Q-41. A 7 years old girl with falling grades and complaints by teacher that she is inattentive in class to her parents and has bad school performance. On hyper-ventilation, her symptoms increased and showed the following EEG findings. Diagnosis is (graph is given)
a) Myoclonic epilepsy
b) Myoclonus
c) Absence seizure
d) Juvenile myoclonic epilepsy
Answer: Absence seizure
Explanation:
Absence or petit mal seizure:
Age of onset- 3-15 years
Clinical manifestations:
Lapse of consciousness or vacant stares lasting about 10 seconds
Automatism of face and hand
Clonic activity
Diagnosis:
Hyperventilation provoke attacks
EEG findings: Bilaterally synchronous, high voltage spikes and waves
Q-42. Which of the following in the natural course of disease has no reversal of the shunt?
a) ASD
b) VSD
c) TOF
d) PDA
Answer: TOF
Explanation:
Heart diseases have reversal of the shunt:
ASD
VSD
PDA
Q-43. Correct about respiratory distress syndrome is
a) Seen after 6 hours of birth
b) Ante natal steroid
c) Term pregnancy
d) Air bronchogram seen on X-ray chest
Answer: Air bronchogram seen on X-ray chest
Explanation:
Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants immediate or soon after birth.
The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the newborn infant.
Chest radiographs in a premature infant with respiratory distress syndrome: Poor lung expansion, air bronchogram, and reticular granular appearance
Antenatal corticosteroid and surfactant therapy reduces the risk of respiratory distress syndrome and neonatal death.
Q-44. A pre-term 32 weeks new-born baby with respiratory rate of 86/min. with presence of grunting. On examination there was on nasal flaring, chest behind in movement than abdomen, minimal intercostals retraction and no xiphi-sternal retraction. The Silverman scoring for the neonate shall be
a) 3
b) 4
c) 5
d) 6
Answer: 4
Explanation:
Q-45. A child presented to the casualty with seizures. On examination an oval hypo- pigmented macules were noted on the trunk, along with sub-normal IQ. Probable diagnosis of the child is
a) Neurofibromatosis
b) Sturge weber
c) Tuberous sclerosis
d) Incontinenta pigmenti
Answer: Tuberous sclerosis
Explanation:
Tuberous sclerosis is a dominantly inherited disease. All most all patients have deletion on chromosome 9 (TSC1) or 16 (TSC2 gene).
The gene products hemartin and tuberin have tumor suppressing effect.
Clinical findings:
Dermatological features:
Hypio-melanotic macules (Oval or ash leaf)
Facial angio-fibroma
Ungual fibromas
Shagreen patches
Neurological features:
Seizures (Most common presenting feature)
Mental retardation:
Renal lesions:
Renal cysts or angio-myo-lipoma
Cardio-pulmonary involvement:
Cystic lung disease
Rhabdomyoma of heart
Diagnosis:
Chest radiograph- Lung honeycombing
CT scan- Pathognomic sub-ependymal nodular calcification
MRI- Hypo-myelinated lesions
Q-46. All of the following are major Jones criteria for diagnosis of rheumatic fever except
a) Arthralgia
b) Subcutaneous nodules
c) Carditis
d) Chorea
Answer: Arthralgia
Explanation:
Major Jones criteria for diagnosis of rheumatic fever:
Carditis
Chorea
Erythema marginatum
Poly-arthritis
Subcutaneous nodules
Q-47. A 2-day-old neonate in the neonatal ICU develops seizures which of the following wound be the next best investigation for the child?
a) Trans-cranial ultrasound
b) Skull X-ray
c) CT scan
d) MRI
Answer: Trans-cranial ultrasound
Explanation:
Essential investigations that should be considered in all neonates with seizures:
Blood sugar
Serum electrolytes
CSF examinations
Cranial USG
EEG
Important point:
Cranial USG is excellent tool for detection of intra-ventricular and parenchymal hemorrhage but is unable to detect SAH and subdural hemorrhage.
Q-48. All of the following are characteristics of Rett syndrome except
a) Increased incidence of mental retardation
b) Seizures
c) Abnormal dendritic morphology in cortical pyramidal cells
d) Macrocephaly
Answer: Macrocephaly
Explanation:
Rett syndrome:
Age of onset- 5 months o 4 years old
Reduced head circumference
Stereotyped hand movement and seizures
Loss of social relatedness
Impaired language and mental functioning
Important points:
Rett syndrome is a neuro-developmental disorder that affects girls almost exclusively.
Abnormal dendritic morphology in cortical pyramidal cells
Q-49. A case of meningomyelocele was posted for surgery. Till the patient is waiting for surgery, the covering of the sac will be protected by gauze soaked in:
a) Normal saline
b) Tincture iodine
c) Methylene blue
d) Mercurochrome
Answer: Normal saline
Explanation:
Immediately following delivery the infant should be placed in a prone position and Meningomyelocele protected from drying, trauma and infection.
This is generally accompanied by a non adherent sterile saline dressing with a plastic shield wrap to maintain the moisture.
Q-50. A 4-year-old child presents to the emergency department with respiratory difficulty and noisy breathing. On examination X-ray shows thumbs sign. The most probable diagnosis is
a) Recurrent papillomatosis
b) Croup
c) Epiglottitis
d) None
Answer: Epiglottitis
Explanation:
The thumb sign of epiglottitis:
A radiographic sign that express an edematous and enlarged epiglottis suggesting the diagnosis of acute infectious epiglottitis