NEET-PG 2015 - Pediatrics Practice Questions

Q: There is overlapping of skull sutures which can be reduced with gentle pressure. What is the grade of moulding?

Grade 2. ***Grade 2*** - **Grade 2 moulding** is characterized by overriding of the skull sutures that can be reduced with gentle pressure. This indicates moderate moulding of the fetal head. - This degree of moulding is a common finding during labor and delivery and usually resolves without intervention. *Grade 1* - **Grade 1 moulding** involves the apposition (touching) of the skull bones without actual overlap. - It signifies minimal moulding of the fetal head. *Grade 3* - **Grade 3 moulding** involves significant overlapping of the skull sutures that is fixed and cannot be reduced with gentle pressure. - This indicates severe moulding and may sometimes be associated with increased risk of intracranial complications. *Grade 4* - There is no universally recognized "Grade 4" for fetal head moulding in standard classifications. - Moulding is typically classified up to Grade 3, indicating increasing severity.

Q: A 45-day-old infant presents with seizures. Examination reveals he is icteric, has bulging fontanelles, and exhibits opisthotonic posture. Which of the following treatments is NOT indicated?

Chlorpromazine. ***Chlorpromazine*** - Chlorpromazine is an **antipsychotic medication** and is **contraindicated** in infants, especially in the presence of seizures and central nervous system (CNS) dysfunction, due to its potential to **lower the seizure threshold** and cause severe extrapyramidal symptoms. - Its mechanism of action via **dopamine receptor blockade** is not relevant for treating bilirubin encephalopathy or its symptoms. *Phototherapy* - Phototherapy is a primary treatment for **neonatal jaundice** to reduce unconjugated bilirubin levels and prevent neurotoxicity. - While the infant's condition suggests severe hyperbilirubinemia with complications, phototherapy would still be indicated as an initial step or adjunct to further interventions, especially if the bilirubin levels are still rising. *Exchange Transfusion* - Exchange transfusion is a **definitive treatment** for severe hyperbilirubinemia, especially when there are signs of **acute bilirubin encephalopathy (kernicterus)**, as suggested by seizures, bulging fontanelles, and opisthotonus. - It rapidly removes bilirubin from the blood and is crucial to prevent further neurological damage in such critical cases. *Phenobarbital* - Phenobarbital is an **anticonvulsant** used to manage seizures, which are a prominent symptom in this infant. - It can also help to **induce hepatic enzymes** involved in bilirubin metabolism, thereby potentially aiding in the reduction of bilirubin levels in cases of severe hyperbilirubinemia, though its primary role here would be seizure control.

Q: Polyarticular onset JRA involves more than how many joints?

4. ***4*** - **Polyarticular onset Juvenile Rheumatoid Arthritis (JRA)**, now often referred to as **Juvenile Idiopathic Arthritis (JIA)**, is defined by the involvement of **five or more joints** within the first six months of the disease. Therefore, "more than 4" correctly describes this threshold. - This subtype of JIA accounts for approximately 30% of all JIA cases and can be further classified into rheumatoid factor-positive and rheumatoid factor-negative forms. *3* - Involvement of **fewer than five joints** (i.e., four or fewer) within the first six months would classify the disease as **oligoarticular JIA**, a distinct and often milder subtype. - Oligoarticular JIA is the most common subtype and often affects large joints like the knees. *5* - While **five or more joints** is the diagnostic criterion for polyarticular JIA, stating "more than 5" would be incorrect as exactly five joints already falls within the polyarticular definition. - The threshold is **equal to or greater than five joints**, not strictly exceeding five. *6* - Specifying "more than 6" joints would exclude cases where 5 or 6 joints are involved, which are still considered polyarticular JIA. - The key diagnostic number is **five**, meaning "more than 4" encompasses the correct definition.

Q: Which of the following urethral anomalies is the most common?

Hypospadias. ***Hypospadias*** - **Hypospadias** is the most common urethral anomaly, occurring when the **urethral opening** is located on the underside of the penis rather than at the tip. - Its prevalence ranges from approximately **1 in 150 to 1 in 300 live male births**, making it significantly more frequent than other urethral malformations. *Pinhole meatus* - A **pinhole meatus** refers to an abnormally small urethral opening. - While it can be a component or consequence of other anomalies, it is **less common as a standalone finding** compared to hypospadias. *Epispadias* - **Epispadias** is a rare anomaly where the urethra opens on the **dorsal (top) aspect** of the penis. - Its incidence is much lower than hypospadias, estimated at **1 in 100,000 to 1 in 500,000 live births**. *Stricture of the urethra* - A **urethral stricture** is a narrowing of the urethra, often due to **scar tissue** from inflammation, trauma, or infection. - Although it can present at any age, it is more commonly an **acquired condition** rather than a congenital anomaly like hypospadias or epispadias.

Q: All of the following are clinical features suggestive of tracheoesophageal fistula except -

Fever. ***Fever*** - **Fever is NOT a primary clinical feature** of tracheoesophageal fistula (TEF) itself. - While fever might occur as a **complication** if aspiration pneumonia develops, it is not a direct presenting sign of TEF. - The classic presentation of TEF occurs in **newborns within hours of birth** and involves the "3 Cs" - not fever. *Choking and Coughing* - Part of the classic **"3 Cs" triad** (Choking, Coughing, Cyanosis) of TEF presentation. - Occurs during the **first feeding attempt** when milk enters the trachea through the abnormal fistulous connection. - This is a **cardinal diagnostic feature** that should immediately raise suspicion for TEF. *Regurgitation* - **Immediate regurgitation** of feeds is characteristic, especially in TEF with esophageal atresia (most common type - Type C). - The **blind-ending proximal esophageal pouch** prevents normal passage of saliva and feeds, causing regurgitation. - Often accompanied by **excessive drooling and frothy secretions** from the mouth and nose. *Cyanosis* - The third component of the **"3 Cs" triad** and a key clinical feature. - Results from **aspiration of feeds or saliva** into the trachea and lungs, causing acute respiratory distress. - May also occur from **laryngospasm** as a protective reflex when fluid enters the airway.

Q: Which of the following statements about development milestones at 6 months of age is incorrect?

Pincer grasp. ***Pincer grasp*** - The **pincer grasp** (using the index finger and thumb to pick up small objects) typically develops much later, usually around **9-12 months** of age. - At 6 months, infants are usually developing a **palmar grasp** or raking motion, not the fine motor control required for a pincer grasp. - This milestone is **NOT expected at 6 months**, making this the incorrect statement. *Watching self in mirror* - By 6 months, infants typically show **interest in their own reflection** and will watch themselves in a mirror, often smiling or vocalizing at the image. - This is a normal social-emotional milestone at this age. *Sitting in tripod position* - Many 6-month-old infants are able to sit with support, and often begin to sit independently for short periods, frequently using their arms for stability in a **tripod position**. - This is a common and expected gross motor milestone at this age. *Monosyllable sounds* - Around 6 months, infants commonly start to produce **monosyllable sounds** like "ba-ba," "da-da," or "ma-ma," as part of their early babbling. - This is a normal and expected language development milestone.

Q: Which of the following is not a known cause of neuroregression in children?

ADHD. ***ADHD*** - **Attention-deficit/hyperactivity disorder (ADHD)** is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity. It is **not** a cause of neuroregression. - While ADHD can impact cognitive and behavioral functioning, it does not involve a loss of previously acquired developmental milestones or skills. *Wilson's disease* - **Wilson's disease** is an inherited disorder that causes **copper accumulation** in organs, particularly the liver and brain. - Neurological symptoms, including **neuroregression**, can occur due to copper toxicity in the central nervous system. *Vitamin B12 deficiency* - **Vitamin B12 deficiency** can lead to neurological complications such as **subacute combined degeneration** of the spinal cord and peripheral neuropathy. - In children, severe or prolonged deficiency can impair brain development and lead to **developmental regression**. *Ataxia telangiectasia* - **Ataxia telangiectasia** is a rare, neurodegenerative, inherited disease that affects multiple body systems. - It is characterized by progressive **cerebellar ataxia**, leading to **neuroregression** and intellectual disability over time.

Question 1

There is overlapping of skull sutures which can be reduced with gentle pressure. What is the grade of moulding?

Accepted Answer

Grade 2

Answer

Grade 1

Answer

Grade 3

Answer

Grade 4

Question 2

A 45-day-old infant presents with seizures. Examination reveals he is icteric, has bulging fontanelles, and exhibits opisthotonic posture. Which of the following treatments is NOT indicated?

Accepted Answer

Chlorpromazine

Answer

Phenobarbital

Answer

Phototherapy

Answer

Exchange Transfusion

Question 3

Polyarticular onset JRA involves more than how many joints?

Accepted Answer

4

Answer

5

Answer

3

Answer

6

Question 4

Which of the following urethral anomalies is the most common?

Accepted Answer

Hypospadias

Answer

Pinhole meatus

Answer

Epispadias

Answer

Stricture of the urethra

Question 5

All of the following are clinical features suggestive of tracheoesophageal fistula except -

Accepted Answer

Fever

Answer

Choking and Coughing

Answer

Regurgitation

Answer

Cyanosis

Question 6

Which of the following statements about development milestones at 6 months of age is incorrect?

Accepted Answer

Pincer grasp

Answer

Watching self in mirror

Answer

Sitting in tripod position

Answer

Monosyllable sounds

Question 7

Which of the following is not a known cause of neuroregression in children?

Accepted Answer

ADHD

Answer

Vitamin B12 deficiency

Answer

Ataxia telangiectasia

Answer

Wilson's disease

NEET-PG 2015 — Pediatrics