Q-1. 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-2. 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-3. 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-4. 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-5. 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
Q-6. A child presents with fever and sore throat. Examination of the oral mucosa revealed yellow patch. A diagnosis of membranous tonsillitis was arrived at. Which of the following non-suppurative complications can occur in the patient?
a) Rheumatic fever
b) Glomerulonephritis
c) Both rheumatic fever and glomerulonephritis
d) Scarlet fever
Answer: Both rheumatic fever and glomerulonephritis
Explanation:
Non-suppurative complications of Group-A Streptococcal pharyngitis:
Acute rheumatic fever
Post streptococcal glomerulonephritis
Q-7. A 2 year old child was brought to the emergency department at 3 AM. The child presented with fever and cough. On examination respiratory rate was 36/min, temperature was 39 degree C and saturation on pulse oximetry was 96%. The child had barking cough and stridor only on crying. Otherwise the child was hydrated, able to drink and consolable. The next step in the management would be
a) Single dose dexamethasone
b) Nebulized racemic epinephrine solution
c) Complete blood count and culture
d) Nasal washings for influenza virus and respiratory syncytial virus
Answer: Single dose dexamethasone
Explanation:
Croup syndrome:
Acute inflammatory disease of the larynx including viral croup (Laryngo-tracheo-bronchitis), epiglottitis and bacterial tracheitis
Viral croup:
Upper respiratory tract symptoms
Barking cough
Stridor
Treatment viral croup:
Oral hydration
Oxygen administration
Nebulize racemic epinephrine solution/ Budesonide inhalation
Single dose dexamethasone (0.6 mg/Kg)
Q-8. A 7-year-old child with steroid dependent nephritic syndrome has developed corticosteroid toxicity and posterior sub-capsular cataracts. Which of the following is the best alternative for the treatment of the patient?
a) Levamisole
b) Cyclophosphamide
c) Mycophenolate Mofetil
d) Rituximab
Answer: Levamisole
Explanation:
The steroid sparing agents for Nephrotic syndrome:
Levamisole
Cyclophosphamide
Mycophenolate Mofetil
Rituximab
Cyclosporine and tacrolimus
Important point:
The initial steroid sparing agent of choice is Levamisole.
Q-9. Which of the following is a slow growing vascular tumour in adults affecting cerebellum, brainstem and spinal cord?
a) Pilocytic Astrocytoma
b) Medulloblastoma
c) Hemangio-blastoma
d) Cavernous malformation
Answer: Hemangio-blastoma
Explanation:
Hemangio-blastoma is a slow growing vascular tumour in adults affecting cerebellum, brainstem and spinal cord.
Radio-graphically, hemangioblastomas are best diagnosed with MRI.
MRI of hemangioblastomas usually shows an enhancing mass clearly delineated from the surrounding brain or spinal cord tissue.
Q-10. A year old child has hepato-splenomegaly. On examination of the bone marrow, large cells are seen with crumpled paper appearance. Which of the following must have accumulated in these cells?
a) Sphingomyelin
b) Glucocerebroside
c) Ceramide
d) Sulfatide
Answer: Glucocerebroside
Explanation:
Gaucher disease:
Lysosomal storage disease
Autosomal recessive
Enzyme defect- Glucocerebroside beta glucosidase
Acute neuron-pathic form:
Accumulation of Glucocerebroside in lysosomes and CNS
Mental retardation
Hepato-splenomegaly
Macular cherry red spot
Gaucher cell in bone marrow
Chronic form:
Accumulation of sphingomyelin in lysosomes
Hepato-splenomegaly
Flak shaped osteolytic bone lesions
Important point:
Gaucher’s cells are seen as large cells with granular or fibrillar distended cytoplasm, with the characteristic ‘wrinkled tissue paper’ appearance, and eccentric nuclei.
Q-11. All of the following suggest a developmental delay in milestones except
a) Absence of pincer grasp at 9 months
b) Not climbing stairs up and down at 2 ½ years
c) Not speaking 2 word phrases at 18 months
d) Not able to sit at 9 months
Answer: Not speaking 2 word phrases at 18 months
Explanation:
Child can sit without support- At 8 months
Develop pincer grasp – At 9 Months
Child can climb stairs up and down- at 30 Months
Speak two word phrase- At 24 months
Q-12. Babies can breathe while suckling due to
a) Short, wide tongue
b) Small pharynx
c) Higher position of larynx
d) Small soft palate
Answer: Higher position of larynx
Explanation:
The voice boxes of babies are positioned higher up in the throat than in adults.
This way, the infants can breathe while suckling, without running the risk of getting their mothers’ milk down into the windpipes and lungs.
Q-13. A 2 year old male child presents with a lump in the right side of the abdomen. Ultrasound revealed it to be a solid mass. On examination his right arm and leg were found to be longer. The most likely diagnosis is
a) Wilm’s tumour
b) Neuroblastoma
c) Angio-myo-lipoma
d) Nephro-blastoma
Answer: Wilm’s tumour
Explanation:
After neuro-blastoma, Wilm’s tumor is the second most common abdominal tumor in children.
Wilm’s tumor occurs most commonly between age 2 and 5 years.
Clinical findings:
Abdominal mass
Hematuria
Fever
Hypertension
Wilm’s tumor is associated with:
Aniridia
Hemi-hypertrophy (One side limb longer than other side)
Cryptorchidism
Hypospadias
Gonadal dysgenesis
Pseudo-hermaphroditism
Horseshoe Kidney
Beckwith Wiedemann syndrome
Denys Drash syndrome
WAGR syndrome
Q-14. Most common organism causing neonatal sepsis
a) Staphylococcus aureus
b) E. coli
c) Haemophilus influenzae
d) Klebsiella
Answer: Klebsiella
Explanation:
Most common organism causing neonatal sepsis: Klebsiella > Staphylococcus aureus > Pseudomonas