INI-CET 2021 - Pediatrics PYQs Practice Questions

Q: Which of the following is given as a part of the therapy for a child with severe COVID?

Corticosteroids. ***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 [Practice more Pediatrics PYQs on OnCourse]

Q: 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?

Coxsackie viral meningitis and Hand Foot Mouth disease. 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. [Practice more Pediatrics PYQs on OnCourse]

Q: Which of the following congenital heart disease has equal saturation in all heart chambers?

Total anomalous pulmonary venous circulation. ***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. [Practice more Pediatrics PYQs on OnCourse]

Q: Which of the following are causes of neonatal seizures? 1. Hypernatremia 2. Hypomagnesemia 3. Hypocalcemia 4. Hyponatremia

1, 2, 3, and 4. ***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. [Practice more Pediatrics PYQs on OnCourse]

Question 1

Which of the following is a true statement about congenital CMV infection?

Accepted Answer

If mother is IgG positive for CMV prior to conception, the child is less likely to develop severe infection

Answer

About 20-30% of the infections are symptomatic

Answer

Triad of SNHL, periventricular calcification and enamel hypoplasia

Answer

Most children asymptomatic at birth can develop conductive hearing loss later in life

Question 2

Which of the following is given as a part of the therapy for a child with severe COVID?

Accepted Answer

Corticosteroids

Answer

Ivermectin

Answer

Remdesivir

Answer

All of the options

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?

Accepted Answer

Coxsackie viral meningitis and Hand Foot Mouth disease

Answer

Bacterial meningitis with sepsis

Answer

Tuberculous meningitis

Answer

Herpes simplex gingivostomatitis and meningoencephalitis

Question 4

Which of the following congenital heart disease has equal saturation in all heart chambers?

Accepted Answer

Total anomalous pulmonary venous circulation

Answer

Tetralogy of Fallot

Answer

Transposition of great arteries

Answer

Tricuspid atresia

Question 5

Which of the following are causes of neonatal seizures?

1. Hypernatremia
2. Hypomagnesemia
3. Hypocalcemia
4. Hyponatremia

Accepted Answer

1, 2, 3, and 4

Answer

2,4 only

Answer

1, 3, 4 only

Answer

1, 2, 3 only

Question 6

At what age does a child attain half-height of the adult height?

Accepted Answer

20 - 24 months

Answer

32 - 36 months

Answer

12 - 18 months

Answer

40 - 48 months

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

Accepted Answer

1-C, 2-D, 3-A, 4-B

Answer

1-C, 2-D, 3-B, 4-A

Answer

1-A, 2-D, 3-B, 4-C

Answer

1-D, 2-C, 3-A, 4-B

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?

Accepted Answer

Ultrasound, CT scan with contrast, and CBC

Answer

Ultrasound, CT scan with contrast, CBC, and Bone marrow biopsy

Answer

Ultrasound and CT scan with contrast

Answer

CT scan with contrast and Bone marrow biopsy

INI-CET 2021 — Pediatrics