Which one of the following childhood epileptic disorders often needs long term treatment with antiepileptic drugs?
Q2
Autosomal dominant mutations in which one of the following genes may cause focal segmental glomerulosclerosis associated with abnormal genitalia, Wilms tumor and mental retardation?
Q3
Which of the following statements are correct regarding the management of gastrointestinal bleeding in children?
I. Somatostatin or octreotide infusion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding
II. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N -butyl-2-cyanoacrylate or iso-butyl-2-cyanoacrylate
III. EST has upto 90 % efficacy in controlling acute bleeding
IV. Following an episode of acute variceal bleeding, all patients should receive secondary prophylaxis to prevent rebleeding
Select the answer using the code given below :
Q4
A child can make a tower of 3 blocks, runs, copies his mother while sweeping and has a vocabulary of 8-10 words. His developmental age is
Q5
A child can ride a tricycle, copies a circle, knows name and gender. The developmental age of this child is
Q6
A term baby with birth weight of 2.8 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth ?
I. The baby should be initiated on breastfeeding within one hour of birth
II. The baby should be kept in a separate area from the mother
III. The baby should be administered with 0.5 mg of vitamin K intramuscularly
IV. The baby should be thoroughly examined for congenital malformations from head to toe
Select the answer using the code given below :
Q7
For a sick child aged 4 years, which of the following are signs of "severe pneumonia or very severe disease", as per IMNCI (Integrated Management of Neonatal and Childhood Illness) Program?
I. Fast breathing (Greater than or equal to 40 breaths per minute)
II. Child vomits everything
III. Stridor in a calm child
IV. Chest indrawing:
Select the correct answer using the code given below :
Q8
Which of the following are characteristic features of cerebral palsy?
I. Disorder of movement
II. Permanent nature
III. Progressive course
IV. Disorder of posture
Select the correct answer using the code given below :
Q9
Which of the following are tools commonly used in the evaluation of children with cerebral palsy for motor function and spasticity assessment?
I. Gross Motor Function Classification System
II. Medical Research Council System
III. Modified Connors Scale (Connors-II)
IV. Modified Ashworth Scale
Select the correct answer using the code given below:
Q10
Which of the following are causes of secondary immunodeficiency in children?
I. Diphenylhydantoin
II. Severe malnutrition
III. Post-varicella state
IV. Nephrotic syndrome
Select the correct answer using the code given below :
UPSC-CMS 2025 - Pediatrics UPSC-CMS Practice Questions and MCQs
Question 1: Which one of the following childhood epileptic disorders often needs long term treatment with antiepileptic drugs?
A. Febrile seizures
B. Juvenile myoclonic epilepsy (Correct Answer)
C. Benign rolandic epilepsy
D. Benign neonatal seizures
Explanation: ***Juvenile myoclonic epilepsy***
- This is a **genetic generalized epilepsy syndrome** that typically emerges during adolescence and often requires **lifelong treatment** with antiepileptic drugs due to a high risk of relapse if treatment is discontinued.
- Characterized by **myoclonic jerks**, particularly in the morning, along with generalized tonic-clonic and absence seizures.
*Febrile seizures*
- These are **age-dependent seizures** that occur in association with fever and typically have a **benign prognosis**, rarely requiring long-term antiepileptic drug treatment.
- They usually resolve spontaneously by **age 5-6 years**, and the risk of developing epilepsy is low unless there are complex features or underlying neurological conditions.
*Benign rolandic epilepsy*
- This is an **idiopathic focal epilepsy** of childhood that is characterized by seizures occurring primarily during sleep, with **motor or sensory symptoms** involving the face and mouth.
- It has a very **favorable prognosis**, with spontaneous remission typically occurring by adolescence, and many children do not require antiepileptic drugs or only short-term treatment.
*Benign neonatal seizures*
- This refers to a group of self-limited epileptic syndromes that occur in the first few weeks of life, often with a **hereditary component**, but they typically **resolve spontaneously** within weeks or months.
- **Long-term antiepileptic drug treatment** is generally not needed, and the **neurodevelopmental outcome is usually excellent**.
Question 2: Autosomal dominant mutations in which one of the following genes may cause focal segmental glomerulosclerosis associated with abnormal genitalia, Wilms tumor and mental retardation?
A. WT1 (Correct Answer)
B. INF2
C. LMX1B
D. APOL1
Explanation: ***WT1***
- Mutations in the **WT1 (Wilms tumor 1) gene** are associated with **Denys-Drash syndrome** and **Frasier syndrome**, both of which feature **focal segmental glomerulosclerosis (FSGS)**, abnormal genitalia, and an increased risk of **Wilms tumor**.
- **Denys-Drash syndrome** specifically includes **glomerulopathy**, **pseudohermaphroditism** (abnormal genitalia), and **Wilms tumor**, often with some degree of mental retardation.
*INF2*
- Mutations in the **INF2 gene** are a common cause of **autosomal dominant FSGS**, often without extra-renal manifestations.
- While it causes FSGS, it typically does not present with abnormal genitalia, Wilms tumor, or mental retardation.
*LMX1B*
- Mutations in the **LMX1B gene** are responsible for **Nail-Patella Syndrome**, which is characterized by abnormalities of the nails, patellae, elbows, and iliac horns.
- It can cause FSGS, but it is not associated with abnormal genitalia, Wilms tumor, or mental retardation.
*APOL1*
- **APOL1 gene variants** (G1 and G2 risk alleles) are strongly associated with a higher risk of developing **FSGS** and other kidney diseases, particularly in individuals of African ancestry.
- While it is a significant genetic risk factor for FSGS, APOL1 mutations are not linked to abnormal genitalia, Wilms tumor, or mental retardation.
Question 3: Which of the following statements are correct regarding the management of gastrointestinal bleeding in children?
I. Somatostatin or octreotide infusion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding
II. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N -butyl-2-cyanoacrylate or iso-butyl-2-cyanoacrylate
III. EST has upto 90 % efficacy in controlling acute bleeding
IV. Following an episode of acute variceal bleeding, all patients should receive secondary prophylaxis to prevent rebleeding
Select the answer using the code given below :
A. III and IV (Correct Answer)
B. I and III
C. II and IV
D. I and II
Explanation: ***III and IV***
**Statement I is INCORRECT:** Somatostatin or octreotide infusions are typically administered for **3-5 days** (not 7 days) after initial bleeding has stopped to prevent rebleeding. Prolonged use beyond this period is not generally recommended due to potential side effects and lack of additional benefit.
**Statement II is INCORRECT:** Endoscopic Sclerotherapy (EST) for esophageal varices involves injection of sclerosants such as **ethanolamine oleate, sodium tetradecyl sulfate**, or polidocanol. The tissue adhesives **N-butyl-2-cyanoacrylate** or **iso-butyl-2-cyanoacrylate** are used in **endoscopic variceal obturation (EVO)** for **gastric varices**, not in standard sclerotherapy for esophageal varices.
**Statement III is CORRECT:** Endoscopic Sclerotherapy (EST) demonstrates **up to 90% efficacy** in controlling acute variceal bleeding, making it a highly effective intervention for managing acute hemorrhage.
**Statement IV is CORRECT:** Following an episode of acute variceal bleeding, **all patients should receive secondary prophylaxis** (typically combination of non-selective beta-blockers and endoscopic band ligation) to prevent rebleeding, which is associated with significant morbidity and mortality.
*I and III* - Incorrect because Statement I is wrong about the duration of vasoactive drug therapy.
*II and IV* - Incorrect because Statement II confuses sclerotherapy agents with tissue adhesives used for gastric varices.
*I and II* - Incorrect because both statements I and II contain inaccuracies regarding duration of therapy and sclerosing agents respectively.
Question 4: A child can make a tower of 3 blocks, runs, copies his mother while sweeping and has a vocabulary of 8-10 words. His developmental age is
A. 18 months (Correct Answer)
B. 15 months
C. 24 months
D. 12 months
Explanation: ***18 months***
- At 18 months, children typically can **build a tower of 2-4 cubes**, run, and have a vocabulary of approximately **10 words**.
- They also begin to engage in **imitative play**, such as copying household tasks like sweeping.
*15 months*
- A 15-month-old can usually **build a tower of 2 blocks** and walk independently, but **running** is generally not yet mastered.
- Their vocabulary is typically smaller, around **4-6 words**, and imitative play is less complex.
*24 months*
- By 24 months, a child can build a tower of **5-7 cubes**, kick a ball, and their vocabulary expands significantly to **50-100 words** or more, including combining two words.
- They participate in more elaborate **pretend play** and understand two-step commands.
*12 months*
- A 12-month-old typically can **pull to stand**, take a few steps, and transfer objects between hands, but **running** is not expected.
- Their vocabulary is limited to **1-3 words** (like "mama" or "dada"), and their constructive play is minimal.
Question 5: A child can ride a tricycle, copies a circle, knows name and gender. The developmental age of this child is
A. 4 years
B. 5 years
C. 2 years
D. 3 years (Correct Answer)
Explanation: ***3 years***
- A child who can **ride a tricycle**, **copy a circle**, and knows their **name and gender** has achieved developmental milestones typically seen around **3 years of age**.
- **Riding a tricycle** demonstrates advanced gross motor skills, while **copying a circle** indicates fine motor skill development. **Knowing name and gender** points to cognitive and social-emotional understanding.
*4 years*
- By 4 years, a child can typically **hop on one foot**, **draw a square**, and **tell stories**.
- While they might refine skills acquired at 3, the listed milestones are primary for the 3-year mark.
*5 years*
- A 5-year-old usually can **skip**, **draw a triangle**, and **count 10 or more objects**.
- These milestones represent further advancements beyond those described in the question.
*2 years*
- At 2 years, a child typically starts to **kick a ball**, **draw a straight line**, and can say **two-to-four-word sentences**.
- The skills described (tricycle, circle) are generally too advanced for a 2-year-old.
Question 6: A term baby with birth weight of 2.8 kg is born to a primigravida mother through vaginal delivery and cried immediately after birth. Which of the following statements are correct regarding his initial care after birth ?
I. The baby should be initiated on breastfeeding within one hour of birth
II. The baby should be kept in a separate area from the mother
III. The baby should be administered with 0.5 mg of vitamin K intramuscularly
IV. The baby should be thoroughly examined for congenital malformations from head to toe
Select the answer using the code given below :
A. I and IV (Correct Answer)
B. II and III
C. I and II
D. I and III
Explanation: ***I and IV***
- **Early initiation of breastfeeding within one hour** is crucial for promoting bonding, establishing successful lactation, and providing the newborn with colostrum for immunity.
- A comprehensive **head-to-toe examination for congenital malformations** is a standard part of immediate newborn care to identify any anomalies requiring further evaluation or intervention.
*II and III*
- **Keeping the baby with the mother (rooming-in)** is recommended to promote bonding, facilitate unrestricted breastfeeding, and enable continuous monitoring by the mother.
- The standard dose of **vitamin K administered intramuscularly for a term baby is 1 mg**, not 0.5 mg, to prevent hemorrhagic disease of the newborn.
*I and II*
- While early breastfeeding (I) is correct, **keeping the baby in a separate area from the mother (II) is incorrect** as rooming-in is highly encouraged for newborn care.
- Separating the baby can hinder initial bonding and interfere with an early and successful breastfeeding experience.
*I and III*
- **Early initiation of breastfeeding within one hour (I) is correct**, but the **dose of vitamin K (III) is incorrect**, as 1 mg is the standard, not 0.5 mg.
- Incorrect medication dosages can have clinical implications, making this combination an unsuitable choice for correct initial care.
Question 7: For a sick child aged 4 years, which of the following are signs of "severe pneumonia or very severe disease", as per IMNCI (Integrated Management of Neonatal and Childhood Illness) Program?
I. Fast breathing (Greater than or equal to 40 breaths per minute)
II. Child vomits everything
III. Stridor in a calm child
IV. Chest indrawing:
Select the correct answer using the code given below :
A. I and II
B. II and III
C. III and IV (Correct Answer)
D. II and IV
Explanation: ***III and IV***
- **Stridor in a calm child** is a critical sign indicating severe upper airway obstruction, classified as "very severe disease" in IMNCI. This is a general danger sign requiring urgent referral.
- **Chest indrawing** (severe lower chest wall indrawing) signifies increased work of breathing and severe respiratory distress, categorizing it under "severe pneumonia" in IMNCI and requiring urgent referral.
- These two signs represent the most specific respiratory indicators of severe pneumonia or very severe disease.
*I and II*
- **Fast breathing** for a 4-year-old (age 12 months to 5 years) is correctly defined as ≥40 breaths per minute per IMNCI. However, fast breathing alone indicates **pneumonia** (not severe pneumonia), which can be managed as outpatient with oral antibiotics.
- **Child vomits everything** is indeed a general danger sign indicating "very severe disease" in IMNCI, but when combined with fast breathing (which indicates only simple pneumonia), this combination is less specific than III and IV.
*II and III*
- **Child vomits everything** is a general danger sign for "very severe disease" requiring urgent referral.
- **Stridor in a calm child** is also a sign of "very severe disease."
- While both are valid signs, this combination misses **chest indrawing**, which is the primary respiratory-specific sign of severe pneumonia and more directly answers the question about severe pneumonia classification.
*II and IV*
- **Child vomits everything** is a general danger sign for "very severe disease."
- **Chest indrawing** is the key sign of "severe pneumonia."
- While both are valid signs of severe pneumonia or very severe disease, the combination of **stridor and chest indrawing (III and IV)** represents the two most specific respiratory signs and is the preferred answer for this classification.
Question 8: Which of the following are characteristic features of cerebral palsy?
I. Disorder of movement
II. Permanent nature
III. Progressive course
IV. Disorder of posture
Select the correct answer using the code given below :
A. I, II and III
B. I, III and IV
C. II, III and IV
D. I, II and IV (Correct Answer)
Explanation: ***Correct: I, II and IV***
- Cerebral palsy is defined as a group of **permanent disorders** that affect the development of **movement and posture**, causing activity limitations.
- It is attributed to **non-progressive disturbances** that occurred in the developing fetal or infant brain.
- Key characteristics: **Disorder of movement (I)** + **Permanent nature (II)** + **Disorder of posture (IV)** + Non-progressive course.
*Incorrect: I, II and III*
- While cerebral palsy is a **disorder of movement** and **permanent**, it is explicitly characterized by its **non-progressive** nature.
- The underlying brain lesion does not worsen over time, though clinical manifestations may change as the child develops.
- Statement III (Progressive course) is incorrect.
*Incorrect: I, III and IV*
- Cerebral palsy is fundamentally a **disorder of movement** and **posture**.
- However, a key distinguishing characteristic is its **non-progressive** nature; the brain injury itself does not advance or worsen.
- Statement III (Progressive course) contradicts the definition of cerebral palsy.
*Incorrect: II, III and IV*
- Cerebral palsy is **permanent** and affects **posture**, but it has a **non-progressive** course, not progressive.
- It is also fundamentally a **disorder of movement**, which is a primary manifestation.
- Statement III (Progressive course) is incorrect, making this combination wrong.
Question 9: Which of the following are tools commonly used in the evaluation of children with cerebral palsy for motor function and spasticity assessment?
I. Gross Motor Function Classification System
II. Medical Research Council System
III. Modified Connors Scale (Connors-II)
IV. Modified Ashworth Scale
Select the correct answer using the code given below:
A. III and IV
B. I and IV (Correct Answer)
C. I and II
D. II and III
Explanation: ***Correct: I and IV***
- The **Gross Motor Function Classification System (GMFCS)** is the gold standard tool to classify gross motor function in children with **cerebral palsy** based on self-initiated movement and functional limitations across five levels (I-V).
- The **Modified Ashworth Scale** is the most widely used clinical tool for assessing **spasticity** and muscle tone in cerebral palsy, grading resistance to passive movement on a 0-4 scale.
- These two tools directly address **motor function classification** and **spasticity assessment** as required in the question.
*Incorrect: III and IV*
- While the **Modified Ashworth Scale (IV)** is correctly identified for spasticity assessment, the **Modified Connors Scale (Connors-II)** is used exclusively for evaluating **Attention-Deficit/Hyperactivity Disorder (ADHD)**, not motor function or spasticity in cerebral palsy.
*Incorrect: I and II*
- The **GMFCS (I)** is correctly identified for motor function classification in cerebral palsy.
- However, the **Medical Research Council (MRC) System** is primarily used for **muscle strength grading** (0-5 scale) in conditions like peripheral neuropathy, stroke, or myopathy—not for motor function classification or spasticity assessment specific to cerebral palsy.
*Incorrect: II and III*
- Both tools are inappropriate for the stated purpose: the **MRC System** assesses muscle strength (not CP-specific motor function classification), and the **Modified Connors Scale** evaluates ADHD symptoms.
- Neither tool is standard for evaluating motor function or spasticity in cerebral palsy.
Question 10: Which of the following are causes of secondary immunodeficiency in children?
I. Diphenylhydantoin
II. Severe malnutrition
III. Post-varicella state
IV. Nephrotic syndrome
Select the correct answer using the code given below :
A. II, III and IV
B. I, III and IV
C. I, II and III
D. I, II and IV (Correct Answer)
Explanation: ***I, II and IV***
- **Diphenylhydantoin (phenytoin)**, an anticonvulsant, causes immunosuppression through multiple mechanisms including IgA deficiency, hypogammaglobulinemia, and impaired T-cell function, making it a well-documented cause of drug-induced secondary immunodeficiency.
- **Severe malnutrition** is one of the most common causes of secondary immunodeficiency worldwide, significantly impairing both cellular and humoral immunity by affecting T cells, B cells, and phagocytic function.
- **Nephrotic syndrome** causes loss of immunoglobulins (particularly IgG) in the urine due to increased glomerular permeability, directly resulting in hypogammaglobulinemia and increased susceptibility to encapsulated bacterial infections (especially *Streptococcus pneumoniae*).
*II, III and IV*
- While **severe malnutrition**, **post-varicella state**, and **nephrotic syndrome** are all causes of immunodeficiency, this option incorrectly excludes diphenylhydantoin.
- **Diphenylhydantoin** is a well-established cause of secondary immunodeficiency, not a minor or questionable cause.
*I, III and IV*
- This option incorrectly excludes **severe malnutrition**, which is one of the most important and prevalent causes of secondary immunodeficiency in children globally.
- Severe malnutrition affects multiple components of the immune system and is considered a primary cause in pediatric populations.
*I, II and III*
- While **diphenylhydantoin**, **severe malnutrition**, and **post-varicella state** can all affect immunity, this option incorrectly excludes **nephrotic syndrome**.
- The **post-varicella state** causes transient T-cell lymphopenia, but this is typically temporary and self-limited compared to the sustained immunoglobulin loss in nephrotic syndrome.
- **Nephrotic syndrome** represents a more consistent and clinically significant cause of secondary immunodeficiency with a clear mechanism (protein loss in urine).