NEET-PG 2012 - Pediatrics Practice Questions

Q: 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?

Propranolol. ***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**.

Q: Rubella is known to cause all of the following conditions except:

Glaucoma. ***Glaucoma*** - While rubella can cause **ocular defects** such as **cataracts** and **pigmentary retinopathy**, glaucoma is not a typical congenital manifestation of rubella syndrome. - **Congenital glaucoma** is more commonly associated with other genetic syndromes or developmental anomalies. *Microcephaly* - **Microcephaly** is a recognized neurological complication of congenital rubella syndrome, resulting from impaired brain development due to viral infection. - The rubella virus can interfere with the **proliferation and migration** of neuronal cells during fetal development. *VSD* - **Ventricular septal defect (VSD)** is a common congenital heart defect associated with congenital rubella syndrome. - Other cardiac anomalies seen include **patent ductus arteriosus (PDA)** and **pulmonary artery stenosis**. *Conduction defects* - **Conduction defects** and other **cardiac arrhythmias** can occur in congenital rubella syndrome due to direct viral damage to the developing cardiac conduction system. - This can manifest as **bradyarrhythmias** or various degrees of **heart block**.

Q: Best treatment for nocturnal enuresis is

Bed alarm. ***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.

Q: What is the threshold for hyperglycemia in neonates?

150 mg/dl. ***150 mg/dl*** - A blood glucose level greater than **150 mg/dL** is the **standard threshold** most commonly taught and used for defining **hyperglycemia** in neonates. - This value is widely accepted in clinical practice and guides decisions regarding **glucose management** and potential **insulin therapy** in this population. - This threshold is particularly relevant for term and late preterm neonates. *125 mg/dl* - While **125 mg/dL** represents an elevated glucose level and some newer guidelines consider this as a threshold (especially >7 mmol/L), it is **not the standard taught threshold** of 150 mg/dL. - For examination purposes, **150 mg/dL** remains the recognized standard definition. *180 mg/dl* - A blood glucose level of **180 mg/dL** indicates **severe hyperglycemia** rather than the initial threshold for defining hyperglycemia. - While some protocols for extremely preterm infants may use higher cutoffs, this exceeds the standard diagnostic threshold. - Intervention is typically initiated well before reaching this level to prevent complications. *100 mg/dl* - A blood glucose level of **100 mg/dL** in a neonate falls within the **normal range**, not hyperglycemia. - This level is desirable for proper brain development and metabolic function. - Normal neonatal glucose ranges from approximately **40-100 mg/dL** in the first days of life.

Q: The recommended ambient temperature for NICU is

22-26° C. ***22-26° C*** - Maintaining an ambient temperature of **22-26°C** in the NICU is crucial for preventing **cold stress** in neonates. - This temperature range helps to maintain the baby's **core body temperature**, reducing metabolic demands and ensuring optimal thermal regulation. *20-22° C* - While this might be a comfortable room temperature for adults, it is generally **too cold** for newborns in the NICU. - Temperatures below the recommended range can lead to significant **cold stress**, increasing oxygen consumption and metabolic rate in vulnerable infants. *26-30° C* - This temperature range is generally **too warm** for a NICU environment. - Excessive warmth can lead to **hyperthermia** and sweating, which increases fluid loss and can be detrimental to a neonate's health. *30-35°C* - This temperature is **dangerously high** for neonates in the NICU. - Such high temperatures would significantly increase the risk of **hyperthermia, dehydration**, and other severe complications, compromising the infant's well-being.

Q: What is the correct dose of i.v. adrenaline in term infants during neonatal resuscitation?

0.1-0.3 ml/kg in 1:10,000. ***0.1-0.3 ml/kg in 1:10,000*** - The recommended intravenous adrenaline dose for neonatal resuscitation is **0.01-0.03 mg/kg** using a **1:10,000 solution (0.1 mg/mL)**. - Volume calculation: 0.01-0.03 mg/kg ÷ 0.1 mg/mL = **0.1-0.3 mL/kg**. - This is the standard dose as per **NRP (Neonatal Resuscitation Program)** and **AHA guidelines** [2]. - The 1:10,000 concentration is safer for IV/umbilical venous catheter administration in neonates. *0.01-0.03 ml/kg in 1:1,000* - This volume is far too low for a 1:1,000 solution. - Would deliver only 0.01-0.03 mg total (not per kg), resulting in a **sub-therapeutic dose**. - The 1:1,000 concentration contains 1 mg/mL, which is **10 times more concentrated** than the recommended dilution. *0.3-0.5 ml/kg in 1:10,000* - This volume would deliver 0.03-0.05 mg/kg, which **exceeds the recommended maximum** of 0.03 mg/kg. - Higher doses can cause **severe adverse effects** including hypertension, arrhythmias, decreased myocardial function, and compromised coronary perfusion. - Not recommended as the standard initial dose. *0.03-0.05 ml/kg in 1:1,000* - The 1:1,000 concentration (1 mg/mL) is **too concentrated for IV use** in neonates [1]. - This volume would deliver 0.03-0.05 mg/kg from a highly concentrated solution, increasing risk of **severe cardiovascular complications**. - The 1:1,000 solution is reserved for **endotracheal administration** (at higher volumes of 0.5-1 mL/kg), not IV route.

Q: What is the recommended CPR ratio for infants when performed by 2 rescuers?

15 : 2. ***15 : 2*** - For **infants and children**, when there are **two or more rescuers**, the recommended compression-to-ventilation ratio is **15 compressions to 2 breaths**. - This ratio provides a better balance between compressions and ventilations to optimize outcomes in pediatric cardiac arrest. *30 : 2* - The **30:2 ratio** is primarily recommended for **adult CPR**, or for **single rescuers** performing CPR on infants and children. - Using this ratio for two-rescuer infant CPR would likely lead to inadequate ventilation and potentially worse outcomes. *1 : 3* - A 1:3 ratio (1 compression to 3 breaths) is not a standard recommended ratio for CPR in any age group based on current guidelines. - This ratio would significantly prioritize ventilations over chest compressions, which is not ideal for maintaining circulation. *1 : 5* - A 1:5 ratio (1 compression to 5 breaths) is not a standard recommended ratio for CPR in any age group. - This ratio heavily emphasizes ventilations and would result in insufficient chest compressions, which are crucial for blood flow.

Q: Double aortic arch is associated with which syndrome?

DiGeorge syndrome. ***DiGeorge syndrome*** - **DiGeorge syndrome** is caused by a **22q11.2 deletion** affecting the development of the third and fourth pharyngeal pouches, leading to **thymic hypoplasia**, **parathyroid hypoplasia**, and **cardiac anomalies**. - Common cardiac defects include **interrupted aortic arch type B**, **truncus arteriosus**, **tetralogy of Fallot**, and **VSD**. - **Double aortic arch** can occur in 22q11.2 deletion syndrome, though it is less common than other cardiac anomalies; however, among the syndromes listed, this represents the most appropriate association. - The question tests recognition that various cardiac arch anomalies, including double aortic arch, may be seen in this genetic syndrome. *CATCH 22 syndrome* - This is an **acronym** for DiGeorge syndrome: **C**ardiac defects, **A**bnormal facies, **T**hymic hypoplasia, **C**left palate, **H**ypocalcemia, and **22q11 deletion**. - It is **essentially the same condition** as DiGeorge syndrome, just using different nomenclature. - While technically correct, "DiGeorge syndrome" is the more standard medical terminology currently used. *Shprintzen syndrome* - **Shprintzen syndrome** (also called **velocardiofacial syndrome or VCFS**) is caused by the **same 22q11.2 deletion** as DiGeorge syndrome. - It represents a **phenotypic variant within the 22q11.2 deletion syndrome spectrum**, with more emphasis on palatal and facial features. - Since it shares the same genetic basis, it can also present with similar cardiac anomalies, but "DiGeorge syndrome" is the more commonly recognized term for this genetic disorder. *None of the options* - This is incorrect because the three syndromes listed above (DiGeorge, CATCH 22, and Shprintzen) all refer to **22q11.2 deletion syndrome** or its variants, which can be associated with various cardiac anomalies including double aortic arch. - Among the listed options, **DiGeorge syndrome** is the most appropriate and widely recognized answer.

Q: Rehydration therapy in a 2 year old severely dehydrated child is -

30 ml/kg in 30 min, 70 ml/kg in 2.5 hours. ***30 ml/kg in 30 min, 70 ml/kg in 2.5 hours*** - This option reflects the recommended rehydration protocol for a severely dehydrated child aged **12 months to 5 years**, where the first 30 ml/kg are given rapidly over 30 minutes, followed by 70 ml/kg over the next 2.5 hours. - This rapid initial infusion helps to quickly restore **circulating volume** and improve perfusion during severe dehydration. *30 ml/kg in 1 hour, 70 ml/kg in 5 hours* - This protocol is typically used for children with **some dehydration**, not severe dehydration, and is usually administered orally when possible. - The slower rate of rehydration would be insufficient for a severely dehydrated child requiring more urgent fluid replacement. *20 ml/kg in 30 min, 80 ml/kg in 2.5 hours* - While reflecting a rapid initial phase, the total volume and distribution of fluids differ from the WHO guidelines for **severe dehydration** in this age group. - The **initial 20 ml/kg over 30 minutes** is generally a slightly lower first bolus than recommended for very severe cases, and the subsequent phase is also adjusted. *75 ml/kg in 4 hours* - This represents a **lower total volume** (75 ml/kg compared to 100 ml/kg) and a different time distribution for severely dehydrated children in the 12 month to 5 year age group. - This protocol is more aligned with the management of **some dehydration** rather than the urgent requirements of severe dehydration.

Question 1

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?

Accepted Answer

Propranolol

Answer

Digoxin

Answer

Frusemide

Answer

Isoptin

Question 2

Rubella is known to cause all of the following conditions except:

Accepted Answer

Glaucoma

Answer

Conduction defects

Answer

VSD

Answer

Microcephaly

Question 3

Best treatment for nocturnal enuresis is

Accepted Answer

Bed alarm

Answer

Positive reinforcement

Answer

Punishment

Answer

Desmopressin

Question 4

What is the threshold for hyperglycemia in neonates?

Accepted Answer

150 mg/dl

Answer

180 mg/dl

Answer

100 mg/dl

Answer

125 mg/dl

Question 5

What is the PRIMARY pathophysiological mechanism underlying the most common cause of neonatal hyperbilirubinemia?

Accepted Answer

Immature liver enzyme

Answer

Inefficient erythropoiesis

Answer

RBC hemolysis

Answer

Decreased bilirubin excretion

Question 6

The recommended ambient temperature for NICU is

Accepted Answer

22-26° C

Answer

20-22° C

Answer

26-30° C

Answer

30-35° C

Question 7

What is the correct dose of i.v. adrenaline in term infants during neonatal resuscitation?

Accepted Answer

0.1-0.3 ml/kg in 1:10,000

Answer

0.03-0.05 ml/kg in 1:1,000

Answer

0.01-0.03 ml/kg in 1:1,000

Answer

0.3-0.5 ml/kg in 1:10,000

Question 8

What is the recommended CPR ratio for infants when performed by 2 rescuers?

Accepted Answer

15 : 2

Answer

30 : 2

Answer

1 : 3

Answer

1 : 5

Question 9

Double aortic arch is associated with which syndrome?

Accepted Answer

DiGeorge syndrome

Answer

CATCH 22 syndrome

Answer

Shprintzen syndrome

Answer

None of the options

Question 10

Rehydration therapy in a 2 year old severely dehydrated child is -

Accepted Answer

30 ml/kg in 30 min, 70 ml/kg in 2.5 hours

Answer

75 ml/kg in 4 hours

Answer

30 ml/kg in 1 hour, 70 ml/kg in 5 hours

Answer

20 ml/kg in 30 min, 80 ml/kg in 2.5 hours

NEET-PG 2012 — Pediatrics