NEET-PG 2024 - Pediatrics PYQs Practice Questions

Q: A 2-year-old boy presents with a history of recurrent urinary tract infections, poor urinary stream, and failure to thrive. A voiding cystourethrogram (VCUG) is performed, and the images provided show dilated posterior urethra and a thickened bladder wall with a keyhole appearance. Based on these findings, the diagnosis of posterior urethral valves (PUV) is made. What is the management for this condition?

Endoscopic valve ablation. ***Endoscopic valve ablation*** - This is the **definitive treatment** for posterior urethral valves (PUV) as it directly addresses the anatomical obstruction. - Ablating the valves with a **cystoscope** relieves the outflow obstruction, preventing further damage to the bladder and kidneys. *Antibiotic prophylaxis and monitoring* - While important for managing recurrent UTIs and preventing future infections in children with PUV, it does **not address the underlying anatomical obstruction**. - Without surgical intervention, the obstruction would persist, leading to progressive urinary tract damage despite antibiotic use. *Suprapubic cystostomy* - This procedure involves placing a catheter directly into the bladder via the abdominal wall to **divert urine**. - It is typically a **temporary measure** used for initial decompression in severely ill patients or those with complete obstruction, not the definitive management. *Urinary diversion with vesicostomy* - Vesicostomy creates an opening between the bladder and abdominal wall for temporary urinary diversion. - This may be used in **very young infants** or critically ill patients as a temporizing measure, but **endoscopic ablation remains the definitive treatment**. *Observation with follow-up imaging* - **Observation is not appropriate** for symptomatic PUV due to the risk of progressive and irreversible renal damage. - The condition requires **prompt intervention** to relieve the obstruction and prevent long-term complications like renal failure. [Practice more Pediatrics PYQs on OnCourse]

Q: A 6-week-old child with a history of vomiting undergoes an ultrasound, which shows an antral nipple sign or target sign, as shown in the image. What is the diagnosis?

Congenital pyloric stenosis. ***Congenital pyloric stenosis*** - The ultrasound findings of an **antral nipple sign** and **target sign** are classic indicators of **hypertrophic pyloric stenosis**. - This condition presents with **projectile vomiting** in infants, typically between 3-6 weeks of age, due to hypertrophy of the pyloric muscle. *Umbilical hernia* - An **umbilical hernia** is a protrusion of abdominal contents through the umbilical ring. It is usually diagnosed clinically and presents as a bulge, not with vomiting. - Ultrasound for an umbilical hernia would show bowel loops or omentum protruding through the abdominal wall defect, not the specific pyloric signs described. *Small bowel obstruction* - While small bowel obstruction can cause vomiting, the ultrasound findings would typically show **dilated loops of bowel** and a **transition point**, not an antral nipple or target sign specifically at the pylorus. - Other clinical features, such as abdominal distention and absence of stool, would also be more prominent. *Jejunal atresia* - **Jejunal atresia** is a congenital anomaly where part of the jejunum is underdeveloped or absent, leading to a complete obstruction. - Ultrasound would reveal **dilated loops of small bowel**, typically without peristalsis past the obstruction, and polyhydramnios antenatally, but not the specific pyloric ultrasound signs. *Duodenal atresia* - **Duodenal atresia** is a congenital obstruction of the duodenum that typically presents with bilious vomiting soon after birth. - The characteristic ultrasound finding is the **"double bubble" sign**, representing a distended stomach and proximal duodenum, not the target or antral nipple sign seen at the pylorus. [Practice more Pediatrics PYQs on OnCourse]

Q: A 3-year-old child presents to the OPD with a history of recurrent urinary tract infections, poor urinary stream, and difficulty voiding. The radiological image is shown below. What is the most appropriate management?

Endoscopic ablation. ***Endoscopic ablation*** - The image shows a distended bladder with a dilated, elongated posterior urethra and a narrow stream of contrast beyond the bladder neck, characteristic findings of **posterior urethral valves (PUV)**. - **Endoscopic ablation (incision or fulguration)** of the valves is the definitive treatment for PUV to relieve obstruction and prevent further kidney damage. - This is the **gold standard primary treatment** for PUV in children who are large enough to undergo the procedure safely. *Dilation of urethra* - **Dilation** is generally ineffective because PUV are folds of tissue that require incision rather than simple stretching. - This approach does not address the underlying anatomical obstruction caused by the valves and could potentially cause damage to the urethra. *Dilation of urethra and bladder* - **Dilation of the urethra** is not an effective treatment for PUV. The bladder is already dilated due to the obstruction, and further dilation would not resolve the issue. - This approach would not remove the obstruction and could worsen bladder function or lead to further complications like reflux. *Conservative* - **Conservative management** with watchful waiting is not appropriate for PUV, as untreated obstruction can lead to progressive and irreversible kidney damage, bladder dysfunction, and recurrent UTIs. - Timely intervention is crucial to preserve renal function and improve long-term outcomes in boys with PUV. *Vesicostomy* - **Vesicostomy** (temporary bladder diversion) is reserved for specific scenarios such as neonates or very young infants too small for safe endoscopic ablation, severe hydronephrosis with renal failure, or failed primary ablation. - In this **3-year-old child**, endoscopic ablation is preferred as the primary definitive treatment rather than temporary diversion, which would require a second procedure later. [Practice more Pediatrics PYQs on OnCourse]

Question 1

A 12-year-old boy presents with symptoms of headaches, visual disturbances, and growth retardation. An MRI scan is performed, and the image provided shows a cystic mass with both solid and calcified components in the suprasellar region, extending into the third ventricle. Based on the clinical presentation and MRI findings, what is the most likely diagnosis?

Accepted Answer

Craniopharyngioma

Answer

Germinoma

Answer

Meningioma

Answer

Pituitary adenoma

Answer

Optic glioma

Question 2

A 2-year-old boy presents with a history of recurrent urinary tract infections, poor urinary stream, and failure to thrive. A voiding cystourethrogram (VCUG) is performed, and the images provided show dilated posterior urethra and a thickened bladder wall with a keyhole appearance. Based on these findings, the diagnosis of posterior urethral valves (PUV) is made. What is the management for this condition?

Accepted Answer

Endoscopic valve ablation

Answer

Antibiotic prophylaxis and monitoring

Answer

Suprapubic cystostomy

Answer

Observation with follow-up imaging

Answer

Urinary diversion with vesicostomy

Question 3

A 6-week-old child with a history of vomiting undergoes an ultrasound, which shows an antral nipple sign or target sign, as shown in the image. What is the diagnosis?

Accepted Answer

Congenital pyloric stenosis

Answer

Umbilical hernia

Answer

Small bowel obstruction

Answer

Jejunal atresia

Answer

Duodenal atresia

Question 4

A 3-year-old child presents to the OPD with a history of recurrent urinary tract infections, poor urinary stream, and difficulty voiding. The radiological image is shown below. What is the most appropriate management?

Accepted Answer

Endoscopic ablation

Answer

Dilation of urethra

Answer

Dilation of urethra and bladder

Answer

Conservative

Answer

Vesicostomy

Question 5

An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on the throat upon inspection. The child's brother is immunized. What is the first step in management?

Accepted Answer

Diphtheria antitoxin

Answer

Diphtheria toxoid

Answer

Penicillin

Answer

Isolation and supportive care

Answer

Tracheostomy

Question 6

An unimmunized 5 -year-old child presents to the OPD with a white membranous layer on inspection, suggesting diphtheria. What is the appropriate prophylaxis for a 2 -year-old contact who has completed their vaccination?

Accepted Answer

Penicillin

Answer

No prophylaxis needed

Answer

Toxoid

Answer

Immunoglobulins

Answer

Erythromycin

Question 7

A 6-week-old baby is brought in by the mother with complaints of vomiting. An X-ray shows a single bubble appearance. What is the most likely diagnosis?

Accepted Answer

Congenital hypertrophic pyloric stenosis (CHPS)

Answer

Duodenal atresia

Answer

Annular pancreas

Answer

Jejunal atresia

Answer

Malrotation with midgut volvulus

Question 8

A neonate presents with failure to pass meconium. The structure absent in the pathology lies in which of the following layers?

Accepted Answer

C, D

Answer

A, B

Answer

B, C

Answer

A, D

Answer

B, D

Question 9

What is the diagnosis based on the image shown
![img-5.jpeg](img-5.jpeg)

Accepted Answer

Bladder exstrophy

Answer

Omphalocele

Answer

Umbilical hernia

Answer

Gastroschisis

Answer

Epispadias

Question 10

A patient presents with an X-ray showing cardiomegaly, along with symptoms of hypotonia, macroglossia, hepatomegaly, and floppy baby syndrome. The X ray of the infant is shown below. What is the most likely diagnosis?

Accepted Answer

Pompe's disease

Answer

Ebstein anomaly

Answer

Transposition of great arteries

Answer

Von Gierke's disease

Answer

Congenital hypothyroidism

NEET-PG 2024 — Pediatrics