Which of the following statements about encephalocoele is false?
Which of the following statements about cephalhematoma is correct?
Which of the following is NOT a symptom of Kwashiorkor?
What is the maintenance fluid requirement in a 6 kg child ?
Most common type of TAPVC is -
Which of the following statements about shock in children is correct?
At what rate should dopamine be administered for inotropic support in a severely dehydrated child?
Which test is used to diagnose congenital syphilis in a newborn born to a syphilitic mother?
Most common site for bone marrow aspiration in neonates is -
Which of the following is true regarding precocious puberty:
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 21: Which of the following statements about encephalocoele is false?
- A. It is a neural tube defect
- B. Common in the parietal region (Correct Answer)
- C. Can be associated with hydrocephalus
- D. It is protrusion of neural tissue through a defect
Explanation: ***Common in the parietal region*** - This statement is **false** because encephaloceles are **rarely found in the parietal region** (only 10-15% of cases). - **Occipital encephaloceles** are most common in Western populations (75-80%), while **frontal/sincipital encephaloceles** are most common in Southeast Asia including India (40-60%). - **Parietal encephaloceles** represent only a small minority of cases globally, making this statement incorrect. *It is a neural tube defect* - **Encephalocele** is indeed a type of **neural tube defect (NTD)**, resulting from incomplete closure of the neural tube during embryonic development. - Specifically, it involves a defect in the skull that allows for protrusion of brain tissue and/or meninges. *Can be associated with hydrocephalus* - **Hydrocephalus**, or the accumulation of cerebrospinal fluid in the brain, is a known complication and associated condition with encephaloceles. - The abnormal brain development and structural defects can disrupt normal CSF flow and absorption, particularly with posterior encephaloceles. *It is protrusion of neural tissue through a defect* - This is the defining characteristic of an **encephalocele**: the **herniation of intracranial contents**, such as brain tissue, meninges, or both, through a congenital **bony defect** in the skull. - The contents of the sac can vary (meninges only = meningocele; brain tissue included = meningoencephalocele), influencing clinical presentation and prognosis.
Question 22: Which of the following statements about cephalhematoma is correct?
- A. It is hemorrhage between the skull and periosteum (Correct Answer)
- B. It is hemorrhage within the subcutaneous tissue around the skull
- C. It is type of subdural hemorrhage
- D. It is subperiosteal bleeding in the skull
Explanation: ***It is hemorrhage between the skull and periosteum*** - A **cephalhematoma** is defined as a collection of blood between the **periosteum** and the underlying **skull bone** (subperiosteal). - Its boundaries are limited by the suture lines because the periosteum is firmly attached at these junctions, preventing blood from crossing. *It is hemorrhage within the subcutaneous tissue around the skull* - This description corresponds to a **caput succedaneum**, which involves **edema and hemorrhage** in the subcutaneous tissue, rather than between the skull and periosteum. - Unlike a cephalhematoma, a **caput succedaneum** can cross suture lines and is typically present at birth. *It is type of subdural hemorrhage* - A **subdural hemorrhage** involves bleeding between the **dura mater** and the **arachnoid mater** within the cranial vault. - This type of hemorrhage is a **neurological emergency** and is distinct from a cephalhematoma, which is an external scalp injury. *It is subperiosteal bleeding in the skull* - While this statement is technically correct (subperiosteal means under the periosteum), the **standard definition** specifically states "between the periosteum and the skull bone." - The distinction is important: **subperiosteal** could theoretically include bleeding within the periosteum itself, whereas the precise location is in the **potential space** between periosteum and bone. - Option A is more precise and is the preferred medical definition.
Question 23: Which of the following is NOT a symptom of Kwashiorkor?
- A. Hypertension (Correct Answer)
- B. Hair changes and depigmentation
- C. Edema
- D. Growth retardation
Explanation: ***Hypertension*** - **Hypertension** is generally **NOT a direct symptom** of Kwashiorkor; rather, children with Kwashiorkor often have **low blood pressure** due to overall cardiovascular system depression. - While chronic malnutrition can have various systemic effects, elevated blood pressure is not a characteristic clinical feature of this condition. - This is the correct answer as the question asks what is NOT a symptom. *Hair changes and depigmentation* - This is a **classic symptom** of Kwashiorkor, characterized by sparse, brittle hair that may be discolored (e.g., reddish or yellowish - "flag sign"). - These changes reflect the severe protein deficiency interfering with hair follicle function and melanin production. *Edema* - **Edema**, particularly in the lower extremities and face, is a **hallmark symptom** of Kwashiorkor, caused by severe protein deficiency leading to decreased oncotic pressure. - This results in fluid shifting from the intravascular space into the interstitial space. *Growth retardation* - **Growth retardation** (stunting) is a common and severe symptom of Kwashiorkor, reflecting the long-term impact of inadequate protein and energy intake on physical development. - Both height and weight are significantly below age-appropriate norms.
Question 24: What is the maintenance fluid requirement in a 6 kg child ?
- A. 240 ml/day
- B. 600 ml/day (Correct Answer)
- C. 300 ml/day
- D. 1200 ml/day
Explanation: **600 ml/day** - The **Holliday-Segar formula** is used to calculate maintenance fluid requirements. For the first 10 kg of body weight, the requirement is 100 ml/kg/day. - For a 6 kg child, the calculation is 6 kg * 100 ml/kg/day = **600 ml/day**. *240 ml/day* - This value is significantly **lower** than the recommended maintenance fluid for a 6 kg child, which would lead to **dehydration**. - It does not align with the standard Holliday-Segar formula for this weight. *300 ml/day* - This amount is **insufficient** for a 6 kg child's daily maintenance fluid needs and would risk **hypovolemia**. - It represents roughly half of the calculated requirement based on standard pediatric guidelines. *1200 ml/day* - This volume is significantly **higher** than the maintenance fluid requirement for a 6 kg child and could lead to **fluid overload** and hyponatremia. - This calculation might be appropriate for a much heavier child or in situations of increased fluid loss.
Question 25: Most common type of TAPVC is -
- A. Supracardiac (Correct Answer)
- B. Cardiac
- C. Infracardiac
- D. Multiple
Explanation: ***Supracardiac*** - This is the **most common type** of Total Anomalous Pulmonary Venous Connection (TAPVC), accounting for about 50% of cases. - Pulmonary veins drain into a **common vertical vein** that ascends to connect with the **innominate vein** or superior vena cava. *Cardiac* - In this type, the pulmonary veins drain directly into the **right atrium** or a coronary sinus. - It is relatively less common than the supracardiac type. *Infracardiac* - This is the **least common** and most severe type, where the pulmonary veins drain below the diaphragm, typically into the portal vein, ductus venosus, or inferior vena cava. - It is often associated with **pulmonary venous obstruction**, leading to cyanosis and pulmonary hypertension. *Multiple* - While it is possible to have anomalous drainage sites, **multiple sites** draining into different systemic veins are less common than a single primary site for TAPVC. - TAPVC is typically classified into specific anatomic types rather than 'multiple' as a primary category.
Question 26: Which of the following statements about shock in children is correct?
- A. Tachycardia is a sensitive indicator of shock in children. (Correct Answer)
- B. Mottling of extremities is an early sign of shock.
- C. Confusion and stupor are early signs of shock.
- D. Respiratory rate is a more sensitive indicator of shock than heart rate.
Explanation: ***Tachycardia is a sensitive indicator of shock in children.*** - **Tachycardia** is often the first and most reliable sign of **compensated shock** in children, as their cardiovascular system initially maintains cardiac output by increasing heart rate. - Children have a remarkable ability to compensate for significant fluid loss, and an elevated heart rate helps maintain **perfusion** before blood pressure drops. *Mottling of extremities is an early sign of shock.* - **Mottling** of extremities is typically a sign of **decompensated shock** and indicates significant vasoconstriction and poor tissue perfusion. - It is a **late sign** that suggests the child's compensatory mechanisms are failing. *Confusion and stupor are early signs of shock.* - **Altered mental status**, such as confusion or stupor, usually indicates **severe shock** and reduced cerebral perfusion. - These are generally **late signs** of shock, appearing after initial compensatory mechanisms have failed. *Respiratory rate is a more sensitive indicator of shock than heart rate.* - While **tachypnea** can be present in shock due to metabolic acidosis or compensatory mechanisms, **tachycardia** is a more consistently sensitive and earlier indicator of circulatory compromise. - Respiratory changes can also be influenced by other factors like pain, fever, or respiratory illness, making heart rate a more specific initial marker for shock.
Question 27: At what rate should dopamine be administered for inotropic support in a severely dehydrated child?
- A. 0.1-0.5 microgram/kg/min
- B. 1-5 microgram/kg/min (Correct Answer)
- C. 1-5 mg/kg/min
- D. 10-15 mg/kg/min
Explanation: ***1-5 microgram/kg/min*** - This dosage range of **dopamine** primarily targets **beta-1 adrenergic receptors**, leading to **increased myocardial contractility** (inotropic effect) and improved cardiac output. - It is appropriate for managing **hypotension** and poor perfusion in a severely dehydrated child after initial **fluid resuscitation** has been attempted but was insufficient. *0.1-0.5 microgram/kg/min* - This very low dose range of dopamine primarily stimulates **dopaminergic receptors** in the renal and mesenteric vascular beds. - Its main effect is **vasodilation** in these areas, which increases blood flow to the kidneys and gut, but it provides minimal to no **inotropic support**. *1-5 mg/kg/min* - This dosage is significantly too high, as it is in milligrams rather than micrograms. - Administering dopamine at this rate would lead to severe **toxicity**, including profound **tachycardia**, ventricular arrhythmias, and extreme **vasoconstriction**. *10-15 mg/kg/min* - This dopamine dosage is also excessively high, again due to being in milligrams per minute rather than micrograms per minute. - Such a dose would be **lethal**, causing catastrophic cardiovascular collapse due to overwhelming **alpha-adrenergic stimulation** and severe arrhythmias.
Question 28: Which test is used to diagnose congenital syphilis in a newborn born to a syphilitic mother?
- A. Detection of IgG
- B. ZN staining
- C. Detection of IgM (Correct Answer)
- D. FTA-ABS test
Explanation: ***Detection of IgM*** - The presence of **IgM antibodies** in a newborn suggests active infection because maternal IgM does not cross the placenta. - This indicates the newborn's immune system has produced its own antibodies in response to *Treponema pallidum* infection. *Detection of IgG* - **Maternal IgG antibodies can cross the placenta**, so detecting IgG in a newborn does not differentiate between passive transfer from the mother and active newborn infection. - While total IgG might be elevated due to infection, specific IgM is a more reliable indicator of active congenital syphilis. *ZN staining* - **Ziehl-Neelsen (ZN) staining** is used to identify **acid-fast bacteria**, such as *Mycobacterium tuberculosis*, not spirochetes like *Treponema pallidum*. - *Treponema pallidum* is typically visualized using darkfield microscopy or silver stains due to its thin, helical shape. *FTA-ABS test* - The **Fluorescent Treponemal Antibody Absorption (FTA-ABS)** test detects specific antibodies against *Treponema pallidum* but primarily measures IgG, which can be maternally transferred. - While it confirms exposure, an IgM-specific FTA-ABS would be more definitive for congenital syphilis, but the general FTA-ABS test alone is not sufficient to diagnose active infection in a newborn.
Question 29: Most common site for bone marrow aspiration in neonates is -
- A. Anterior superior iliac crest
- B. Posterior superior iliac crest
- C. Sternum
- D. Anteromedial tibia (Correct Answer)
Explanation: ***Anteromedial tibia*** - The **anteromedial tibia** is the preferred site in neonates due to its relatively **large marrow cavity**, superficial location, and reduced risk of vital organ injury. - This site is easily accessible and provides a good yield of marrow cells, making it suitable for diagnostic purposes in newborns. *Anterior superior iliac crest* - While a common site for bone marrow aspiration in older children and adults, the **anterior superior iliac crest** can be more challenging and poses a greater risk in neonates due to their smaller bone structures. - The iliac crest offers less bony prominence and a thinner cortex in neonates, increasing the difficulty of the procedure and potential for sampling error. *Posterior superior iliac crest* - The **posterior superior iliac crest** is another common site in older children and adults but is generally avoided in neonates due to the difficulty in positioning and the risk of damaging vital structures in the vicinity. - It requires prone positioning and offers less superficial bone, making it a less practical and safe choice for neonates compared to the tibia. *Sternum* - **Sternal aspiration** is generally contraindicated in neonates and young children due to the thinness of the sternal bone and proximity to vital structures like the heart and great vessels. - There is a high risk of **perforation** of the sternum and injury to underlying organs, making this site unsafe for bone marrow aspiration in this age group.
Question 30: Which of the following is true regarding precocious puberty:
- A. Sexual maturity is attained early (Correct Answer)
- B. Mental function is increased
- C. Reproductive function is absent
- D. Body proportions remain unchanged
Explanation: ***Sexual maturity is attained early*** - **Precocious puberty** is defined by the development of secondary sexual characteristics significantly earlier than the average age. - This early onset of puberty means that affected individuals reach **sexual maturity** at a younger chronological age. *Mental function is increased* - Precocious puberty does not inherently lead to an increase in **mental function** or cognitive abilities. - While hormonal changes can influence mood and behavior, they do not enhance intelligence. *Reproductive function is absent* - Precocious puberty implies the premature activation of the **hypothalamic-pituitary-gonadal axis**, leading to the appearance of secondary sexual characteristics and, in many cases, the potential for **reproductive function**. - Girls, for example, can experience early menarche and boys can produce sperm, meaning fertility is not absent but rather accelerated. *Body proportions remain unchanged* - Precocious puberty often results in changes in **body proportions**, particularly due to the early closure of epiphyseal plates. - Although there is an initial growth spurt, the premature fusion of growth plates can lead to a shorter-than-average adult height.