A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?
A 24-day-old neonate presents with projectile vomiting and failure to gain weight. What is the most likely diagnosis?
What are the first-line disease-modifying treatments for Guillain-Barre Syndrome (GBS) in a child?
Opsoclonus-myoclonus is a phenomenon seen in:
Best treatment for nocturnal enuresis is
In Precocious puberty, the age limit for girls is?
A 30-week preterm neonate is admitted to NICU immediately after birth. Which of the following complications is MOST directly related to surfactant deficiency?
What is the primary reason for low glucose levels in premature infants?
What is correct about febrile seizures
A 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography shows normal cardiac morphology with asymmetric septal hypertrophy. Which of the following medications is indicated for the management of this child's condition?
NEET-PG 2012 - Pediatrics NEET-PG Practice Questions and MCQs
Question 31: A child presents with recurrent pulmonary infections and hemoptysis due to associated bronchiectasis. Imaging shows unilateral loss of lung volume with hyperlucency on chest radiograph and reduced vascularity on CT scan of the chest. The abdominal organs are normally placed. What is the most likely cause?
- A. Swyer-James-MacLeod syndrome (Correct Answer)
- B. Immotile cilia syndrome
- C. Kartagener syndrome
- D. Mendelson syndrome
Explanation: ***Swyer-James-MacLeod syndrome*** - This syndrome presents with **unilateral hyperlucent lung**, reduced vascularity, and bronchiectasis, often following a severe childhood respiratory infection, leading to air trapping and recurrent infections. - The imaging findings of **unilateral loss of lung volume**, hyperlucency, and reduced vascularity are classic for Swyer-James-MacLeod syndrome, which is also known as unilateral emphysema. *Immotile cilia syndrome* - This is a broader term that encompasses conditions like Kartagener syndrome, characterized by ciliary dysfunction leading to **recurrent sinopulmonary infections**; however, it does not typically present with unilateral hyperlucent lung or reduced vascularity. - While it causes bronchiectasis, the specific imaging findings described (unilateral hyperlucency) are not characteristic of isolated immotile cilia syndrome. *Kartagener syndrome* - This is a subgroup of primary ciliary dyskinesia that includes the classic triad of **situs inversus**, bronchiectasis, and sinusitis. The patient in the prompt has normally placed abdominal organs, ruling out situs inversus. - Although it involves recurrent pulmonary infections and bronchiectasis, the presence of **normally placed abdominal organs** and unilateral hyperlucency on imaging makes Kartagener syndrome less likely. *Mendelson syndrome* - This refers to **chemical pneumonitis** caused by the aspiration of gastric contents, typically during anesthesia or in patients with impaired consciousness. - It presents acutely with respiratory distress, hypoxemia, and diffuse infiltrates on imaging, which is inconsistent with the chronic presentation of recurrent infections and unilateral hyperlucency described.
Question 32: A 24-day-old neonate presents with projectile vomiting and failure to gain weight. What is the most likely diagnosis?
- A. NEC
- B. Duodenal atresia
- C. Hirschsprung's disease
- D. Congenital Hypertrophic Pyloric Stenosis (Correct Answer)
Explanation: ***Congenital Hypertrophic Pyloric Stenosis*** - The classic presentation includes **projectile, non-bilious vomiting** in a neonate around 2-8 weeks old, leading to **failure to thrive**. - An **olive-shaped mass** (hypertrophied pylorus) may be palpable in the epigastrium. *NEC* - **Necrotizing enterocolitis (NEC)** is an inflammatory disease of the intestine, primarily affecting premature infants. - Symptoms typically include **abdominal distension**, bloody stools, and lethargy, rather than projectile vomiting. *Duodenal atresia* - Presents with **bilious vomiting** within the first 24-48 hours of life due to an obstruction below the ampulla of Vater. - An X-ray would show a **"double bubble" sign**, which is not implied by the provided symptoms. *Hirschsprung's disease* - Characterized by **failure to pass meconium** within the first 24-48 hours and chronic constipation. - Vomiting, if present, is usually **bilious** and associated with abdominal distension, not projectile in nature.
Question 33: What are the first-line disease-modifying treatments for Guillain-Barre Syndrome (GBS) in a child?
- A. Intravenous Immunoglobulin (IV Ig) and Plasmapheresis (Correct Answer)
- B. Intravenous Immunoglobulin (IV Ig) alone
- C. Mechanical Ventilation alone
- D. Plasmapheresis
Explanation: ***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
Question 34: Opsoclonus-myoclonus is a phenomenon seen in:
- A. Wilms' tumor
- B. Meningioma
- C. Cortical tuberculoma
- D. Neuroblastoma (Correct Answer)
Explanation: ***Neuroblastoma*** - **Opsoclonus-myoclonus syndrome (OMS)** is a rare paraneoplastic neurological disorder primarily associated with childhood neuroblastoma. - It is characterized by rapid, irregular eye movements (**opsoclonus**), brief, involuntary muscle jerks (**myoclonus**), ataxia, and irritability. *Wilm's tumor* - Wilms' tumor (nephroblastoma) is a kidney tumor of childhood and is not typically associated with opsoclonus-myoclonus syndrome. - While it is also a pediatric cancer, its paraneoplastic manifestations are different and do not include OMS. *Meningioma* - Meningiomas are typically slow-growing tumors arising from the meninges in adults, and are not associated with opsoclonus-myoclonus. - Paraneoplastic syndromes are rare with meningiomas, and OMS is not one of them. *Cortical tuberculoma* - A cortical tuberculoma is a granulomatous lesion in the brain caused by Mycobacterium tuberculosis, often seen in individuals with tuberculosis. - While it can cause neurological symptoms like seizures, headaches, and focal deficits, it does not cause opsoclonus-myoclonus syndrome.
Question 35: Best treatment for nocturnal enuresis is
- A. Positive reinforcement
- B. Punishment
- C. Bed alarm (Correct Answer)
- D. Desmopressin
Explanation: ***Bed alarm*** - **Bed alarms** are considered the most effective long-term treatment for nocturnal enuresis by conditioning the child to wake up to a full bladder. - This method has a high success rate and a lower relapse rate compared to pharmacological treatments. *Positive reinforcement* - While helpful for building confidence and encouraging adherence to treatment, **positive reinforcement** alone is generally not sufficient to cure nocturnal enuresis. - It works best as an adjunct to other established treatments, like bed alarms, to motivate the child. *Punishment* - **Punishment** is not an effective or appropriate treatment for nocturnal enuresis and can be psychologically harmful to the child. - Enuresis is an involuntary condition, and punishment can lead to increased stress, anxiety, and shame, potentially worsening the problem. *Desmopressin* - **Desmopressin** (DDAVP) is a synthetic analog of antidiuretic hormone and can reduce urine production at night, offering a short-term solution. - It is effective in reducing the frequency of wet nights but has a higher relapse rate once discontinued, and it does not cure the underlying problem like a bed alarm does.
Question 36: In Precocious puberty, the age limit for girls is?
- A. 8 years (Correct Answer)
- B. 10 years
- C. 9 years
- D. 11 years
Explanation: ***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.
Question 37: A 30-week preterm neonate is admitted to NICU immediately after birth. Which of the following complications is MOST directly related to surfactant deficiency?
- A. Increased risk of intraventricular hemorrhage
- B. Increased risk of respiratory distress syndrome (Correct Answer)
- C. Increased risk of hypothermia
- D. Increased risk of hypoglycemia
Explanation: ***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.
Question 38: What is the primary reason for low glucose levels in premature infants?
- A. Decreased glycogen stores (Correct Answer)
- B. Increased brain to body ratio
- C. Decreased action of pyruvate carboxylase
- D. None of the options
Explanation: ***Decreased glycogen stores*** - Premature infants have undeveloped livers, leading to significantly **reduced glycogen reserves** at birth compared to full-term infants. - These limited stores are rapidly depleted within hours after birth, leaving the infant vulnerable to **hypoglycemia** as they cannot maintain glucose homeostasis. *Increased brain to body ratio* - While premature infants do have a relatively **larger brain-to-body ratio**, this primarily increases their glucose utilization, rather than causing low glucose directly. - The increased glucose demand is an exacerbating factor for hypoglycemia, but the fundamental issue remains the lack of available glucose to meet this demand. *Decreased action of pyruvate carboxylase* - **Pyruvate carboxylase** is an enzyme crucial for **gluconeogenesis**, the process of synthesizing glucose from non-carbohydrate precursors. - While immature hepatic enzyme systems in premature infants can contribute to impaired gluconeogenesis, the primary and most immediate reason for initial low glucose levels is the lack of stored glycogen. *None of the options* - Given that a specific and significant reason for low glucose levels in premature infants is clearly identified (decreased glycogen stores), this option is incorrect.
Question 39: What is correct about febrile seizures
- A. Focal deficits
- B. Repeated seizure
- C. Abnormal EEG
- D. Normal EEG (Correct Answer)
Explanation: ***Normal EEG*** - An **electroencephalogram (EEG)** is generally **not recommended** after a simple febrile seizure because these seizures are due to the brain's response to fever, not an underlying epileptic disorder. - The **EEG typically appears normal** following a simple febrile seizure, as there is no intrinsic cerebral pathology to detect. - Simple febrile seizures are benign events that do not require routine EEG investigation. *Focal deficits* - **Focal neurological deficits** (e.g., weakness on one side of the body) are **not characteristic** of **simple febrile seizures** and would suggest a more complex neurological issue or an underlying etiology. - The presence of focal deficits would prompt further investigation for complex febrile seizures or other neurological conditions. *Repeated seizure* - While **recurrence of febrile seizures** is common (about 30-35% of children experience a second seizure), this refers to a **risk factor** for recurrence rather than a defining characteristic of febrile seizures. - Risk factors for recurrence include young age at first seizure, family history of febrile seizures, low fever at onset, and brief duration between fever onset and seizure. *Abnormal EEG* - An **abnormal EEG** in the context of a febrile seizure would raise concerns for an **underlying epileptic syndrome** or other neurological pathology, which is not typical for **simple febrile seizures**. - Routine EEG is not indicated for simple febrile seizures as it is unlikely to show abnormalities and is not predictive of future epilepsy.
Question 40: A 9-month-old child of a diabetic mother presents with tachypnea and hepatomegaly. Echocardiography shows normal cardiac morphology with asymmetric septal hypertrophy. Which of the following medications is indicated for the management of this child's condition?
- A. Digoxin
- B. Frusemide
- C. Propranolol (Correct Answer)
- D. Isoptin
Explanation: ***Propranolol*** - **Propranolol** is a **beta-blocker** that is indicated for **hypertrophic cardiomyopathy** (HCM) in infants, especially those of diabetic mothers. - It works by reducing the **heart rate** and **myocardial contractility**, which decreases the **left ventricular outflow tract (LVOT) obstruction** caused by the hypertrophied septum. *Digoxin* - **Digoxin** is a **positive inotrope**, meaning it increases the force of myocardial contraction. - This effect would worsen the **outflow tract obstruction** in hypertrophic cardiomyopathy and is therefore contraindicated. *Frusemide* - **Frusemide** is a **diuretic** used to manage **fluid overload** and **congestive heart failure**. - While fluid management can be part of heart failure treatment, frusemide does not directly address the underlying **asymmetric septal hypertrophy** or **LVOT obstruction** in this context. *Isoptin* - **Isoptin** (verapamil) is a **non-dihydropyridine calcium channel blocker**. - While some calcium channel blockers can be used in adult hypertrophic cardiomyopathy, verapamil is generally avoided in infants with HCM due to its potential for **negative inotropic effects** and worsening hypotension, especially in the presence of outflow obstruction, and the risk of significant **bradycardia** and **atrioventricular block**.