NEET-PG 2012 - Pediatrics Practice Questions

Q: A 30-week preterm neonate is admitted to NICU immediately after birth. Which of the following complications is MOST directly related to surfactant deficiency?

Increased risk of respiratory distress syndrome. ***Increased risk of respiratory distress syndrome*** - RDS is **most directly caused by surfactant deficiency** in preterm infants, as surfactant production begins around 24-28 weeks and becomes adequate only by 34-36 weeks of gestation. - Surfactant reduces **surface tension in alveoli**, preventing alveolar collapse during expiration. Without adequate surfactant, there is diffuse atelectasis and impaired gas exchange. - Clinical features include **tachypnea, grunting, intercostal retractions, and cyanosis** typically appearing within the first few hours of life. - Chest X-ray shows characteristic **ground-glass appearance with air bronchograms**. *Increased risk of hypothermia* - While preterm infants are indeed at risk for hypothermia due to **large surface area-to-body mass ratio, reduced brown fat, and immature thermoregulation**, this is not directly related to surfactant deficiency. - Hypothermia is primarily related to **thermal regulation mechanisms** rather than lung maturity. *Increased risk of hypoglycemia* - Preterm babies have **limited glycogen stores and immature gluconeogenesis**, increasing hypoglycemia risk. - However, this is related to **metabolic and hepatic immaturity**, not surfactant deficiency. *Increased risk of intraventricular hemorrhage* - Preterm infants are at risk for IVH due to **fragile germinal matrix capillaries and fluctuating cerebral blood flow**. - This is a **neurovascular complication**, not directly related to surfactant deficiency, though severe RDS with hypoxia can be a contributing factor.

Q: Which of the following is a common symptom of neonatal lupus?

Cutaneous lesion. ***Cutaneous lesion*** - **Cutaneous lesions** are the most common manifestation of neonatal lupus, typically appearing as an **annular erythematous rash** on the face and scalp. - These lesions often develop after exposure to **ultraviolet light** and usually resolve within 6 months as maternal autoantibodies clear from the infant's system. *Thrombocytopenia* - While **hematologic abnormalities** such as thrombocytopenia can occur in neonatal lupus, they are less common than cutaneous lesions. - **Thrombocytopenia** refers to a low platelet count, which can increase the risk of bleeding. *All of the options* - While all listed options (cutaneous lesions, thrombocytopenia, and heart block) can be features of neonatal lupus, **cutaneous lesions** are the most frequently observed symptom. - Choosing "All of the options" would imply equal commonality or presence of all in every case, which is not accurate. *Heart block* - **Congenital heart block** is a serious, but less common and often irreversible, manifestation of neonatal lupus, caused by maternal antibodies attacking the fetal cardiac conduction system. - It usually presents as **bradycardia** and may require a pacemaker, but it is not the most common symptom overall.

Q: What are the first-line disease-modifying treatments for Guillain-Barre Syndrome (GBS) in a child?

Intravenous Immunoglobulin (IV Ig) and Plasmapheresis. ***Intravenous Immunoglobulin (IV Ig) and Plasmapheresis*** - Both **IV Ig** and **plasmapheresis** are equally effective first-line disease-modifying treatments for GBS in children - **IV Ig** works by neutralizing pathogenic antibodies and modulating the immune response - **Plasmapheresis** removes circulating antibodies and inflammatory mediators from the plasma - Both treatments reduce the severity and duration of paralysis and accelerate recovery - They are equally effective with **no significant difference in outcomes**; choice depends on availability, contraindications, and patient factors *Intravenous Immunoglobulin (IV Ig) alone* - While IV Ig is indeed a first-line treatment, it is not the only one - The question asks for treatments (plural), and plasmapheresis is equally effective *Mechanical Ventilation alone* - This is a **supportive measure** for respiratory failure, not a disease-modifying treatment - About 20-30% of GBS patients require mechanical ventilation due to respiratory muscle weakness - It manages complications but does not treat the underlying immune-mediated neuropathy *Plasmapheresis alone* - While plasmapheresis is indeed a first-line treatment, it is not the only one - The question asks for treatments (plural), and IV Ig is equally effective

Q: In Precocious puberty, the age limit for girls is?

8 years. ***8 years*** - Precocious puberty is defined clinically by the development of secondary sexual characteristics in girls before the age of **8 years old**. - This age cut-off is based on population studies and clinical consensus to identify children needing further evaluation for underlying causes. *10 years* - This age is generally considered within the **normal range** for the onset of puberty, not precocious. - Pubertal development typically begins between ages 8 and 13 in girls. *9 years* - While close to the precocious threshold, **9 years** is still considered within the typical window for the onset of puberty. - The established clinical definition for precocious puberty in girls is explicitly _before_ the age of 8. *11 years* - This age is well within the **normal range** for pubertal onset and progression in girls. - Development of secondary sexual characteristics at this age would not be considered precocious.

Q: In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Hepatomegaly. ***Hepatomegaly*** - In children, **hepatomegaly** is a crucial indicator of **right-sided heart failure** due to congestion of the hepatic venous system. - The liver is a compressible organ and can accommodate a significant increase in blood volume, causing it to enlarge considerably before other signs of **venous congestion** become apparent. *Raised JVP* - **Raised jugular venous pressure (JVP)** is often difficult to assess reliably in infants and young children due to their short necks and uncooperative nature. - While present in older children with CHF, it is not considered as sensitive or specific as other signs in younger pediatric patients. *Pedal edema* - **Pedal edema** is less common in pediatric CHF compared to adults, particularly in infants and toddlers. - Their shorter hydrostatic columns and tendency to spend more time supine make dependent edema less prominent. *Basal crepitations* - **Basal crepitations** (rales) indicate **pulmonary edema**, which is a sign of **left-sided heart failure**. - While a part of CHF, **hepatomegaly** is a more consistent and often earlier sign that can be detected across different forms of pediatric CHF (right or left-sided).

Q: What is the treatment of choice for a 5-year-old child with bedwetting?

Motivational therapy. ***Motivational therapy*** - This is the **first-line active treatment** for **primary nocturnal enuresis** in children, involving encouragement, positive reinforcement (star charts), rewards, and education about bladder control. - It focuses on **behavioral strategies** and can be highly effective with parental involvement. - When intervention is pursued at age 5, motivational therapy is preferred over pharmacological options due to safety and effectiveness. *No treatment* - At age 5, **watchful waiting with reassurance** is often appropriate since nocturnal enuresis is common at this age (affects 15-20% of 5-year-olds) and has a **spontaneous resolution rate of 15% per year**. - However, when the question asks for "treatment of choice," it implies active intervention rather than observation alone. - Active behavioral therapy is preferred when bedwetting causes distress or affects the child's self-esteem. *Imipramine* - **Imipramine** is a **tricyclic antidepressant** with anticholinergic effects that can reduce bladder contractions, but it has significant side effects including **cardiac arrhythmias** and is **not first-line treatment**. - It is typically reserved for children ≥7 years after behavioral interventions fail, due to its potential adverse effects and high relapse rate after discontinuation. *Desmopressin* - **Desmopressin** is an **antidiuretic hormone analog** that reduces urine production overnight. - While effective, it is typically reserved for children ≥6 years who are unresponsive to behavioral therapy or for **short-term situational use** (e.g., sleepovers, camps). - Side effects include potential **hyponatremia** and high relapse rate after discontinuation.

Q: An XX baby presenting with male genitalia (penis and scrotum) is likely due to which of the following conditions?

High level of testosterone in maternal blood. ***High level of testosterone in maternal blood*** - An **XX baby** (genetically female) presenting with **fully masculinized external genitalia** (penis and scrotum) indicates significant **androgen exposure** during the critical period of sexual differentiation (8-12 weeks of gestation). - While the most common cause is **congenital adrenal hyperplasia (CAH)** due to fetal androgen excess, **maternal sources of androgens** can also cause complete masculinization. - Maternal causes include **virilizing tumors** (e.g., luteoma of pregnancy, Krukenberg tumor, arrhenoblastoma), **exogenous androgen administration**, or **maternal CAH**. - High sustained maternal testosterone crosses the placenta and causes **virilization of female fetus**, which can range from clitoromegaly to complete male phenotype. - This is the **only medically correct option** among the choices given, though CAH (not listed) would be the most common cause overall. *Klinefelter syndrome* - **47, XXY karyotype** - genetically male due to presence of Y chromosome with SRY gene. - Presents as phenotypic male, not relevant to an **XX individual**. - Features include hypogonadism, infertility, tall stature, and gynecomastia. *Turner syndrome* - **45, X karyotype** - monosomy X, genetically and phenotypically female. - Presents with **female external genitalia**, streak gonads, short stature, webbed neck. - Cannot explain masculinized genitalia in any scenario. *None of the options* - This is incorrect because **high level of testosterone in maternal blood** is a documented cause of XX virilization with male phenotype, though less common than fetal CAH.

Q: What is the recommended rate for blood transfusion in neonates?

1-5 ml/min. ***1-5 ml/min*** - The recommended rate for blood transfusion in neonates is **1-5 ml/min** to prevent **circulatory overload** and other complications. - Slower rates are crucial for neonates due to their limited cardiovascular reserves and smaller blood volume. *5-10 ml/min* - This rate is generally **too fast** for routine neonatal blood transfusions, increasing the risk of **fluid overload** and **cardiac strain**. - Rapid administration can lead to complications such as **necrotizing enterocolitis (NEC)** or **respiratory distress**. *10-15 ml/min* - Administering blood at this rate in neonates is **contraindicated** due to the high risk of **cardiovascular compromise**. - It could quickly overwhelm the neonate's circulatory system, leading to severe adverse events. *15-20 ml/min* - This rate is significantly **too rapid** for any neonatal blood transfusion and would almost certainly result in **severe volume overload** and potential cardiac arrest. - Such high rates are only rarely considered in extreme emergency situations, like massive hemorrhage with specific considerations and monitoring.

Q: A 3-month-old infant presents with an abdominal palpable mass and non-bilious vomiting. What is the most likely diagnosis?

Hypertrophic pyloric stenosis. ***Hypertrophic pyloric stenosis*** - The classic presentation includes **projectile non-bilious vomiting** and a palpable **olive-shaped mass** in the epigastrium of an infant typically between 3 weeks and 6 months of age. - The vomiting is non-bilious because the obstruction is proximal to the ampulla of Vater. *Intussusception* - While it can present with an **abdominal mass** and vomiting, the vomiting is often **bilious** and the classic stool is **'currant jelly'**, which is not mentioned here. - It usually presents with sudden onset of severe, **colicky abdominal pain** and occurs more commonly in slightly older infants (6-12 months). *Tracheoesophageal fistula* - This condition presents at birth with symptoms such as **choking, coughing**, and **cyanosis** during feeding. - It usually causes respiratory distress and feeding difficulties from the first days of life, not a palpable abdominal mass and non-bilious vomiting at 3 months. *Duodenal atresia* - This is a congenital obstruction that typically presents with **bilious vomiting** (as the obstruction is distal to the ampulla of Vater) within the first 24-48 hours of life. - Imaging usually shows a **“double bubble” sign** on abdominal X-ray, and an abdominal mass is not typically palpable.

Q: Most common site of extramedullary relapse of ALL in a 6-year-old boy is

CNS (Central Nervous System). ***CNS (Central Nervous System)*** - The **central nervous system** is the **most common site of extramedullary relapse** in pediatric acute lymphoblastic leukemia (ALL), accounting for the majority of extramedullary relapses. - CNS is an immunologically privileged sanctuary site where chemotherapy penetration is limited due to the blood-brain barrier. - CNS relapse presents with symptoms like headache, vomiting, cranial nerve palsies, or signs of increased intracranial pressure and requires intrathecal chemotherapy and cranial irradiation. - Prophylactic CNS therapy is a standard component of ALL treatment protocols to prevent CNS relapse. *Testes* - **Testes** are the **second most common** site of extramedullary relapse and the most common **solid organ** site in boys with ALL. - Like the CNS, testes are immunologically privileged sites with limited chemotherapy penetration. - Testicular relapse presents as painless testicular enlargement (unilateral or bilateral) and requires testicular radiation plus systemic therapy intensification. *Liver* - While **hepatic infiltration** can occur in ALL, the liver is not a common site for **isolated extramedullary relapse**. - Hepatic involvement typically indicates widespread systemic disease rather than a primary relapse site. *Lung* - **Pulmonary involvement** in ALL is rare as an isolated extramedullary relapse site. - Lung findings in ALL patients are more commonly due to infection, leukostasis in hyperleukocytosis, or disseminated disease.

Question 1

A 30-week preterm neonate is admitted to NICU immediately after birth. Which of the following complications is MOST directly related to surfactant deficiency?

Accepted Answer

Increased risk of respiratory distress syndrome

Answer

Increased risk of intraventricular hemorrhage

Answer

Increased risk of hypothermia

Answer

Increased risk of hypoglycemia

Question 2

Which of the following is a common symptom of neonatal lupus?

Accepted Answer

Cutaneous lesion

Answer

All of the options

Answer

Thrombocytopenia

Answer

Heart block

Question 3

What are the first-line disease-modifying treatments for Guillain-Barre Syndrome (GBS) in a child?

Accepted Answer

Intravenous Immunoglobulin (IV Ig) and Plasmapheresis

Answer

Intravenous Immunoglobulin (IV Ig) alone

Answer

Mechanical Ventilation alone

Answer

Plasmapheresis

Question 4

In Precocious puberty, the age limit for girls is?

Accepted Answer

8 years

Answer

10 years

Answer

9 years

Answer

11 years

Question 5

In children, which of the following is a key diagnostic sign of congestive heart failure (CHF)?

Accepted Answer

Hepatomegaly

Answer

Pedal edema

Answer

Raised JVP

Answer

Basal crepitations

Question 6

What is the treatment of choice for a 5-year-old child with bedwetting?

Accepted Answer

Motivational therapy

Answer

No treatment

Answer

Imipramine

Answer

Desmopressin

Question 7

An XX baby presenting with male genitalia (penis and scrotum) is likely due to which of the following conditions?

Accepted Answer

High level of testosterone in maternal blood

Answer

Turner syndrome

Answer

None of the options

Answer

Klinefelter syndrome

Question 8

What is the recommended rate for blood transfusion in neonates?

Accepted Answer

1-5 ml/min

Answer

10-15 ml/min

Answer

15-20 ml/min

Answer

5-10 ml/min

Question 9

A 3-month-old infant presents with an abdominal palpable mass and non-bilious vomiting. What is the most likely diagnosis?

Accepted Answer

Hypertrophic pyloric stenosis

Answer

Tracheoesophageal fistula

Answer

Duodenal atresia

Answer

Intussusception

Question 10

Most common site of extramedullary relapse of ALL in a 6-year-old boy is

Accepted Answer

CNS (Central Nervous System)

Answer

Testes

Answer

Liver

Answer

Lung

NEET-PG 2012 — Pediatrics