FMGE 2025 - Pediatrics Practice Questions

Q: A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the right upper quadrant, which showed movement while feeding. What is the likely diagnosis of this child?

IHPS. ***Correct: IHPS (Infantile Hypertrophic Pyloric Stenosis)*** - Classic presentation: **2-8 weeks old neonate** with progressive **non-bilious projectile vomiting** - Hallmark finding: **Palpable olive-shaped mass in right upper quadrant** (hypertrophied pyloric muscle) - **Visible peristaltic waves** from left to right upper abdomen, especially after feeding - Associated with **hypochloremic hypokalemic metabolic alkalosis** - Treatment: Ramstedt pyloromyotomy *Incorrect: Duodenal atresia* - Presents within **first day of life** (not at 2 weeks) - Causes **bilious vomiting** (obstruction distal to ampulla of Vater) - "Double bubble" sign on X-ray - Associated with Down syndrome *Incorrect: Esophageal atresia* - Presents **immediately after birth** with drooling and choking - No palpable abdominal mass - Diagnosed with **inability to pass nasogastric tube** - Often associated with tracheoesophageal fistula (TEF) *Incorrect: Intussusception* - Typical age: **6-36 months** (not neonates) - Presents with **colicky abdominal pain** and "currant jelly" stools - Palpable "sausage-shaped" mass in right upper quadrant - Treatment: Air/hydrostatic reduction

Q: A 4-year-old unvaccinated child presents with fever, rash, and Bitot spots. What is the appropriate line of management?

Vitamin A Supplementation. ***Vitamin A Supplementation*** - **Bitot spots** are pathognomonic for **xerophthalmia** due to **Vitamin A deficiency**, a serious complication of measles in malnourished children - **High-dose Vitamin A supplementation** (200,000 IU on two consecutive days per WHO guidelines) is the **critical priority** to prevent blindness and reduce measles-related mortality - Supportive care (hydration, fever management, nutrition) is also essential but the key differentiator in this question is recognizing and treating the **Vitamin A deficiency** indicated by Bitot spots *Measles Vaccine + Vitamin A Supplementation* - While **Vitamin A** is correct, the **measles vaccine is contraindicated** during acute febrile illness with active measles infection - Vaccination is prophylactic, not treatment for active disease - After recovery, catch-up vaccination should be considered if child remains unvaccinated *Measles Vaccine* - Administering measles vaccine during **acute measles infection** is inappropriate - This option ignores the **urgent need for Vitamin A** when Bitot spots are present - Missing Vitamin A supplementation risks **irreversible blindness** *Supportive Care* - While supportive care (hydration, fever control, nutrition) is essential in measles management, it does not address the **specific deficiency** indicated by Bitot spots - **Vitamin A supplementation is mandatory** when xerophthalmia signs are present - Supportive care alone without Vitamin A carries high risk of **permanent ocular damage**

Q: A mother brings her 5-month-old baby to the clinic for a routine pediatric check-up. The pediatrician observes that the baby actively looks at his mother's face and responds with interest as she talks to him, showing recognition and engagement. At what age is this developmental milestone typically first achieved?

3 months. ***3 months*** - This is the age when infants typically develop a **true social smile** and demonstrate increased interest and sustained gazing at faces, especially parents, showing early **recognition and engagement**. - At this stage, the coordination of vision and social interaction allows the baby to purposefully interact with the caregiver (reciprocal face-to-face exchange), often involving cooing and looking directly at the eyes. - This milestone represents a key social-emotional developmental marker in early infancy. *2 months* - At 2 months, infants typically begin exhibiting a **social smile**, but the sustained, attentive engagement, recognition, and responsive interaction described are usually not fully consistent until 3 months. - Visual skills are improving, but fixation is often transient, and recognition remains basic without the active, responsive interest observed in this scenario. *6 months* - By 6 months, recognition of familiar people is well established; this period is often characterized by the onset of **stranger anxiety** and more mature motor skills like sitting unsupported. - This stage focuses more on object manipulation (e.g., passing objects hand-to-hand) and early communication (babbling) rather than the initial emergence of face recognition and sustained social gaze. *9 months* - Milestones at 9 months include advanced motor skills such as the development of the **pincer grasp** and standing while holding onto furniture, as well as complex communication like understanding simple commands. - While social interaction is highly sophisticated, the initial establishment of active face recognition and responsive engagement (the core of the scenario) occurs much earlier, typically by 3 months.

Q: A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?

Zinc Deficiency. ***Zinc Deficiency*** - The clinical triad of **periorificial** (perioral, perianal) and **acral dermatitis**, **alopecia**, and **diarrhea** is characteristic of **Acrodermatitis Enteropathica**, which is caused by zinc deficiency. - The rash seen in the image, an eczematous, vesiculobullous, and crusted eruption around the mouth and eyes, is the hallmark cutaneous manifestation of this condition. *Niacin Deficiency* - Niacin (Vitamin B3) deficiency results in **Pellagra**, classically presenting with the “3 Ds”: **dermatitis**, **diarrhea**, and **dementia**. - The dermatitis of pellagra is a **photosensitive rash**, typically in sun-exposed areas like the neck (**Casal's necklace**), and does not have a periorificial distribution. *Selenium Deficiency* - Selenium deficiency is primarily associated with **cardiomyopathy** (**Keshan disease**) and skeletal myopathy (**Kashin-Beck disease**). - While it can cause nail bed changes (whitening) and hair loss, it is not associated with the characteristic periorificial rash seen in the image. *Magnesium Deficiency* - Hypomagnesemia primarily causes **neuromuscular hyperexcitability**, leading to symptoms like **tetany**, **tremors**, seizures, and **cardiac arrhythmias** (e.g., Torsades de pointes). - It does not cause a characteristic dermatological rash like the one presented.

Q: A newborn child is brought to the emergency department with respiratory difficulty. On evaluation, the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?

Bochdalek hernia. ***Bochdalek hernia*** - This is the most common type of **congenital diaphragmatic hernia (CDH)**, representing about 85-90% of cases, and is characterized by a defect in the **posterolateral** aspect of the diaphragm. - It most commonly occurs on the **left side**, allowing abdominal contents like the stomach and intestines to herniate into the chest, leading to **pulmonary hypoplasia** and severe respiratory distress in a newborn, which is consistent with the X-ray findings. *Morgagni hernia* - This is a rare type of CDH involving an **anteromedial** defect in the diaphragm, specifically through the foramen of Morgagni, not a posterolateral one. - It is more commonly found on the **right side** and is often asymptomatic, typically diagnosed incidentally later in life rather than causing acute respiratory failure in a newborn. *Hiatal hernia* - This involves the protrusion of the upper part of the stomach into the thorax through the **esophageal hiatus**, a different anatomical location than the defect in this case. - Hiatal hernias are most often associated with **gastroesophageal reflux disease (GERD)** and are uncommon causes of severe respiratory distress in the neonatal period. *Traumatic diaphragmatic hernia* - This is an **acquired** condition resulting from blunt or penetrating trauma to the chest or abdomen that causes a rupture of the diaphragm. - The patient is a newborn, making a **congenital defect** the cause of the hernia, not trauma.

Q: A child was brought to the casualty with complaints of vomiting and loose stools with a history of laxative use. On examination, arrhythmia is present. What will be the abnormality present?

Hypokalemia. ***Hypokalemia*** - **Laxative abuse** leads to significant gastrointestinal losses of fluid and electrolytes, particularly **potassium** - Combined with **vomiting and loose stools**, potassium depletion is further aggravated - **Hypokalemia causes cardiac arrhythmias** through altered myocardial excitability - **ECG changes** include: U waves, T wave flattening, ST segment depression, prolonged QT interval, and risk of ventricular arrhythmias - This is a classic presentation requiring **urgent potassium replacement** *Hypocalcemia* - Presents with **tetany, carpopedal spasm**, and perioral numbness - ECG shows **prolonged QT interval** but not typical arrhythmias seen here - Not primarily associated with laxative abuse *Hyperkalemia* - Causes **peaked T waves, widened QRS**, and bradyarrhythmias - Occurs with **renal failure or potassium retention**, not GI losses - Opposite of what occurs with laxative abuse and diarrhea *Hyponatremia* - Primarily causes **CNS symptoms**: confusion, seizures, altered sensorium - Cardiac arrhythmias are **not a typical feature** - Can occur with fluid losses but doesn't explain the arrhythmia

Q: A neonate on examination has bilateral cataracts and, after investigations, is found to have a patent ductus arteriosus and salt and pepper retinopathy. What is the most likely congenital infection?

Rubella. ***Rubella***- The constellation of **bilateral cataracts**, **patent ductus arteriosus (PDA)**, and **salt and pepper retinopathy** is highly characteristic, if not pathognomonic, of **Congenital Rubella Syndrome (CRS)**.- Other common findings in CRS include **sensorineural hearing loss**, microcephaly, and **pulmonary artery stenosis**.*CMV*- Congenital Cytomegalovirus (CMV) infection is classically associated with **periventricular calcifications** on neuroimaging, microcephaly, and **sensorineural hearing loss**.- While CMV can cause chorioretinitis, it rarely causes the specific combination of **cataracts** and **PDA** found in this neonate, which strongly favors rubella.*Toxoplasma*- Congenital toxoplasmosis typically presents with the classic triad of **hydrocephalus**, **intracranial calcifications** (often random or diffuse), and focal **chorioretinitis**.- It is not typically associated with common cardiovascular defects like **PDA** or the specific appearance of **salt and pepper retinopathy**.*Varicella*- Congenital Varicella Syndrome is characterized by **skin scarring** (often a zigzag pattern), **limb hypoplasia**, and cortical atrophy.- Ocular findings usually involve **microphthalmia** and severe scarring rather than the specific combination of **cataracts** and **PDA**.

Q: A 3-month-old child has a respiratory rate of 56/min with no chest indrawing and no danger signs. As per IMNCI what is the most appropriate diagnosis?

Pneumonia. ***Pneumonia***- As per IMNCI guidelines, for a child aged 2 months up to 12 months, a respiratory rate of $\geq 50$ breaths/min is classified as **fast breathing**.- Since the child has **fast breathing** (56/min) but lacks **chest indrawing** or **danger signs**, the yellow category of **Pneumonia** is diagnosed.*Cold and cough*- This classification is utilized when the child has cough or cold but shows **no fast breathing** and **no chest indrawing** (Green classification, No Pneumonia).*Severe Pneumonia*- This classification requires the presence of **chest indrawing** or any **general danger sign** (e.g., lethargy, convulsions, inability to drink) alongside fast breathing or stridor (Red classification).*Allergy*- IMNCI focuses on classifying levels of severity of common infections (like respiratory infections, diarrhea, fever) for immediate management, and **allergy** is not one of the primary classification categories.

Q: A neonate was born to a controlled gestational diabetes mother. At the time of birth, he was fine but 4 days later, he developed dyspnea with SpO2 80% at room air. What is the initial management?

Give 100% O2. ***Give 100% O2***- The infant is suffering from **severe hypoxemia** (SpO2 80%), which is a life-threatening emergency requiring immediate stabilization.- The initial step in managing severe, unexplained neonatal hypoxemia or respiratory distress is to administer **100% oxygen** (maximal FiO2) to quickly improve SpO2 above critical levels (typically targeting >90-95%) while investigations or ventilation preparations are made.*Give 21% to 30% O2*- This concentration range represents minimal supplementation and is insufficient for treating **severe hypoxemia** (SpO2 80%) in a neonate.- Such low levels of supplemental oxygen are typically reserved for patients with very **mild desaturations** or during the process of weaning oxygen support.*Give 50% O2*- While this is a higher concentration than room air, 50% O2 may still be inadequate for the initial stabilization of an infant with **SpO2 80%**.- In severe, life-threatening hypoxemia, the priority is maximum oxygen concentration (100% O2) delivery to ensure rapid correction of tissue hypoxia.*Observation*- An oxygen saturation of 80% signifies acute **respiratory failure** or severe compromise and must be treated as a medical emergency, not simply observed.- **Observation** without immediate intervention inevitably leads to worsening hypoxemia, potential end-organ damage, and cardiorespiratory arrest.

Question 1

A 2-week-old neonate was brought to the hospital with a complaint of non-bilious vomiting. While examining the baby, the physician noted a lump in the right upper quadrant, which showed movement while feeding. What is the likely diagnosis of this child?

Accepted Answer

IHPS

Answer

Duodenal atresia

Answer

Esophageal atresia

Answer

Intusussception

Question 2

A 4-year-old unvaccinated child presents with fever, rash, and Bitot spots. What is the appropriate line of management?

Accepted Answer

Vitamin A Supplementation

Answer

Measles Vaccine

Answer

Supportive Care

Answer

Measles Vaccine + Vitamin A Supplementation

Question 3

A mother brings her 5-month-old baby to the clinic for a routine pediatric check-up. The pediatrician observes that the baby actively looks at his mother's face and responds with interest as she talks to him, showing recognition and engagement. At what age is this developmental milestone typically first achieved?

Accepted Answer

3 months

Answer

9 months

Answer

2 months

Answer

6 months

Question 4

A baby presents with the clinical features shown in the image, including characteristic perioral and perianal rash along with a history of diarrhea. Which of the following is the most likely deficiency responsible for this condition?

Accepted Answer

Zinc Deficiency

Answer

Niacin Deficiency

Answer

Selenium Deficiency

Answer

Magnesium Deficiency

Question 5

A newborn child is brought to the emergency department with respiratory difficulty. On evaluation, the child was found to have a posterolateral defect, as shown in the x-ray given. What is the diagnosis?

Accepted Answer

Bochdalek hernia

Answer

Morgagni hernia

Answer

Hiatal hernia

Answer

Traumatic diaphragmatic hernia

Question 6

A child was brought to the casualty with complaints of vomiting and loose stools with a history of laxative use. On examination, arrhythmia is present. What will be the abnormality present?

Accepted Answer

Hypokalemia

Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Hyponatremia

Question 7

A neonate on examination has bilateral cataracts and, after investigations, is found to have a patent ductus arteriosus and salt and pepper retinopathy. What is the most likely congenital infection?

Accepted Answer

Rubella

Answer

Varicella

Answer

CMV

Answer

Toxoplasma

Question 8

An unvaccinated 5-year-old child of a migrant worker family was brought to the casualty with fever and a characteristic skin rash. Upon eye examination, Bitot's spot was seen. What is the appropriate management?

Accepted Answer

Isolate and give nutritional supply with vitamin A supplement

Answer

Only measles vaccine

Answer

Institutional Isolation, nutritional management with vitamin A supplement

Answer

Give measles vaccine and vitamin A supplement

Question 9

A 3-month-old child has a respiratory rate of 56/min with no chest indrawing and no danger signs. As per IMNCI what is the most appropriate diagnosis?

Accepted Answer

Pneumonia

Answer

Cold and cough

Answer

Severe Pneumonia

Answer

Allergy

Question 10

A neonate was born to a controlled gestational diabetes mother. At the time of birth, he was fine but 4 days later, he developed dyspnea with SpO2 80% at room air. What is the initial management?

Accepted Answer

Give 100% O2

Answer

Observation

Answer

Give 50% O2

Answer

Give 21% to 30% O2

FMGE 2025 — Pediatrics