INI-CET 2024 - Pediatrics PYQs Practice Questions

Q: Which of the following is a common benign condition characterized by white/yellow keratin-filled cysts on a newborn's skin?

Milia. ***Milia*** - These are **tiny, white bumps** (1-2mm) that appear on a newborn's nose, chin, or cheeks - Caused by **trapped keratin beneath the skin surface** in immature sebaceous glands - Occur in **40-50% of newborns** and are completely benign - Resolve spontaneously within **2-4 weeks** without treatment *Mongolian spots* - These are **blue-gray flat birthmarks** (not cysts) caused by dermal melanocytosis - Most commonly found on the **lumbosacral area and buttocks** - Very common in Asian, African, and Hispanic populations but are **pigmentary lesions**, not keratin cysts - Not the answer as they are not characterized by white/yellow cysts *Epstein pearls* - These are **small whitish-yellow cysts** on the **palate** (roof of mouth), not on skin - Found in **60-85% of newborns** and are epithelial inclusion cysts - While very common and benign, they occur on the **oral mucosa**, not the skin surface - Not the answer as the question specifies skin *Congenital melanoma* - This is an **extremely rare malignant tumor**, not a benign condition - Represents a **serious cancer** requiring immediate treatment - Not the answer as it is neither common nor benign [Practice more Pediatrics PYQs on OnCourse]

Q: When should breastfeeding be initiated after a normal delivery?

Immediately after delivery. **Correct: Immediately after delivery** - Initiating breastfeeding **within the first hour** of birth (early initiation) is crucial for establishing **successful lactation** and promoting optimal infant health. - This early initiation allows for **skin-to-skin contact**, which helps stabilize the newborn's temperature, heart rate, and breathing, and facilitates **bonding** between mother and baby. - Aligned with **WHO and UNICEF recommendations** for best practice in postpartum care. *Incorrect: 2 hours after delivery* - While earlier is generally better, waiting two hours misses the **optimal window** for initiating feeding and bonding. - The newborn's **alert period** is typically strongest in the first hour post-birth, making it an ideal time for the first latch. *Incorrect: 4 hours after delivery* - Delaying breastfeeding by four hours can make it more challenging for the baby to latch effectively as they may have passed their **initial alert state** and become sleepy. - This delay can also hinder the establishment of the mother's **milk supply**, as stimulation from early feeding is important for prolactin release. *Incorrect: 6 hours after delivery* - Waiting six hours significantly **misses the critical window** for early initiation and can lead to increased difficulties with breastfeeding. - Prolonged delays may necessitate supplementation, potentially interfering with exclusive breastfeeding and establishing a **strong milk supply**. [Practice more Pediatrics PYQs on OnCourse]

Q: What is the mode of inheritance for the most common form of hypophosphatemic rickets?

X-Linked Dominant (XD). ***X-Linked Dominant (XD)*** - The most common form of hypophosphatemic rickets is **X-linked hypophosphatemic rickets (XLH)**, which is inherited in an X-linked dominant pattern. - This condition is caused by mutations in the **PHEX gene** on the X chromosome, leading to impaired phosphate reabsorption in the kidneys. *Autosomal Recessive (AR)* - While some rare forms of hypophosphatemic rickets exist with **autosomal recessive** inheritance, they are not the most common. - These forms typically involve mutations in genes affecting phosphate transport or vitamin D metabolism, distinct from the primary defect in XLH. *Autosomal Dominant (AD)* - There are also rare **autosomal dominant** forms of hypophosphatemic rickets, such as hereditary hypophosphatemic rickets with hypercalciuria (HHRH) or autosomal dominant hypophosphatemic rickets (ADHR). - However, these are less common than the X-linked dominant form (XLH). *X-Linked Recessive (XR)* - **X-linked recessive** inheritance typically affects males more severely and exclusively, with carrier females usually unaffected or mildly affected. - In X-linked dominant conditions like XLH, both males and females are affected, though females may exhibit variable expressivity. [Practice more Pediatrics PYQs on OnCourse]

Q: Which one of the following is a criterion of Kawasaki disease?

Rash. ***Rash*** - A **polymorphous rash**, which can be macular, papular, or scarlatiniform, is one of the **five principal diagnostic criteria** for **Kawasaki disease**. - This rash typically appears early in the course of the illness and can affect any part of the body, often involving the trunk and extremities. *Edema* - **Edema of the hands and feet**, especially when accompanied by **erythema** (redness), is actually one of the **principal diagnostic criteria** for Kawasaki disease under "extremity changes." - This finding typically occurs in the acute phase, followed by **desquamation** (peeling) in the convalescent phase, particularly in the periungual region. - Note: While edema is a valid criterion, **rash** is considered the most characteristic and commonly used criterion among the options listed. *Purulent conjunctivitis* - **Kawasaki disease** characteristically presents with **bilateral non-purulent (non-exudative) conjunctival injection** - red eyes without discharge or exudate. - **Purulent conjunctivitis** (conjunctivitis with pus/discharge) indicates a bacterial infection and actually argues **against** the diagnosis of Kawasaki disease. - This is the only option that is definitively **not** a criterion. *Strawberry tongue* - **Strawberry tongue** (red, swollen tongue with prominent papillae) is part of the **oral changes criterion** in Kawasaki disease, which includes red cracked lips, strawberry tongue, and erythema of the oropharyngeal mucosa. - While also seen in scarlet fever and toxic shock syndrome, strawberry tongue is a **recognized feature** of Kawasaki disease. - Note: This is technically a valid criterion, though less specific than the polymorphous rash. [Practice more Pediatrics PYQs on OnCourse]

Q: A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?

Constitutional short stature. ***Constitutional short stature*** - This condition is characterized by a **delayed bone age** compared to chronological age, indicating a delay in skeletal maturation. - Children with constitutional short stature typically have **normal parental height** and will eventually reach a normal adult height, although puberty and growth spurts are often delayed. *Malnutrition* - While malnutrition causes **short stature** and **delayed bone age**, it would also likely present with other signs of nutritional deficiency such as **weight loss** or failure to thrive. - The case does not mention any dietary issues or poor socioeconomic conditions typically associated with malnutrition. *Familial short stature* - In familial short stature, the child's height is typically proportional to the parents' height, indicating a strong genetic component to their shorter stature. - It is characterized by a **normal bone age** for chronological age, unlike the delayed bone age seen in this child. *Cretinism* - Cretinism, or congenital hypothyroidism, results in **severe growth retardation** and **delayed bone age**. - However, it is also associated with distinct features like **coarse facial features**, macroglossia, umbilical hernia, and severe developmental delays, which are not mentioned in this case. [Practice more Pediatrics PYQs on OnCourse]

Question 1

Which of the following is a common benign condition characterized by white/yellow keratin-filled cysts on a newborn's skin?

Accepted Answer

Milia

Answer

Mongolian spots

Answer

Epstein pearls

Answer

Congenital melanoma

Question 2

When should breastfeeding be initiated after a normal delivery?

Accepted Answer

Immediately after delivery

Answer

2 hours after delivery

Answer

4 hours after delivery

Answer

6 hours after delivery

Question 3

What is the mode of inheritance for the most common form of hypophosphatemic rickets?

Accepted Answer

X-Linked Dominant (XD)

Answer

Autosomal Recessive (AR)

Answer

Autosomal Dominant (AD)

Answer

X-Linked Recessive (XR)

Question 4

Which one of the following is a criterion of Kawasaki disease?

Accepted Answer

Rash

Answer

Edema

Answer

Purulent conjunctivitis

Answer

Strawberry tongue

Question 5

A child presents with short stature. His bone age is less than chronological age. The height of his parents is normal. What is the most likely diagnosis?

Accepted Answer

Constitutional short stature

Answer

Malnutrition

Answer

Familial short stature

Answer

Cretinism

Question 6

Which of the following statements regarding Wilms tumor is false?

Accepted Answer

Lung metastasis is rare and occurs late

Answer

Most commonly seen < 5 years of age

Answer

Most patients recover well with chemotherapy and radiotherapy.

Answer

Presents as a renal mass.

Question 7

An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?

Accepted Answer

1,00,000 IU

Answer

50,000 IU

Answer

75,000 IU

Answer

2,00,000 IU

Question 8

Which of the following statements about the ABCDE approach in pediatric Advanced Life Support (PALS) is incorrect?

Accepted Answer

Dehydration is a component of the ABCDE approach.

Answer

Airway management is essential in PALS.

Answer

Breathing assessment is part of the ABCDE approach.

Answer

Circulation is a critical component of the ABCDE approach.

Question 9

Fluid of choice for shock in a child with severe acute malnutrition + hypoglycemia

Accepted Answer

Ringer lactate + 5% dextrose

Answer

Normal saline

Answer

Ringer lactate

Answer

10% dextrose

Question 10

Most reliable indicator of some dehydration?

Accepted Answer

Thirst

Answer

Lethargy

Answer

Delayed skin pinch

Answer

Sunken eyes

INI-CET 2024 — Pediatrics