INI-CET 2024 — Pediatrics

Q: Which of the following is a common benign condition characterized by white/yellow keratin-filled cysts on a newborn's skin?

Milia. ***Milia*** - These are **tiny, white bumps** (1-2mm) that appear on a newborn's nose, chin, or cheeks - Caused by **trapped keratin beneath the skin surface** in immature sebaceous glands - Occur in **40-50% of newborns** and are completely benign - Resolve spontaneously within **2-4 weeks** without treatment *Mongolian spots* - These are **blue-gray flat birthmarks** (not cysts) caused by dermal melanocytosis - Most commonly found on the **lumbosacral area and buttocks** - Very common in Asian, African, and Hispanic populations but are **pigmentary lesions**, not keratin cysts - Not the answer as they are not characterized by white/yellow cysts *Epstein pearls* - These are **small whitish-yellow cysts** on the **palate** (roof of mouth), not on skin - Found in **60-85% of newborns** and are epithelial inclusion cysts - While very common and benign, they occur on the **oral mucosa**, not the skin surface - Not the answer as the question specifies skin *Congenital melanoma* - This is an **extremely rare malignant tumor**, not a benign condition - Represents a **serious cancer** requiring immediate treatment - Not the answer as it is neither common nor benign [Practice more Pediatrics PYQs on OnCourse]

Q: Which one of the following is a criterion of Kawasaki disease?

Rash. ***Rash*** - A **polymorphous rash**, which can be macular, papular, or scarlatiniform, is one of the **five principal diagnostic criteria** for **Kawasaki disease**. - This rash typically appears early in the course of the illness and can affect any part of the body, often involving the trunk and extremities. *Edema* - **Edema of the hands and feet**, especially when accompanied by **erythema** (redness), is actually one of the **principal diagnostic criteria** for Kawasaki disease under "extremity changes." - This finding typically occurs in the acute phase, followed by **desquamation** (peeling) in the convalescent phase, particularly in the periungual region. - Note: While edema is a valid criterion, **rash** is considered the most characteristic and commonly used criterion among the options listed. *Purulent conjunctivitis* - **Kawasaki disease** characteristically presents with **bilateral non-purulent (non-exudative) conjunctival injection** - red eyes without discharge or exudate. - **Purulent conjunctivitis** (conjunctivitis with pus/discharge) indicates a bacterial infection and actually argues **against** the diagnosis of Kawasaki disease. - This is the only option that is definitively **not** a criterion. *Strawberry tongue* - **Strawberry tongue** (red, swollen tongue with prominent papillae) is part of the **oral changes criterion** in Kawasaki disease, which includes red cracked lips, strawberry tongue, and erythema of the oropharyngeal mucosa. - While also seen in scarlet fever and toxic shock syndrome, strawberry tongue is a **recognized feature** of Kawasaki disease. - Note: This is technically a valid criterion, though less specific than the polymorphous rash. [Practice more Pediatrics PYQs on OnCourse]

Q: A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?

Constitutional short stature. ***Constitutional short stature*** - This condition is characterized by a **delayed bone age** compared to chronological age, indicating a delay in skeletal maturation. - Children with constitutional short stature typically have **normal parental height** and will eventually reach a normal adult height, although puberty and growth spurts are often delayed. *Malnutrition* - While malnutrition causes **short stature** and **delayed bone age**, it would also likely present with other signs of nutritional deficiency such as **weight loss** or failure to thrive. - The case does not mention any dietary issues or poor socioeconomic conditions typically associated with malnutrition. *Familial short stature* - In familial short stature, the child's height is typically proportional to the parents' height, indicating a strong genetic component to their shorter stature. - It is characterized by a **normal bone age** for chronological age, unlike the delayed bone age seen in this child. *Cretinism* - Cretinism, or congenital hypothyroidism, results in **severe growth retardation** and **delayed bone age**. - However, it is also associated with distinct features like **coarse facial features**, macroglossia, umbilical hernia, and severe developmental delays, which are not mentioned in this case. [Practice more Pediatrics PYQs on OnCourse]

Q: Which of the following statements regarding Wilms tumor is false?

Lung metastasis is rare and occurs late. ***Lung metastasis is rare and occurs late*** - This statement is **false** primarily because when lung metastases occur, they often present **early (at initial diagnosis)** rather than late. - Approximately **10-15% of patients** have pulmonary metastases at presentation, making the "occurs late" portion incorrect. - While lungs are the **most common site** for distant metastases when they do occur, the overall incidence is relatively low, so calling it "rare" is debatable but the "late" timing is definitively wrong. - The statement's claim about late occurrence contradicts clinical reality where metastatic disease, when present, is typically identified at diagnosis or within the first 2 years. *Most commonly seen < 5 years of age* - This statement is **true** as Wilms tumor has **peak incidence at ages 2-3 years**, with the majority of cases diagnosed before age **5 years**. - It is the most common primary **renal malignancy in children**, predominantly affecting young children. *Most patients recover well with chemotherapy and radiotherapy.* - This statement is **true** as Wilms tumor has an **excellent prognosis** with **overall survival rates exceeding 90%** using multimodal therapy. - Treatment includes **surgery (nephrectomy), chemotherapy**, and **radiotherapy** (in selected cases), resulting in high cure rates even in advanced stages. *Presents as a renal mass.* - This statement is **true** as the typical presentation is an **asymptomatic abdominal mass** discovered incidentally by parents or during routine examination. - The mass is usually **firm, smooth, and non-tender**, representing an **intrarenal tumor** that may cause abdominal distension. [Practice more Pediatrics PYQs on OnCourse]

Q: An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?

1,00,000 IU. ***1,00,000 IU*** - For children aged **6-11 months** with clinical vitamin A deficiency, the recommended dose of oral vitamin A is **1,00,000 IU** (100,000 IU). - An 8-month-old child falls in this age category and requires this specific dose. - This dose is given as part of a **three-dose regimen**: on day 1 (immediately), day 2, and after 2-4 weeks as per **WHO guidelines**. *50,000 IU* - This dose is recommended for **infants less than 6 months** of age with vitamin A deficiency. - Using this dose for an 8-month-old would be **underdosing**, providing inadequate treatment for the deficiency. *75,000 IU* - This is **not a standard dose** for vitamin A supplementation in any age group for deficiency treatment. - Standard WHO guidelines specify 50,000 IU for infants <6 months, 100,000 IU for 6-11 months, and 200,000 IU for children 12-59 months. *2,00,000 IU* - This higher dose is used for children aged **12-59 months** (1-5 years) with vitamin A deficiency. - Administering 200,000 IU to an 8-month-old would be an **overdose**, potentially leading to **acute vitamin A toxicity** with symptoms like bulging fontanelle, vomiting, and irritability. [Practice more Pediatrics PYQs on OnCourse]

8 Previous Year Questions with Answers & Explanations

Questions

Which of the following is a common benign condition characterized by white/yellow keratin-filled cysts on a newborn's skin?

Which one of the following is a criterion of Kawasaki disease?

A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?

Which of the following statements regarding Wilms tumor is false?

An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?

Which of the following statements about the ABCDE approach in pediatric Advanced Life Support (PALS) is incorrect?

Fluid of choice for shock in a child with severe acute malnutrition + hypoglycemia

According to neonatal resuscitation protocol, how much oxygen to give in a term neonate with apnea and bradycardia initially?

INI-CET 2024 - Pediatrics INI-CET Practice Questions and MCQs

Question 1: Which of the following is a common benign condition characterized by white/yellow keratin-filled cysts on a newborn's skin?

A. Mongolian spots
B. Milia (Correct Answer)
C. Epstein pearls
D. Congenital melanoma

Explanation: ***Milia*** - These are **tiny, white bumps** (1-2mm) that appear on a newborn's nose, chin, or cheeks - Caused by **trapped keratin beneath the skin surface** in immature sebaceous glands - Occur in **40-50% of newborns** and are completely benign - Resolve spontaneously within **2-4 weeks** without treatment *Mongolian spots* - These are **blue-gray flat birthmarks** (not cysts) caused by dermal melanocytosis - Most commonly found on the **lumbosacral area and buttocks** - Very common in Asian, African, and Hispanic populations but are **pigmentary lesions**, not keratin cysts - Not the answer as they are not characterized by white/yellow cysts *Epstein pearls* - These are **small whitish-yellow cysts** on the **palate** (roof of mouth), not on skin - Found in **60-85% of newborns** and are epithelial inclusion cysts - While very common and benign, they occur on the **oral mucosa**, not the skin surface - Not the answer as the question specifies skin *Congenital melanoma* - This is an **extremely rare malignant tumor**, not a benign condition - Represents a **serious cancer** requiring immediate treatment - Not the answer as it is neither common nor benign

Question 2: Which one of the following is a criterion of Kawasaki disease?

A. Edema
B. Rash (Correct Answer)
C. Purulent conjunctivitis
D. Strawberry tongue

Explanation: ***Rash*** - A **polymorphous rash**, which can be macular, papular, or scarlatiniform, is one of the **five principal diagnostic criteria** for **Kawasaki disease**. - This rash typically appears early in the course of the illness and can affect any part of the body, often involving the trunk and extremities. *Edema* - **Edema of the hands and feet**, especially when accompanied by **erythema** (redness), is actually one of the **principal diagnostic criteria** for Kawasaki disease under "extremity changes." - This finding typically occurs in the acute phase, followed by **desquamation** (peeling) in the convalescent phase, particularly in the periungual region. - Note: While edema is a valid criterion, **rash** is considered the most characteristic and commonly used criterion among the options listed. *Purulent conjunctivitis* - **Kawasaki disease** characteristically presents with **bilateral non-purulent (non-exudative) conjunctival injection** - red eyes without discharge or exudate. - **Purulent conjunctivitis** (conjunctivitis with pus/discharge) indicates a bacterial infection and actually argues **against** the diagnosis of Kawasaki disease. - This is the only option that is definitively **not** a criterion. *Strawberry tongue* - **Strawberry tongue** (red, swollen tongue with prominent papillae) is part of the **oral changes criterion** in Kawasaki disease, which includes red cracked lips, strawberry tongue, and erythema of the oropharyngeal mucosa. - While also seen in scarlet fever and toxic shock syndrome, strawberry tongue is a **recognized feature** of Kawasaki disease. - Note: This is technically a valid criterion, though less specific than the polymorphous rash.

Question 3: A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?

A. Malnutrition
B. Familial short stature
C. Constitutional short stature (Correct Answer)
D. Cretinism

Explanation: ***Constitutional short stature*** - This condition is characterized by a **delayed bone age** compared to chronological age, indicating a delay in skeletal maturation. - Children with constitutional short stature typically have **normal parental height** and will eventually reach a normal adult height, although puberty and growth spurts are often delayed. *Malnutrition* - While malnutrition causes **short stature** and **delayed bone age**, it would also likely present with other signs of nutritional deficiency such as **weight loss** or failure to thrive. - The case does not mention any dietary issues or poor socioeconomic conditions typically associated with malnutrition. *Familial short stature* - In familial short stature, the child's height is typically proportional to the parents' height, indicating a strong genetic component to their shorter stature. - It is characterized by a **normal bone age** for chronological age, unlike the delayed bone age seen in this child. *Cretinism* - Cretinism, or congenital hypothyroidism, results in **severe growth retardation** and **delayed bone age**. - However, it is also associated with distinct features like **coarse facial features**, macroglossia, umbilical hernia, and severe developmental delays, which are not mentioned in this case.

Question 4: Which of the following statements regarding Wilms tumor is false?

A. Most commonly seen < 5 years of age
B. Most patients recover well with chemotherapy and radiotherapy.
C. Presents as a renal mass.
D. Lung metastasis is rare and occurs late (Correct Answer)

Explanation: ***Lung metastasis is rare and occurs late*** - This statement is **false** primarily because when lung metastases occur, they often present **early (at initial diagnosis)** rather than late. - Approximately **10-15% of patients** have pulmonary metastases at presentation, making the "occurs late" portion incorrect. - While lungs are the **most common site** for distant metastases when they do occur, the overall incidence is relatively low, so calling it "rare" is debatable but the "late" timing is definitively wrong. - The statement's claim about late occurrence contradicts clinical reality where metastatic disease, when present, is typically identified at diagnosis or within the first 2 years. *Most commonly seen < 5 years of age* - This statement is **true** as Wilms tumor has **peak incidence at ages 2-3 years**, with the majority of cases diagnosed before age **5 years**. - It is the most common primary **renal malignancy in children**, predominantly affecting young children. *Most patients recover well with chemotherapy and radiotherapy.* - This statement is **true** as Wilms tumor has an **excellent prognosis** with **overall survival rates exceeding 90%** using multimodal therapy. - Treatment includes **surgery (nephrectomy), chemotherapy**, and **radiotherapy** (in selected cases), resulting in high cure rates even in advanced stages. *Presents as a renal mass.* - This statement is **true** as the typical presentation is an **asymptomatic abdominal mass** discovered incidentally by parents or during routine examination. - The mass is usually **firm, smooth, and non-tender**, representing an **intrarenal tumor** that may cause abdominal distension.

Question 5: An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?

A. 50,000 IU
B. 1,00,000 IU (Correct Answer)
C. 75,000 IU
D. 2,00,000 IU

Explanation: ***1,00,000 IU*** - For children aged **6-11 months** with clinical vitamin A deficiency, the recommended dose of oral vitamin A is **1,00,000 IU** (100,000 IU). - An 8-month-old child falls in this age category and requires this specific dose. - This dose is given as part of a **three-dose regimen**: on day 1 (immediately), day 2, and after 2-4 weeks as per **WHO guidelines**. *50,000 IU* - This dose is recommended for **infants less than 6 months** of age with vitamin A deficiency. - Using this dose for an 8-month-old would be **underdosing**, providing inadequate treatment for the deficiency. *75,000 IU* - This is **not a standard dose** for vitamin A supplementation in any age group for deficiency treatment. - Standard WHO guidelines specify 50,000 IU for infants <6 months, 100,000 IU for 6-11 months, and 200,000 IU for children 12-59 months. *2,00,000 IU* - This higher dose is used for children aged **12-59 months** (1-5 years) with vitamin A deficiency. - Administering 200,000 IU to an 8-month-old would be an **overdose**, potentially leading to **acute vitamin A toxicity** with symptoms like bulging fontanelle, vomiting, and irritability.

Question 6: Which of the following statements about the ABCDE approach in pediatric Advanced Life Support (PALS) is incorrect?

A. Dehydration is a component of the ABCDE approach. (Correct Answer)
B. Airway management is essential in PALS.
C. Breathing assessment is part of the ABCDE approach.
D. Circulation is a critical component of the ABCDE approach.

Explanation: ***Dehydration is a component of the ABCDE approach.*** - The **ABCDE approach** in PALS focuses on **Airway, Breathing, Circulation, Disability, and Exposure**, which are immediate life threats. - While dehydration is a crucial clinical concern in children, it's a **diagnostic consideration** and management target, not a primary component of the initial rapid assessment categories (A, B, C, D, E) themselves. - Dehydration may affect circulation (C) but is not itself a separate component of the ABCDE framework. *Airway management is essential in PALS.* - **Airway** is the first step in the ABCDE approach, focusing on ensuring a **patent and protected airway** to allow for effective ventilation. - **Airway management** is critical in pediatric resuscitation to prevent respiratory arrest and optimize oxygen delivery. *Breathing assessment is part of the ABCDE approach.* - **Breathing** is the second step, involving the assessment of **respiratory rate, effort, breath sounds, and oxygen saturation**. - Effective breathing is vital for adequate **oxygenation and ventilation**, and addressing breathing problems is a key part of PALS. *Circulation is a critical component of the ABCDE approach.* - **Circulation** is the third step, involving the assessment of **heart rate, blood pressure, capillary refill time, and peripheral perfusion**. - **Circulatory assessment** helps identify shock or cardiac arrest, which require immediate intervention. - The complete ABCDE also includes **Disability** (neurological status assessment using AVPU or GCS) and **Exposure** (full examination while preventing hypothermia).

Question 7: Fluid of choice for shock in a child with severe acute malnutrition + hypoglycemia

A. Normal saline
B. Ringer lactate
C. 10% dextrose
D. Ringer lactate + 5% dextrose (Correct Answer)

Explanation: ***Ringer lactate + 5% dextrose*** - This combination provides both **electrolytes** (from Ringer lactate) to help correct **shock** and **glucose** (from 5% dextrose) to address **hypoglycemia** in a child with severe acute malnutrition (SAM). - Patients with SAM are at a high risk of **hypoglycemia** during shock, making glucose supplementation crucial. *Normal saline* - While suitable for initial fluid resuscitation in shock, it does **not contain glucose** and would not address the concomitant hypoglycemia. - Excessive use of normal saline can also lead to **hyperchloremic metabolic acidosis**, which is undesirable in already compromised patients. *Ringer lactate* - Ringer lactate provides **electrolytes** and is a good crystalloid for shock resuscitation, but it **lacks glucose** to correct hypoglycemia. - In SAM patients, where energy stores are depleted, simply providing Ringer lactate might not be sufficient to prevent or treat hypoglycemia. *10% dextrose* - 10% dextrose would effectively treat **hypoglycemia** but is not an appropriate fluid for fluid resuscitation in **shock**. - It would not adequately expand the intravascular volume or provide the necessary electrolytes for managing shock alone.

Question 8: According to neonatal resuscitation protocol, how much oxygen to give in a term neonate with apnea and bradycardia initially?

A. 100%
B. 21% (Correct Answer)
C. 50%
D. 30%

Explanation: ***21%*** - According to **NRP (Neonatal Resuscitation Program) 2020 guidelines**, for **term neonates (≥35 weeks gestation)** requiring resuscitation, the initial recommendation is to use **room air (21% oxygen)** to minimize the risk of hyperoxia and oxidative injury. - Multiple randomized controlled trials have demonstrated that room air is as effective as 100% oxygen for initial resuscitation. - Supplemental oxygen is only added if **oxygen saturation targets** are not met despite adequate ventilation, and should be titrated using **pulse oximetry**. *30%* - This concentration is **higher than room air** and is not the initial recommendation for term neonates needing resuscitation. - Starting with a higher oxygen concentration can lead to **oxidative stress** without immediate benefit. - Higher initial concentrations (21-30%) are reserved for **preterm neonates (<35 weeks)**. *100%* - Administering **100% oxygen** can be harmful to a neonate, potentially causing **oxidative injury** to developing organs, including the lungs, brain, and retina. - This was the old practice but has been **discontinued** based on evidence showing increased mortality and morbidity. - High concentrations are no longer recommended even in severe cases; oxygen should be titrated to saturation targets. *50%* - While lower than 100%, 50% oxygen is still **not the initial recommended concentration** for term neonates in resuscitation protocols. - The goal is to start with **21% oxygen** and gradually increase based on **pulse oximetry monitoring** and target saturation ranges if 21% is insufficient.