Pediatric Radiology Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Pediatric Radiology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Pediatric Radiology Indian Medical PG Question 1: A 5-month old child rushed into hospital with complaint of colicky pain, bilious vomiting and red current jelly like appearance of stools. On examination, there was a sausage shaped mass in the right lumbar region. Which of the following is the preferred modality that is used as both diagnostic and therapeutic?
- A. Air enema (Correct Answer)
- B. MRI
- C. Anoscopy
- D. Barium enema
Pediatric Radiology Explanation: ***Air enema***
- An **air enema** can be both diagnostic and therapeutic for **intussusception**, using air pressure to reduce the telescoping bowel segment.
- The classic triad of **colicky pain, bilious vomiting, and red currant jelly stools** strongly suggests intussusception, and an air enema is often the first-line intervention.
*MRI*
- **MRI** is not typically used for the initial diagnosis or treatment of pediatric intussusception due to its long imaging times and need for sedation.
- While it can provide detailed anatomical information, it is not a **therapeutic** modality for this condition.
*Anoscopy*
- **Anoscopy** is a procedure used to visualize the anal canal and distal rectum, primarily for conditions like hemorrhoids or anal fissures.
- It is **not suitable** for diagnosing or treating intussusception, which involves a more proximal bowel obstruction.
*Barium enema*
- A **barium enema** can be diagnostic and therapeutic for intussusception, using barium solution to reduce the intussusception.
- However, **air enema** is generally preferred due to a lower risk of perforation and easier interpretation of reduction, making it the more common choice.
Pediatric Radiology Indian Medical PG Question 2: A child of 2 years having a respiratory rate of 46 per minute shall be classified by a health worker as
- A. no pneumonia, cough or cold
- B. severe pneumonia
- C. very severe disease
- D. pneumonia (Correct Answer)
Pediatric Radiology Explanation: ***Correct: Pneumonia***
- A respiratory rate of **46 breaths per minute** in a 2-year-old child falls within the criteria for **fast breathing**. According to World Health Organization (WHO) IMCI guidelines, fast breathing is defined as a respiratory rate ≥ 50 breaths/minute for children aged 2 months to 12 months, and **≥ 40 breaths/minute for children aged 12 months to 5 years**.
- Fast breathing alone (without chest indrawing or danger signs) is the **key clinical sign** for classifying a child with cough or difficulty breathing as having **pneumonia**.
- This is based on the **WHO IMCI classification** used by health workers for management of childhood illness.
*Incorrect: No pneumonia, cough or cold*
- This classification would be made if the child's respiratory rate was **within the normal range** for their age (< 40 breaths per minute for age 1-5 years) and if there were no other signs of pneumonia or severe disease.
- A respiratory rate of 46 breaths per minute in a 2-year-old is **above the normal limit** and meets the criteria for fast breathing.
*Incorrect: Severe pneumonia*
- Severe pneumonia is classified by the presence of **chest indrawing** in addition to cough or difficult breathing, without danger signs.
- While the child has fast breathing, the question does not mention **chest indrawing**, which is required for this classification.
*Incorrect: Very severe disease*
- Very severe disease is classified when there are **danger signs** present: inability to drink or breastfeed, persistent vomiting, convulsions, lethargy or unconsciousness, or stridor in a calm child.
- The question only mentions elevated respiratory rate without any **danger signs**, so this classification does not apply.
Pediatric Radiology Indian Medical PG Question 3: A healthy appearing 8-year-old boy is evaluated for an abdominal mass, felt by his mother during a bath. What is the most likely diagnosis?
- A. Wilms' tumor (Correct Answer)
- B. Hodgkin's lymphoma
- C. Embryonal rhabdomyosarcoma
- D. Stage 4 neuroblastoma
Pediatric Radiology Explanation: ***Wilms' tumor***
- **Wilms' tumor**, or **nephroblastoma**, is the most common primary renal malignancy in children, typically presenting as an asymptomatic abdominal mass.
- The peak incidence is between ages 2 and 5, but it can occur up to 8 years old; a **palpable abdominal mass** is the classic presentation.
*Hodgkin's lymphoma*
- Hodgkin's lymphoma usually presents with **lymphadenopathy** (enlarged lymph nodes), often in the neck or supraclavicular region, along with systemic symptoms like fever and weight loss.
- While it can occur in childhood, an isolated abdominal mass without other typical signs makes it less likely.
*Embryonal rhabdomyosarcoma*
- **Rhabdomyosarcoma** is a soft tissue sarcoma and can occur in various locations, but an isolated abdominal mass in an 8-year-old is less commonly embryonal rhabdomyosarcoma without other localizing symptoms.
- It usually presents with symptoms related to the primary site, such as a painful mass, swelling, or organ dysfunction if it invades structures.
*Stage 4 neuroblastoma*
- **Neuroblastoma** typically presents in infants and young children, often with an abdominal mass but also with signs of metastasis (e.g., bone pain, periorbital ecchymosis, opsoclonus-myoclonus syndrome).
- While it can manifest as an abdominal mass, the "healthy appearing" aspect makes stage 4 less likely, as advanced neuroblastoma often causes systemic symptoms.
Pediatric Radiology Indian Medical PG Question 4: A child presented with blunt abdominal trauma, the first investigation to be done is -
- A. USG (Correct Answer)
- B. CT Scan
- C. Complete Hemogram
- D. Abdominal X-ray
Pediatric Radiology Explanation: ***USG***
- An **ultrasound (USG)** is the **first-line imaging investigation** for blunt abdominal trauma in children due to its **non-invasive nature**, lack of radiation exposure, and rapid bedside availability.
- **FAST (Focused Assessment with Sonography for Trauma)** effectively identifies the presence of **free fluid** (indicating internal bleeding/hemoperitoneum) and can assess solid organ injuries, particularly the **spleen and liver**.
- It is the **preferred initial investigation in hemodynamically stable pediatric patients**.
*CT Scan*
- A **CT scan** is more sensitive and provides detailed anatomical information but involves significant **radiation exposure**, which is a major concern in children.
- It is usually reserved for cases where USG is inconclusive, there is a **high clinical suspicion of severe injury**, or when determining the need for surgical intervention in hemodynamically stable patients.
*Complete Hemogram*
- A **complete hemogram** assesses blood components like hemoglobin and hematocrit, which are crucial for evaluating blood loss, but it is a **laboratory test, not an imaging investigation**.
- While important for initial assessment and serial monitoring, it doesn't provide immediate information about the **location, type, or extent of internal abdominal injuries**.
*Abdominal X-ray*
- An **abdominal X-ray** has limited utility in blunt abdominal trauma as it is primarily useful for detecting **hollow viscus perforation (free air)** or bony fractures.
- It does not effectively visualize soft tissue injuries, fluid collections, or solid organ damage, making it unsuitable as the primary diagnostic tool in blunt abdominal trauma.
Pediatric Radiology Indian Medical PG Question 5: What is the investigation of choice for an 8-year-old child presenting with an acute abdomen?
- A. USG (Correct Answer)
- B. CT Scan
- C. X-ray
- D. MRI
Pediatric Radiology Explanation: ***USG***
- An **ultrasound (USG)** is the preferred initial imaging modality in pediatric acute abdomen due to its **lack of ionizing radiation**, ease of use, and ability to visualize common causes like appendicitis and intussusception.
- It is particularly useful for assessing **fluid collections**, inflammation, and obstruction in a non-invasive manner suitable for children.
*CT Scan*
- While it offers detailed anatomical views, **CT scans** involve significant **ionizing radiation**, which is a concern in children due to increased lifetime cancer risk.
- It is typically reserved for cases where **USG is inconclusive** or if there is a high suspicion of conditions not well visualized by ultrasound.
*X-ray*
- **X-rays** provide limited information for soft tissue pathologies and are primarily useful for detecting **bowel obstruction (air-fluid levels)** or **free air** (perforation).
- They lack the resolution to diagnose many common causes of acute abdomen in children, such as appendicitis or intussusception.
*MRI*
- **MRI** provides excellent soft tissue contrast without ionizing radiation but often requires **sedation** in young children due to the long scan times and need for stillness.
- It is less readily available and more expensive than USG, making it a less practical first-line investigation for an acute presentation.
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