INI-CET 2025 - Pediatrics Practice Questions

Q: Which of the following is not true in Turner Syndrome?

Prominent occiput. ***Prominent occiput*** - This physical feature is **NOT** associated with Turner Syndrome and is therefore the correct answer. - A prominent occiput is a classic distinguishing feature of **Trisomy 18 (Edwards Syndrome)**, not Turner syndrome. - Turner syndrome patients typically have normal occiput configuration, helping differentiate it from other chromosomal aneuploidies. *Incorrect - Short 4th metacarpals* - This is actually a **classic feature** of Turner Syndrome, known as the **metacarpal sign**. - Short 4th and 5th metacarpals are well-documented skeletal abnormalities in Turner syndrome. - On X-ray, extending a line along the 4th and 5th metacarpal heads normally passes distal to the 3rd metacarpal head, but in Turner syndrome it passes through or proximal to it. *Incorrect - Webbed neck* - This is a highly characteristic feature of Turner Syndrome, clinically known as **pterygium colli**. - Results from regression of fetal cystic hygromas (lymphatic malformations). - Strongly associated with the **45,X karyotype** and is a significant phenotypic marker. *Incorrect - Widely spaced hypoplastic nipples* - This describes the **shield chest** appearance, a key physical characteristic of Turner syndrome. - Part of the constellation of congenital developmental anomalies including broad chest with increased internipple distance. - Directly linked to the underlying chromosomal abnormality and developmental changes.

Q: A 7-year-old child with a history of ear infection is complaining of lockjaw and limb spasm/fever/neck rigidity. Choose the most appropriate diagnosis:

Tetanus. ***Tetanus*** - The striking combination of **lockjaw (trismus)** and generalized **limb spasms** is the hallmark clinical presentation of **Tetanus**, caused by the neurotoxin from *Clostridium tetani*. - The presence of **fever** and **neck rigidity** alongside an antecedent **ear infection** (potential portal of entry) strongly supports this diagnosis. - Tetanus causes sustained muscle contractions due to the inhibition of inhibitory neurons, leading to characteristic trismus, risus sardonicus, and opisthotonus. - Note: This is distinct from metabolic **tetany** (hypocalcemia), which causes carpopedal spasm without fever or lockjaw. *Incorrect: Meningitis* - While meningitis causes **fever** and **neck rigidity** (nuchal rigidity), it does not typically present with severe **lockjaw (trismus)** or sustained generalized **muscle spasms**. - Meningitis usually presents with headache, photophobia, altered consciousness, and positive Kernig's/Brudzinski's signs. *Incorrect: Bezold abscess* - A Bezold abscess is a deep neck abscess complicating mastoiditis, causing localized symptoms like neck pain, swelling, and **torticollis** (fixed head tilt). - It does not cause neuromuscular hyperexcitability resulting in **lockjaw** and widespread **limb spasms**. *Incorrect: Sinus thrombosis* - Lateral sinus thrombosis is a complication of otitis media presenting with **picket-fence fever**, headache, and signs of raised intracranial pressure. - It does not cause the characteristic muscle spasms and lockjaw seen in this presentation.

Question 1

Which of the following is not true in Turner Syndrome?

Accepted Answer

Prominent occiput

Answer

Short 4th metacarpals

Answer

Webbed neck

Answer

Widely spaced hypoplastic nipples

Question 2

A 7-year-old child with a history of ear infection is complaining of lockjaw and limb spasm/fever/neck rigidity. Choose the most appropriate diagnosis:

Accepted Answer

Tetanus

Answer

Meningitis

Answer

Bezold abscess

Answer

Sinus thrombosis

INI-CET 2025 — Pediatrics