A newborn presents with subconjunctival hemorrhage. The treatment is
Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is
Which of the following is true regarding precocious puberty:
Which of the following urethral anomalies is the most common?
All of the following are clinical features suggestive of tracheoesophageal fistula except -
Which of the following statements about encephalocoele is false?
Which of the following statements about cephalhematoma is correct?
Which of the following is NOT a symptom of Kwashiorkor?
What is the maintenance fluid requirement in a 6 kg child ?
Most common type of TAPVC is -
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 21: A newborn presents with subconjunctival hemorrhage. The treatment is
- A. No treatment (Correct Answer)
- B. Antibiotic eye drops
- C. Antibiotic and steroid drops
- D. Aspiration
Explanation: ***No treatment*** - **Subconjunctival hemorrhage** in a newborn is typically **benign** and **resolves spontaneously** within **1-2 weeks**. - It is often caused by the trauma of birth and does not require intervention. *Antibiotic eye drops* - These are indicated for **bacterial conjunctivitis** or to prevent bacterial infection, which is not the case here. - Using antibiotics without a bacterial indication is unnecessary and can contribute to **antibiotic resistance**. *Aspiration* - **Aspiration** is an invasive procedure and is **not indicated** for a subconjunctival hemorrhage, which is a collection of blood under the conjunctiva. - It could cause further damage or introduce infection. *Antibiotic and steroid drops* - **Steroid drops** are typically used to reduce **inflammation**, which is not the primary issue in a subconjunctival hemorrhage. - Like plain antibiotic drops, the **antibiotic component** is not necessary in the absence of infection.
Question 22: Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is
- A. Administer 10% dextrose solution
- B. Administer intravenous Ringer's lactate (Correct Answer)
- C. Encourage breastfeeding
- D. Provide oral rehydration solution (ORS)
Explanation: ***Administer intravenous Ringer's lactate*** - The child presents with signs of **severe dehydration** (sunken dry eyes, very slow skin pinch, absent tears, 10 episodes of diarrhea), which necessitates **rapid intravenous fluid resuscitation**. - **Ringer's lactate** is an isotonic crystalloid solution that effectively replenishes intravascular volume and corrects electrolyte imbalances, making it the most appropriate initial management for severe dehydration. *Encourage breastfeeding* - While **breastfeeding** is crucial for hydration and nutrition in children with diarrhea, it is insufficient to correct **severe dehydration** rapidly. - This intervention is more suitable for managing **mild to moderate dehydration** or for rehydration after initial stabilization. *Administer 10% dextrose solution* - **10% dextrose solution** is used primarily to correct **hypoglycemia** or provide a source of calories, not for rapid volume expansion in severe dehydration. - Administering hypertonic solutions like 10% dextrose without adequate volume can worsen dehydration or cause electrolyte disturbances. *Provide oral rehydration solution (ORS)* - **Oral rehydration solution (ORS)** is the gold standard for treating **mild to moderate dehydration** and preventing dehydration due to diarrhea. - However, in cases of **severe dehydration**, where the child may be lethargic, vomiting frequently, or have impaired absorption, ORS alone is often insufficient and intravenous fluids are required for initial stabilization.
Question 23: Which of the following is true regarding precocious puberty:
- A. Sexual maturity is attained early (Correct Answer)
- B. Mental function is increased
- C. Reproductive function is absent
- D. Body proportions remain unchanged
Explanation: ***Sexual maturity is attained early*** - **Precocious puberty** is defined by the development of secondary sexual characteristics significantly earlier than the average age. - This early onset of puberty means that affected individuals reach **sexual maturity** at a younger chronological age. *Mental function is increased* - Precocious puberty does not inherently lead to an increase in **mental function** or cognitive abilities. - While hormonal changes can influence mood and behavior, they do not enhance intelligence. *Reproductive function is absent* - Precocious puberty implies the premature activation of the **hypothalamic-pituitary-gonadal axis**, leading to the appearance of secondary sexual characteristics and, in many cases, the potential for **reproductive function**. - Girls, for example, can experience early menarche and boys can produce sperm, meaning fertility is not absent but rather accelerated. *Body proportions remain unchanged* - Precocious puberty often results in changes in **body proportions**, particularly due to the early closure of epiphyseal plates. - Although there is an initial growth spurt, the premature fusion of growth plates can lead to a shorter-than-average adult height.
Question 24: Which of the following urethral anomalies is the most common?
- A. Hypospadias (Correct Answer)
- B. Pinhole meatus
- C. Epispadias
- D. Stricture of the urethra
Explanation: ***Hypospadias*** - **Hypospadias** is the most common urethral anomaly, occurring when the **urethral opening** is located on the underside of the penis rather than at the tip. - Its prevalence ranges from approximately **1 in 150 to 1 in 300 live male births**, making it significantly more frequent than other urethral malformations. *Pinhole meatus* - A **pinhole meatus** refers to an abnormally small urethral opening. - While it can be a component or consequence of other anomalies, it is **less common as a standalone finding** compared to hypospadias. *Epispadias* - **Epispadias** is a rare anomaly where the urethra opens on the **dorsal (top) aspect** of the penis. - Its incidence is much lower than hypospadias, estimated at **1 in 100,000 to 1 in 500,000 live births**. *Stricture of the urethra* - A **urethral stricture** is a narrowing of the urethra, often due to **scar tissue** from inflammation, trauma, or infection. - Although it can present at any age, it is more commonly an **acquired condition** rather than a congenital anomaly like hypospadias or epispadias.
Question 25: All of the following are clinical features suggestive of tracheoesophageal fistula except -
- A. Fever (Correct Answer)
- B. Choking and Coughing
- C. Regurgitation
- D. Cyanosis
Explanation: ***Fever*** - **Fever is NOT a primary clinical feature** of tracheoesophageal fistula (TEF) itself. - While fever might occur as a **complication** if aspiration pneumonia develops, it is not a direct presenting sign of TEF. - The classic presentation of TEF occurs in **newborns within hours of birth** and involves the "3 Cs" - not fever. *Choking and Coughing* - Part of the classic **"3 Cs" triad** (Choking, Coughing, Cyanosis) of TEF presentation. - Occurs during the **first feeding attempt** when milk enters the trachea through the abnormal fistulous connection. - This is a **cardinal diagnostic feature** that should immediately raise suspicion for TEF. *Regurgitation* - **Immediate regurgitation** of feeds is characteristic, especially in TEF with esophageal atresia (most common type - Type C). - The **blind-ending proximal esophageal pouch** prevents normal passage of saliva and feeds, causing regurgitation. - Often accompanied by **excessive drooling and frothy secretions** from the mouth and nose. *Cyanosis* - The third component of the **"3 Cs" triad** and a key clinical feature. - Results from **aspiration of feeds or saliva** into the trachea and lungs, causing acute respiratory distress. - May also occur from **laryngospasm** as a protective reflex when fluid enters the airway.
Question 26: Which of the following statements about encephalocoele is false?
- A. It is a neural tube defect
- B. Common in the parietal region (Correct Answer)
- C. Can be associated with hydrocephalus
- D. It is protrusion of neural tissue through a defect
Explanation: ***Common in the parietal region*** - This statement is **false** because encephaloceles are **rarely found in the parietal region** (only 10-15% of cases). - **Occipital encephaloceles** are most common in Western populations (75-80%), while **frontal/sincipital encephaloceles** are most common in Southeast Asia including India (40-60%). - **Parietal encephaloceles** represent only a small minority of cases globally, making this statement incorrect. *It is a neural tube defect* - **Encephalocele** is indeed a type of **neural tube defect (NTD)**, resulting from incomplete closure of the neural tube during embryonic development. - Specifically, it involves a defect in the skull that allows for protrusion of brain tissue and/or meninges. *Can be associated with hydrocephalus* - **Hydrocephalus**, or the accumulation of cerebrospinal fluid in the brain, is a known complication and associated condition with encephaloceles. - The abnormal brain development and structural defects can disrupt normal CSF flow and absorption, particularly with posterior encephaloceles. *It is protrusion of neural tissue through a defect* - This is the defining characteristic of an **encephalocele**: the **herniation of intracranial contents**, such as brain tissue, meninges, or both, through a congenital **bony defect** in the skull. - The contents of the sac can vary (meninges only = meningocele; brain tissue included = meningoencephalocele), influencing clinical presentation and prognosis.
Question 27: Which of the following statements about cephalhematoma is correct?
- A. It is hemorrhage between the skull and periosteum (Correct Answer)
- B. It is hemorrhage within the subcutaneous tissue around the skull
- C. It is type of subdural hemorrhage
- D. It is subperiosteal bleeding in the skull
Explanation: ***It is hemorrhage between the skull and periosteum*** - A **cephalhematoma** is defined as a collection of blood between the **periosteum** and the underlying **skull bone** (subperiosteal). - Its boundaries are limited by the suture lines because the periosteum is firmly attached at these junctions, preventing blood from crossing. *It is hemorrhage within the subcutaneous tissue around the skull* - This description corresponds to a **caput succedaneum**, which involves **edema and hemorrhage** in the subcutaneous tissue, rather than between the skull and periosteum. - Unlike a cephalhematoma, a **caput succedaneum** can cross suture lines and is typically present at birth. *It is type of subdural hemorrhage* - A **subdural hemorrhage** involves bleeding between the **dura mater** and the **arachnoid mater** within the cranial vault. - This type of hemorrhage is a **neurological emergency** and is distinct from a cephalhematoma, which is an external scalp injury. *It is subperiosteal bleeding in the skull* - While this statement is technically correct (subperiosteal means under the periosteum), the **standard definition** specifically states "between the periosteum and the skull bone." - The distinction is important: **subperiosteal** could theoretically include bleeding within the periosteum itself, whereas the precise location is in the **potential space** between periosteum and bone. - Option A is more precise and is the preferred medical definition.
Question 28: Which of the following is NOT a symptom of Kwashiorkor?
- A. Hypertension (Correct Answer)
- B. Hair changes and depigmentation
- C. Edema
- D. Growth retardation
Explanation: ***Hypertension*** - **Hypertension** is generally **NOT a direct symptom** of Kwashiorkor; rather, children with Kwashiorkor often have **low blood pressure** due to overall cardiovascular system depression. - While chronic malnutrition can have various systemic effects, elevated blood pressure is not a characteristic clinical feature of this condition. - This is the correct answer as the question asks what is NOT a symptom. *Hair changes and depigmentation* - This is a **classic symptom** of Kwashiorkor, characterized by sparse, brittle hair that may be discolored (e.g., reddish or yellowish - "flag sign"). - These changes reflect the severe protein deficiency interfering with hair follicle function and melanin production. *Edema* - **Edema**, particularly in the lower extremities and face, is a **hallmark symptom** of Kwashiorkor, caused by severe protein deficiency leading to decreased oncotic pressure. - This results in fluid shifting from the intravascular space into the interstitial space. *Growth retardation* - **Growth retardation** (stunting) is a common and severe symptom of Kwashiorkor, reflecting the long-term impact of inadequate protein and energy intake on physical development. - Both height and weight are significantly below age-appropriate norms.
Question 29: What is the maintenance fluid requirement in a 6 kg child ?
- A. 240 ml/day
- B. 600 ml/day (Correct Answer)
- C. 300 ml/day
- D. 1200 ml/day
Explanation: **600 ml/day** - The **Holliday-Segar formula** is used to calculate maintenance fluid requirements. For the first 10 kg of body weight, the requirement is 100 ml/kg/day. - For a 6 kg child, the calculation is 6 kg * 100 ml/kg/day = **600 ml/day**. *240 ml/day* - This value is significantly **lower** than the recommended maintenance fluid for a 6 kg child, which would lead to **dehydration**. - It does not align with the standard Holliday-Segar formula for this weight. *300 ml/day* - This amount is **insufficient** for a 6 kg child's daily maintenance fluid needs and would risk **hypovolemia**. - It represents roughly half of the calculated requirement based on standard pediatric guidelines. *1200 ml/day* - This volume is significantly **higher** than the maintenance fluid requirement for a 6 kg child and could lead to **fluid overload** and hyponatremia. - This calculation might be appropriate for a much heavier child or in situations of increased fluid loss.
Question 30: Most common type of TAPVC is -
- A. Supracardiac (Correct Answer)
- B. Cardiac
- C. Infracardiac
- D. Multiple
Explanation: ***Supracardiac*** - This is the **most common type** of Total Anomalous Pulmonary Venous Connection (TAPVC), accounting for about 50% of cases. - Pulmonary veins drain into a **common vertical vein** that ascends to connect with the **innominate vein** or superior vena cava. *Cardiac* - In this type, the pulmonary veins drain directly into the **right atrium** or a coronary sinus. - It is relatively less common than the supracardiac type. *Infracardiac* - This is the **least common** and most severe type, where the pulmonary veins drain below the diaphragm, typically into the portal vein, ductus venosus, or inferior vena cava. - It is often associated with **pulmonary venous obstruction**, leading to cyanosis and pulmonary hypertension. *Multiple* - While it is possible to have anomalous drainage sites, **multiple sites** draining into different systemic veins are less common than a single primary site for TAPVC. - TAPVC is typically classified into specific anatomic types rather than 'multiple' as a primary category.