UPSC-CMS 2023 — Pediatrics
6 Previous Year Questions with Answers & Explanations
Consider the following statements in respect of congenital hypertrophic pyloric stenosis: 1. The condition is more common in males. 2. The investigation of choice is ultrasonography. 3. Hypertrophy is maximal in the pre pyloric region. 4. Projectile vomiting is seen in this condition. Which of the statements given above are correct?
A 37-week small-for-date neonate is most likely to develop
In measles, when do the Koplik's spots appear?
A 5-year-old male child comes with a left sided scrotal swelling which has no cough impulse and does not reduce on compression or lying down but the parents give a definite history that swelling is absent in the morning and comes by in the evening. The best treatment is :
Clinical features of an infant with Fetal growth retardation at birth include which of the following ? 1. Physical features give 'an old man look'. 2. Baby is alert, reflexes are normal. 3. Thick fat accumulates around shoulders of baby. Select the correct answer using the code given below :
Consider the following disorders : 1. Delayed motor milestones 2. Spastic diplegia 3. Nyctalopia 4. Hearing defects Which of the above disorders occur as part of the spectrum of iodine deficiency disorders ?
UPSC-CMS 2023 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 1: Consider the following statements in respect of congenital hypertrophic pyloric stenosis: 1. The condition is more common in males. 2. The investigation of choice is ultrasonography. 3. Hypertrophy is maximal in the pre pyloric region. 4. Projectile vomiting is seen in this condition. Which of the statements given above are correct?
- A. 1, 2 and 4 only (Correct Answer)
- B. 3 only
- C. 2, 3 and 4 only
- D. 1 and 2 only
Explanation: ***1, 2 and 4 only*** - **Statement 1 is CORRECT**: Congenital hypertrophic pyloric stenosis (CHPS) is more common in males with a male-to-female ratio of approximately 4-5:1. - **Statement 2 is CORRECT**: Ultrasonography is the investigation of choice for CHPS, being non-invasive and accurate in measuring pyloric muscle thickness (>3 mm) and pyloric length (>15 mm). - **Statement 3 is INCORRECT**: The hypertrophy is maximal in the **pyloric muscle** (circular muscle layer of the pylorus), NOT in the pre-pyloric region. This is a key anatomical distinction. - **Statement 4 is CORRECT**: Projectile non-bilious vomiting typically occurring 30-60 minutes after feeding is the hallmark clinical presentation of CHPS. *3 only* - Incorrect because statement 3 is false (hypertrophy is in the pylorus, not pre-pyloric region), while statements 1, 2, and 4 are all true. *2, 3 and 4 only* - Incorrect because it includes statement 3, which is false. The maximal hypertrophy occurs in the **pyloric canal**, not the pre-pyloric region. *1 and 2 only* - Incomplete as it omits statement 4 about projectile vomiting, which is a cardinal feature of CHPS and is definitely correct.
Question 2: A 37-week small-for-date neonate is most likely to develop
- A. Hypoglycaemia (Correct Answer)
- B. Hyaline membrane disease
- C. Hypocalcaemia
- D. Hypothermia
Explanation: ***Hypoglycaemia*** - **Small-for-date** neonates have reduced **glycogen stores** due to chronic fetal stress or placental insufficiency. - Their increased metabolic demands relative to limited energy reserves make them prone to **low blood glucose**. - This is the **most immediate metabolic complication** requiring urgent screening and management. *Hyaline membrane disease* - This condition, also known as **respiratory distress syndrome**, primarily affects **premature neonates** due to surfactant deficiency. - **Small-for-date infants** at term (37 weeks) typically have **accelerated lung maturity** due to chronic intrauterine stress, making them **less susceptible** to RDS compared to appropriately grown preterm infants. *Hypocalcaemia* - While neonates can experience hypocalcemia, it is particularly common in infants of **diabetic mothers**, those with **asphyxia**, or those born **prematurely**. - Small-for-date status alone isn't the primary risk factor for **neonatal hypocalcaemia**. *Hypothermia* - **Small-for-date** infants have a larger **surface area to body mass ratio** and reduced **subcutaneous fat**, which significantly increases heat loss. - This is indeed a **major risk** requiring immediate attention at birth (thermal protection, skin-to-skin care). - However, **hypoglycemia** is considered the **most characteristic metabolic derangement** and "most likely" complication specifically associated with SGA status, making it the best answer for this question.
Question 3: In measles, when do the Koplik's spots appear?
- A. On the day that rashes appear
- B. 1-2 days before the rashes appear (Correct Answer)
- C. On the day that fever occurs
- D. 1-2 days before the fever occurs
Explanation: ***1-2 days before the rashes appear*** - **Koplik's spots** are considered an **enanthem**, a pathognomonic sign of **measles**. - These small, white spots with a bluish-white center on an erythematous base on the buccal mucosa typically appear 1-2 days before the generalized maculopapular rash. *On the day that rashes appear* - The generalized **maculopapular rash** of measles typically appears a few days *after* Koplik's spots. - While the rash is a hallmark of measles, it is preceded by the oral lesions. *On the day that fever occurs* - **Fever** is usually one of the initial symptoms of measles, often appearing several days before Koplik's spots. - The fever is part of the **prodromal phase**, which includes cough, coryza, and conjunctivitis. *1-2 days before the fever occurs* - Measles symptoms, including fever, are usually the first indicators of infection, making it unlikely for a specific sign like Koplik's spots to appear before the fever itself. - The incubation period precedes any symptoms, including fever.
Question 4: A 5-year-old male child comes with a left sided scrotal swelling which has no cough impulse and does not reduce on compression or lying down but the parents give a definite history that swelling is absent in the morning and comes by in the evening. The best treatment is :
- A. Herniotomy (Correct Answer)
- B. Eversion of sac
- C. To leave it alone (masterly inactivity)
- D. Hernioplasty
Explanation: ***Herniotomy*** - This presentation is classic for a **communicating hydrocele** in a 5-year-old child, where peritoneal fluid accumulates in the scrotum through a **patent processus vaginalis** during the day (when upright) and drains back into the peritoneal cavity overnight (when recumbent), explaining the absence in morning and presence in evening. - The absence of cough impulse and lack of reducibility on compression distinguishes this from a typical inguinal hernia, but the fluctuating size pattern confirms communication with the peritoneal cavity. - **Management:** While communicating hydroceles may resolve spontaneously in infancy (typically by 12-18 months), **persistence beyond 2 years of age is an indication for surgical repair**. At **age 5**, surgical correction is clearly indicated. - **Herniotomy** with **high ligation of the patent processus vaginalis** is the treatment of choice. This procedure closes the communication between the peritoneal cavity and the tunica vaginalis, preventing further fluid accumulation. - The processus vaginalis is ligated at the internal inguinal ring, and the distal sac is left open to allow reabsorption of any residual fluid. *To leave it alone (masterly inactivity)* - **Observation (masterly inactivity)** is appropriate for communicating hydroceles in **infants under 12-18 months** as spontaneous closure of the processus vaginalis commonly occurs. - However, at **age 5 years**, the likelihood of spontaneous resolution is extremely low, and continued observation would be inappropriate. - Persistent patent processus vaginalis carries a risk of developing an indirect inguinal hernia, making surgical intervention the standard of care at this age. *Eversion of sac* - **Eversion of the sac** (Jaboulay's procedure) or plication (Lord's procedure) is used for **non-communicating hydroceles in adults** where the processus vaginalis is obliterated. - These procedures are **not appropriate for communicating hydroceles in children** as they do not address the underlying patent processus vaginalis. - Without ligating the patent communication, fluid will continue to accumulate from the peritoneal cavity. *Hernioplasty* - **Hernioplasty** typically refers to hernia repair with **mesh reinforcement**, which is an adult procedure. - In pediatric inguinal region surgery, mesh is generally **avoided** due to concerns about growth, tissue reaction, and long-term complications. - The pediatric approach focuses on simple high ligation of the sac (herniotomy) rather than mesh repair (hernioplasty).
Question 5: Clinical features of an infant with Fetal growth retardation at birth include which of the following ? 1. Physical features give 'an old man look'. 2. Baby is alert, reflexes are normal. 3. Thick fat accumulates around shoulders of baby. Select the correct answer using the code given below :
- A. 1, 2 and 3
- B. 1 and 3 only
- C. 2 and 3 only
- D. 1 and 2 only (Correct Answer)
Explanation: ***1 and 2 only*** - Infants with **fetal growth restriction (FGR)** often have a **wasted appearance** with sparse subcutaneous fat, giving them an "old man look" due to prominence of skin folds and bones. - Despite their small size, typically FGR infants are **neurologically intact** at birth, maintaining normal alertness and reflexes. *1, 2 and 3* - This option is incorrect because the third statement, regarding **thick fat accumulation**, is not characteristic of FGR infants. FGR involves **poor fetal growth**, leading to reduced subcutaneous fat. - **Thick fat** would suggest normal or even accelerated growth, which is contrary to the definition of fetal growth restriction. *2 and 3 only* - This option is incorrect as it includes the incorrect statement about **thick fat accumulation** (statement 3) and omits the correct finding of an "old man look" (statement 1), which is a classic presentation of FGR. - While statement 2 is correct regarding alertness and reflexes, the inclusion of statement 3 makes this option invalid. *1 and 3 only* - This option is incorrect because statement 3, describing **thick fat accumulation**, is contrary to the features of FGR, which are characterized by **poor fat reserves** and a wasted appearance. - It also omits the correct statement about the baby being alert with normal reflexes (statement 2).
Question 6: Consider the following disorders : 1. Delayed motor milestones 2. Spastic diplegia 3. Nyctalopia 4. Hearing defects Which of the above disorders occur as part of the spectrum of iodine deficiency disorders ?
- A. 2, 3 and 4
- B. 1, 2 and 3
- C. 1 and 3 only
- D. 1, 2 and 4 (Correct Answer)
Explanation: ***1, 2 and 4*** - **Delayed motor milestones** and **spastic diplegia** are hallmark neurological symptoms of **cretinism**, caused by severe congenital iodine deficiency. The spasticity results from pyramidal tract involvement affecting motor development. - **Hearing defects** (sensorineural deafness) are frequently observed in individuals with iodine deficiency disorders due to impaired thyroid hormone synthesis affecting inner ear development during critical developmental periods. *2, 3 and 4* - **Nyctalopia (night blindness)** is primarily associated with **Vitamin A deficiency**, not iodine deficiency. - While spastic diplegia and hearing defects are linked to iodine deficiency, the inclusion of nyctalopia makes this option incorrect. *1, 2 and 3* - This option correctly identifies delayed motor milestones and spastic diplegia as symptoms of iodine deficiency, but **nyctalopia** is an incorrect association with iodine deficiency. - Therefore, the presence of nyctalopia invalidates this choice. *1 and 3 only* - This option correctly includes **delayed motor milestones** but incorrectly includes **nyctalopia** as an iodine deficiency disorder. - It also omits other significant neurological and developmental problems like spastic diplegia and hearing defects that are part of the IDD spectrum.