NEET-PG 2020 - Pediatrics Practice Questions

Q: A 5-year-old unvaccinated child presents to the OPD with fever, red eyes, and a maculopapular rash. What is the most likely complication associated with this condition?

Pneumonia. ***Pneumonia*** - **Pneumonia** is the **most common and most likely complication of measles**, occurring in approximately **1-6% of measles cases** - The clinical presentation of **fever, red eyes (conjunctivitis), and maculopapular rash** in an **unvaccinated child** is classic for **measles (rubeola)** - Pneumonia may be due to **direct viral pneumonitis** from measles virus or **secondary bacterial infection** (most commonly *Streptococcus pneumoniae*, *Staphylococcus aureus*, or *Haemophilus influenzae*) - It is a major cause of **measles-related mortality**, particularly in young children and immunocompromised individuals *Acute myocarditis* - **Acute myocarditis** is an extremely rare complication of measles - While myocardial involvement can theoretically occur with severe viral infections, it is **not a recognized characteristic or common complication** of measles - This is not the most likely complication when compared to pneumonia, otitis media, or diarrhea *Acute nephritis* - **Acute nephritis** is not a characteristic complication of measles - It is more commonly associated with **post-streptococcal glomerulonephritis** following Group A Streptococcus infection - Kidney involvement in measles is not a well-documented or common complication *Acute orchitis* - **Acute orchitis** is a recognized complication of **mumps** virus infection, particularly in post-pubertal males (occurring in 20-30% of infected males) - It is **not associated with measles infection** - This is a classic distractor testing knowledge of viral exanthems and their specific complications

Q: A 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?

Peritonsillar abscess. ***Peritonsillar abscess*** - This is the most common deep neck infection and typically presents with **unilateral tonsillar swelling**, **uvular deviation**, fever, and severe sore throat with difficulty swallowing (dysphagia) or speaking (muffled voice). - It usually develops as a complication of **acute tonsillitis**, where infection spreads from the tonsil into the peritonsillar space. *Parapharyngeal abscess* - While it can cause fever and severe throat pain, it typically presents with **trismus**, neck swelling below the angle of the mandible, and medial displacement of the lateral pharyngeal wall, rather than direct uvula deviation. - This type of abscess is located in the **parapharyngeal space**, which is lateral to the pharynx, and causes more diffuse swelling. *Ludwig's angina* - This is a rapidly spreading cellulitis of the **submandibular** and **sublingual spaces** and does not primarily involve the tonsils or cause uvular deviation. - Patients typically present with **symmetrical submental swelling**, painful swallowing, and tongue elevation, which can lead to airway obstruction. *Retropharyngeal abscess* - This abscess forms in the space behind the posterior pharyngeal wall and is more common in young children. - It often causes **neck stiffness**, muffled voice, stridor, and difficulty breathing, but less commonly presents with unilateral tonsillar swelling and uvular deviation.

Q: A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Give antibiotics. ***Give antibiotics*** - The child presents with **chest indrawing** along with cough and fever, which according to **IMNCI guidelines** classifies as **pneumonia**. - Note: RR of 38/min is **within normal limits** for a 24-month-old child (fast breathing threshold is ≥40/min for 12-59 months age group). - The diagnosis of pneumonia is based on the presence of **chest indrawing**, not fast breathing in this case. - According to **IMNCI**, pneumonia (without danger signs) should be treated with **oral antibiotics** (amoxicillin 250 mg twice daily for 5 days) at the primary care level. - The child should be followed up in 2 days and the mother advised on when to return immediately. *Refer to a higher-level health facility for further management.* - Referral is indicated for **severe pneumonia**, which requires presence of any **general danger sign** (inability to drink/breastfeed, persistent vomiting, convulsions, lethargy/unconsciousness, or stridor in calm child). - This child has **pneumonia** (not severe), so outpatient treatment with oral antibiotics is appropriate. *Monitor at home without medical treatment.* - This would be inappropriate as the child has **pneumonia** requiring antibiotic treatment. - Untreated pneumonia can rapidly progress to severe disease and is a **leading cause of child mortality** in developing countries. *Provide symptomatic treatment with antipyretics only.* - While antipyretics (paracetamol) can be given for fever, they do not treat the underlying **bacterial infection**. - Antibiotics are essential to treat pneumonia and prevent complications and mortality.

Q: A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?

Age < 11 years. ***Age < 11 years*** - Age is **NOT included** in the original King's College criteria for acute liver failure - King's College criteria are based on **biochemical parameters** (INR, bilirubin, pH, creatinine) and **clinical factors** (encephalopathy grade, jaundice-to-encephalopathy interval), not patient age - While **younger age may be a prognostic factor** in pediatric liver failure, it is not part of the formal King's College criteria used to predict poor prognosis or need for transplantation *INR > 6.5* - An **elevated INR > 6.5** (or PT > 100 seconds) is a **key criterion** in King's College criteria for non-paracetamol acute liver failure - Indicates severe **coagulopathy** and hepatic synthetic dysfunction - One of the most important predictors of poor outcome *Jaundice 7 days = subacute (worse prognosis, indicates need for transplant) - This temporal relationship is a **critical prognostic indicator** *Bilirubin > 300 mmol/L* - **Serum bilirubin > 300 μmol/L** (17.5 mg/dL) is explicitly included in King's College criteria for non-paracetamol ALF - Indicates severe **cholestasis** and hepatocellular dysfunction - Part of the multi-parameter assessment for transplant listing

Q: Pulmonary plethora in a child presenting with cyanosis, is seen in?

Total Anomalous Pulmonary Venous Connection (TAPVC). ***Total Anomalous Pulmonary Venous Connection (TAPVC)*** - In **non-obstructed TAPVC**, all pulmonary veins drain anomalously into the right atrium (or its tributaries) instead of the left atrium. - This causes **complete mixing of oxygenated pulmonary venous blood with deoxygenated systemic venous blood** in the right atrium → **cyanosis**. - Since an obligatory **atrial septal defect (ASD)** allows blood to reach the left heart, and there is **increased volume load on the right heart**, there is **increased pulmonary blood flow → pulmonary plethora** on chest X-ray. - Key point: **Obstructed TAPVC** causes pulmonary venous congestion and oligemia, NOT plethora. *Coarctation of the aorta* - **Coarctation of the aorta** is an **acyanotic** congenital heart disease involving systemic outflow obstruction. - It does **not cause cyanosis** unless there is differential cyanosis (lower body only) with a PDA and pulmonary hypertension causing right-to-left shunt. - Does not cause pulmonary plethora. *Tetralogy of Fallot (TOF)* - **Tetralogy of Fallot** presents with **cyanosis** due to right-to-left shunting through a VSD. - However, it has **pulmonary oligemia (decreased pulmonary blood flow)** due to right ventricular outflow tract obstruction and pulmonary stenosis. - Chest X-ray shows **boot-shaped heart** with decreased pulmonary vascular markings, NOT plethora. *Tricuspid Atresia (TA)* - **Tricuspid atresia** causes **cyanosis** due to obligatory right-to-left shunting at the atrial level. - Pulmonary blood flow is typically **decreased or normal** (depending on presence of VSD/PDA), NOT increased. - Does not typically cause pulmonary plethora.

Q: A newborn baby presented with a failure to pass meconium in the immediate postnatal period. The pediatrician also notices visible yet ineffective peristalsis, and abdominal distention. A radiological contrast enema demonstrated a narrow conical segment and a dilated proximal bowel. A diagnosis of Hirschsprung disease was made. Which of the following is a cause of the condition in the patient?

Failure of migration of neural crest cells. ***Failure of migration of neural crest cells*** - Hirschsprung disease is characterized by the **absence of ganglion cells** (specifically **Auerbach's and Meissner's plexuses**) in the distal bowel. - This aganglionosis results from the **failure of neural crest cells to migrate** completely into the intestinal wall during embryonic development. *Persistence of embryonic structures in the bowel wall* - This mechanism is associated with conditions like **Meckel's diverticulum**, where a remnant of the **vitelline duct** persists. - It does not explain the absence of ganglion cells or the functional obstruction seen in Hirschsprung disease. *Congenital obstruction due to external factors* - This would involve conditions such as an **annular pancreas**, **bands**, or **malrotation with volvulus**, creating a physical barrier. - Hirschsprung disease is a **functional obstruction** due to neuromuscular dysfunction, not an external compression or blockage. *Abnormal peristalsis due to neural dysfunction* - While there is abnormal peristalsis, the underlying cause is not just **"neural dysfunction"** in a general sense, but specifically the **absence of entire ganglion cell plexuses** within the bowel wall. - This option is too broad and doesn't pinpoint the precise developmental defect.

Question 1

A 5-year-old unvaccinated child presents to the OPD with fever, red eyes, and a maculopapular rash. What is the most likely complication associated with this condition?

Accepted Answer

Pneumonia

Answer

Acute myocarditis

Answer

Acute nephritis

Answer

Acute orchitis

Question 2

A 3-year-old boy presents with fever, throat pain, and difficulty swallowing. On examination, there is unilateral tonsillar swelling with deviation of the uvula. What is the most likely diagnosis?

Accepted Answer

Peritonsillar abscess

Answer

Parapharyngeal abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Question 3

A 24 month child, with a weight of 11 kg, has RR of 38 / min, chest indrawing, cough and fever. Management according to IMNCI?

Accepted Answer

Give antibiotics

Answer

Refer to a higher-level health facility for further management.

Answer

Monitor at home without medical treatment.

Answer

Provide symptomatic treatment with antipyretics only.

Question 4

A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?

Accepted Answer

Age < 11 years

Answer

INR > 6.5

Answer

Jaundice < 7 days before development of encephalopathy

Answer

Bilirubin > 300 mmol/L

Question 5

Pulmonary plethora in a child presenting with cyanosis, is seen in?

Accepted Answer

Total Anomalous Pulmonary Venous Connection (TAPVC)

Answer

Coarctation of the aorta

Answer

Tetralogy of Fallot (TOF)

Answer

Tricuspid Atresia (TA)

Question 6

A newborn baby presented with a failure to pass meconium in the immediate postnatal period. The pediatrician also notices visible yet ineffective peristalsis, and abdominal distention. A radiological contrast enema demonstrated a narrow conical segment and a dilated proximal bowel. A diagnosis of Hirschsprung disease was made. Which of the following is a cause of the condition in the patient?

Accepted Answer

Failure of migration of neural crest cells

Answer

Persistence of embryonic structures in the bowel wall

Answer

Congenital obstruction due to external factors

Answer

Abnormal peristalsis due to neural dysfunction

NEET-PG 2020 — Pediatrics