What is the most appropriate method for administering asthma treatment to an infant under one year of age?
Most common age for intussusception is
In which condition do symptoms improve with crying?
Among the following, which pulmonary tumor is most likely to occur in children?
Which of the following statements about Kernicterus is TRUE?
The most common cause of per rectal bleeding in infants is:
Which of the following is the most practical method for transporting a newborn while maintaining a warm temperature, especially in resource-limited settings?
A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?
On USG, a mass was found in the abdomen which was displacing the kidney laterally in a 1-year-old child. What is the most likely diagnosis?
Which of the following is not a feature of hypothyroidism in infancy?
NEET-PG 2013 - Pediatrics NEET-PG Practice Questions and MCQs
Question 21: What is the most appropriate method for administering asthma treatment to an infant under one year of age?
- A. MDI with Mask (no spacer)
- B. Nebulizer therapy
- C. MDI with Spacer (no mask)
- D. MDI with Spacer and Mask (Correct Answer)
Explanation: ***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.
Question 22: Most common age for intussusception is
- A. 0 - 6 months
- B. 6 months - 3 years (Correct Answer)
- C. 3 - 5 years
- D. > 5 years
Explanation: ***6 months - 3 years*** - Intussusception commonly occurs in infants and young children, with the peak incidence between **6 months and 3 years** of age. - This age range coincides with changes in feeding practices and increased exposure to viral infections, which can sometimes precede intussusception. - The **typical age** is 5-9 months, with most cases occurring before 2 years. *0 - 6 months* - While intussusception can occur in this age group, it is **less common** than in slightly older infants. - Intussusception in very young infants may have different underlying causes, such as a **pathologic lead point**. *3 - 5 years* - Intussusception is **less frequent** in this age group compared to infants and toddlers. - When it does occur, there is a higher likelihood of an **identifiable lead point**, such as a Meckel's diverticulum or polyp. *> 5 years* - Intussusception is **rare** in children over the age of 5 years. - In older children and adults, it is almost always associated with a **pathological lead point**, such as a tumor or postoperative adhesions.
Question 23: In which condition do symptoms improve with crying?
- A. Tetralogy of Fallot
- B. Choanal atresia (Correct Answer)
- C. Bronchial asthma
- D. None of the options
Explanation: ***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.
Question 24: Among the following, which pulmonary tumor is most likely to occur in children?
- A. Carcinoid (Correct Answer)
- B. Small cell carcinoma
- C. Squamous cell carcinoma
- D. Adenocarcinoma
Explanation: ***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.
Question 25: Which of the following statements about Kernicterus is TRUE?
- A. Prematurity is the primary cause of Kernicterus
- B. Kernicterus is due to Unconjugated Hyperbilirubinemia (Correct Answer)
- C. Kernicterus is not associated with increased morbidity.
- D. Yellowish staining occurs primarily in the Cerebellum in Kernicterus
Explanation: ***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.
Question 26: The most common cause of per rectal bleeding in infants is:
- A. Anal fissure (Correct Answer)
- B. Rectal polyp
- C. Intussusception
- D. Meckel's diverticulum
Explanation: ***Anal fissure*** - **Anal fissures** are tiny tears in the **anus** lining, causing bright red blood on the stool surface or diaper. - They are very common in infants due to **constipation** or passing **hard stools**, leading to trauma. *Rectal polyp* - Rectal polyps can cause **painless rectal bleeding**, but they are **less common** than anal fissures in infants. - Bleeding from polyps is usually **intermittent** and can be darker or mixed with stool. *Intussusception* - Intussusception presents with sudden onset of **crampy abdominal pain**, **vomiting**, and **currant jelly stools** (blood mixed with mucus). - This condition is an **emergency** and typically affects infants between 3 months and 3 years old. *Meckel's diverticulum* - **Meckel's diverticulum** can cause painless, recurrent **dark red or maroon bleeding**, often described as "brick-red" due to ectopic gastric mucosa. - While a significant cause of bleeding, it is **less common** than anal fissures as the primary etiology in infants.
Question 27: Which of the following is the most practical method for transporting a newborn while maintaining a warm temperature, especially in resource-limited settings?
- A. Kangaroo Mother Care (KMC) (Correct Answer)
- B. Transport incubator
- C. Insulated box (e.g., Thermacol box)
- D. Warm water bag
Explanation: ***Kangaroo Mother Care (KMC)*** - KMC involves continuous **skin-to-skin contact** between the newborn and the caregiver, which is highly effective in maintaining the infant's temperature through direct body warmth transfer. - It is a **low-cost**, easily accessible method, making it particularly practical and sustainable in **resource-limited settings**. - KMC is endorsed by **WHO** as an evidence-based intervention for thermal care of low birth weight and preterm infants. *Transport incubator* - While effective for maintaining temperature, a transport incubator is **expensive**, requires electricity or specialized batteries, and is not readily available in many resource-limited settings. - The use of an incubator requires **trained personnel** for operation and maintenance, making it less practical for widespread use in such environments. *Insulated box (e.g., Thermacol box)* - An insulated box can provide some thermal insulation, but it lacks an **active heating mechanism** and does not provide tactile stimulation or bonding benefits. - The temperature inside can still fluctuate significantly, and it does not allow for **continuous monitoring** of the newborn, increasing the risk of overheating or hypothermia if not managed carefully. *Warm water bag* - A warm water bag can provide localized warmth but carries a significant risk of **burns** if the water is too hot or if the bag leaks. - Its warming effect is also **temporary** and not evenly distributed, making it less reliable for maintaining stable body temperature during prolonged transport.
Question 28: A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?
- A. Fungal infection (Correct Answer)
- B. Shigella infection
- C. Salmonella infection
- D. Lactose intolerance
Explanation: ***Fungal infection (Candida diaper dermatitis)*** - **Diarrhea with perianal diaper rash** is the classic presentation of **Candida (fungal) diaper dermatitis**, the most common cause of diaper rash in infants with diarrhea. - **Diarrhea increases skin moisture and alters pH**, creating optimal conditions for **Candida albicans overgrowth**. - **Perianal involvement with bright erythema** is characteristic of Candida, often with **satellite lesions** and involvement of skin folds. - This is a **clinical diagnosis** based on distribution pattern and association with diarrhea; consanguinity is not directly relevant to this common condition. *Lactose intolerance* - **Congenital lactase deficiency** is extremely rare (< 50 cases worldwide) and unlikely to be the primary diagnosis. - While **secondary lactose intolerance** can occur with gastroenteritis causing diarrhea, it doesn't explain the **specific perianal rash pattern** described. - The perianal redness in lactose malabsorption would be **irritant contact dermatitis** from acidic stools, which would secondarily get infected with **Candida** - making fungal infection the more complete diagnosis. *Shigella infection* - Typically presents with **bloody diarrhea (dysentery)**, high fever, abdominal cramps, and tenesmus. - Would not specifically cause the **perianal diaper rash pattern** characteristic of Candida. - Consanguinity doesn't predispose to this bacterial infection. *Salmonella infection* - Usually presents with **fever, vomiting, and systemic symptoms** along with diarrhea. - May cause bloody or non-bloody diarrhea but doesn't explain the **characteristic perianal redness pattern**. - Not associated with consanguinity as it's an acquired infectious disease.
Question 29: On USG, a mass was found in the abdomen which was displacing the kidney laterally in a 1-year-old child. What is the most likely diagnosis?
- A. Neuroblastoma (Correct Answer)
- B. Wilms' tumor
- C. Renal cell carcinoma
- D. All of the options
Explanation: ***Neuroblastoma*** - A retroperitoneal mass displacing the kidney laterally in an infant is highly characteristic of **neuroblastoma**, which originates from neural crest cells in the adrenal gland or sympathetic ganglia. - The key finding is **extrarenal origin** - the mass pushes the kidney aside rather than arising from within it. - Most common extrarenal abdominal mass in children under 2 years. *Wilms' tumor* - This is an **intrarenal mass** that originates within the kidney parenchyma. - Wilms' tumor **expands and distorts the kidney** rather than displacing it laterally from outside. - Most common renal tumor in children (peak age 3-4 years), presenting with abdominal mass, hematuria, and hypertension. *Renal cell carcinoma* - Exceedingly **rare in a 1-year-old child** - primarily an adult malignancy (typically >40 years). - Would be an intrarenal mass, not an extrarenal mass displacing the kidney laterally. *All of the options* - Incorrect because the specific imaging finding of **lateral kidney displacement** indicates an extrarenal origin, which is pathognomonic for neuroblastoma, not the intrarenal tumors listed.
Question 30: Which of the following is not a feature of hypothyroidism in infancy?
- A. Umbilical hernia
- B. Constipation
- C. Coarse facies
- D. Premature closure of posterior fontanelle (Correct Answer)
Explanation: ***Premature closure of posterior fontanelle*** - Delayed closure of fontanelles, particularly the **posterior fontanelle**, is a characteristic feature of **congenital hypothyroidism** due to impaired bone maturation. - Therefore, **premature closure** would be inconsistent with a diagnosis of hypothyroidism in infancy. *Coarse facies* - **Coarse facial features** such as a broad nasal bridge, puffy eyelids, and a protuberant tongue are common manifestations of **congenital hypothyroidism** due to the accumulation of glycosaminoglycans. - This is a direct consequence of the metabolic derangements caused by insufficient thyroid hormone. *Umbilical hernia* - An **umbilical hernia** is frequently observed in infants with hypothyroidism, resulting from generalized **hypotonia** and incomplete closure of the umbilical ring. - The reduced muscle tone characteristic of the condition contributes to this physical finding. *Constipation* - **Constipation** is a common gastrointestinal symptom in infants with hypothyroidism, caused by **decreased gut motility** secondary to reduced thyroid hormone levels. - This is a clinical indicator of the systemic metabolic slowing associated with the condition.