NEET-PG 2017 - Pediatrics PYQs Practice Questions

Q: The given ECG of a neonate born to a mother with SLE shows?

Complete heart block. ***Complete heart block*** - The ECG demonstrates **complete dissociation** between the P waves (atrial activity) and the QRS complexes (ventricular activity). The atrial rate is faster than the ventricular rate, and there is no consistent relationship between P waves and QRS complexes. - In a neonate of a mother with SLE, **congenital complete heart block** is a well-known complication due to transplacental transfer of maternal antibodies (anti-Ro/SSA and anti-La/SSB) that damage the atrioventricular (AV) node. *Mobitz I heart block* - This type of heart block (also known as **Wenckebach phenomenon**) is characterized by a **progressive prolongation of the PR interval** until a P wave is eventually not conducted, leading to a dropped QRS complex. - The ECG provided does not show a gradual lengthening of the PR interval; rather, it shows a complete lack of conduction between atria and ventricles. *Mobitz II heart block* - In Mobitz II block, there is a **fixed PR interval** for conducted beats, but some P waves are **intermittently blocked** without prior PR prolongation. - The ECG in the question shows no consistent PR interval whatsoever, as P waves and QRS complexes are completely dissociated. *Sick sinus syndrome* - This condition involves a malfunction of the **sinoatrial node**, leading to a variety of rhythm disturbances such as sinus bradycardia, sinus arrest, or *tachycardia-bradycardia syndrome*. - While it can cause bradycardia, it does not typically present with the **P-QRS dissociation** characteristic of advanced AV block seen in the ECG. [Practice more Pediatrics PYQs on OnCourse]

Q: A 10-year-old child with Valvular heart disease on heart failure treatment, has the following ECG tracing. What is the diagnosis?

Non paroxysmal atrial tachycardia with regular AV block. ***Non paroxysmal atrial tachycardia with regular AV block*** - The ECG shows a sustained atrial tachycardia with a **consistent P-P interval**, indicating a non-paroxysmal origin. - There is a **fixed ratio between P waves and QRS complexes** (e.g., 2:1 or 3:1), demonstrating a regular AV block, likely due to increased vagal tone or AV nodal dysfunction, often seen in cases of **digoxin toxicity** (given the patient is on heart failure treatment for valvular heart disease). *Tall tented T-wave* - **Tall, tented T-waves** are characteristic of **hyperkalemia**, but the ECG tracing does not exhibit this morphology. - While hyperkalemia can cause rhythm disturbances, the predominant feature here is a regular atrial tachycardia with AV block, not T-wave changes typical of electrolyte imbalance. *Ventricular bigeminy* - **Ventricular bigeminy** would manifest as alternating normal QRS complexes with premature ventricular contractions (PVCs). - The ECG shows a narrow complex tachycardia with visible P waves, which are not characteristic of PVCs or ventricular bigeminy. *Non paroxysmal atrial tachycardia with irregular AV block* - Although there is non-paroxysmal atrial tachycardia, the **AV block is regular** (e.g., a consistent 2:1 or 3:1 conduction ratio), not irregular. - An irregular AV block would suggest variability in AV nodal conduction, such as in AV Wenckebach or Mobitz type II with variable conduction, which is not what is seen in this tracing. [Practice more Pediatrics PYQs on OnCourse]

Q: A 3-year-old child presents with the clinical features shown in the image. What is the most likely diagnosis?

Kawasaki disease. ***Kawasaki disease*** * The image displays classic signs of **Kawasaki disease**, including **bilateral conjunctivitis without exudates** (top left), **erythema of the palms and soles with desquamation** (top right), **cervical lymphadenopathy** (bottom left, indicated by swelling in the neck region), and a **strawberry tongue** (bottom right). * These clinical features, especially in a young child, are diagnostic for **Kawasaki disease**, which is a vasculitis affecting medium-sized arteries, most notably the coronary arteries. *Scarlet fever* * While **scarlet fever** can cause a **strawberry tongue** and a rash, the rash is typically a **fine, sandpaper-like rash** that blanches with pressure, not usually characterized by the distinct palm/sole erythema and desquamation seen in the image. * **Conjunctivitis** is not a prominent feature of scarlet fever, and the lymphadenopathy is typically less pronounced and may be tender. *Kikuchi disease* * **Kikuchi disease** (histiocytic necrotizing lymphadenitis) primarily presents with **cervical lymphadenopathy, fever**, and often rash, but it does **not typically involve conjunctivitis or changes in the hands, feet, or tongue** as dramatically depicted. * It is a self-limiting condition of unknown etiology, distinct from the systemic vasculitis of Kawasaki disease. *Rosai-Dorfman disease* * **Rosai-Dorfman disease** (sinus histiocytosis with massive lymphadenopathy) is characterized by **massive, painless lymphadenopathy**, particularly cervical, with fever and other systemic symptoms. * However, it does **not present with the specific mucocutaneous findings** of conjunctivitis, strawberry tongue, or characteristic hand/foot changes seen in the images indicative of Kawasaki disease. [Practice more Pediatrics PYQs on OnCourse]

Q: A 2-year-old epileptic child with developmental delay presents to emergency with fever for the last two days. NCCT shows:

Lissencephaly. ***Lissencephaly*** - The image shows a **smooth brain surface** with **absent or reduced gyri and sulci**, which is characteristic of lissencephaly. - This condition is often associated with **developmental delay** and **epilepsy**, consistent with the child's presentation. *Subdural hemorrhage* - A subdural hemorrhage would appear as a **crescent-shaped collection of blood** between the dura mater and arachnoid mater. - The image does not demonstrate any such blood collection. *Arnold-Chiari malformation* - Arnold-Chiari malformation involves the downward displacement of the **cerebellar tonsils** into the foramen magnum. - While it can cause neurological symptoms, the primary finding in the image is a smooth cerebral cortex, not cerebellar displacement. *Schizencephaly* - Schizencephaly is characterized by **clefts or slits in the cerebral hemispheres** that extend from the pial surface to the ventricles. - The image shows a smooth brain surface rather than distinct full-thickness clefts. [Practice more Pediatrics PYQs on OnCourse]

Q: Comment on the diagnosis based on the image shown below. (Recent NEET Pattern 2016-17)

Plexiform neurofibromatosis. ***Plexiform neurofibromatosis*** - The image exhibits significant facial disfigurement with **nodular and soft tissue overgrowth**, particularly around the eye and midface, consistent with a **plexiform neurofibroma**. - This presentation is a classic feature of **Neurofibromatosis Type 1 (NF1)**, where plexiform neurofibromas can be extensive and cause severe cosmetic and functional issues. *Proteus syndrome* - Proteus syndrome is characterized by **asymmetric overgrowth** of various tissues including bone, skin, and fat, often leading to patchy or mosaic patterns of disproportionate growth. - While it involves overgrowth, the specific appearance in the image with its nodular, bag-like masses is more typical of plexiform neurofibroma than the broader, more generalized overgrowth seen in Proteus syndrome. *Rhabdomyosarcoma* - Rhabdomyosarcoma is a **malignant tumor of skeletal muscle**, typically presenting as a rapidly growing mass. - The lesions in the image appear more chronic and diffuse, lacking the aggressive, distinct tumoral characteristics of a typical rhabdomyosarcoma. *Malignant fibrous histiocytosis* - Malignant fibrous histiocytosis (now often classified under **undifferentiated pleomorphic sarcoma**) is a **high-grade soft tissue sarcoma** primarily affecting older adults, typically presenting as a rapidly enlarging mass. - Similar to rhabdomyosarcoma, this is a distinct malignant tumor and does not match the diffuse, chronic, and somewhat benign-appearing overgrowth seen in the picture. [Practice more Pediatrics PYQs on OnCourse]

Question 1

The given ECG of a neonate born to a mother with SLE shows?

Accepted Answer

Complete heart block

Answer

Mobitz I heart block

Answer

Mobitz II heart block

Answer

Sick sinus syndrome

Question 2

A 10-year-old child with Valvular heart disease on heart failure treatment, has the following ECG tracing. What is the diagnosis?

Accepted Answer

Non paroxysmal atrial tachycardia with regular AV block

Answer

Tall tented T-wave

Answer

Ventricular bigeminy

Answer

Non paroxysmal atrial tachycardia with irregular AV block

Question 3

A 3-year-old child presents with the clinical features shown in the image. What is the most likely diagnosis?

Accepted Answer

Kawasaki disease

Answer

Scarlet fever

Answer

Kikuchi disease

Answer

Rosai-Dorfman disease

Question 4

A 2-year-old epileptic child with developmental delay presents to emergency with fever for the last two days. NCCT shows:

Accepted Answer

Lissencephaly

Answer

Subdural hemorrhage

Answer

Arnold-Chiari malformation

Answer

Schizencephaly

Question 5

Comment on the diagnosis based on the image shown below. (Recent NEET Pattern 2016-17)

Accepted Answer

Plexiform neurofibromatosis

Answer

Proteus syndrome

Answer

Rhabdomyosarcoma

Answer

Malignant fibrous histiocytosis

Question 6

Which of the following is correct about the image shown? (Recent NEET Pattern 2016-17)

Accepted Answer

A = Kayser Fleischer ring, B = Arcus senilis

Answer

A = Arcus senilis, B = Kayser-Fleischer ring

Answer

A = Arcus senilis, B = Hudson-Stahli line

Answer

A = Hudson-Stahli line, B = Arcus senilis

Question 7

Comment on the diagnosis of this child, presenting with eye swelling. (Recent NEET Pattern 2016-17)

Accepted Answer

Neuroblastoma

Answer

Chloroma

Answer

Wilms tumor

Answer

Ameloblastoma

Question 8

Neonate born at 34 weeks with premature rupture of membranes develops respiratory distress. CXR was performed. All are considered in differential diagnosis except:

Accepted Answer

Tetralogy of Fallot

Answer

Congenital pneumonia

Answer

Hyaline membrane disease

Answer

Congenital alveolar proteinosis

Question 9

Preterm child on cow milk due to death of mother is having blood in stools. X-ray abdomen was done. Diagnosis is:

Accepted Answer

Rigler sign

Answer

Double bubble appearance

Answer

Claw sign

Answer

Bird of prey sign

Question 10

Which of the following is the best diagnosis of this neonate who is excessively hungry, warm with flushed skin?

Accepted Answer

Neonatal thyrotoxicosis

Answer

Neonatal lupus

Answer

Congenital hypothyroidism

Answer

Progeria

NEET-PG 2017 — Pediatrics