FMGE 2023 — Pediatrics
14 Previous Year Questions with Answers & Explanations
Following urine microscopy and examination, a child is found to have hematuria and RBC casts in the urine. What is the probable cause for this?
Which of the following is not true about CHPS? CHPS - Congenital hypertrophic pyloric stenosis
How much oxygen is given to a term infant with respiratory distress during resuscitation?
Which of the following is an absolute contraindication for breastfeeding?
An 8-year-old child presented with a sudden onset of high-grade fever, seizures, and loss of consciousness. On examination, the child had anemia, hypoglycemia, and no focal neurological deficits. What is the probable diagnosis?
Gonadal growth corresponds with _____.
A 6-year-old child is brought for complaints of short stature. His height is comparable with his parent's height and his bone age corresponds to his chronological age. What is the likely diagnosis?
A 5-year-old child presented with recurrent respiratory infections with thickened sputum. Chest X-ray showed bronchial wall thickening. He has been suffering from steatorrhea since birth. Which of the following is the first differential diagnosis?
A child presents with the findings shown in the image below. What is the true statement regarding this condition?
A 5-year-old girl is brought to the clinic with a fever, cough, red eyes, running nose, and rash. The appearance of the child is shown below. What is the diagnosis? 
FMGE 2023 - Pediatrics FMGE Practice Questions and MCQs
Question 1: Following urine microscopy and examination, a child is found to have hematuria and RBC casts in the urine. What is the probable cause for this?
- A. Focal segmental glomerulosclerosis (FSGS)
- B. Membranoproliferative glomerulonephritis (MPGN)
- C. Minimal change disease
- D. Post-streptococcal glomerulonephritis (PSGN) (Correct Answer)
Explanation: ***Post-streptococcal glomerulonephritis (PSGN)***- RBC casts are highly indicative of **active glomerulonephritis**, demonstrating that red blood cells have leaked through damaged glomeruli and aggregated in the renal tubules.- **PSGN** is the most common cause of acute nephritic syndrome in children, typically following a *Streptococcal* infection, characterized by **hematuria**, hypertension, and mild proteinuria.*Focal segmental glomerulosclerosis (FSGS)*- FSGS almost universally presents as **nephrotic syndrome**, characterized by heavy **proteinuria**, profound edema, and hypoalbuminemia.- While microscopic hematuria may be present, the finding of **RBC casts** is highly uncommon and points away from a primary diagnosis of FSGS.*Membranoproliferative glomerulonephritis (MPGN)*- MPGN often presents with a **mixed nephrotic and nephritic picture**, including hematuria, but is less common acutely than PSGN in children.- PSGN presents with a very typical acute onset of **nephritic features** (hematuria, casts, hypertension) following infection, making it the more probable cause.*Minimal change disease*- This is the leading cause of **nephrotic syndrome** in children, defined by massive **proteinuria** with minimal to no damage visible on light microscopy.- **Minimal change disease** classically presents without significant hematuria and **RBC casts** are virtually absent.
Question 2: Which of the following is not true about CHPS? CHPS - Congenital hypertrophic pyloric stenosis
- A. a.Presents with non-bilious vomiting
- B. c.USG is very sensitive in diagnosing this condition
- C. d.Hypokalemic metabolic alkalosis seen
- D. b.Caused by hypertrophy of longitudinal muscles (Correct Answer)
Explanation: ***b.Caused by hypertrophy of longitudinal muscles***- The defining pathology of congenital hypertrophic pyloric stenosis involves hypertrophy and hyperplasia of the **circular muscle layer** of the pylorus, not the longitudinal muscle layer.- This thickening of the circular muscle narrows the pyloric canal lumen, leading to gastric outlet obstruction.*a.Presents with non-bilious vomiting*- This is a true statement; vomiting is typically **non-bilious** because the obstruction is proximal to the **ampulla of Vater** (where bile enters the duodenum).- The vomiting is often projectile, feeding soon after a meal, and progresses from occasional to nearly every feed.*c.USG is very sensitive in diagnosing this condition*- This is a true statement; ultrasonography is the diagnostic modality of choice due to its high sensitivity and specificity, avoiding radiation exposure.- Diagnosis is confirmed when the **pyloric muscle wall thickness** is >4 mm or the **pyloric channel length** is >16 mm.*d.Hypokalemic metabolic alkalosis seen*- This is a true statement; persistent, massive vomiting leads to the loss of gastric **hydrochloric acid (HCl)**.- The resulting primary loss of H+ ions leads to **metabolic alkalosis**, which is compensated by renal excretion of K+ and retention of HCO3- (leading to secondary **hypokalemia**).
Question 3: How much oxygen is given to a term infant with respiratory distress during resuscitation?
- A. 21% (Correct Answer)
- B. 70%
- C. 100%
- D. 50%
Explanation: ***Correct: 21% (Room Air)*** - **Current NRP and WHO guidelines** recommend starting resuscitation of **term infants with 21% oxygen (room air)** - Evidence shows room air is **equally effective** as 100% oxygen for initial resuscitation - Reduces **oxidative stress and potential harm** from hyperoxia - Oxygen can be **titrated up** if preductal SpO2 targets are not achieved within expected timeframes - This applies specifically to **term infants (≥37 weeks gestation)** *Incorrect: 70%* - Not a standard concentration used in neonatal resuscitation - Would expose infant to unnecessarily high oxygen levels without clear benefit *Incorrect: 100%* - **Outdated practice** - previously used but no longer recommended for term infants - Associated with increased **oxidative stress** and potential harm - May still be considered for **preterm infants <35 weeks** (start with 21-30% and titrate) *Incorrect: 50%* - Not the recommended starting concentration for term infants - May be used as an **intermediate step** when titrating oxygen if initial room air is insufficient **Key Point:** For term infants, always start with room air (21%) during resuscitation and titrate based on SpO2 targets.
Question 4: Which of the following is an absolute contraindication for breastfeeding?
- A. HIV positive mother
- B. Galactosemia in infant (Correct Answer)
- C. Tuberculosis in mother
- D. Hepatitis C in mother
Explanation: ***Galactosemia in infant***- **Galactosemia** is an absolute contraindication as the infant lacks the enzyme needed to metabolize **galactose** found in breast milk (**lactose**).- Ingestion of breast milk leads to the accumulation of toxic metabolites, potentially causing **liver failure**, **cataracts**, and **developmental delay**.*HIV positive mother*- In resource-rich settings, **HIV** is generally considered a contraindication, but it is not universally absolute; in low-resource settings, exclusive breastfeeding might be recommended if formula feeding is unsafe.- Effective maternal **Antiretroviral Therapy (ART)** significantly reduces the risk of transmission via breast milk, making it a relative risk based on local context and ART adherence.*Hepatitis C in mother*- **Hepatitis C virus (HCV)** is generally **not transmitted** through breast milk, and breastfeeding is usually considered safe.- Breastfeeding is only cautioned against if the mother has **bleeding or fissured nipples**, which could theoretically allow blood-borne virus transmission.*Tuberculosis in mother*- Mothers with routine, **active pulmonary TB** can breastfeed if they are on appropriate treatment and wear a mask, as the bacteria is rarely excreted in milk.- If the mother has newly diagnosed, **untreated active TB**, temporary separation and feeding expressed milk may be necessary until she is non-infectious, but breastfeeding is not permanently contraindicated.
Question 5: An 8-year-old child presented with a sudden onset of high-grade fever, seizures, and loss of consciousness. On examination, the child had anemia, hypoglycemia, and no focal neurological deficits. What is the probable diagnosis?
- A. Tubercular meningitis
- B. Viral meningitis
- C. Cerebral malaria (Correct Answer)
- D. Fungal meningitis
Explanation: ***Cerebral malaria***- This diagnosis is strongly suggested by the sudden onset of high-grade fever, seizures, and loss of consciousness in a child, coupled with systemic complications like **anemia** and significant **hypoglycemia**.- Cerebral malaria, caused by *Plasmodium falciparum*, is a medical emergency where **hypoglycemia** results from high glucose consumption by parasites and impaired hepatic gluconeogenesis; **anemia** is also a key feature. *Tubercular meningitis*- Tuberculous meningitis typically presents with an **insidious, subacute onset** (over weeks) of fever, headache, and altered sensorium, not the sudden, explosive presentation described.- While it can cause neurological deficits, it is less commonly associated with the acute, severe systemic triad of high fever, profound **hypoglycemia**, and **anemia** seen here.*Viral meningitis*- Viral meningitis is usually associated with a milder clinical course and typically lacks the profound systemic complications like severe **anemia** and significant **hypoglycemia** that often precipitate seizures and coma in this age group.- Though high fever and seizures can occur, the presence of severe systemic features points away from typical viral etiologies and towards a systemic parasitic infection.*Fungal meningitis*- Fungal meningitis (e.g., *Cryptococcus*) is typically an **indolent or chronic infection** developing over weeks to months, primarily affecting **immunocompromised patients** (e.g., HIV/AIDS), which is unlikely in an otherwise healthy 8-year-old.- It rarely presents as an acute febrile illness with subsequent rapid onset of **anemia** and severe **hypoglycemia** leading to loss of consciousness.
Question 6: Gonadal growth corresponds with _____.
- A. Dental growth
- B. Lymphoid growth
- C. Skeletal system (Correct Answer)
- D. Brain
Explanation: ***Skeletal system*** - **Gonadal growth** follows the Genital growth curve (Scammon's curves), characterized by minimal pre-pubertal growth and dramatic acceleration during **puberty** (ages 12-18). - The **skeletal system** follows the General growth curve, which similarly exhibits a significant **pubertal growth spurt** coinciding with the surge in sex hormones. - Both gonadal maturation and skeletal growth during puberty are driven by **sex steroids** (estrogen and testosterone), making their growth patterns temporally aligned and hormonally interdependent. - The timing of peak skeletal growth velocity (PHV) corresponds closely with the rapid gonadal development during **adolescence**. *Brain* - The **brain** follows the Neural growth curve, which shows rapid growth in **early childhood** (reaching ~90% of adult size by age 6 years) and then plateaus. - This pattern is **opposite** to gonadal growth, which remains relatively dormant in childhood and accelerates only during puberty. - Neural and Genital curves are the most divergent among Scammon's four growth curves. *Lymphoid growth* - **Lymphoid tissue** (thymus, lymph nodes, tonsils) follows a unique curve with rapid early growth, reaching peak size (>100% adult size) by age **10-12 years**, then involuting during puberty. - This pattern of early hypertrophy and pubertal regression is **inverse** to gonadal development. *Dental growth* - **Dental eruption** follows a predictable, age-specific schedule related to the General growth pattern and craniofacial bone development. - While influenced by overall maturation, dental development does not exhibit the characteristic hormone-dependent **pubertal acceleration** seen in gonadal growth.
Question 7: A 6-year-old child is brought for complaints of short stature. His height is comparable with his parent's height and his bone age corresponds to his chronological age. What is the likely diagnosis?
- A. Constitutional delay
- B. Undernutrition
- C. Growth hormone deficiency
- D. Familial short stature (Correct Answer)
Explanation: ***Familial short stature***- The short stature is proportional, and the growth velocity is usually normal, with the child tracking below the 3rd percentile but parallel to the normal curve.- Crucially, the **bone age corresponds to the chronological age**, meaning the skeletal maturation rate is normal, and they have an adult height potential consistent with their genetic background.*Constitutional delay*- This condition is characterized by a **delayed bone age** (e.g., bone age is 4 years in a 6-year-old child), which contradicts the case findings.- These children often have delayed puberty but will eventually reach a normal adult height, simply having a late **growth spurt**.*Undernutrition*- Chronic severe undernutrition causes short stature, often presenting with features like **wasting or stunting** and usually **delayed bone maturation**.- While it is a cause of growth failure, the history of height correlating with parents and normal bone age makes primary undernutrition less likely.*Growth hormone deficiency*- GH deficiency typically results in a **severely reduced growth velocity** and often significantly **delayed bone age**.- The pattern of growth velocity and height is typically inconsistent with the mid-parental height, unlike in familial short stature.
Question 8: A 5-year-old child presented with recurrent respiratory infections with thickened sputum. Chest X-ray showed bronchial wall thickening. He has been suffering from steatorrhea since birth. Which of the following is the first differential diagnosis?
- A. Hyaline membrane disease
- B. Alpha 1 anti-trypsin deficiency
- C. Malabsorption syndrome
- D. Cystic fibrosis (Correct Answer)
Explanation: ***Cystic fibrosis*** - This diagnosis is strongly supported by the triad of chronic **recurrent respiratory infections** (due to thick, retained sputum and subsequent bronchiectasis/bronchial wall thickening), and evidence of **pancreatic exocrine insufficiency** presenting as steatorrhea since birth. - It is an autosomal recessive disorder caused by mutations in the **CFTR gene**, leading to defective chloride transport and thick, sticky mucus formation in multiple organs. *Hyaline membrane disease* - Also known as **Respiratory Distress Syndrome (RDS)**, it is a condition primarily affecting **premature infants** due to deficiency of pulmonary surfactant. - It presents acutely within the first few hours of life and is not a cause of chronic, recurrent respiratory infections or steatorrhea in a 5-year-old child. *Alpha 1 anti-trypsin deficiency* - This hereditary condition typically presents with early-onset **panacinar emphysema** and/or liver disease (cirrhosis). - It is not associated with severe **pancreatic exocrine insufficiency** and steatorrhea in childhood, which is a hallmark feature of this patient's presentation. *Malabsorption syndrome* - While the patient exhibits findings consistent with **malabsorption** (steatorrhea), this is a general descriptive term and not a specific primary diagnosis for the entire clinical picture. - Cystic Fibrosis is the most specific primary diagnosis that explains both the **respiratory and gastrointestinal symptoms** (thick sputum, bronchial wall thickening, and steatorrhea).
Question 9: A child presents with the findings shown in the image below. What is the true statement regarding this condition?
- A. Kwashiorkor due to calorie malnutrition
- B. Marasmus due to calorie malnutrition
- C. Kwashiorkor due to protein malnutrition (Correct Answer)
- D. Marasmus due to protein malnutrition
Explanation: ***Kwashiorkor due to protein malnutrition*** - The image shows a child with characteristic features of **Kwashiorkor**, including generalized **edema** (swollen legs and feet) and a **distended abdomen** due to hypoalbuminemia and hepatomegaly. - This condition is a form of severe acute malnutrition caused primarily by a dietary **protein deficiency**, often in the setting of adequate or near-adequate calorie intake. *Kwashiorkor due to calorie malnutrition* - The primary cause of **Kwashiorkor** is insufficient **protein** intake, which leads to decreased plasma oncotic pressure and edema; a deficiency in calories is not the defining etiological factor. - Severe **calorie deficiency** is the main feature of **Marasmus**, which presents with severe wasting rather than edema. *Marasmus due to protein malnutrition* - The clinical presentation in the image is **Kwashiorkor**, not **Marasmus**, as evidenced by the presence of significant **edema**. - Marasmus is caused by a combined deficiency of **both protein and calories**, leading to severe wasting and an emaciated appearance. *Marasmus due to calorie malnutrition* - **Marasmus** is characterized by severe **wasting** of subcutaneous fat and muscle, resulting in a 'skin and bones' appearance, which is absent in this child. - The presence of a 'pot belly' and **pitting edema** are the hallmark signs that differentiate **Kwashiorkor** from **Marasmus**.
Question 10: A 5-year-old girl is brought to the clinic with a fever, cough, red eyes, running nose, and rash. The appearance of the child is shown below. What is the diagnosis? 
- A. Measles (Correct Answer)
- B. Chickenpox
- C. Mumps
- D. Erythema infectiosum
Explanation: ***Measles*** - The clinical presentation of fever with the classic triad of **cough, coryza, and conjunctivitis** (the "3 Cs") is highly suggestive of measles (rubeola). - The image shows **Koplik's spots** (small white spots on the buccal mucosa), which are pathognomonic for measles and appear before the characteristic maculopapular rash. *Mumps* - Mumps is primarily characterized by **parotitis**, a painful swelling of the salivary glands, which is not described in this patient. - The classic prodrome of the "3 Cs" and Koplik's spots are absent in mumps. *Chickenpox* - The rash in chickenpox (varicella) is **vesicular**, often described as a "dewdrop on a rose petal," and appears in crops. This is different from the maculopapular rash of measles. - While a fever and malaise can occur, the prominent upper respiratory symptoms and conjunctivitis of measles are not typical of chickenpox. *Erythema infectiosum* - Caused by **Parvovirus B19**, this condition is characterized by a distinctive "**slapped-cheek**" rash on the face. - It is followed by a **lacy, reticular rash** on the trunk and extremities, which is inconsistent with the patient's presentation.