NEET-PG 2013 - Pediatrics Practice Questions

Q: The most common cause of per rectal bleeding in infants is:

Anal fissure. ***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.

Q: Which of the following is the most practical method for transporting a newborn while maintaining a warm temperature, especially in resource-limited settings?

Kangaroo Mother Care (KMC). ***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.

Q: A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?

Fungal infection. ***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.

Q: 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?

Neuroblastoma. ***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.

Q: Which of the following is not a feature of hypothyroidism in infancy?

Premature closure of posterior fontanelle. ***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.

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: At what month does a baby typically sit in the tripod position?

6 months. **6 months** - Around **6 months** of age, infants typically develop sufficient **head control** and **trunk strength** to sit unsupported, often using their hands for balance in a **tripod position**. - This developmental milestone is crucial for further motor development, enabling improved visual exploration and hand use. *5 months* - At **5 months**, infants can usually **roll over** and support themselves on their forearms, but generally lack the **trunk stability** for unsupported sitting. - While they might briefly sit with support, the sustained **tripod position** is typically not achieved until later. *8 months* - By **8 months**, most infants can sit **unsupported for extended periods** and often begin to **crawl** or pull themselves to stand. - The tripod position is usually a precursor to fully unsupported sitting, which is well-established by this age. *9 months* - At **9 months**, infants are typically highly mobile, often **crawling**, **cruising** (walking while holding onto furniture), and sitting completely **independently** without needing hand support. - The need for a tripod position for stability would indicate a **developmental delay** at this age.

Q: What is the most common differential diagnosis for appendicitis in children?

Mesenteric lymphadenitis. ***Mesenteric lymphadenitis*** - **Mesenteric lymphadenitis** commonly mimics appendicitis in children due to similar symptoms like **abdominal pain**, **fever**, and **vomiting**. - It often follows a **viral infection** and causes enlarged lymph nodes in the mesentery, leading to pain in the **right lower quadrant**. *Gastroenteritis* - While gastroenteritis also causes **abdominal pain**, **vomiting**, and often **diarrhea**, the pain is usually more generalized or diffuse, unlike the localized **right lower quadrant pain** of appendicitis. - Furthermore, patients with gastroenteritis typically do not present with the progressive, worsening pain characteristic of appendicitis. *Intussusception* - Intussusception usually presents with sudden onset of **crampy, intermittent abdominal pain** and **currant jelly stools** in younger children (typically 3 months to 3 years), which is distinct from appendicitis pain. - A palpable **sausage-shaped mass** in the abdomen can also be a key diagnostic feature, rarely seen in appendicitis. *Meckel's diverticulitis* - **Meckel's diverticulitis** can mimic appendicitis very closely in its presentation of **right lower quadrant pain** and inflammation. - However, it is a less common condition than mesenteric lymphadenitis and appendicitis itself, making it a differential rather than the **most common differential diagnosis**.

Q: What is the average weight gain per day for infants from 6 weeks to 12 weeks of age?

30 g/d. ***30 g/d*** - From **6 to 12 weeks** of age, infants typically experience a rapid growth phase, with an average daily weight gain of approximately **30 grams** (or about 1 ounce per day). - This rate of gain is crucial for monitoring proper nutrition and overall development during this early stage of infancy. *40 g/d* - A daily weight gain of **40 g/d** is higher than the typical average for infants between 6 and 12 weeks of age. - While individual growth rates can vary, sustained gains at this level might raise questions about overfeeding or unusually rapid growth, although it is not usually a cause for concern. *50 g/d* - A weight gain of **50 g/d** is significantly above the expected average for infants in the 6- to 12-week age range. - Such rapid weight gain, if sustained, could indicate excessive caloric intake or potentially signal underlying metabolic issues that need evaluation. *60 g/d* - A daily weight gain of **60 g/d** is an exceptionally high rate for infants between 6 and 12 weeks, far exceeding the average. - This level of growth would be a strong indicator for further investigation into feeding practices and the infant's health to rule out any potential concerns.

Q: What is the standard duration used to define apnea of prematurity?

20 sec. ***20 sec*** - Apnea of prematurity is defined as a cessation of breathing lasting **20 seconds or longer**, or a shorter pause in breathing accompanied by **bradycardia** (heart rate <100 bpm), **cyanosis**, or **pallor**. - This duration is crucial for determining the need for intervention and diagnosis in preterm infants. - The definition is standardized by the **American Academy of Pediatrics (AAP)** and is widely accepted in neonatal care. *Between 10 and 15 sec* - While pauses in breathing of this duration can be observed in preterm infants, they are usually considered **central periodic breathing** and not true apnea of prematurity unless accompanied by desaturation or bradycardia. - These shorter pauses are often considered benign, as significant physiological changes like bradycardia or cyanosis are less likely to occur. *More than 30 sec* - While a breathing cessation of more than 30 seconds certainly qualifies as apnea of prematurity, **20 seconds is the established minimum duration** for diagnosis. - Any apnea lasting longer than 20 seconds signifies a more severe event, indicating a greater risk to the infant. *Less than 10 sec* - Pauses in breathing lasting less than 10 seconds are generally considered **normal physiological variations** in both preterm and full-term infants. - These short pauses do not typically lead to significant oxygen desaturation or bradycardia and are not indicative of apnea of prematurity.

Question 1

The most common cause of per rectal bleeding in infants is:

Accepted Answer

Anal fissure

Answer

Rectal polyp

Answer

Intussusception

Answer

Meckel's diverticulum

Question 2

Which of the following is the most practical method for transporting a newborn while maintaining a warm temperature, especially in resource-limited settings?

Accepted Answer

Kangaroo Mother Care (KMC)

Answer

Transport incubator

Answer

Insulated box (e.g., Thermacol box)

Answer

Warm water bag

Question 3

A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?

Accepted Answer

Fungal infection

Answer

Shigella infection

Answer

Salmonella infection

Answer

Lactose intolerance

Question 4

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?

Accepted Answer

Neuroblastoma

Answer

Wilms' tumor

Answer

Renal cell carcinoma

Answer

All of the options

Question 5

Which of the following is not a feature of hypothyroidism in infancy?

Accepted Answer

Premature closure of posterior fontanelle

Answer

Umbilical hernia

Answer

Constipation

Answer

Coarse facies

Question 6

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 7

At what month does a baby typically sit in the tripod position?

Accepted Answer

6 months

Answer

9 months

Answer

8 months

Answer

5 months

Question 8

What is the most common differential diagnosis for appendicitis in children?

Accepted Answer

Mesenteric lymphadenitis

Answer

Intussusception

Answer

Meckel's diverticulitis

Answer

Gastroenteritis

Question 9

What is the average weight gain per day for infants from 6 weeks to 12 weeks of age?

Accepted Answer

30 g/d

Answer

40 g/d

Answer

50 g/d

Answer

60 g/d

Question 10

What is the standard duration used to define apnea of prematurity?

Accepted Answer

20 sec

Answer

Between 10 and 15 sec

Answer

More than 30 sec

Answer

Less than 10 sec

NEET-PG 2013 — Pediatrics