INI-CET 2021 — Pediatrics
8 Previous Year Questions with Answers & Explanations
Which of the following is a true statement about congenital CMV infection?
Which of the following is given as a part of the therapy for a child with severe COVID?
A child presents with fever and vesicular lesions on the upper limb and the lower limb. Neck stiffness was present. Similar lesions were present on the palms, soles, and oral cavity. CSF analysis revealed normal glucose levels and elevated lymphocytes and protein. What is the most likely diagnosis?
Which of the following congenital heart disease has equal saturation in all heart chambers?
Which of the following are causes of neonatal seizures? 1. Hypernatremia 2. Hypomagnesemia 3. Hypocalcemia 4. Hyponatremia
At what age does a child attain half-height of the adult height?
Match the following 1. Hirschsprung's disease 2. Posterior urethral valve 3. Choledochal cyst 4. Intussusception A. Jaundice B. Currant jelly stools C. Distended abdomen D. Oligohydramnios
A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?
INI-CET 2021 - Pediatrics INI-CET Practice Questions and MCQs
Question 1: Which of the following is a true statement about congenital CMV infection?
- A. About 20-30% of the infections are symptomatic
- B. If mother is IgG positive for CMV prior to conception, the child is less likely to develop severe infection (Correct Answer)
- C. Triad of SNHL, periventricular calcification and enamel hypoplasia
- D. Most children asymptomatic at birth can develop conductive hearing loss later in life
Explanation: ***If mother is IgG positive for CMV prior to conception, the child is less likely to develop severe infection*** - A mother who is **IgG positive for CMV prior to conception** has pre-existing immunity, which provides significant protection to the fetus. - While maternal immunity doesn't completely prevent transmission (reactivation/reinfection can occur), it **substantially reduces the risk of severe congenital CMV infection** and symptomatic disease in the infant compared to primary maternal infection during pregnancy. - Primary maternal CMV infection during pregnancy carries a **30-40% transmission rate** with higher risk of severe disease, whereas non-primary infection (in seropositive mothers) has much lower transmission rates and severity. *About 20-30% of the infections are symptomatic* - The majority of congenital CMV infections are **asymptomatic at birth**, with only about **10-15% of infected infants exhibiting symptoms**. - 20-30% is an **overestimation of symptomatic cases** at birth. *Triad of SNHL, periventricular calcification and enamel hypoplasia* - The classical features of congenital CMV infection include **sensorineural hearing loss (SNHL)**, **periventricular calcifications**, and **chorioretinitis**, not enamel hypoplasia. - **Enamel hypoplasia** is more commonly associated with conditions like congenital syphilis, fluorosis, or severe childhood illnesses, not CMV. - Other features include microcephaly, hepatosplenomegaly, thrombocytopenia, and petechiae. *Most children asymptomatic at birth can develop conductive hearing loss later in life* - Children with congenital CMV infection (even asymptomatic) are at risk for **sensorineural hearing loss (SNHL)**, not conductive hearing loss. - SNHL is the most common long-term sequela of congenital CMV, affecting up to **10-15% of asymptomatic cases**, and can be **progressive or delayed in onset**.
Question 2: Which of the following is given as a part of the therapy for a child with severe COVID?
- A. Corticosteroids (Correct Answer)
- B. Ivermectin
- C. Remdesivir
- D. All of the options
Explanation: ***Correct: Corticosteroids*** - **Corticosteroids** (specifically **dexamethasone**) are the **most established evidence-based therapy** for severe COVID-19 in children requiring oxygen support or mechanical ventilation - They reduce **mortality** by suppressing the hyperinflammatory response and cytokine storm associated with severe COVID-19 - Recommended by **WHO, NIH, and Indian Academy of Pediatrics (IAP)** for hospitalized children with severe COVID-19 requiring supplemental oxygen - The **RECOVERY trial** demonstrated significant mortality reduction in patients receiving oxygen therapy *Incorrect: Ivermectin* - **Ivermectin** is **NOT recommended** for COVID-19 treatment by WHO, FDA, NIH, or IAP - Multiple large randomized controlled trials (including TOGETHER trial) showed **no significant benefit** in preventing severe disease, hospitalization, or mortality - Initial in-vitro activity did not translate to clinical efficacy - Not part of standard therapy for severe COVID-19 in children *Incorrect: Remdesivir* - **Remdesivir** is an antiviral that may shorten recovery time in hospitalized adults - Evidence in **pediatric patients** is limited compared to adults - While used in some hospitalized patients, it is **not as universally recommended** as corticosteroids for severe disease - The **primary established therapy** for severe COVID-19 remains corticosteroids *Incorrect: All of the options* - Only **corticosteroids** represent standard, evidence-based therapy for severe pediatric COVID-19 - Ivermectin lacks efficacy evidence and is not recommended - The question asks what "is given as part of therapy" - corticosteroids are the definitive answer
Question 3: A child presents with fever and vesicular lesions on the upper limb and the lower limb. Neck stiffness was present. Similar lesions were present on the palms, soles, and oral cavity. CSF analysis revealed normal glucose levels and elevated lymphocytes and protein. What is the most likely diagnosis?
- A. Bacterial meningitis with sepsis
- B. Coxsackie viral meningitis and Hand Foot Mouth disease (Correct Answer)
- C. Tuberculous meningitis
- D. Herpes simplex gingivostomatitis and meningoencephalitis
Explanation: Coxsackie viral meningitis and Hand Foot Mouth disease - The presence of **vesicular lesions** on the palms, soles, and oral cavity, along with fever, is highly characteristic of **Hand Foot Mouth Disease (HFMD)** caused by Coxsackievirus. - The CSF findings of **normal glucose**, **elevated lymphocytes** (pleocytosis), and **elevated protein** are typical for **aseptic meningitis**, which is often caused by enteroviruses like Coxsackievirus [2]. *Bacterial meningitis with sepsis* - **Bacterial meningitis** would typically present with **low CSF glucose**, **high protein**, and a predominance of **neutrophils**, not lymphocytes [2]. - The characteristic vesicular rash of HFMD is not seen in bacterial meningitis. *Tuberculous meningitis* - **Tuberculous meningitis** typically has **very low CSF glucose**, **markedly elevated protein**, and a pleocytosis with a high percentage of lymphocytes. - The vesicular lesions on the palms, soles, and oral cavity are not a feature of tuberculous meningitis. *Herpes simplex gingivostomatitis and meningoencephalitis* - While **Herpes simplex** can cause **vesicular lesions** (gingivostomatitis) and **meningoencephalitis** with similar CSF findings (lymphocytic pleocytosis, elevated protein), the widespread nature of the lesions on the palms and soles is **not characteristic of HSV** [1]. - HSV lesions are typically clustered and localized to specific dermatomes or mucosal surfaces.
Question 4: Which of the following congenital heart disease has equal saturation in all heart chambers?
- A. Total anomalous pulmonary venous circulation (Correct Answer)
- B. Tetralogy of Fallot
- C. Transposition of great arteries
- D. Tricuspid atresia
Explanation: ***Total anomalous pulmonary venous circulation*** - In this condition, all **pulmonary veins drain abnormally** into the systemic venous circulation, mixing oxygenated and deoxygenated blood before it reaches the left atrium. - This complete mixing results in **equal oxygen saturation** throughout all four heart chambers and the great arteries, as there is a single common mixing chamber. *Tetralogy of Fallot* - This condition involves **four defects**: pulmonary stenosis, ventricular septal defect (VSD), overriding aorta, and right ventricular hypertrophy, leading to right-to-left shunting. - Oxygen saturations would be **lower in the systemic circulation** and aorta compared to the pulmonary circulation (if measurable), but not equal across all chambers due to deoxygenated blood mixing in the systemic flow. *Transposition of great arteries* - Characterized by the **aorta arising from the right ventricle** and the pulmonary artery from the left ventricle, creating two parallel circulations. - Without mixing lesions (like a VSD or patent foramen ovale), the systemic circulation would be severely desaturated and the pulmonary circulation fully saturated, resulting in **highly disparate saturations** between chambers. *Tricuspid atresia* - Involves the **absence of a tricuspid valve**, preventing blood flow from the right atrium to the right ventricle, necessitating an atrial septal defect (ASD) or patent foramen ovale (PFO) for survival. - Blood from the right atrium goes directly to the left atrium, and then via a VSD to the pulmonary artery, leading to **different saturations** in the systemic and pulmonary circulations and not equal saturation in all chambers.
Question 5: Which of the following are causes of neonatal seizures? 1. Hypernatremia 2. Hypomagnesemia 3. Hypocalcemia 4. Hyponatremia
- A. 2,4 only
- B. 1, 3, 4 only
- C. 1, 2, 3 only
- D. 1, 2, 3, and 4 (Correct Answer)
Explanation: ***1, 2, 3, and 4*** - **All listed electrolyte imbalances** can disrupt neuronal function and lead to neonatal seizures. - **Severe shifts** in sodium, calcium, and magnesium levels directly impact neuronal excitability. *2, 4 only* - This option is incorrect because **hypernatremia** and **hypocalcemia** are also significant causes of neonatal seizures. - Electrolyte disturbances such as **hypomagnesium** and **hyponatremia** can cause neonatal seizures, but they are not the only ones. *1, 3, 4 only* - This choice is incorrect as it **excludes hypomagnesemia**, which is a known cause of neonatal seizures. - **Severely deranged sodium and calcium levels** are important causes, but magnesium disturbances also contribute. *1, 2, 3 only* - This option is incorrect because **hyponatremia** is a well-established cause of neonatal seizures. - While hypernatremia, hypomagnesemia, and hypocalcemia can cause seizures, **hyponatremia** can also lead to cerebral edema and subsequent seizure activity.
Question 6: At what age does a child attain half-height of the adult height?
- A. 32 - 36 months
- B. 20 - 24 months (Correct Answer)
- C. 12 - 18 months
- D. 40 - 48 months
Explanation: ***20 - 24 months*** - A child typically reaches **half of their adult height at approximately 2 years of age**, which corresponds to 20-24 months. - This is a well-established **pediatric growth milestone** used clinically to assess normal growth patterns. - At 2 years, average height is around **85-87 cm**, which represents approximately 50% of average adult height (170-175 cm). - This milestone applies to both boys and girls, though individual variations occur based on genetics and parental height. *32 - 36 months* - By this age (2.5-3 years), a child has already **exceeded half of their adult height**. - Children at this age are typically around **92-96 cm**, which is more than 50% of eventual adult stature. - This represents continued linear growth beyond the 2-year milestone. *12 - 18 months* - At this age, a child is usually around **74-82 cm** tall. - This period is characterized by rapid infant growth, but height attained is **less than half** of eventual adult height. - Represents approximately 40-45% of adult height. *40 - 48 months* - By this age (3.5-4 years), a child has **significantly exceeded half of their adult height**. - Children at this age are typically around **98-105 cm**, representing approximately 55-60% of adult height. - This marks the slower, steady growth phase of early childhood.
Question 7: Match the following 1. Hirschsprung's disease 2. Posterior urethral valve 3. Choledochal cyst 4. Intussusception A. Jaundice B. Currant jelly stools C. Distended abdomen D. Oligohydramnios
- A. 1-C, 2-D, 3-B, 4-A
- B. 1-A, 2-D, 3-B, 4-C
- C. 1-C, 2-D, 3-A, 4-B (Correct Answer)
- D. 1-D, 2-C, 3-A, 4-B
Explanation: ***Correct Answer: 1-C, 2-D, 3-A, 4-B*** **Correct Associations:** - **Hirschsprung's disease (1) → Distended abdomen (C)**: Congenital absence of ganglion cells in the distal bowel leads to functional obstruction and subsequent abdominal distension. This is a hallmark presentation in neonates and infants. - **Posterior urethral valve (2) → Oligohydramnios (D)**: Urethral obstruction in utero prevents normal fetal urine output, resulting in decreased amniotic fluid (oligohydramnios). This can be detected on prenatal ultrasound. - **Choledochal cyst (3) → Jaundice (A)**: Congenital dilatation of the bile ducts causes biliary obstruction, presenting with jaundice as part of the classic triad (jaundice, abdominal mass, and pain). - **Intussusception (4) → Currant jelly stools (B)**: Telescoping of bowel causes mucosal ischemia and venous congestion, leading to bloody mucoid stools with characteristic "currant jelly" appearance. This is a pathognomonic feature. *Incorrect: 1-C, 2-D, 3-B, 4-A* - Incorrectly associates choledochal cyst with currant jelly stools (which is specific to intussusception) and intussusception with jaundice (which indicates biliary pathology). *Incorrect: 1-A, 2-D, 3-B, 4-C* - Wrongly links Hirschsprung's disease with jaundice instead of its characteristic abdominal distension, and misidentifies intussusception's primary feature. *Incorrect: 1-D, 2-C, 3-A, 4-B* - Swaps the associations between Hirschsprung's disease and PUV. Oligohydramnios is specific to urinary tract obstruction (PUV), not intestinal pathology (Hirschsprung's).
Question 8: A mother notices a swelling in the abdomen of her 3-year-old child while bathing him. He had a history of hematuria two weeks back, which resolved spontaneously. On examination, a right-sided reniform ballotable mass was found. What is the most appropriate initial investigative approach?
- A. Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy
- B. Ultrasound, CT scan with contrast, and CBC (Correct Answer)
- C. Ultrasound and CT scan with contrast
- D. CT scan with contrast and Bone marrow biopsy
Explanation: ***Ultrasound, CT scan with contrast, and CBC*** - This combination allows for comprehensive **assessment of the kidney mass**, its extent, and helps differentiate it from other abdominal masses, while a CBC checks for paraneoplastic anemia or polycythemia. - **Ultrasound** is typically the initial imaging modality due to its non-invasiveness and ability to characterize the mass as solid or cystic, followed by a **CT scan with contrast** for detailed anatomical information and staging. *Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy* - While ultrasound, CT scan with contrast, and CBC are appropriate, a **bone marrow biopsy** is usually reserved for suspected metastasis or specific types of tumors like neuroblastoma, not as an initial step for a primary renal mass presentation in a 3-year-old child. - The initial focus is on characterizing the renal mass and systemic workup, and bone marrow biopsy would be considered later if there's evidence or high suspicion of metastatic disease to the bone marrow. *Ultrasound and CT scan with contrast* - While these imaging studies are crucial for diagnosing and staging the renal mass, neglecting a **complete blood count (CBC)** would be an oversight. - A CBC can reveal important information such as anemia (common with renal tumors), thrombocytosis, or other hematological abnormalities that might influence treatment decisions or indicate prognosis. *CT scan with contrast and Bone marrow biopsy* - Relying solely on a **CT scan with contrast** as the initial imaging can be less efficient than starting with ultrasound, especially in children, and lacks the preliminary information provided by a CBC. - A **bone marrow biopsy** is not typically part of the initial workup for a suspected Wilms' tumor unless there is specific concern for bone marrow involvement or to rule out a neuroblastoma.