NEET-PG 2015 - Pediatrics Practice Questions

Q: What is the most common cause of pneumonia in early onset sepsis in neonates?

Group B streptococcus. ***Group B streptococcus*** - **Group B Streptococcus (GBS)** is the leading cause of **early-onset sepsis** and pneumonia in neonates, typically acquired during passage through the birth canal. - Maternal GBS colonization is a significant risk factor, and GBS can cause **severe respiratory distress** in affected newborns. *H influenzae* - **_Haemophilus influenzae_** is a more common cause of **late-onset sepsis** or pneumonia in infants and children, rather than early-onset neonatal disease. - While it can cause neonatal infections, it is much less frequent than GBS in the early-onset period. *Coagulase positive staph aureus* - **_Staphylococcus aureus_** is a common cause of **nosocomial infections** or late-onset sepsis in neonates, particularly in ventilated or catheterized infants. - It is not the most common pathogen for community-acquired **early-onset neonatal pneumonia**. *Listeria* - **_Listeria monocytogenes_** can cause severe neonatal sepsis and pneumonia, often associated with maternal consumption of contaminated food. - While it is a significant pathogen, it is less common overall than GBS as a cause of early-onset neonatal pneumonia in most regions.

Q: Most common site for bone marrow aspiration in neonates is -

Anteromedial tibia. ***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.

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: Which of the following statements about encephalocoele is false?

Common in the parietal region. ***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.

Q: At what age do children typically begin to use past and present tense in their speech?

30 Months. ***30 Months*** - Around 30 months (2.5 years), children typically begin to comprehend and produce **simple past and present tense forms**. - This stage reflects an increased understanding of **time concepts** and more complex grammatical structures. *1 Year* - At 1 year, children are usually at the **single-word stage**, using vocabulary like 'mama' or 'dada'. - They are primarily focused on **naming objects and people**, with little to no grasp of verb tenses. *2 Years* - By 2 years, children are generally using **two-word phrases** and beginning to combine words into simple sentences. - While they are expanding their vocabulary, consistent use of distinct past and present tenses is still developing. *18 Months* - Children at 18 months are typically expanding their **single-word vocabulary** and may be starting to use two-word combinations. - Their language is still focused on immediate needs and objects, without the grammatical complexity of verb tenses.

Q: A 3-month-old child presents with indrawing of the chest and a respiratory rate of 52 breaths per minute. This condition can be classified as:

Respiratory distress. ***Respiratory distress*** - **Indrawing of the chest** is a classic sign of increased work of breathing, indicating the child is struggling to oxygenate. - A respiratory rate of **52 breaths per minute in a 3-month-old** is significantly elevated and, combined with indrawing, points to respiratory distress. - According to **WHO IMCI guidelines**, chest indrawing in a child with fast breathing is classified as **pneumonia/respiratory distress** requiring immediate treatment. *SIRS* - **Systemic Inflammatory Response Syndrome (SIRS)** criteria are typically more comprehensive and include fever or hypothermia, tachycardia, tachypnea, and abnormal white blood cell count. - While tachypnea is present, the other defining features of SIRS are not fully met by the information provided, nor does indrawing directly classify as SIRS. *Tachypnoea* - **Tachypnoea** refers specifically to an elevated respiratory rate, which is present (52 breaths per minute). - However, the presence of **chest indrawing** indicates more than just rapid breathing; it signifies significant respiratory effort and compromise. - The classification must capture both the elevated rate and the increased work of breathing. *ARDS* - **Acute Respiratory Distress Syndrome (ARDS)** is a severe form of lung injury characterized by widespread inflammation, hypoxemia, and bilateral infiltrates on chest imaging. - While respiratory distress is a feature of ARDS, the given information is insufficient to diagnose ARDS, which requires specific criteria relating to oxygenation and radiological findings.

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

What is the most common cause of pneumonia in early onset sepsis in neonates?

Accepted Answer

Group B streptococcus

Answer

H influenzae

Answer

Coagulase positive staph aureus

Answer

Listeria

Question 2

Most common site for bone marrow aspiration in neonates is -

Accepted Answer

Anteromedial tibia

Answer

Anterior superior iliac crest

Answer

Posterior superior iliac crest

Answer

Sternum

Question 3

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 4

Which of the following statements about encephalocoele is false?

Accepted Answer

Common in the parietal region

Answer

It is a neural tube defect

Answer

Can be associated with hydrocephalus

Answer

It is protrusion of neural tissue through a defect

Question 5

At what age do children typically begin to use past and present tense in their speech?

Accepted Answer

30 Months

Answer

18 Months

Answer

1 Year

Answer

2 Years

Question 6

A 3-month-old child presents with indrawing of the chest and a respiratory rate of 52 breaths per minute. This condition can be classified as:

Accepted Answer

Respiratory distress

Answer

SIRS

Answer

Tachypnoea

Answer

ARDS

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