NEET-PG 2018 - Pediatrics Practice Questions

Q: In a child with rickets which part of the bone is affected?

C. ***C*** - C points to the **growth plate (physis) and metaphyseal region**, which is the **primary site of pathology in rickets**. - Rickets causes defective mineralization at the growth plate where endochondral ossification occurs, leading to accumulation of unmineralized osteoid and disorganized chondrocyte columns. - The **metaphysis** (the region including the growth plate) shows the characteristic radiological findings: widening, fraying, cupping, and loss of sharp margins. *A* - A indicates the **diaphysis** (shaft of the bone), which consists of mature cortical bone. - The diaphysis is **not primarily affected** in rickets, though severe cases may lead to bowing deformities due to bone softening. - The initial and primary pathological changes occur at the actively growing regions, not the shaft. *B* - B points to the **metaphysis**, which is the flared region of long bone adjacent to the growth plate. - The metaphysis is indeed significantly affected in rickets, showing widening and irregular mineralization. - However, if the image distinguishes between the broader metaphyseal region (B) and the specific growth plate zone (C), then C represents the more precise site where the pathological process of defective mineralization originates. *D* - D points to the **epiphysis**, the rounded end of the long bone that forms part of the joint. - The epiphysis consists of already-formed bone and is **not the primary site** of rickets pathology. - Rickets affects the zone of provisional calcification at the growth plate, not the pre-existing epiphyseal bone.

Q: Identify the deformity seen in this child with rickets:

Genu varum (Bow legs). ***Genu varum (Bow legs)*** - The image shows the knees bowed outwards resulting in a **bow-legged appearance**, which is characteristic of **genu varum**. - **Rickets** is a common cause of genu varum, as the softened bones are unable to bear weight and bend outwards. *Genu valgum (knock knees)* - **Genu valgum** presents as the knees bending inwards, appearing to "knock" against each other, which is the opposite of what is seen in the image. - While rickets can also cause genu valgum, the depicted deformity clearly shows outward bowing. *Windswept deformity* - A **windswept deformity** involves one knee being in **valgus** (knock-kneed) and the other in **varus** (bow-legged). - The image does not show this combination; both knees appear to be bowed outwards. *Gunstock deformity* - **Gunstock deformity** is an angular deformity of the elbow, typically related to a **supracondylar humerus fracture**. - This deformity affects the upper limb and is not related to the lower limb presentation in the image.

Q: In a neonate with the following findings, what is the likely etiology of hypothyroidism? (NEET Pattern 2018)

Thyroid dysgenesis. ***Thyroid dysgenesis*** - The image shows a neonate with **cretinism features** (e.g., puffy face, large tongue, umbilical hernia) and a **newborn screening card** being collected (heel prick blood spots). - **Thyroid dysgenesis** (aplasia, hypoplasia, or ectopic thyroid) is the most common cause of **congenital hypothyroidism**, accounting for about 85% of cases. *Chronic lymphocytic thyroiditis* - Also known as **Hashimoto's thyroiditis**, this is an **autoimmune condition** that primarily affects adults and older children, not typically neonates. - While it can lead to hypothyroidism, it is an **acquired** rather than a congenital cause. *Thyroid dyshormonogenesis* - This refers to genetic defects in the **synthesis of thyroid hormones** due to enzymatic deficiencies within a structurally normal thyroid gland. - While it is a **congenital cause** of hypothyroidism, it is less common than thyroid dysgenesis (accounting for about 10-15% of cases). *None of above* - This option is incorrect because **thyroid dysgenesis** is a highly likely etiology given the clinical presentation and context of newborn screening.

Q: The following cell type is seen in peripheral smear of a patient with membrane over the tonsils. All can be used in treatment except?

Acyclovir. ***Acyclovir*** - The image depicts an **atypical lymphocyte** (Downey cell), characteristic of **infectious mononucleosis**, commonly caused by the **Epstein-Barr virus (EBV)**. - Acyclovir is an **antiviral medication** primarily used for **herpes simplex virus (HSV)** and **varicella-zoster virus (VZV)** infections, and it is **not effective against EBV**. *Prednisolone* - **Corticosteroids** like prednisolone may be used in severe cases of infectious mononucleosis, especially when complications such as **airway obstruction** due to tonsillar hypertrophy, **hemolytic anemia**, or **thrombocytopenia** are present. - They help to **reduce inflammation** and suppress the immune response. *IVIG* - **Intravenous immunoglobulin (IVIG)** can be used in rare, severe, or complicated cases of infectious mononucleosis, particularly if there are significant **hematologic complications** (e.g., severe thrombocytopenia, severe hemolytic anemia) or in patients with **immunodeficiency**. - IVIG provides **passive immunity** and modulates the immune response. *Acetaminophen* - **Acetaminophen (paracetamol)** is a common **analgesic** and **antipyretic** used to manage symptomatic relief for fever, sore throat, and muscle aches associated with infectious mononucleosis. - It helps to **alleviate discomfort** and improve patient well-being during the acute phase of the illness.

Question 1

In a child with rickets which part of the bone is affected?

Accepted Answer

C

Answer

A

Answer

B

Answer

D

Question 2

Identify the deformity seen in this child with rickets:

Accepted Answer

Genu varum (Bow legs)

Answer

Genu valgum (knock knees)

Answer

Windswept deformity

Answer

Gunstock deformity

Question 3

In a neonate with the following findings, what is the likely etiology of hypothyroidism? (NEET Pattern 2018)

Accepted Answer

Thyroid dysgenesis

Answer

Chronic lymphocytic thyroiditis

Answer

Thyroid dyshormonogenesis

Answer

None of above

Question 4

The following cell type is seen in peripheral smear of a patient with membrane over the tonsils. All can be used in treatment except?

Accepted Answer

Acyclovir

Answer

Prednisolone

Answer

IVIG

Answer

Acetaminophen

NEET-PG 2018 — Pediatrics