FMGE 2024 - Pediatrics PYQs Practice Questions

Q: For how long is exclusive breastfeeding recommended?

6 months. ***6 months*** - The **World Health Organization (WHO)** and the **American Academy of Pediatrics (AAP)** strongly recommend **exclusive breastfeeding for the first 6 months** of life to ensure optimal growth and development. - Breast milk provides all the necessary **nutrients, antibodies, and hydration** required by the infant during this period, offering protection against **infections** and **sudden infant death syndrome (SIDS)**. - After 6 months, **complementary feeding** should be introduced alongside continued breastfeeding up to 2 years or beyond. *3 months* - This duration is **insufficient** as it prevents the infant from receiving the full protective and nutritional benefits provided by breast milk up to 6 months. - Introducing other foods or formula before 6 months can increase the risk of **infections** and **allergy development** due to immature gut immunity. *9 months* - Exclusive breastfeeding for 9 months is **not recommended** because the infant's increasing metabolic demands cannot be met by breast milk alone after 6 months. - By 9 months, insufficient intake of nutrients like **iron** and **zinc** from exclusive breastfeeding can lead to **nutritional deficiencies** and impaired development. *12 months* - Exclusive breastfeeding for 12 months is **inappropriate** as infants require the energy and micronutrients provided by **complementary foods** starting from 6 months of age. - Failure to introduce solids by 12 months can hinder the development of **oral motor skills** and lead to severe **nutritional deficits**. [Practice more Pediatrics PYQs on OnCourse]

Q: What condition is likely in a newborn presenting with dry, rough skin, a big tongue and rough hair?

Congenital hypothyroidism. ***Congenital hypothyroidism*** - This condition is classically associated with signs of **cretinism** in newborns, including developmental delays, **dry/rough skin** (due to **myxedema**), and distinct facial features like **macroglossia** (big tongue). - The presentation of rough hair and generalized skin changes reflect reduced metabolic rate and accumulation of **glycosaminoglycans** in the dermis. *Prader-Willi syndrome* - Characterized by severe **neonatal hypotonia** and feeding difficulties followed by unremitting **hyperphagia** and obesity starting in early childhood. - The key features are related to the deletion of paternal chromosome 15 genes, and it does not typically present with the specific severe **myxedematous skin changes** seen here. *Edward syndrome* - Edward syndrome (**Trisomy 18**) is characterized by severe growth deficiency, **micrognathia**, **rocker-bottom feet**, overlapping fingers, and often severe congenital heart anomalies. - These findings are indicative of severe chromosomal abnormalities that typically result in distinct physical malformations, not primary hypothyroidism features such as **macroglossia** and widespread myxedema. *Galactosemia* - This is an inborn error of metabolism that usually presents after milk feeding starts, leading to poor feeding, **jaundice**, **hepatomegaly**, and subsequent formation of **cataracts**. - The initial clinical picture is dominated by metabolic decompensation, **sepsis (E. coli)**, and liver disease, not the classic physical features of thyroid hormone deficiency. [Practice more Pediatrics PYQs on OnCourse]

Q: What is the likely age of a child who can ride a tricycle, walk up stairs with alternate steps, but cannot hop?

3.5 years. ***Correct: 3.5 years*** - At **3.5 years**, a child typically achieves the milestone of **walking up stairs with alternate steps** (reciprocal stair climbing) - The ability to **ride a tricycle** is typically achieved by **3 years** - **Hopping on one foot** is a milestone achieved around **4 years**, so a child at 3.5 years would not yet be able to hop - The combination of these milestones (can ride tricycle, can do alternate steps, cannot hop) places the child at approximately **3.5 years** *Incorrect: 4.5 years and 5.5 years* - By 4.5-5.5 years, children should have already achieved the ability to **hop on one foot** (typically by 4 years) - These ages are too advanced for a child who cannot yet hop *Incorrect: 2.5 years* - At 2.5 years, most children walk up stairs with **both feet on each step** rather than using alternate steps - **Reciprocal stair climbing** (alternate steps) typically develops around **3-3.5 years** - This age is too young for the described skill set [Practice more Pediatrics PYQs on OnCourse]

Q: What is the daily fluid requirement for a 3-day-old baby with a birth weight of 1500 grams?

80-90 ml/kg/day. ***80-90 ml/kg/day***- This range represents the typical fluid requirement for a very low birth weight (**VLBW**) infant on the second or third day of life (DOL 2-3).- It allows for a safe transition from the restricted fluids (60-80 ml/kg/day) of DOL 1 towards higher maintenance needs, minimizing the risk of conditions like **patent ductus arteriosus (PDA)**.*100-110 ml/kg/day*- This rate is usually required later in the first week (around **DOL 4 to DOL 7**) as the infant's renal function matures and catabolism increases.- Providing this high volume prematurely to a 3-day-old **VLBW** infant increases the risk of **fluid overload** and associated neonatal morbidities.*120-130 ml/kg/day*- This represents a standard high maintenance fluid rate, typically achieved by **DOL 7** or later, especially for infants utilizing **phototherapy**.- It is significantly above the required baseline for a **3-day-old** baby and would lead to potential hyponatremia and **pulmonary edema**.*130-150 ml/kg/day*- This is the usual **full maintenance** or "maximal" fluid requirement often seen after the first week of life (DOL 7+) or in situations requiring high replacement.- Administration of this rate on DOL 3 is strongly discouraged due to the extreme risk of **cardiovascular and pulmonary complications**. [Practice more Pediatrics PYQs on OnCourse]

Q: What could be the possible diagnosis for a newborn exhibiting weak lower limb pulses and strong upper limb pulses?

COA. ***COA*** (Coarctation of the Aorta) - The classic presentation of **Coarctation of the Aorta** involves a narrowing of the aorta, usually distal to the left subclavian artery, leading to increased pressure proximal to the coarctation (strong upper limb pulses) and decreased pressure distal to it (weak lower limb pulses). - This severe pressure gradient is manifested as **differential pulses** and potential **blood pressure discrepancy** between the arms and legs, making this the most likely diagnosis. *TGA* - **Transposition of the Great Arteries** is characterized by severe **cyanosis** presenting shortly after birth due to two parallel circulations (aorta from RV, pulmonary artery from LV). - It does not typically cause a significant differential in pulse strength between the upper and lower limbs unless complicated by underlying aortic arch anomalies. *TOF* - **Tetralogy of Fallot** typically presents with cyanosis and **hypercyanotic spells** (**tet spells**) due to severe right ventricular outflow tract obstruction and a large VSD. - While it is a common cyanotic heart disease, it primarily affects flow to the pulmonary circulation and does not cause obstruction in the systemic aorta leading to differential pulses. *Ebstein anomaly* - This condition involves the apical displacement of the **tricuspid valve** leaflets into the **right ventricle**, leading to tricuspid regurgitation and large right atrium. - Clinical features usually include varying degrees of cyanosis and signs of right heart failure but do not typically involve a differential in systemic arterial pulses. [Practice more Pediatrics PYQs on OnCourse]

Question 1

For how long is exclusive breastfeeding recommended?

Accepted Answer

6 months

Answer

3 months

Answer

12 months

Answer

9 months

Question 2

What condition is likely in a newborn presenting with dry, rough skin, a big tongue and rough hair?

Accepted Answer

Congenital hypothyroidism

Answer

Prader-Willi syndrome

Answer

Edward syndrome

Answer

Galactosemia

Question 3

What is the likely age of a child who can ride a tricycle, walk up stairs with alternate steps, but cannot hop?

Accepted Answer

3.5 years

Answer

4.5 years

Answer

5.5 years

Answer

2.5 years

Question 4

What is the daily fluid requirement for a 3-day-old baby with a birth weight of 1500 grams?

Accepted Answer

80-90 ml/kg/day

Answer

100-110 ml/kg/day

Answer

130-150 ml/kg/day

Answer

120-130 ml/kg/day

Question 5

What could be the possible diagnosis for a newborn exhibiting weak lower limb pulses and strong upper limb pulses?

Accepted Answer

COA

Answer

TOF

Answer

Ebstein anomaly

Answer

TGA

Question 6

At what age does the transfer of one object to another hand happen?

Accepted Answer

7 months

Answer

4 months

Answer

12 months

Answer

9 months

Question 7

An 8-year-old child with a history of GTCS came with an episode of convulsions for more than 45 minutes. What will be the appropriate management for this patient?

Accepted Answer

Lorazepam followed by levetiracetam

Answer

Levetiracetam followed by valproate

Answer

Valproate followed by gabapentin

Answer

Carbamazepine followed by lorazepam

Question 8

A child with diarrhea was eager to drink, and the skin pinch went back slowly. Which of the following categories is the child classified into as per IMNCI?

Accepted Answer

Yellow

Answer

Green

Answer

None

Answer

Pink

FMGE 2024 — Pediatrics