NEET-PG 2013 Practice Questions

Q: Acrodermatitis enteropathica is associated with a deficiency of which of the following?

Zinc. ***Zinc*** - Acrodermatitis enteropathica is a rare, inherited metabolic disorder characterized by a **deficiency in zinc absorption** or utilization. - Clinical manifestations include a characteristic **periorificial and acral dermatitis**, alopecia, and diarrhea, all of which respond dramatically to zinc supplementation. *Manganese* - Manganese is a trace element essential for various enzyme functions, but its deficiency does not cause acrodermatitis enteropathica. - Deficiency symptoms include impaired growth, skeletal abnormalities, and reproductive problems. *Copper* - Copper deficiency can lead to anemia, neutropenia, and neurological problems, but it is not associated with acrodermatitis enteropathica. - Conditions like Menkes disease involve problems with copper transport and metabolism. *Selenium* - Selenium deficiency can contribute to Keshan disease (cardiomyopathy) and impaired immune function. - It is not directly linked to the dermatological and gastrointestinal symptoms seen in acrodermatitis enteropathica.

Q: Which of the following is a symptom of protein deficiency?

Flaky paint like skin. ***Flaky paint like skin*** - This dermatological manifestation, known as **"flaky paint" dermatosis** or **crazy pavement dermatosis**, is a classic sign of **severe protein-energy malnutrition** (PEM), particularly **kwashiorkor**. - It results from **altered skin keratinization** and **desquamation** due to inadequate protein synthesis, leading to patches of hyperpigmentation and peeling skin that resemble peeling paint. *Glossitis* - **Glossitis**, or inflammation of the tongue, is primarily associated with deficiencies of **B vitamins** (especially B12, folate, niacin, and riboflavin) and **iron deficiency**. - While protein deficiency can broadly affect cell turnover, glossitis is not a primary or specific symptom directly attributable to it. *Nail change* - Various **nail changes** can indicate nutritional deficiencies, but they are more commonly linked to deficiencies in **iron** (e.g., koilonychia or "spoon nails"), **zinc** (e.g., Beau's lines, white spots), or certain **vitamins**. - While chronic malnutrition can impact nail health, there isn't a specific, characteristic nail change solely indicative of protein deficiency. *Cherry like skin* - "Cherry-like skin" is not a recognized dermatological symptom associated with any specific nutritional deficiency in medical literature. - Skin manifestations like **cherry angiomas** are benign vascular proliferations and are generally not linked to nutritional status.

Q: Which of the following is associated with WPW syndrome?

Ebstein anomaly. ***Ebstein anomaly*** - **Ebstein anomaly** is a congenital heart defect characterized by apical displacement of the septal and posterior leaflets of the tricuspid valve, which is strongly associated with **Wolff-Parkinson-White (WPW) syndrome.** - WPW syndrome, involving an **accessory pathway** that bypasses the AV node [1], is found in 5-25% of patients with Ebstein anomaly, predisposing them to re-entrant tachycardias [3]. *TOF* - **Tetralogy of Fallot (TOF)** is a complex cyanotic congenital heart defect that includes four main features: VSD, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy [2]. - There is no direct or strong association between TOF and WPW syndrome. *VSD* - A **Ventricular Septal Defect (VSD)** is a common congenital heart defect where there is an opening in the interventricular septum, allowing blood to flow between the ventricles [4]. - While VSDs can occur with other cardiac anomalies, there is no specific or frequent association with WPW syndrome. *TAPVC* - **Total Anomalous Pulmonary Venous Connection (TAPVC)** is a rare congenital heart defect where all four pulmonary veins connect to the systemic venous circulation instead of the left atrium. - This condition does not have a recognized association with WPW syndrome.

Q: The most common cause of meningitis in children aged 5 yrs is-

S. pneumoniae. ***S. pneumoniae*** - **_Streptococcus pneumoniae_** (Pneumococcus) is the **most common cause of bacterial meningitis** in children aged 5 years and older, as well as in adults. - Widespread vaccination has reduced its incidence but it remains a significant pathogen. *H. influenzae* - **_Haemophilus influenzae_ type b (Hib)** was a major cause of meningitis in young children, but its incidence has **drastically decreased** due to the routine **Hib vaccine**. - Without vaccination, it would still be a significant cause in this age group, but with high vaccine coverage, it is less common than _S. pneumoniae_. *Staphylococcus* - **_Staphylococcus aureus_** and other staphylococcal species are **less common causes of meningitis** in otherwise healthy children. - They are more typically associated with meningitis following **neurosurgery**, trauma, or in immunocompromised patients. *E.coli* - **_Escherichia coli_** is a common cause of **neonatal meningitis** (in infants less than 3 months old), often acquired during passage through the birth canal. - It is **rarely a cause of meningitis** in children aged 5 years.

Q: Which of the following is not a recommended treatment for bronchiolitis?

Macrolides. ***Macrolides*** - **Macrolide antibiotics** are *not* recommended for treatment of **bronchiolitis**, as the condition is primarily caused by **viral infections** (mainly RSV), rendering antibiotics completely ineffective. - Bronchiolitis is a **viral illness**, and use of antibiotics like macrolides provides *no benefit*, increases risk of **antibiotic resistance**, and may cause unnecessary side effects. - This is the **most clearly not recommended** option among the choices. *Humid oxygen* - While **supplemental oxygen** is indicated for infants with **hypoxemia** (oxygen saturation <90%), **routine humidification** of oxygen is *not specifically recommended* by current guidelines. - Evidence does *not support* routine use of humidified oxygen therapy in bronchiolitis. - However, supplemental oxygen itself (when needed for low oxygen levels) is appropriate supportive care. *Bronchodilator* - **Bronchodilators** (like albuterol or salbutamol) are *not routinely recommended* for bronchiolitis, as most infants do not have significant **bronchospasm** and show *no sustained benefit*. - Guidelines suggest a **trial dose** may be considered, but should be *discontinued* if there is no clear clinical improvement. - The primary pathology is **bronchiolar inflammation and mucus plugging**, not reversible bronchospasm. *All of the options* - This option is incorrect because the question asks for what is "*not* recommended." - **Macrolides** are the most definitively not recommended, as they are completely ineffective against viral infections. - While bronchodilators and routine humidification also lack strong evidence, **macrolides** represent inappropriate therapy with no mechanism of benefit.

Q: What is the most appropriate method for administering asthma treatment to an infant under one year of age?

MDI with Spacer and Mask. ***MDI with Spacer and Mask*** - For infants and young children, a **metered-dose inhaler (MDI)** used with a **spacer** and a **well-fitting mask** is the **most appropriate** method for delivering asthma medication. - The spacer helps to reduce the velocity of the aerosol and allows the infant to inhale the medication over several breaths, while the mask ensures the medication is delivered to the airways without significant loss. - This method is **portable**, **convenient**, and **cost-effective** for routine outpatient management. *MDI with Spacer (no mask)* - While a spacer is crucial for optimizing drug delivery from an MDI, an infant cannot effectively seal their lips around a spacer mouthpiece for proper inhalation. - This method would result in significant **medication loss** and insufficient dose delivery to the lungs. *MDI with Mask (no spacer)* - An MDI used directly with a mask without a spacer leads to inefficient drug delivery due to the **high velocity** of the aerosol spray. - The medication impinges on the back of the throat and face, reducing the amount that reaches the small airways. *Nebulizer therapy* - Nebulizers are also an **acceptable and effective option** for infants, particularly in acute settings or when families find them easier to use. - However, they are **time-consuming** (typically 10-15 minutes per treatment), require a power source or batteries, and are less portable than MDI systems. - For **routine outpatient management**, an MDI with spacer and mask is generally **preferred** due to its convenience, portability, and comparable efficacy when used correctly.

Q: Most common syndrome associated with A-V canal defect -

Down syndrome. ***Down syndrome*** - **Down syndrome (Trisomy 21)** is the most common syndrome associated with **atrioventricular (AV) canal defects** (endocardial cushion defects) - Occurs in approximately **40-50% of individuals with Down syndrome**, making it the hallmark cardiac anomaly in this condition - AV canal defects range from partial to complete defects involving atrial and ventricular septa and AV valves *Klinefelter syndrome* - **Klinefelter syndrome (47,XXY)** is not characteristically associated with AV canal defects - May have **mitral valve prolapse** or **aortic root dilation**, but AV canal defects are not a typical feature *Turner syndrome* - **Turner syndrome (45,X)** has distinct cardiovascular associations including **coarctation of the aorta** and **bicuspid aortic valve** - AV canal defects are **not** characteristic of Turner syndrome *Marfan syndrome* - **Marfan syndrome** is a connective tissue disorder with **aortic root dilation**, **aortic aneurysms**, and **mitral valve prolapse** - **AV canal defects are not a feature** of Marfan syndrome

Q: What is the APGAR score for a baby that grimaces in response to stimulation?

1. ***1*** - A score of **1** is given for **grimace** in response to stimulation, indicating some reflex irritability but not a vigorous cry or sneeze. - This response shows a minimal protective reflex, suggesting the baby is not completely flaccid but also not optimally responsive. - The APGAR scoring for reflex irritability ranges from 0 to 2, with grimacing specifically scoring **1 point**. *0* - A score of **0** for reflex irritability is reserved for **no response** or **complete absence** of reflexes. - This would indicate a severely depressed neurological state, unlike the grimace observed. *2* - A score of **2** for reflex irritability is given for a **vigorous cry**, **sneeze**, **cough**, or **active withdrawal** from stimulation. - A grimace is a less robust response than these, thus not warranting a score of 2. *3* - The APGAR scoring system uses a **0-2 scale** for each of the five components (Appearance, Pulse, Grimace, Activity, Respiration). - The maximum score for any single component is **2**, making 3 an invalid score. - Total APGAR scores range from 0-10, but individual components never exceed 2.

Q: In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?

Acrodermatitis enteropathica. ***Acrodermatitis enteropathica*** - This condition is a **zinc deficiency** syndrome, which can be either inherited or acquired. - It presents with a classic triad of **diarrhoea**, **dermatitis** (often periorificial and acral with moist, crusted lesions), and **alopecia**. - The **perianal moist crust** is a characteristic finding of the periorificial dermatitis seen in this condition. *Pellagra* - Pellagra is caused by **niacin (Vitamin B3) deficiency** and is characterized by the "4 D's": **dermatitis** (often sun-exposed areas), **diarrhoea**, **dementia**, and eventually death. - The dermatitis of pellagra is typically **symmetrical, hyperpigmented, and photosensitive**, not moist perianal crusts, differentiating it from the presented case. *Riboflavin deficiency* - **Riboflavin deficiency** typically manifests as **cheilosis**, angular stomatitis, glossitis, and seborrheic dermatitis, but not specifically perianal moist crusts with diarrhoea. - While it can affect mucous membranes, the specific perianal presentation with diarrhoea points away from this diagnosis. *Kwashiorkor* - **Kwashiorkor** is a form of protein-energy malnutrition that can present with **diarrhoea** and skin changes (flaky paint dermatosis, hypopigmentation). - However, the skin changes are typically **desquamating** and affect dependent areas, not the characteristic **moist, crusted periorificial lesions** seen in zinc deficiency. - Kwashiorkor also typically presents with **edema**, which is not mentioned in this case.

Q: Which of the following is NOT a characteristic of caput succedaneum?

It does not disappear within 2-3 days. ***It does not disappear within 2-3 days*** - Caput succedaneum is a benign condition that typically resolves within **2 to 3 days** after birth as the edema is reabsorbed. - Therefore, a characteristic of caput succedaneum is that it *does* disappear relatively quickly, making the statement that it "does not disappear within 2-3 days" incorrect. *Crosses midline* - Caput succedaneum is a **diffuse swelling** that extends across the scalp and is **not limited by anatomical boundaries** like the midline of the skull. - This characteristic helps differentiate it from a **cephalohematoma**, which is typically confined to one side of the head. *Crosses the suture line* - The edema of caput succedaneum is in the **soft tissues superficial to the periosteum**, allowing it to **cross the suture lines** of the skull. - This is a key differentiating feature from a **cephalohematoma**, which is a subperiosteal hemorrhage and therefore confined by suture lines. *It is a diffuse edematous swelling of the soft tissues of the scalp* - This statement accurately describes caput succedaneum as a **collection of serosanguineous fluid** and **edema** in the most superficial layers of the scalp. - It results from pressure on the fetal scalp during labor, leading to **venous congestion** and extravasation of fluid.

Question 1

Acrodermatitis enteropathica is associated with a deficiency of which of the following?

Accepted Answer

Zinc

Answer

Manganese

Answer

Copper

Answer

Selenium

Question 2

Which of the following is a symptom of protein deficiency?

Accepted Answer

Flaky paint like skin

Answer

Cherry like skin

Answer

Glossitis

Answer

Nail change

Question 3

Which of the following is associated with WPW syndrome?

Accepted Answer

Ebstein anomaly

Answer

TOF

Answer

VSD

Answer

TAPVC

Question 4

The most common cause of meningitis in children aged 5 yrs is-

Accepted Answer

S. pneumoniae

Answer

Staphylococcus

Answer

E.coli

Answer

H. influenzae

Question 5

Which of the following is not a recommended treatment for bronchiolitis?

Accepted Answer

Macrolides

Answer

Bronchodilator

Answer

Humid oxygen

Answer

All of the options

Question 6

What is the most appropriate method for administering asthma treatment to an infant under one year of age?

Accepted Answer

MDI with Spacer and Mask

Answer

MDI with Mask (no spacer)

Answer

Nebulizer therapy

Answer

MDI with Spacer (no mask)

Question 7

Most common syndrome associated with A-V canal defect -

Accepted Answer

Down syndrome

Answer

Klinefelter syndrome

Answer

Turner syndrome

Answer

Marfan syndrome

Question 8

What is the APGAR score for a baby that grimaces in response to stimulation?

Accepted Answer

1

Answer

0

Answer

2

Answer

3

Question 9

In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?

Accepted Answer

Acrodermatitis enteropathica

Answer

Pellagra

Answer

Riboflavin deficiency

Answer

Kwashiorkor

Question 10

Which of the following is NOT a characteristic of caput succedaneum?

Accepted Answer

It does not disappear within 2-3 days

Answer

Crosses the suture line

Answer

Crosses midline

Answer

It is a diffuse edematous swelling of the soft tissues of the scalp

NEET-PG 2013

Dermatology

Internal Medicine

Microbiology

Pediatrics