NEET-PG 2013 Practice Questions

Q: In which condition do symptoms improve with crying?

Choanal atresia. ***Choanal atresia*** - In **bilateral choanal atresia**, a newborn is unable to breathe through the nose due to a bony or membranous obstruction. Symptoms like **cyanosis** worsen with feeding and improve with crying because crying involves **mouth breathing**, which bypasses the nasal obstruction. - This condition is a **medical emergency** as newborns are obligate nasal breathers, and immediate intervention (e.g., oral airway, surgical repair) is often required. *Tetralogy of Fallot* - This congenital heart defect can lead to **cyanotic spells** (hypercyanotic or "tet" spells), which are characterized by increased cyanosis, tachypnea, and irritability. These spells are often precipitated by activities that increase right-to-left shunting, and **crying can worsen them** rather than improve them due to increased systemic oxygen demand and vascular resistance. - Management often involves positioning (knee-chest) and medications to reduce pulmonary vascular resistance or increase systemic vascular resistance, to alleviate shunting. *Bronchial asthma* - **Crying is a common trigger for asthma attacks** in children, as it can induce bronchoconstriction due to hyperventilation and airway irritation. Symptoms typically worsen with crying, leading to **wheezing, coughing, and shortness of breath**. - Asthma is characterized by **reversible airway obstruction** and airway hyperresponsiveness, and its symptoms do not improve with crying. *None of the options* - This option is incorrect because **choanal atresia** is a condition where symptoms (specifically cyanosis) do improve with crying due to the switch from nasal to mouth breathing.

Q: What is the preferred method for removing a foreign body from the lung in children?

Rigid bronchoscopy. ***Rigid bronchoscopy*** - **Rigid bronchoscopy** is the preferred method for removing foreign bodies from the lung in children due to its ability to provide better air control, magnified viewing, and larger working channels for robust grasping tools. - It allows for complete ventilation control and isolation of the airway, which is crucial in children where airway obstruction can rapidly lead to respiratory compromise. *Chest x-ray* - A **chest x-ray** is a diagnostic tool used to identify the presence and location of a foreign body, but it is not a method for removal. - Many foreign bodies, especially non-radiopaque ones like food, may not be visible on an x-ray, making it unreliable for definitive diagnosis of presence or absence. *Flexible endoscopy* - While **flexible bronchoscopy** can be used for foreign body removal in some adults or specific situations, it is generally less effective and carries higher risks in children, especially for larger or lodged objects. - Its smaller working channels and less stable airway control make it less suitable for urgent and complete removal in the pediatric population. *Direct laryngoscopy* - **Direct laryngoscopy** is used to visualize the larynx and vocal cords, primarily to remove foreign bodies from the upper airway or intubate, but not typically for removal of foreign bodies lodged deep within the main bronchi or lungs. - It does not offer direct access or visualization of the lower bronchial tree where most aspirated foreign bodies in children tend to lodge.

Q: The most common cause of meningitis in children aged 5 yrs is-

S. pneumoniae. ***S. pneumoniae*** - **_Streptococcus pneumoniae_** (Pneumococcus) is the **most common cause of bacterial meningitis** in children aged 5 years and older, as well as in adults. - Widespread vaccination has reduced its incidence but it remains a significant pathogen. *H. influenzae* - **_Haemophilus influenzae_ type b (Hib)** was a major cause of meningitis in young children, but its incidence has **drastically decreased** due to the routine **Hib vaccine**. - Without vaccination, it would still be a significant cause in this age group, but with high vaccine coverage, it is less common than _S. pneumoniae_. *Staphylococcus* - **_Staphylococcus aureus_** and other staphylococcal species are **less common causes of meningitis** in otherwise healthy children. - They are more typically associated with meningitis following **neurosurgery**, trauma, or in immunocompromised patients. *E.coli* - **_Escherichia coli_** is a common cause of **neonatal meningitis** (in infants less than 3 months old), often acquired during passage through the birth canal. - It is **rarely a cause of meningitis** in children aged 5 years.

Q: Which of the following statements about Kernicterus is TRUE?

Kernicterus is due to Unconjugated Hyperbilirubinemia. ***Kernicterus is due to Unconjugated Hyperbilirubinemia*** - **Kernicterus** is a rare but severe neurological condition caused by **high levels of unconjugated bilirubin** in a newborn's blood. - **Unconjugated bilirubin** is lipophilic and can cross the **blood-brain barrier**, particularly when levels are excessively high or the barrier is compromised. *Prematurity is the primary cause of Kernicterus* - **Prematurity** is a **major risk factor** for kernicterus, as premature infants have immature livers, reduced albumin binding sites, and a less developed blood-brain barrier. - However, the primary cause is the **unconjugated hyperbilirubinemia** itself, which can occur in both term and preterm infants, though it is more common and severe in prematures. *Yellowish staining occurs primarily in the Cerebellum in Kernicterus* - While kernicterus does affect the **cerebellum**, the **primary and most characteristic sites** of bilirubin deposition are the **basal ganglia**, hippocampus, and brainstem nuclei. - The **basal ganglia** are the predominant target, not the cerebellum, making this statement anatomically incorrect. *Kernicterus is not associated with increased morbidity.* - Kernicterus is associated with **significant morbidity** and can lead to permanent neurological damage, including **cerebral palsy**, hearing loss, intellectual disabilities, and gaze abnormalities. - It is a medical emergency that requires prompt diagnosis and treatment to prevent long-term neurological sequelae.

Q: Among the following, which pulmonary tumor is most likely to occur in children?

Carcinoid. ***Carcinoid*** - **Bronchial carcinoid tumors** are the most common primary lung tumors found in children and adolescents, accounting for a significant percentage of pediatric pulmonary neoplasms. - These tumors arise from **neuroendocrine cells** and generally have a low-grade malignant potential. *Small cell carcinoma* - **Small cell lung carcinoma (SCLC)** is strongly associated with smoking and is highly aggressive, almost exclusively occurring in adults. - It is exceedingly rare in children, making it an unlikely diagnosis in this age group. *Adenocarcinoma* - **Adenocarcinoma** is the most common histological type of lung cancer in adults who do not smoke but is still extremely rare in children. - Although it can occur in non-smokers and younger adults, it is not the most likely primary pulmonary tumor in the pediatric population. *Squamous cell carcinoma* - **Squamous cell carcinoma** is primarily linked to extensive smoking history and is predominantly seen in older adult patients. - It is virtually unheard of in children, making it a highly improbable diagnosis.

Q: Which of the following is not a recommended treatment for bronchiolitis?

Macrolides. ***Macrolides*** - **Macrolide antibiotics** are *not* recommended for treatment of **bronchiolitis**, as the condition is primarily caused by **viral infections** (mainly RSV), rendering antibiotics completely ineffective. - Bronchiolitis is a **viral illness**, and use of antibiotics like macrolides provides *no benefit*, increases risk of **antibiotic resistance**, and may cause unnecessary side effects. - This is the **most clearly not recommended** option among the choices. *Humid oxygen* - While **supplemental oxygen** is indicated for infants with **hypoxemia** (oxygen saturation <90%), **routine humidification** of oxygen is *not specifically recommended* by current guidelines. - Evidence does *not support* routine use of humidified oxygen therapy in bronchiolitis. - However, supplemental oxygen itself (when needed for low oxygen levels) is appropriate supportive care. *Bronchodilator* - **Bronchodilators** (like albuterol or salbutamol) are *not routinely recommended* for bronchiolitis, as most infants do not have significant **bronchospasm** and show *no sustained benefit*. - Guidelines suggest a **trial dose** may be considered, but should be *discontinued* if there is no clear clinical improvement. - The primary pathology is **bronchiolar inflammation and mucus plugging**, not reversible bronchospasm. *All of the options* - This option is incorrect because the question asks for what is "*not* recommended." - **Macrolides** are the most definitively not recommended, as they are completely ineffective against viral infections. - While bronchodilators and routine humidification also lack strong evidence, **macrolides** represent inappropriate therapy with no mechanism of benefit.

Q: What is the most appropriate method for administering asthma treatment to an infant under one year of age?

MDI with Spacer and Mask. ***MDI with Spacer and Mask*** - For infants and young children, a **metered-dose inhaler (MDI)** used with a **spacer** and a **well-fitting mask** is the **most appropriate** method for delivering asthma medication. - The spacer helps to reduce the velocity of the aerosol and allows the infant to inhale the medication over several breaths, while the mask ensures the medication is delivered to the airways without significant loss. - This method is **portable**, **convenient**, and **cost-effective** for routine outpatient management. *MDI with Spacer (no mask)* - While a spacer is crucial for optimizing drug delivery from an MDI, an infant cannot effectively seal their lips around a spacer mouthpiece for proper inhalation. - This method would result in significant **medication loss** and insufficient dose delivery to the lungs. *MDI with Mask (no spacer)* - An MDI used directly with a mask without a spacer leads to inefficient drug delivery due to the **high velocity** of the aerosol spray. - The medication impinges on the back of the throat and face, reducing the amount that reaches the small airways. *Nebulizer therapy* - Nebulizers are also an **acceptable and effective option** for infants, particularly in acute settings or when families find them easier to use. - However, they are **time-consuming** (typically 10-15 minutes per treatment), require a power source or batteries, and are less portable than MDI systems. - For **routine outpatient management**, an MDI with spacer and mask is generally **preferred** due to its convenience, portability, and comparable efficacy when used correctly.

Q: Most common syndrome associated with A-V canal defect -

Down syndrome. ***Down syndrome*** - **Down syndrome (Trisomy 21)** is the most common syndrome associated with **atrioventricular (AV) canal defects** (endocardial cushion defects) - Occurs in approximately **40-50% of individuals with Down syndrome**, making it the hallmark cardiac anomaly in this condition - AV canal defects range from partial to complete defects involving atrial and ventricular septa and AV valves *Klinefelter syndrome* - **Klinefelter syndrome (47,XXY)** is not characteristically associated with AV canal defects - May have **mitral valve prolapse** or **aortic root dilation**, but AV canal defects are not a typical feature *Turner syndrome* - **Turner syndrome (45,X)** has distinct cardiovascular associations including **coarctation of the aorta** and **bicuspid aortic valve** - AV canal defects are **not** characteristic of Turner syndrome *Marfan syndrome* - **Marfan syndrome** is a connective tissue disorder with **aortic root dilation**, **aortic aneurysms**, and **mitral valve prolapse** - **AV canal defects are not a feature** of Marfan syndrome

Q: What is the APGAR score for a baby that grimaces in response to stimulation?

1. ***1*** - A score of **1** is given for **grimace** in response to stimulation, indicating some reflex irritability but not a vigorous cry or sneeze. - This response shows a minimal protective reflex, suggesting the baby is not completely flaccid but also not optimally responsive. - The APGAR scoring for reflex irritability ranges from 0 to 2, with grimacing specifically scoring **1 point**. *0* - A score of **0** for reflex irritability is reserved for **no response** or **complete absence** of reflexes. - This would indicate a severely depressed neurological state, unlike the grimace observed. *2* - A score of **2** for reflex irritability is given for a **vigorous cry**, **sneeze**, **cough**, or **active withdrawal** from stimulation. - A grimace is a less robust response than these, thus not warranting a score of 2. *3* - The APGAR scoring system uses a **0-2 scale** for each of the five components (Appearance, Pulse, Grimace, Activity, Respiration). - The maximum score for any single component is **2**, making 3 an invalid score. - Total APGAR scores range from 0-10, but individual components never exceed 2.

Q: In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?

Acrodermatitis enteropathica. ***Acrodermatitis enteropathica*** - This condition is a **zinc deficiency** syndrome, which can be either inherited or acquired. - It presents with a classic triad of **diarrhoea**, **dermatitis** (often periorificial and acral with moist, crusted lesions), and **alopecia**. - The **perianal moist crust** is a characteristic finding of the periorificial dermatitis seen in this condition. *Pellagra* - Pellagra is caused by **niacin (Vitamin B3) deficiency** and is characterized by the "4 D's": **dermatitis** (often sun-exposed areas), **diarrhoea**, **dementia**, and eventually death. - The dermatitis of pellagra is typically **symmetrical, hyperpigmented, and photosensitive**, not moist perianal crusts, differentiating it from the presented case. *Riboflavin deficiency* - **Riboflavin deficiency** typically manifests as **cheilosis**, angular stomatitis, glossitis, and seborrheic dermatitis, but not specifically perianal moist crusts with diarrhoea. - While it can affect mucous membranes, the specific perianal presentation with diarrhoea points away from this diagnosis. *Kwashiorkor* - **Kwashiorkor** is a form of protein-energy malnutrition that can present with **diarrhoea** and skin changes (flaky paint dermatosis, hypopigmentation). - However, the skin changes are typically **desquamating** and affect dependent areas, not the characteristic **moist, crusted periorificial lesions** seen in zinc deficiency. - Kwashiorkor also typically presents with **edema**, which is not mentioned in this case.

Question 1

In which condition do symptoms improve with crying?

Accepted Answer

Choanal atresia

Answer

Tetralogy of Fallot

Answer

Bronchial asthma

Answer

None of the options

Question 2

What is the preferred method for removing a foreign body from the lung in children?

Accepted Answer

Rigid bronchoscopy

Answer

Chest x-ray

Answer

Flexible endoscopy

Answer

Direct laryngoscopy

Question 3

The most common cause of meningitis in children aged 5 yrs is-

Accepted Answer

S. pneumoniae

Answer

Staphylococcus

Answer

E.coli

Answer

H. influenzae

Question 4

Which of the following statements about Kernicterus is TRUE?

Accepted Answer

Kernicterus is due to Unconjugated Hyperbilirubinemia

Answer

Prematurity is the primary cause of Kernicterus

Answer

Kernicterus is not associated with increased morbidity.

Answer

Yellowish staining occurs primarily in the Cerebellum in Kernicterus

Question 5

Among the following, which pulmonary tumor is most likely to occur in children?

Accepted Answer

Carcinoid

Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Question 6

Which of the following is not a recommended treatment for bronchiolitis?

Accepted Answer

Macrolides

Answer

Bronchodilator

Answer

Humid oxygen

Answer

All of the options

Question 7

What is the most appropriate method for administering asthma treatment to an infant under one year of age?

Accepted Answer

MDI with Spacer and Mask

Answer

MDI with Mask (no spacer)

Answer

Nebulizer therapy

Answer

MDI with Spacer (no mask)

Question 8

Most common syndrome associated with A-V canal defect -

Accepted Answer

Down syndrome

Answer

Klinefelter syndrome

Answer

Turner syndrome

Answer

Marfan syndrome

Question 9

What is the APGAR score for a baby that grimaces in response to stimulation?

Accepted Answer

1

Answer

0

Answer

2

Answer

3

Question 10

In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?

Accepted Answer

Acrodermatitis enteropathica

Answer

Pellagra

Answer

Riboflavin deficiency

Answer

Kwashiorkor

NEET-PG 2013

ENT

Microbiology

Pediatrics