtheria toxoid, Tetanus toxoid, and Pertussis.*. These antigens are inactivated to create the DTP vaccine.*. On receiving the vaccine, antibodies are produced within the body to fight occurrence of the diseases.Rota V6th week 1st 10th week 2nd 14th week 3rd*. This vaccination is essential to protect a child against Rotavirus infection which can cause severe diarrhea in children.*. Rota virus vaccine is composed of 5 strains of inactivated rotaviruses.*. It is developed using DNA technology to build immunity in the infants against rotavirus infection.PCV6th week 1st 10th week 2nd 14th week 3rd 13th-15th month Booster*. Pneumococcal Conjugate Vaccine (PCV):*. It is given to prevent Pneumococcal infections in child.*. Pneumococcal bacteria causes ear infections, pneumonia of the lungs, bacteremia of the blood and brain meningitis.*. PCV vaccine is inactivated & does not contain any live Pneumococcal bacteria.Influenza type B (HiB)6th week 1st10th week 2nd 14th week 3rd 16th-18th month B1*. This vaccination is necessary to protect a child against Haemophilus Influenza type B (HiB) - a bacteria that causes diseases like Meningitis, Pneumonia and Epiglottitis.*. HiB is a conjugate vaccine.*. It consists of inactivated bacterial components which on being introduced to the body helps create immunity against the bacteria.MMR9th month 1st 13th-15th month 2nd 4-6 years 3rd*. Measles, Mumps & Rubella (MMR):*. Vaccination is mandatory to prevent from diseases like Measles, Mumps, and Rubella (MMR).*. Vaccine contains live, attenuated measles, mumps and rubella virus with Moraten & Edmonston- Zagreb strain in Genotype A.Typhoid9th-12th month 24th month*. Typhoid Conjugate Vaccine (TCV):*. It is given to prevent typhoid in child. It is made up of Purified Vi polysaccharide from the TY2 S or Typhi Strain.Hep A12th month 1st 18th month 2nd*. Hepatitis A vaccination is a mandatory one to prevent chronic liver infections, protection from Hepatitis A Virus.*. Hepatitis A is made from sterile suspension of inactivated virus (Strain HM175) propagated in MRC-5.Varicella13rd-15th month 1st 4-6 years 2nd*. Varicella vaccine:*. It is a vaccine that protects against chickenpox.*. One dose of vaccine prevents 95% of moderate disease & 100% of severe disease.*. Two doses of vaccine are more effective than one.


Question: Most specific but late Radiographic feature of Scurvy is

Laboratory Findings and Diagnosis of ScurvyThe diagnosis of vitamin C deficiency is usually based on the characteristic clinical picture, the radiographic appearance of the long bones, and a history of poor vitamin C intake. The typical radiographic changes occur at the distal ends of the long bones and are paicularly common at the knees. The shafts of the long bones have a ground-glass appearance because of trabecular atrophy. The coex is thin and dense, giving the appearance of pencil outlining of the diaphysis and epiphysis. The white line of Frankel, an irregular but thickened white line at the metaphysis, represents the zone of well-calcified cailage. The epiphyseal centers of ossification also have a ground-glass appearance and are surrounded by a sclerotic ring. The more specific but late radiologic feature of scurvy is a zone of rarefaction under the white line at the metaphysis. This zone of rarefaction (Trummerfeld zone), a linear break in the bone that is proximal and parallel to the white line, represents the area of debris of broken-down bone trabeculae and connective tissue. A Pelkan spur is a lateral prolongation of the white line and may be present at coical ends.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 50; Vitamin C (Ascorbic Acid)

Ground Glass appearance of Shaft of long bones


Question: A neonate is having jaundice involving palms and soles. The approximate serum bilirubin is

Serum levels of total bilirubin are approximately 4-6 mg/dl (Face), 6-8 mg/dl (Chest and upper abdomen), 8-12 mg/dl (Lower abdomen and thighs), 12-14 mg/dl (Arms and legs) and >15 mg/dl (Palms and soles). Yellow staining of palms and soles is a danger sign and requires urgent serum bilirubin estimation and fuher management.In general, the estimation of bilirubin levels by dermal zones is unreliable paicularly at higher TSB levels, after phototherapy and when it is carried out by an inexperienced observer. Total serum bilirubin can be assessed non invasively by a transcutaneous handheld device.Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 173


Question: In children renal failure is defined as

Urine output less than 0.5ml/kg/hr for 8hr

estimated creatinine clearance decrease by 50%

Urine output less than 0.3ml/kg/hr for 24hr


Question: The most common type of total anomalous pulmonary venous connection is

Most common type of TAPVC is supracardiac type,where 2 pulmonary vein join to form common pulmonary vein that may drains to left innominate vein or right superior venacava. Classification of TAPVC : Darling&;s classification (1957) is the most popular. 1. Type I-Supracardiac connections : 45% of TAPVC patients.The common venous confluence joins SVC. 2. Type II-Cardiac TAPVC It accounts for 25% of cases.CVC drains into coronary sinus or directly into RA. 3. Type III-Infracardiac TAPVC Approx.21% of cases.CVC drains into hepatic vein,ductus venosus,poal vein or IVC.The common pulmonary vein penetrates the diaphragm through the esophageal hiatus. 4. Type IV-Mixed Type It accounts for <10% of cases. Ref : Ghai essential of pediatrics, eighth edition, p.no:426


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

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


Question: The risk of recurrence of congenital hea disease is

The incidence of congenital hea disease in the normal population is 0.8%.The risk increases to 2-6% for a second child if the sibling is having congenital hea disease(recurrence) or if the parent is affected.When two 1st degree relatives have congenital hea disease, the risk for the subsequent child may reach 20-30%.VSD30-35%ASD(SECUNDUM)6-8%PDA6-8%TOF5-7%


Question: First sign of puberty in boys is

(Testes enlargement) (68-G) (498-Ghai 7th)First sign of sexual maturation is enlargement of breast in female and testes in boy (68-G)* Pubertal onset before he age of 8 years in girl and 9.5 years in boys is suggestive of precocious pubertyAdolescentWHO/UN definitionsStages of adolescence* Adolescent = 10-19 years* Youth = 15-24 years* Young people = 10-24 years* Early adolescence = 9-13 years* Mid adolescence = 14-15 years* Late adolescence = 16-19 years* Menarche usually occurs at breast and pubic hairs stage 4


Question: Maternal disomy of chromosome 15 is seen in

Uniparental disomy occurs when both chromosomes of a pair or areas from 2 chromosome in any individual have been inherited from a single parent. Maternal uniparental disomy is seen in Leader -Willi syndrome. Paternal uniparental disomy is seen in Angelman syndrome . Reference: Nelson TB of pediatrics pg 412 19th edition.


Question: Commonest cause of head banging in children are

Ans. b (Mental retardation). (Ref. Nelson, 18th/116)HABIT DISORDERS##Head bangingNail biting# Body rocking# Hair pulling (trichotillomania)# Tnumb sucking# Teeth grinding (bruxism)#Hitting/biting own body# Body manipulations# Repetitive vocalizations#Aerophagia (air swallowing)# Tics Certain habit disorders are more common in children with developmental delays, particularly those with pervasive devel- opmental disorders. Self-injurious habits, such as self-biting or head banging, can occur in up to 25% of normally developing toddlers, but are almost invariably associated with developmental delays in children older than 5 yr.NOTE: Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) is a condition in which antibodies to group A streptococcus cross react with basal ganglia tissue.


Question: Antidote of paracetamol poisoning

i.e. (N- acetyl cysteine): (680 - Ghai 7th)Overdosage of PCM is treated with N-acetyl cysteine used orally within 16 hour after ingestion at a loading dose of 140 mg/ Kg diluted to 5% solution orally. Followed by 70 mg /Kg q 4hr for another 2 daysPCM is the most common analgesic, antipyretic used in childrenParacetamol produces a hghly reactive toxic minor metabolites - N-acetyl benzoquinone amine. Normally this metabolite is detoxified by conjugation with glutathione - when a very large doses of paracetamol is taken glucuronidation capacity is saturated and this metabolite is not detoxified (Hepatic glutathione is depleted)|Excess metabolite N acetyl benzoquinone** binds to protein in liver cells (and renal tubules)|Centrilobular hepatic necrosis**This single most important laboratory test in patient who present after acetaminophen is the acetaminophen level in the serum.Antidotes for common poisoningPoison Antidote* Acetaminophen (PCM)N- acetyl cysteine* AnticholinergicsPhysostigmine* BenzodiazepinesFlumazenil* DigoxinDigoxin immune antibody* MethemoglobinemiaFragnent* OpioidsMethylene blue* OrganophosphatesNaloxone* SalicylatesAtropine* Ethylene glycolSodium bicarbonates* MethanolFomepizole


Question: Drug used in congenital hea disease to keep PDA patent

Ans. is 'a' i.e., PGE, Prostaglandin El (PGE1) infusion usually effective in keeping the ductus aeriosus open before surgical intervention to reduce hypoxemia and acidemia before surgery in ductus dependent lesion like. Pulmonary atresia TOF with severe PS TOF with pulmonary atresia Transposition of great aeries with VSD and PS Indomethacin is used for ductal closure


Question: In phenylketonuria FeCI test with urine gives .............. color

In ferric chloride test used for detecting the presence of phenols in phenylketonuria,a drop of ferric chloride is added to the urine.Phenols present in urine,will form a complex with Fe(III) to give a transient green colour. Reference:Essential pediatrics-Ghai,8th edition,page no:652


Question: Salmonellosis is most common in

child with sickle cell disease are more prone to infection by H.influenzae, S.pneumoniae, salmonella,M.pneumoniae, E.coli,S.aureus. Reference : Ghai essential of pediatrics, eighth edition, p.no:345


Question: Laron dwarfism is caused by

Laron syndromeDwarfDevelopment of end-organ resistance to growth hormone(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2640-2641)


Question: Most common manifestation of congenital Rubella syndrome is

Triad of congenital Rubella syndrome :

Salt pepper retiopathy > cataract.
Deafness.
PDA.
Of which deafness is the most common finding.


Question: Most common infection in a child Nephrotic Syndrome

Most common infection in children nephrotic syndrome is spontaneous bacterial peritonitis . Reference: GHAI Essential pediatrics, 8th edition


Question: The time taken for air to reach the descending colon in a normal infant is

The time taken to reach the descending colon in an infant is 7-9 hrs approximately Reference: GHAI Essential pediatrics, 8th edition


Question: Eteplirsen has been recently FDA approved for the treatment of

Duchenne muscular dystrophy: MC hereditary neuromuscular disease in children. X-linked recessive deletion of dystrophin gene ( Xp 21)- one of the largest gene C/F: More common in males. Family history present Pseudohyperophy of calf muscles Cardiac involvement Recurrent respiratory infection Proximal muscle weakness in limbs Intellectual disability 'GOWER SIGN'is positive- Gowers' sign indicates weakness of the proximal muscles, esp of the lower limb. Mx- Phase 3 trials have shown benefits from ETEPLIRSEN - FDA APPROVED


Question: Infant with cystic fibrosis (CF) are likely to develop

The common clinical presentations include meconium ileus in neonatal period,recurrent bronchiolitis in infancy and early childhod,recurrent respiratory tract infections ,chronic lung disease , bronchiectasis, steatorrhoea,with incresing age pancreatitis and azoospermia. Ref : Essential pediatrics,O.P.Ghai,7 th edition ,pg no:36


Question: Keshan disease in due to deficiency of

Ans. is 'a' i.e., Selenium Keshan disease Cardiomyopathy associated with selenium deficiency. Wilson disease Autosomal recessive. Defective metabolism of copper leads to copper toxicity. Deficiency of ceruloplasmin. Presence of KF ring in cornea. Acrodermatitis enteropathica Deficiency of zinc. Dermatitis of extremities & around orifices.


Question: A renal mass seen on prenatal checkup is most probably

Prenatal renal tumors:Enlargement of a kidney on prenatal imaging is usually due to hydronephrosis or a cystic renal enlargement, such as multicystic dysplastic kidney or polycystic diseaseSolid tumors of the kidneys are rarely seen in the antenatal period but can be diagnosed by ultrasound. Most develop properly as the baby is growing in the womb.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2467)


Question: Most common situation associated with transient tachypnea of newborn is

Ans. is 'c & d' i.e., Elective caesarean section & Normal vaginal delivery [Ref O.P. Ghai 8th/e p. 171 & 7th/e p. 146; Various articles of Obs & GynaTransient tachypnea of Newborn* Transient tachypnea of the newborn is a benign self-limiting disease occuring usually in term neonates and is d to delayed clearance of lung fluid. It is also called respiratory distress syndrome type II.* TTN follows -i) Uneventful normal preterm or term vaginal deliveryii) Cesarean delivery* TTN is believed to be secondary to slow absorption of fetal lung fluid resulting in decreased pulmona compliance and tidal volume and increased dead space therefore also known as wet lung.* Clinical manifestations# Early onset of tachypnea# Sometimes retraction or expiratory grunting# Occasionally cyanosis# Patients usually recover rapidly within 3 days.# Hypoxemia, hypercapnia and acidosis are uncommon.* The lungs are generally clear without rales or rhonchi and chest roentgenogram shows -# Prominent pulmonary vascular markings# Overaeration# Fluid lines in the fissure# Flat diaphragms# Prominent inter-labar fissure# Occasionally pleural fluid.* Distinguishig this disease from hyaline membrane disease is difficult. The distinctive feature of transient tachyapnea are -# Mild symptomology# Sudden recovery of the infant# Absence of roentgenographic reticulogranular pattern or air bronchogram.


Question: In a child, one should be worried if

.ge 2 months 3 months 6 months 9 months 12 months 15 months 18 months 2 years 3 years 4 years 5 years Milestone . . ( mile after being talked to) social smile s ther* anticipates feeds Recognizes mo * . t angers stranger anxiety Recognizes s r ' waves "bye bye" . h Called* plays simple ball game comes w en ' Jargon . Copies parents in task (~.g. sweeping) f food drink toilet; pulls people to Asks or * ' show toys Shares toys; knows full name and gender Plays cooperatively in a group; goes to toilet alone Helps in household tasks, dresses and undress


Question: Requirement of Potassium in child is

Requirement of potassium in child is 1-2 mEq/kg . Reference: GHAI Essential pediatrics, 8th edition


Question: A newborn has hydrocephalus, chorioretinitis, intracranial calcifications, and anemia. For the mentioned clinical scenario, select the most likely diagnosis

Toxoplasmosis can cause symptoms similar to other congenital infections, but the combination of hydrocephalus, chorioretinitis, and intracranial calcifications is considered the "classic triad" of toxoplasma infection in a neonate. Infection usually occurs during primary infection of the mother or as a reactivation of infection in an immune-compromised host. These infants may also display symptoms similar to other congenital infections, such as anemia, a petechial rash, organomegaly, jaundice, and seizures.


Question: Inheritence of Familial hypophosphatemic Rickets is


Question: Acute malnutrition is manifested by

Acute malnutrition is manifested by weight for height which is a result of more recent food deficit or illnessRef: Ghai Essential Pediatrics 8th edition


Question: Duchenne&;s Muscular Dystrophy is a disease of

Duchenne and Becker muscular dystrophy are caused by loss-of-function mutations in the dystrophin gene on the X chromosome. The encoded protein, dystrophin, is a key component of the dystrophin-glycoprotein complex.Dystrophin is thought to provide mechanical stability to the myofiber and its cell membrane during muscle contraction.Robbins 9e 1242


Question: Infantile polycythemia is seen in

Other clinical features include lethargy, tachypnea, cyanosis, jitteriness, poor feeding, feeding intolerance, hypoglycemia. Most common presentation: The majority of newborn infants withpolycythemia are asymptomatic. They can only be identified by performance of a hematocrit. Reference: GHAI Essential pediatrics, 8th edition


Question: Most common cause of Acute Aseptic Meningitis in children is

(C) Enterovirus # VIRAL CAUSES INCLUDE THE FOLLOWING: Enteroviruses - coxsackievirus, echovirus, poliovirus. Herpes simplex virus (HSV) types 1 and 2 (HSV-1, HSV-2) Varicella-zoster virus. Arboviruses, Epstein-Barr virus, HIV, Influenza virus types A and B, Mumps virus.> Many different viruses can cause meningitis.> About 90% of cases of viral meningitis are caused by members of a group of viruses known as Enteroviruses, such as Coxsacki-eviruses and Echoviruses.> These viruses are more common during summer and fall months.>Herpesviruses and the mumps virus can also cause viral meningitis.


Question: Fanconi&;s anaemia is a

Fanconi anemia is a rare disease passed down through families (inherited) that mainly affects the bone marrow. It results in decreased production of all types of blood cells. This is the most common inherited form of , a rare kidney disorder. Causes Fanconi anemia is due to an abnormal gene that damages cells, which keeps them from repairing damaged DNA. To inherit Fanconi anemia, a person must get one copy of the abnormal gene from each parent. The condition is most often diagnosed in children between 3 and 14 years old. Symptoms People with Fanconi anemia have lower-than-normal numbers of white blood cells, red blood cells, and platelets (cells that help the blood clot). Not enough white blood cells can lead to infections. A lack of red blood cells may result in fatigue (Changes in the color of the skin, such as darkened areas of the skin, called cafe au lait spots, and Reference: GHAI Essential pediatrics, 8th edition


Question: Pseudoparalysis in an infant is suggestive of

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


Question: The antidote of paracetamol poisoning

Overdosage of PCM is treated with N-acetyl cysteine used orally within 16 hours after ingestion at a loading dose of 140 mg/ Kg diluted to 5% solution orally.
Followed by 70 mg /Kg q 4hr for another 2 days PCM is the most common analgesic, antipyretic used in children Paracetamol produces a highly reactive toxic minor metabolites -
N-acetyl benzoquinone amine. Normally this metabolite is detoxified by conjugation with glutathione - when a very large dose of paracetamol is taken glucuronidation capacity is saturated and this metabolite is not detoxified (Hepatic glutathione is depleted) ↓
Excess metabolite N acetyl benzoquinone** binds to the protein in liver cells (and renal tubules) ↓ Centrilobular hepatic necrosis** This single most important laboratory test in a patient who present after acetaminophen is the acetaminophen level in the serum.


Question: The percentage of fetal haemoglobin at bih is

At bih, fetal hemoglobin comprises 50-95% of the infant&;s hemoglobin Reference: GHAI Essential pediatrics, 8th edition


Question: In RBC development, Haemoglobin first appears in

Polychromatic/ Intermediate erythroblast is the stage where haemoglobin first appears in RBC development.


Question: New born babies are able to breathe and suck at the same time due to

Infant&;s larynx is positioned high in the neck, the level of glottis being opposite to C3 or C4 at rest and reaches C1 or C2 during swallowing. This high position allows the epiglottis to meet soft palate and make a nasopharyngeal channel for nasal breathing during suckling. The milk feed passes separately over the dorsum of tongue and the sides of epiglottis, thus allowing breathing and feeding to go on simultaneously. Reference: GHAI Essential pediatrics, 8th edition


Question: 5 month old child with hepatomegaly, ketosis, hyperuricemia and malaise diagnosis

Mucopolysaccharidosis Acid mucopolysaccharides are abnormally deposited in the tissues,and excreted in the urine. clinical features Mental retardation Cloudy cornea Bone changes:thickening of skull,broad spatula like ribs,beak shaped veebrae facies:coarse,lips are thick,teeth are peg like,bridge of nose depressed hepatosplenomegaly hyperurecemia Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:636, 7th edition


Question: Most common cause of stridor sholy after bih

Laryngomalacia is the most common congenital anomaly of larynx.Inspiratory stridor is the hallmark of this condition.Symptoms aggrevated when child is in supine position or crying.Condition is generally benign and self limited and most cases resolve by 18 months of age. Ref : Essential Pediatrics,O.P.Ghai,7th edition,Pg No:340


Question: A normal child develops the ability to use 10 words with meaning at the age of

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


Question: The Most common cause of meningitis in children aged 5 years is

Several kinds of bacteria can cause bacterial meningitis. The most common ones in the U.S. are: problems) A bacteria called Haemophilus influenzaetype b (Hib) was a common cause of meningitis in babies and young children until the Hib <a href=" available for infants. There are also vaccines for Neisseria meningitidis and Streptococcus pneumoniae. Reference: GHAI Essential pediatrics, 8th edition


Question: Breastfeeding is contraindicated in

Contraindications of breastfeedingGalactosemiaActive untreated tuberculosis-only in the initial periodHIV positive mother-especially in a developed country; In India its not contraindicatedSome medication(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 287)