Further investigation is essential in a newborn with which of the following conditions?
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 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 -
Which of the following statements about shock in children is correct?
At what rate should dopamine be administered for inotropic support in a severely dehydrated child?
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 21: Further investigation is essential in a newborn with which of the following conditions?
- A. Vaginal bleed
- B. Subconjunctival hemorrhage
- C. Lens opacity (Correct Answer)
- D. Erythema toxicum
Explanation: ***Lens opacity*** - A **lens opacity** in a newborn suggests congenital **cataracts**, which can lead to permanent vision impairment if not identified and treated early. - **Investigation is essential** to identify underlying causes such as **TORCH infections** (Toxoplasmosis, Rubella, CMV, HSV), **metabolic disorders** (galactosemia, Lowe syndrome), **genetic syndromes**, or **chromosomal abnormalities**. - Early detection and management are crucial to prevent **amblyopia** (lazy eye) and optimize visual development during the **critical period** of visual maturation. - Investigations include: TORCH titers, urine for reducing substances, metabolic screening, and genetic evaluation. *Erythema toxicum* - This is a common, **benign newborn rash** characterized by blotchy red macules and papules with central vesicles or pustules. - It typically resolves spontaneously within days to a few weeks and requires **no specific investigation or treatment**. *Vaginal bleed* - A small amount of **vaginal bleeding** in female newborns is usually due to the temporary withdrawal of maternal hormones (e.g., estrogen) after birth. - This is a **physiologic response** and generally self-resolves, requiring no further investigation unless excessive or prolonged. *Subconjunctival hemorrhage* - This occurs due to the rupture of tiny blood vessels in the eye during the birthing process, often associated with **vaginal delivery**. - It is a **benign condition** that resolves on its own within a couple of weeks and does not affect vision.
Question 22: 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 23: 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 24: 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 25: 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 26: 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 27: 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 28: 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.
Question 29: Which of the following statements about shock in children is correct?
- A. Tachycardia is a sensitive indicator of shock in children. (Correct Answer)
- B. Mottling of extremities is an early sign of shock.
- C. Confusion and stupor are early signs of shock.
- D. Respiratory rate is a more sensitive indicator of shock than heart rate.
Explanation: ***Tachycardia is a sensitive indicator of shock in children.*** - **Tachycardia** is often the first and most reliable sign of **compensated shock** in children, as their cardiovascular system initially maintains cardiac output by increasing heart rate. - Children have a remarkable ability to compensate for significant fluid loss, and an elevated heart rate helps maintain **perfusion** before blood pressure drops. *Mottling of extremities is an early sign of shock.* - **Mottling** of extremities is typically a sign of **decompensated shock** and indicates significant vasoconstriction and poor tissue perfusion. - It is a **late sign** that suggests the child's compensatory mechanisms are failing. *Confusion and stupor are early signs of shock.* - **Altered mental status**, such as confusion or stupor, usually indicates **severe shock** and reduced cerebral perfusion. - These are generally **late signs** of shock, appearing after initial compensatory mechanisms have failed. *Respiratory rate is a more sensitive indicator of shock than heart rate.* - While **tachypnea** can be present in shock due to metabolic acidosis or compensatory mechanisms, **tachycardia** is a more consistently sensitive and earlier indicator of circulatory compromise. - Respiratory changes can also be influenced by other factors like pain, fever, or respiratory illness, making heart rate a more specific initial marker for shock.
Question 30: At what rate should dopamine be administered for inotropic support in a severely dehydrated child?
- A. 0.1-0.5 microgram/kg/min
- B. 1-5 microgram/kg/min (Correct Answer)
- C. 1-5 mg/kg/min
- D. 10-15 mg/kg/min
Explanation: ***1-5 microgram/kg/min*** - This dosage range of **dopamine** primarily targets **beta-1 adrenergic receptors**, leading to **increased myocardial contractility** (inotropic effect) and improved cardiac output. - It is appropriate for managing **hypotension** and poor perfusion in a severely dehydrated child after initial **fluid resuscitation** has been attempted but was insufficient. *0.1-0.5 microgram/kg/min* - This very low dose range of dopamine primarily stimulates **dopaminergic receptors** in the renal and mesenteric vascular beds. - Its main effect is **vasodilation** in these areas, which increases blood flow to the kidneys and gut, but it provides minimal to no **inotropic support**. *1-5 mg/kg/min* - This dosage is significantly too high, as it is in milligrams rather than micrograms. - Administering dopamine at this rate would lead to severe **toxicity**, including profound **tachycardia**, ventricular arrhythmias, and extreme **vasoconstriction**. *10-15 mg/kg/min* - This dopamine dosage is also excessively high, again due to being in milligrams per minute rather than micrograms per minute. - Such a dose would be **lethal**, causing catastrophic cardiovascular collapse due to overwhelming **alpha-adrenergic stimulation** and severe arrhythmias.