NEET-PG 2015 - Pediatrics Practice Questions

Q: A newborn presents with subconjunctival hemorrhage. The treatment is

No treatment. ***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.

Q: What is the maintenance fluid requirement in a 6 kg child ?

600 ml/day. **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.

Q: Polyarticular onset JRA involves more than how many joints?

4. ***4*** - **Polyarticular onset Juvenile Rheumatoid Arthritis (JRA)**, now often referred to as **Juvenile Idiopathic Arthritis (JIA)**, is defined by the involvement of **five or more joints** within the first six months of the disease. Therefore, "more than 4" correctly describes this threshold. - This subtype of JIA accounts for approximately 30% of all JIA cases and can be further classified into rheumatoid factor-positive and rheumatoid factor-negative forms. *3* - Involvement of **fewer than five joints** (i.e., four or fewer) within the first six months would classify the disease as **oligoarticular JIA**, a distinct and often milder subtype. - Oligoarticular JIA is the most common subtype and often affects large joints like the knees. *5* - While **five or more joints** is the diagnostic criterion for polyarticular JIA, stating "more than 5" would be incorrect as exactly five joints already falls within the polyarticular definition. - The threshold is **equal to or greater than five joints**, not strictly exceeding five. *6* - Specifying "more than 6" joints would exclude cases where 5 or 6 joints are involved, which are still considered polyarticular JIA. - The key diagnostic number is **five**, meaning "more than 4" encompasses the correct definition.

Q: Which of the following statements about shock in children is correct?

Tachycardia is a sensitive indicator of shock in children.. ***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.

Q: Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is

Administer intravenous Ringer's lactate. ***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.

Q: Treatment of choice for symptomatic neonatal hypoglycemia is

10% dextrose. ***10% dextrose*** - For **symptomatic neonatal hypoglycemia**, 10% dextrose solution is the **standard initial treatment** with a bolus of 2 mL/kg (200 mg/kg) given IV over 5-10 minutes - This concentration safely and effectively raises blood glucose levels while minimizing the risk of **hyperglycemic rebound** or complications like **osmotic injury** - Followed by continuous infusion to maintain normoglycemia *Dextrose normal saline* - This combination is **not used** for acute hypoglycemia management as the saline component is unnecessary - The glucose concentration would be inadequate for rapid correction of **symptomatic neonatal hypoglycemia** - May lead to excessive fluid administration *5% dextrose* - A **5% dextrose solution** is insufficient to rapidly correct symptomatic neonatal hypoglycemia - Would require much faster infusion rates to deliver adequate glucose, potentially leading to **fluid overload** - May be used for maintenance therapy in asymptomatic cases *25% dextrose* - Too concentrated for routine neonatal use - carries significant risk of **vein sclerosis**, **osmotic injury**, and **rebound hypoglycemia** - Risk of extravasation injury and **hyperglycemia** - Reserved only for extreme cases under close monitoring with careful dilution

Q: Which of the following statements about development milestones at 6 months of age is incorrect?

Pincer grasp. ***Pincer grasp*** - The **pincer grasp** (using the index finger and thumb to pick up small objects) typically develops much later, usually around **9-12 months** of age. - At 6 months, infants are usually developing a **palmar grasp** or raking motion, not the fine motor control required for a pincer grasp. - This milestone is **NOT expected at 6 months**, making this the incorrect statement. *Watching self in mirror* - By 6 months, infants typically show **interest in their own reflection** and will watch themselves in a mirror, often smiling or vocalizing at the image. - This is a normal social-emotional milestone at this age. *Sitting in tripod position* - Many 6-month-old infants are able to sit with support, and often begin to sit independently for short periods, frequently using their arms for stability in a **tripod position**. - This is a common and expected gross motor milestone at this age. *Monosyllable sounds* - Around 6 months, infants commonly start to produce **monosyllable sounds** like "ba-ba," "da-da," or "ma-ma," as part of their early babbling. - This is a normal and expected language development milestone.

Q: Further investigation is essential in a newborn with which of the following conditions?

Lens opacity. ***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.

Q: What is the average weight gain of the neonate per day after the initial weight loss period?

25-30 g. ***25-30 g*** - After the initial physiological weight loss (typically 5-10% of birth weight in the first few days), healthy term neonates should gain approximately **25-30 grams per day**. - This consistent weight gain indicates adequate feeding and healthy development in the first month of life. *5-10 g* - This range is too low for the average daily weight gain after the initial weight loss period. - A gain of only **5-10 g per day** would suggest inadequate feeding or an underlying medical issue. *50-60 g* - This rate of weight gain is typically seen in **older infants** (e.g., 2-3 months of age) or in cases of catch-up growth, not usually in the immediate neonatal period after initial weight loss. - While rapid growth can occur, 50-60 g/day is above the average for a neonate. *100-150 g* - This is an **excessively high** rate of daily weight gain for a neonate. - Such rapid weight gain is not typical and could potentially indicate measurement error or an unusual metabolic state.

Q: Most common type of TAPVC is -

Supracardiac. ***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 1

A newborn presents with subconjunctival hemorrhage. The treatment is

Accepted Answer

No treatment

Answer

Antibiotic eye drops

Answer

Antibiotic and steroid drops

Answer

Aspiration

Question 2

What is the maintenance fluid requirement in a 6 kg child ?

Accepted Answer

600 ml/day

Answer

240 ml/day

Answer

300 ml/day

Answer

1200 ml/day

Question 3

Polyarticular onset JRA involves more than how many joints?

Accepted Answer

4

Answer

5

Answer

3

Answer

6

Question 4

Which of the following statements about shock in children is correct?

Accepted Answer

Tachycardia is a sensitive indicator of shock in children.

Answer

Mottling of extremities is an early sign of shock.

Answer

Confusion and stupor are early signs of shock.

Answer

Respiratory rate is a more sensitive indicator of shock than heart rate.

Question 5

Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is

Accepted Answer

Administer intravenous Ringer's lactate

Answer

Administer 10% dextrose solution

Answer

Encourage breastfeeding

Answer

Provide oral rehydration solution (ORS)

Question 6

Treatment of choice for symptomatic neonatal hypoglycemia is

Accepted Answer

10% dextrose

Answer

Dextrose normal saline

Answer

5% dextrose

Answer

25% dextrose

Question 7

Which of the following statements about development milestones at 6 months of age is incorrect?

Accepted Answer

Pincer grasp

Answer

Watching self in mirror

Answer

Sitting in tripod position

Answer

Monosyllable sounds

Question 8

Further investigation is essential in a newborn with which of the following conditions?

Accepted Answer

Lens opacity

Answer

Vaginal bleed

Answer

Subconjunctival hemorrhage

Answer

Erythema toxicum

Question 9

What is the average weight gain of the neonate per day after the initial weight loss period?

Accepted Answer

25-30 g

Answer

5-10 g

Answer

50-60 g

Answer

100-150 g

Question 10

Most common type of TAPVC is -

Accepted Answer

Supracardiac

Answer

Cardiac

Answer

Infracardiac

Answer

Multiple

NEET-PG 2015 — Pediatrics