INI-CET 2014 — Pediatrics

Q: A 7-year-old girl is easily distracted in class and exhibits poor scholastic performance. EEG shows? (AIIMS May 2014)

Absence seizures. ***Absence seizures*** - The clinical presentation of a young girl who is **easily distracted** and has **poor scholastic performance** is highly suggestive of absence seizures. These are brief episodes of impaired consciousness often mistaken for daydreaming. - The EEG image shows a characteristic **generalized 3-Hz spike-and-wave discharge** pattern, which is the hallmark of typical absence seizures. *Myoclonic seizures* - Myoclonic seizures involve **sudden, brief muscle jerks** or twitches, which are not described in the patient's presentation. - The EEG in myoclonic seizures typically shows **polyspike-and-wave discharges**, not the 3-Hz spike-and-wave pattern seen here. *Atonic seizures* - Atonic seizures, also known as **drop attacks**, cause a sudden loss of muscle tone leading to falls, which is not consistent with the described symptoms. - While EEG may show generalized spike-and-wave activity or diffuse slow waves during an atonic seizure, the 3-Hz rhythmic pattern is less typical for this seizure type. *Myoclonia* - Myoclonia refers to **involuntary, sudden muscle contractions**, which can be physiological (e.g., hiccups, sleep starts) or pathological. - While myoclonic seizures are a type of myoclonia, the term "myoclonia" alone is too general and does not specifically align with the classic EEG pattern and subtle clinical signs of absence seizures. [Practice more Pediatrics PYQs on OnCourse]

Q: A 6-week-old baby presents with cough and cold for the past 3 days. The respiratory rate is 48/min. On examination, the patient is febrile with wheezing but no chest indrawing. Which of the following statements is not true?

The child has pneumonia.. ### Explanation The core of this question lies in the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for classifying respiratory infections. **1. Why "The child has pneumonia" is NOT true:** According to WHO/IMNCI criteria for a child aged 2 months to 5 years, pneumonia is defined by **fast breathing** or **chest indrawing**. For a child aged **2 months to 12 months**, the cutoff for fast breathing is **≥ 50 breaths/min**. In this case, the 6-week-old (1.5 months) infant has a respiratory rate of **48/min**, which is **normal** (the cutoff for infants < 2 months is ≥ 60/min). Since there is no fast breathing and no chest indrawing, the child is classified as having a **"No Pneumonia" (Cough or Cold)**. **2. Analysis of other options:** * **Antibiotics are not required:** True. Since the diagnosis is a simple cough/cold (likely viral bronchiolitis or URTI), antibiotics are not indicated. * **Wheezing should be treated:** True. Wheezing in an infant indicates airway obstruction (often Bronchiolitis). Supportive care or a trial of bronchodilators is appropriate. * **Fever should be treated:** True. Symptomatic management of fever (e.g., Paracetamol) is standard care to ensure the infant's comfort and hydration. **Clinical Pearls for NEET-PG:** * **IMNCI Respiratory Rate Cutoffs:** * < 2 months: ≥ 60/min (Fast breathing) * 2–12 months: ≥ 50/min * 12 months–5 years: ≥ 40/min * **Classification Tip:** If a child has wheeze but no fast breathing/chest indrawing, it is managed as "No Pneumonia." If wheeze is present with fast breathing, treat with a bronchodilator first; if fast breathing persists after 3 doses, then classify as pneumonia. [Practice more Pediatrics PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

All Subjects Biochemistry (1)Forensic Medicine (1)General Medicine (1)Internal Medicine (1)Internal Medicine (1)Ophthalmology (1)Orthopaedics (1)Pathology (1)Pediatrics (2)Pharmacology (2)Surgery (1)

A 7-year-old girl is easily distracted in class and exhibits poor scholastic performance. EEG shows? (AIIMS May 2014)

Q2Medium

A 6-week-old baby presents with cough and cold for the past 3 days. The respiratory rate is 48/min. On examination, the patient is febrile with wheezing but no chest indrawing. Which of the following statements is not true?

INI-CET 2014 - Pediatrics INI-CET Practice Questions and MCQs

Question 1: A 7-year-old girl is easily distracted in class and exhibits poor scholastic performance. EEG shows? (AIIMS May 2014)

A. Myoclonic seizures
B. Absence seizures (Correct Answer)
C. Atonic seizures
D. Myoclonia

Explanation: ***Absence seizures*** - The clinical presentation of a young girl who is **easily distracted** and has **poor scholastic performance** is highly suggestive of absence seizures. These are brief episodes of impaired consciousness often mistaken for daydreaming. - The EEG image shows a characteristic **generalized 3-Hz spike-and-wave discharge** pattern, which is the hallmark of typical absence seizures. *Myoclonic seizures* - Myoclonic seizures involve **sudden, brief muscle jerks** or twitches, which are not described in the patient's presentation. - The EEG in myoclonic seizures typically shows **polyspike-and-wave discharges**, not the 3-Hz spike-and-wave pattern seen here. *Atonic seizures* - Atonic seizures, also known as **drop attacks**, cause a sudden loss of muscle tone leading to falls, which is not consistent with the described symptoms. - While EEG may show generalized spike-and-wave activity or diffuse slow waves during an atonic seizure, the 3-Hz rhythmic pattern is less typical for this seizure type. *Myoclonia* - Myoclonia refers to **involuntary, sudden muscle contractions**, which can be physiological (e.g., hiccups, sleep starts) or pathological. - While myoclonic seizures are a type of myoclonia, the term "myoclonia" alone is too general and does not specifically align with the classic EEG pattern and subtle clinical signs of absence seizures.

Question 2: A 6-week-old baby presents with cough and cold for the past 3 days. The respiratory rate is 48/min. On examination, the patient is febrile with wheezing but no chest indrawing. Which of the following statements is not true?

A. The child has pneumonia. (Correct Answer)
B. Antibiotics are not required.
C. Wheezing should be treated.
D. Fever should be treated.

Explanation: ### Explanation The core of this question lies in the **WHO Integrated Management of Neonatal and Childhood Illness (IMNCI)** guidelines for classifying respiratory infections. **1. Why "The child has pneumonia" is NOT true:** According to WHO/IMNCI criteria for a child aged 2 months to 5 years, pneumonia is defined by **fast breathing** or **chest indrawing**. For a child aged **2 months to 12 months**, the cutoff for fast breathing is **≥ 50 breaths/min**. In this case, the 6-week-old (1.5 months) infant has a respiratory rate of **48/min**, which is **normal** (the cutoff for infants < 2 months is ≥ 60/min). Since there is no fast breathing and no chest indrawing, the child is classified as having a **"No Pneumonia" (Cough or Cold)**. **2. Analysis of other options:** * **Antibiotics are not required:** True. Since the diagnosis is a simple cough/cold (likely viral bronchiolitis or URTI), antibiotics are not indicated. * **Wheezing should be treated:** True. Wheezing in an infant indicates airway obstruction (often Bronchiolitis). Supportive care or a trial of bronchodilators is appropriate. * **Fever should be treated:** True. Symptomatic management of fever (e.g., Paracetamol) is standard care to ensure the infant's comfort and hydration. **Clinical Pearls for NEET-PG:** * **IMNCI Respiratory Rate Cutoffs:** * < 2 months: ≥ 60/min (Fast breathing) * 2–12 months: ≥ 50/min * 12 months–5 years: ≥ 40/min * **Classification Tip:** If a child has wheeze but no fast breathing/chest indrawing, it is managed as "No Pneumonia." If wheeze is present with fast breathing, treat with a bronchodilator first; if fast breathing persists after 3 doses, then classify as pneumonia.