Pediatrics: AIIMS NOV 2014

Q-1. A child with cyanosis and choking on feeding at birth was diagnosed as TEF and had undergone a corrective surgery. He comes to you with complaints of barking cough and expiratory wheeze. What is the most likely diagnosis?
a) Bronchial asthma
b) Croup
c) Tracheo-malacia
d) Subglottic stenosis

Answer: Tracheo-malacia
Explanation:
Tracheo-malacia after tracheo-esophageal fistula (TEF) repair:
Tracheo-malacia is an abnormal collapse of the tracheal walls.
Tracheo-malacia is frequently found after repair of a tracheo-esophageal fistula.
Low pitched wheeze prominent over central airways
Beta adrenergic agents cause worsening of symptoms

Q-2. A child complains of fluid coming out of umbilicus on straining. What is the diagnosis?
a) Patent vitello-intestinal duct
b) Urachal fistula
c) Umbilical hernia
d) Gastroschisis

Answer: Urachal fistula
Explanation:
Patent Urachus occurs when the urachus doesn’t seal off and there is a connection between the bladder and the umbilicus.
A patent urachus can cause varying amounts of clear urine to leak at the umbilicus.

Q-3. A neonate present with respiratory distress with enlargement of left upper lobe of lung and mediastinal shift towards the right. What is the most likely diagnosis?
a) Congenital lobar emphysema
b) Alpha 1 antitrypsin deficiency
c) Pneumonia
d) Cystic fibrosis

Answer: Congenital lobar emphysema
Explanation:
Congenital lobar emphysema:
Congenital lobar emphysema is a congenital lung abnormality that results in progressive over-inflation of one or more lobes of a neonate lung and possibly life-threatening cause of respiratory distress in the neonate.
X-Ray findings:
A large, hyper-lucent lung with attenuated but defined vascularity
Left upper lobe: most common
Mass effect with mediastinal shift

Q-4. A 10 month child weighing 5 kg and 65 cm presents with cough and cold. He was found to have a respiratory rate of 48 per minute with no retractions, grunting and cyanosis. There is no history of convulsions. Which is true?
a) No pneumonia only cough and cold
b) Child has pneumonia
c) Severe pneumonia
d) Very severe disease

Answer: No pneumonia only cough and cold
Explanation:
Old WHO classification of pneumonia:
No pneumonia: Cough and cold
Pneumonia: Fast breathing
Severe pneumonia: Chest indrawing
Very severe pneumonia: Any general danger sign
Revised WHO classification and treatment of childhood pneumonia:
The new classification is therefore simplified to include only two categories of pneumonia; “pneumonia” with fast breathing and/or chest indrawing, which requires home therapy with oral amoxicillin, and “severe pneumonia”, pneumonia with any general danger sign, which requires referral and injectable therapy.
Important point:
WHO respiratory rate thresholds for identifying children with pneumonia:
Children younger than 2 months: Greater than or equal to 60 breaths/ min
Children aged 2-11 months: Greater than or equal to 50 breaths/ min
Children aged 12-59 months: Greater than or equal to 40 breaths/ min

Q-5. A female girl child came with complaints of involuntary movements was diagnosed as a case of Sydenham Chorea suggestive of a diagnosis of acute rheumatic fever. There are no complaints of carditis or arthritis. Throat culture is negative. Which of the following will most likely suggest recent streptococcal infection?
a) Anti-streptolysin S
b) ASL-O
c) PCR for M protein
d) Anti-hyaluronidase

Answer: ASL-O
Explanation:
Anti-streptolysin O titers should be obtained to confirm a recent invasive streptococcal infection.

Q-6. A neonate at 48 hours of birth with a history of non passage of meconium. Next step in evaluation will be
a) Lower GI study
b) Manometry
c) Sweat chloride levels
d) CFTR mutation analysis

Answer: Lower GI study
Explanation:
During normal fetal development, cells from the neural crest migrate into the large intestine (colon) to form the networks of nerves called Auerbach’s plexus and Meissner’s plexus.
In Hirschsprug’s disease, results from an absence of ganglion cells in mucosal and muscular layers of colon.
Failure of new born to pass meconium followed by vomiting, abdominal distension and reluctant to feed suggests the diagnosis of Hirschsprung disease.
Diagnostic techniques involve barium enema, ano-rectal manometry, and rectal biopsy.
Important point:
The suction rectal biopsy is considered the current international gold standard in the diagnosis of Hirschsprug’s disease.

Q-7. Which of the following is not seen in adults?
a) Kawasaki disease
b) Henoch Schonlein purpura
c) Susac’s syndrome
d) Takayasu arteritis

Answer: Kawasaki disease
Explanation:
Eighty percent of affected patients are younger than age 5 years and male and female ratio is 1.5:1.
Coronary artery lesions range from mild transient dilatation of a coronary artery to large aneurysm formation.
Gold standard for diagnosing coronary artery aneurysm is angiography.
Immediate management of Kawasaki disease consists of intra-venous immunoglobulin and high dose aspirin.

Q-8. A 6 month child woke up in night crying with abdominal pain which got relived on passing red stools. What is the diagnosis?
a) Meckel’s diverticulum
b) Intussusception
c) Mal-rotation
d) Intestinal obstruction

Answer: Intussusception
Explanation:
Intussusception:
Intussusception is most frequent cause of intestinal obstruction in the first 2 years of life.
In most cases (85 %) the cause is not apparent. In children older than six years, lymphoma is the most common cause.
Clinical findings:
Paroxysms of abdominal pain with screaming and drawing up of the knee
Red colored jelly stool (Blood and mucous)
Sausage shaped mass may be found, usually in the upper mid abdomen.
Investigations:
Barium enema and air enema are both diagnostic and therapeutic.
X-ray abdomen shows paucity of air in the right lower quadrant.
USG is investigation of choice.

Q-9. Which is not seen in tuberous sclerosis?
a) Astrocytoma
b) Ependymoma
c) White matter lesions
d) Sub-ependymal nodules

Answer: Ependymoma
Explanation:
Tuberous sclerosis or Bourneville disease:
Tuberous sclerosis is a dominant inherited disease. All most all patients have deletion on chromosome 9 (TSC-1 gene) or 16 (TSC-2 gene).
The gene products hemartin and tuberin have tumor suppressing effects.
Major features:
Cortical tubers
Sub-ependymal glial nodules
Sub-ependymal Glial Cell Astrocytoma
Facial angio-fibroma, sub-ungual fibromas, gingival fibromas
Hypo-melanotic macules
Retinal hamartomas
Renal angiomyolipomas
Important point:
The triad of seizures, mental retardation and adenoma sebaceum occurs in only 33 % of the patients.

Q-10. Which of the following if seen on day 10 on life is worrisome?
a) Conjugated hyper-Bilirubinemia
b) Dolls eye reflex
c) No weight gain
d) Un-conjugated hyper-Bilirubinemia

Answer: Conjugated hyper-Bilirubinemia
Explanation:
Un-conjugated (Indirect) hyper-Bilirubinemia is potentially neuro-toxic and conjugated hyper-bilirubinemia often signifies a serious hepatic or systemic illness.

Q-11. A child with nephrotic syndrome following an episode of diarrhoea presented with acute kidney injury with a creatinine of 4.5. All of the following are possible reasons except
a) Renal vein thrombosis
b) Diarrhoea water depletion
c) Frusemide
d) Steroid induced diabetes

Answer: Steroid induced diabetes
Explanation: