PAEDIATRICS YEAR 4 (1ST OCT 2012) 1. The followings are TRUE regarding Haemolytic Disease of Newborn: A.

It occurs in the presence of Rh antibody in the mother. B. It is less common than haemolysis due to ABO incompatibility. C. Haemolysis due to Rh incompatibility occurs in first born babies. D. It is prevented by giving vitamin K to newborn. E. It leads to hydrops fetalis

Answer: A. True; when an Rh-negative mother carries an Rh-positive fetus, there is stimulation of maternal immune response and production of antibodies (Mudaliar and Menons Clinical Obstetrics, page 225)

B. True; ABO incompatibility is more common than hemolytic disease due Rhesus incompatibility (Avery's Diseases of the Newborn, 8 th Edition, page 1191)

C. False; haemolysis due to Rh incompatibility occurs in a subsequent pregnancy (Mudaliar and Menons Clinical Obstetrics, page 225)

D. False; it is prevented by administration of anti-D at 28 weeks of gestation and at the time of abortion/delivery (Mudaliar and Menons Clinical Obstetrics, page 230)

E. True; severe disease leads to kernicterus and even hydrops fetalis (Textbook of Haematology, Dr. Tejinder Singh, page 53)

2. The followings are TRUE regarding newborn babies: A. Physiological closure of ductus arteriosus occurs within hours after birth. B. Hyperglycemia is a manifestation of infant of diabetic mother. C. Haemoglobin is mainly HbF. D. Neonatal Respiratory Distress Syndrome shows ground glass lung fields in CXR. E. Vitamin drops are mandatory during first week of life.

Answer: A. True; the ductus arteriosus is present in the fetal life but closes functionally and anatomically soon after birth (Ghai Essential Pediatrics, page 405)

B. False; hypoglycemia is a manifestation of infant of diabetic mother (Ghai Essential Pediatrics, page 156)

C. True; the main hemoglobin in fetal life is HbF of which only traces remain after one-year of life (Ghai Essential Pediatrics, page 307)

D. True; radiological features include reticulogranular pattern, ground glass opacity, low lung volume, air bronchogram (Ghai Essential Pediatrics, page 143)

E. False; vitamin drops are not mandatory during first week of life (Ghai Essential Pediatrics, page 103)

3. TRUE regarding the growth and development of a child: A. Cognitive development means capacity for creative thought. B. Brain growth is fastest during 3 to 5 years of age. C. Six months-old baby can reach the objects and bring them into mouth. D. Hearing distraction test is used for an 8 months-old child. E. An epileptic child always has associated developmental delay.

Answer: A. False; cognitive development is the emergence of the ability to think and understand (http://en.wikipedia.org/wiki/Cognitive_development)

B. False; the brain grows at a rapid rate in the third trimester and first year of life (Clinical Paediatrics A.Lakshmanaswamy, page 93)

C. True; at 6 months, child tends to mouth all objects offered to him (Ghai Essential Pediatrics, page 28)

D. True; the distraction test is ideally used for babies who are developmentally six to eight months old (http://www.gosh.nhs.uk/healthprofessionals/clinical-specialties/audiological-medicine-information-forhealth-professionals/paediatric-hearing-test/)

E. False; poorly controlled seizure disorders almost always affect school progress and may result in developmental delays (Encyclopedia of clinical child and pediatric psychology, page 212)

4. Signs of hydrocephalus in a neonate are:

A. Crackpot sign B. Depressed fontanelle C. Enlarged head D. Sunset eye sign E. Separation of cranial sutures Answer: A. True; also known as Macewen sign, it is due to separation of sutures in a child having increased intracranial tension (Clinical Paediatrics A.Lakshmanaswamy, page 623)

B. False; hydrocephalus may manifest with delayed closure of fontanel and sutures (Ghai Essential Pediatrics, page 549)

C. True; hydrocephalus may manifest with enlarging head size (Ghai Essential Padiatrics, page 549)

D. True; sunset is seen in the eyes, i.e. sclera above the cornea becomes visible (Ghai Essential Pediatrics, page 549)

E. True; hydrocephalus may manifest with delayed closure of fontanel and sutures (Ghai Essential Pediatrics, page 549)

5. TRUE regarding iron deficiency anemia: A. Iron is absorbed from terminal ileum. B. Cow milk contains less iron than breast milk. C. School performance deteriorates. D. Red cell Distribution Width (RDW) decreases.

E. Oral iron for 1 week is the treatment of choice. Answer: A. False; most iron is absorbed in the duodenum (Robbins and Cotran Pathologic Basis of Disease, page 644)

B. False; cows milk contains about twice as much iron as human breast milk (Robbins and Cotran Pathologic Basis of Disease, page 645)

C. True; iron deficient children are irritable and demonstrate lack of interest in surroundings (Textbook of Haematology, Dr. Tejinder Singh, page 53)

D. False; the peripheral blood smears of IDA shows that red cells are microcytic, hypochromic, and shows anisocytosis, poikilocytosis and increased RDW (Ghai Essential Pediatrics, page 300)

E. False; the most effective and economical oral preparation is ferrous sulfate (20% elemental iron). In children, the dose for treatment of anemia is 3-6 mg/kg/day iron. After correction of anemia, oral iron should be continued for 4-6 months to replenish iron stores (Ghai Essential Pediatrics, page 301)

6. TRUE regarding Beta Thalassemia Major: A. Failure to thrive is a common presentation. B. The inheritance is autosomal dominant type. C. Bony changes are irreversible. D. Serum iron level is used to monitor the disease. E. Cardiac arrhythmia is one of the complications.

Answer: A. True; after 3 months, HbF production wanes, beta-chains are not formed, so anemia develops. Thereafter, these infants may present with failure to thrive,intermittent infection and poor feeding (Textbook of Haematology, Dr. Tejinder Singh, page 92)

B. False; beta thalassemia major is an autosomal recessive homozygous disorder (Textbook of Haematology, Dr. Tejinder Singh, page 92)

C. True; bony changes are irreversible (Textbook of Haematology, Dr. Tejinder Singh, page 92) D. True; serum iron and serum ferritin are markedly increased (Textbook of Haematology, Dr. Tejinder Singh, page 93)

E. True; cardiac arrhythmia is one of the complications (Textbook of Haematology, Dr. Tejinder Singh, page 92)

7. Regarding Acute Immune Thrombocytopaenic Purpura in children A. It is common during infancy B. It is preceded by viral infection C. Cutaneous bleeding is a common presentation D. Megakaryocyte level in bone marrow increases E. Haemarthrosis is a common complication

Answer A. False; peak of incidence is between 2-8 years old. Purpura below 1 year is often chronic. (Ghai Essential Paediatrics, 6th Edition, m/s 324)

B.

True ; 50% of the cases preceded by viral infection (Ghai Essential Paediatrics, 6th Edition, m/s 324)

C.

True; ITP is characterized by petechial haemorrhages, ecchymosis, thrombocytopenia. Easy bruisability and subcutaneous haemorrhage occur spontaneously or following minor trauma. Bleeding from the mucosal surfaces in 1/3rd cases. (Ghai Essential Paediatrics, 6th Edition, m/s 323-324)

D.

True; there will be normal or increased megakaryocytes in bone marrow examination. (Ghai Essential Paediatrics, 6th Edition, m/s 324)

E.

False; hematemesis, melena and haemarthrosis are unusual. (Ghai Essential Paediatrics, 6th Edition, m/s 324)

8. The following are complications of chicken pox (Varicella Zoster) A. Enteritis B. Meningoencephalitis C. Ataxia D. Hepatitis E. Pneumonia

Answer A. False;; not present in both books (Ghai Essential Paediatrics, 6 th Edition, m/s 206; Harrison Internal Medicine,17th Edition,m/s 1103)

B. True ; meningeal inflammation appears 21 days after the onset of the rash and rarely develops in pre-eruptive phase.CNS involvement are aseptic meningitis,

encephalitis, transverse myelitis, Guillain-Barre syndrome, and Reyes syndromecan also occur. Encephalitis is reported in 0.10.2% of children with chicken pox. (Harrison Internal Medicine,17th Edition,m/s 1103)

C. True; acute cerebellar ataxia is one of the complications. (Ghai Essential Paediatrics, 6th Edition, m/s 206; Harrison Internal Medicine,17 th Edition,m/s 1103)

D. True; hepatitis is one of the complications. (Ghai Essential Paediatrics, 6 th Edition, m/s 206; Harrison Internal Medicine,17 th Edition,m/s 1103)

E. True ; varicella pneumonia, the most serious complication following chickenpox. (Harrison Internal Medicine,17th Edition,m/s 1103)

9. TRUE regarding cerebral palsy A. Lower limb is affected more than upper limb in hemiplegic type B. Hyperbilirubinemia in neonatal period is a cause C. It mainly affects sensory system D. Persistence of grasp reflex is a feature E. BCG vaccination is contraindicated

Answer A. False; the arms are more affected than the leg. (http://www.qcpr.org.au/file_folder/hemiplegia.pdf)

B. True ; indirect hyperbilirubinemia is one of the cause. (Ghai Essential Paediatrics, 6th Edition, m/s 540)

C. False; 65% of the cases are spastic cerebral palsy which involve motor system. And sensory defects such as astereognosis and spatial disorientation seen in 1/3rd case only. (Ghai Essential Paediatrics, 6th Edition, m/s 540-541)

D. True; In spastic cerebral palsy, early diagnostic features of neural damage include persistence neonatal reflexes, feeding difficulties, persistent cortical thumb after 3months of age and a firm grasp. (Ghai Essential Paediatrics, 6 th Edition, m/s 540)

E. False; BCG vaccination is not contraindicated in stable neurological condition such as cerebral palsy. (http://www.nhs.uk/Conditions/vaccinations/Pages/myths-truths-kidsvaccines.aspx)

10. The following are TRUE regarding Childhood Immunisations A. A history of febrile convulsion is a contraindications B. BCG vaccination should not be given to children with symptomatic HIV C. Encephalitis is a common complication of Measles vaccination D. Hepatitis D is prevented by giving Hepatitis B vaccination E. Polio vaccine is routinely given worldwide

Answer
A. False; vaccination is not contraindicated in stable neurological condition such

as cerebral palsy. (http://www.nhs.uk/Conditions/vaccinations/Pages/mythstruths-kids-vaccines.aspx)

B. True ; Live virus vaccine of all types and BCG should not be given to patients with congenital disorders of immune functions and symptomatic HIV infection. (Ghai Essential Paediatrics, 6th Edition, m/s 191)

C. False; encephalitis is a rare complication in measles. It is <1/1 000 000. 1(http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#adverse)

D. True; ENGERIX-B (hepatitis b vaccine recombinant) is indicated for immunization against infection caused by all known subtypes of hepatitis B virus. As hepatitis D (caused by the delta virus) does not occur in the absence of hepatitis B infection, it can be expected that hepatitis D will also be prevented by ENGERIX-B (hepatitis b vaccine recombinant) vaccination. (http://www.rxlist.com/engerix-b-drug/indications-dosage.htm)

E. True; The Global Polio Eradication Program has dramatically reduced poliovirus transmission throughout the world. (http://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#epi)

11. Regarding Tuberculosis in children A. Child to child transmission is common in primary infection B. Unresolved pneumonia is one of the presentations C. Haemoptysis is a common presentation D. Steroid is mandatory in meningitis E. Hydrocephalus is one of the complications

Answer

A. False; Childhood tuberculosis is mainly result of failure of tuberculosis control in adults. (Ghai Essential Paediatrics, 6 th Edition, m/s 231)

B.

True ; pneumonia does not resolve with antibiotics. (http://www.pediatriconcall.com/forpatients/CommonChild/infectious_disease s/tuberculosis.asp)

C.

False; Nonproductive cough and mild dyspnea are the most common symptoms.( http://www.medscape.com/viewarticle/484123_4)

D.

True; Corticosteroids (usually prednisone) are recommended for all children with TB meningitis in a dosage of 2 mg/kg daily for 4 weeks. The dose should then be gradually reduced (tapered) over 12 weeks before stopping. The dosage of prednisone can be increased to 4 mg/kg daily (maximum 60 mg/day) in the case of seriously ill children because rifampicin will decrease corticosteroid concentrations, but higher doses carry a risk of greater immune suppression. (http://whqlibdoc.who.int/hq/2006/WHO_HTM_TB_2006.371_eng.pdf ...under chapter management of tb meningitis)

E.

True; hydrocephalus is one of the complications. (http://www.pediatriconcall.com/forpatients/CommonChild/infectious_disease s/tuberculosis.asp)

12. Regarding pyogenic meningitis A. Neck rigidity is not always prominent in a 3 month old baby B. Meningitis caused by H.influenza is frequent in children 3-12 months of age C. Meningoccocal meningitis is often associated with haemorrhagic manesfestations D. Amikacin is the preferred drug for empirical treatment E. Syndrome of inappropriate Antidiuretic Hormone Secretion (SIADH) is a known complication

Answer A. False; Bacterial meningitis in the newborn and the forst 4-6 months of life has many atypical features. Neck rigidity and Kernigs sign are seldom prominent. (Ghai Essential Paediatrics, 6th Edition, m/s 517)

B. True ; From the age of 3 months to 2-3 years, the infection is most often due to H.influenza, S.pneumoniae and meningococci. (Ghai Essential Paediatrics, 6 th Edition, m/s 517).

C. True; beside classical feature of meningitis, this children show petechial haemorrhages on the sin and mucosa. Waterhouse Freiderichsen syndrome occurs due to haemorrhages and necrosis of adrenal glands during the course of meningococcal septicaemia. (Ghai Essential Paediatrics, 6 th Edition, m/s 518).

D. False; In neonates, during the first 2 to 3 weeks of life, bacterial meningitis, ampicillin with either an aminoglycoside or cefotaxime is commonly used as initial empirical therapy. For neonates with late-onset meningitis, a regimen containing an antistaphylococcal antibiotic, such as nafcillin or vancomycin, plus cefotaxime or ceftazidime with or without an aminoglycoside is recommended. For children older than 1 month of age, vancomycin plus a third-generation cephalosporin (ceftriaxone or cefotaxime) are recommended for initial therapy. In patients with predisposing factors, such as penetrating trauma, postneurosurgery, or CSF shunt, empirical therapy should include vancomycin plus cefepime or ceftazidime or meropenem. In cases of basilar skull fracture, a regimen containing vancomycin plus ceftriaxone or cefotaxime usually provides adequate empirical therapy. (http://www.ohsu.edu/xd/health/services/doernbecher/researcheducation/education/med-education/upload/Bacterial-Meningitis.pdf)

E. False; pyogenic meningitis are shock associated with DIC, seizure, subdural effusion, subdural empyema, brain abscesses, hydrocephalus, arachnoiditis, ventriculitis. Long term complication include hemiplegia, aphasia,ocular palsies, hemianopsia, blindness, deafness, mental retardation. . (Ghai Essential Paediatrics, 6th Edition, m/s 518 and http://www.ohsu.edu/xd/health/services/doernbecher/researcheducation/education/med-education/upload/Bacterial-Meningitis.pdf).

13. Regarding Hepatitis in children A. B. C. D. E. Answer: A. True : Ghai Essential Pediatrics; 7th Ed.;pg. 195) B. False:HAV infection induces lifelong protection against reinfection (Ghai Essential Pediatrics; 7th Ed.;pg. 191) C. True:Most children exposed to HCV are at risk to become chronically infected based on persistantly detectable serum anti_HCV antibodies and HCV RNA. (Ghai Essential Pediatrics; 7th Ed.;pg.194) D. True: Combination of HBIG and HBV vaccination in infant born to HBSAg postive mothers prevent transmission in approximately 95% case (Ghai Essential Pediatrics; 7th Ed.;pg. 193) E. False:No specific therapyis capable of altering the course of acute hepatits E infection (Ghai Essential Pediatrics; 7th Ed.;pg. 195) Hepatitis E virus is transmitted by faecal-oral route Persistent infection is common in Hepatitis A Chronic Hepatitis is common in Hepatitis C virus infection Hepatitis D is prevented by Hepatitis B vaccination Antiviral drugs are used in Hepatitis E infection

14. Clinical Signs in right sided heart failure in children are: A. B. C. D. E. Answer: A.True : B. False: persistant cough is left heart failure C. False left heart failure Hepatomegaly Cough Tachycardia Tachypnoea Pedal edema

D. False left heart failure E. True (Ghai Essential Pediatrics; 7th Ed.;pg.375)

15. The following are true regarding tetralogy of fallot: A. B. C. D. E. Answer: A. True:it is the commonest cyanotic congenital heart disease in children above age 2 years constituting 75% of patient (Ghai Essential Pediatrics; 6th Ed.;pg. 408) B. True: (Ghai Essential Pediatrics; 7th Ed.;pg.408) C. True : (Ghai Essential Pediatrics; 7th Ed.;pg. 409) D. False: The abnormal "coeur-en-sabot" (boot-like) appearance of a heart with tetralogy of Fallot is classically visible via chest x-ray (Ghai Essential Pediatrics; 7th Ed.;pg 409) E. True: (Ghai Essential Pediatrics; 7th Ed.;pg410) It is more common than transposition of great arteries Right ventricular hyperthrophy is one of its component Cyanosis is usually evident at birth Chest x ray shows plethora One of the complication is multiple brain abscess

16. Regarding rheumatic heart disease A. B. C. Heart failure is feature of carditis Aortic valve is commonly affected Pansystolic murmur at apex of heart suggest mitral regurgitation of vegetation in echocardiogram excludes infective

D. Absence endocarditis E. Answer:

Secondary prophylaxis is given life long

A. True: ((Ghai Essential Pediatrics; 7th Ed.;pg 380)

B. False:Commonly affected is mitral valve (Ghai Essential Pediatrics; 7th Ed.;pg384) C. True: (Ghai Essential Pediatrics; 7th Ed.;pg 385) D. False:Echocardiogram can detect vegetations of 2mm or more(Ghai Essential Pediatrics; 7th Ed.;pg 390) E. True:ideally it is given life long (Ghai Essential Pediatrics; 7th Ed.;pg384)

17. Regarding nutrition of infant and children A. B. C. D. E. Answer: A. True: (Ghai Essential Pediatrics; 7th Ed.;pg 60) B. True: (Ghai Essential Pediatrics; 7th Ed.;pg 61 C. True (Ghai Essential Pediatrics; 7th Ed.;pg 67) D. True : http://www.nrv.gov.au/nutrients/sodium.htm E. False :it is genetic disorder Breast feeding is recommended to continue up to 2 years of age Normal adult diet is given at 2 years of age Nutritional deficiency sometimes present with immune deficiency Cow milk has higher sodium content than human milk nutritional deficiency leads to G6PD deficiency

18. Regarding Bronchiolitis A. B. C. D. E. Respiratory syncitial virus is the commonest causative organism It is characterised by paroxysmal cough Liver and spleen are often palpable Hyperinflated lungs filed in CXR findings Dexamethasone is useful in severe case

Answer: A. True: (Ghai Essential Pediatrics; 7th Ed.;pg 356)

B. False:characterized by wheezing (Ghai Essential Pediatrics; 7th Ed.;pg357) C. False: (Ghai Essential Pediatrics; 7th Ed.;pg357) D. True: (Ghai Essential Pediatrics; 7th Ed.;pg357) E. False: (Ghai Essential Pediatrics; 7th Ed.;pg 358)

19.

The followings are TRUE regarding acute stridor: A) B) C) D) E) It is mostly due to lower airway obstruction Haemophilus influenza is the most common pathogen for croups. Pseudomembrane is a feature of acute epiglottitis. Steroid is useful drug management for croups Croups can be prevented by childhood immunization.

ANSWER: FALSE: The term stridor refers to the physical findings of excessively noisy breathing and is generally due to upper airway obstruction( EssentialPeadiatrics, OP Ghai 7th edition, page339-Diseases of Larynx and Trachea) TRUE: The term croup is used for a variety of conditions in which a peculiar brassy cough is the main presenting feature. The diseases included are acute epiglottitis, laryngitis, laryngotracheobronchitis and spasmodic laryngitis. Epiglottitis is commonly caused by H.influenza type B. Laryngitis and laryngotracheobronchitis(a.k.a infectious croup) is commonly caused by parainfluenza type 1 virus.( Essential paediatrics, OP Ghai 7 theditioni, page351; Harrisons 17th edition, page 212) FALSE:Pseudomembrane is a feature of Diptheria (Essential Paediatrics, OP Ghai 7th edition, page220-diptheria) Croup presents with swelling of the subglottic region or the larynx (Essential Paediatric, OP Ghai 7 th edition, page 339;Harrisons 17th edition, page 212) TRUE: Steroids are helpful in moderate to severe cases of Laryngotracheobronchitis. Other treatments include humidified oxygen inhalation and nebulized epinephrine (1:1000). Antibiotics are only indicatedif child fails to improve or if purulent secretions are present [Evidence of bacterial infection] (Essential paediatrics, OP Ghai 7 th edition, page 339) TRUE: In some countries, mass vaccination against Hib has reduced the incidence of acute epiglottitis by >90% (Harrisons 17 th edition, page 212)

Currently theres no vaccination available against parainfluenza virus for laryngotracheobronchitis. (Medscape- parainfluenza virus)

20.

Regarding pneumonia in children: A. B. Mycoplasma pneumonia causes bronchopneumonia. Group B streptococci is the main organism causing pneumonia in newborn. C. D. E. Pneumatoceles are a complication of staphylococcal pneumonia. Protein content in exudative pleural fluid is <3gm/dl Bronchophony is a feature of lobar consolidation.

ANSWER: TRUE: Mycoplasma pneumonia is the eiologicalafent of primary atypical pneumonia. Xray findings include varied bronchopneumonic infiltrates in the lower lobes and small areas of segmental and subsegmental atelectasis. (Clinical Pediatrics 3rd edition, Lippincott Williams & Wilkins, AruchamyLakshmanaswamy; page 411-412) TRUE: The common bacteria causing pneumonia in the neonatal period includes Group B streptococci, E.coli, Klebsiella, Listeria and S. aureus. (Clinical Pediatrics 3rd edition, Lippincott Williams & Wilkins, AruchamyLakshmanaswamy; page 411-412) TRUE: Pneumatoceles are a complication of Staphylococcal pneumonia (Essential paediatrics, OP Ghai, page 353- staphylococcal pneumonia) FALSE: Protein content in exudative pleural fluid is >3 gm/dl. (Clinical Pediatrics 3rd edition, Lippincott Williams & Wilkins, AruchamyLakshmanaswamy; page 417- Table 9.22) TRUE:Bronchophony is an abnormal voice sounds heard over the lung, with the voice too clear and high-pitched, indicating solidification. It is heard over an area of consolidation (Clinical Pediatrics 3rd edition, Lippincott Williams & Wilkins, AruchamyLakshmanaswamy; page 404)

21.

Regarding childhood asthma: A. B. C. D. E. It is a chronic inflammatory condition of the airways. Recurrent wheezing is sometimes associated with viral infection. Exercise is one of the triggers for acute attack. Steroids are compulsorily used in all forms of asthma. Pneumothorax is one of the complications.

ANSWER: FALSE: Asthma is the hyper responsiveness of the airway to various stimuli which manifests by narrowing of the airways causing dyspnea and wheezing that is reversible either spontaneously or with medication. (Essential paediatrics, OP Ghai 7th edition, page 358) TRUE: Amongst the triggers of asthma attacks in the younger children are viral infections. It induces bronchoconstriction. RSV are mainly implicated. (Essential paediatrics, OP Ghai 7th edition, page 359-Triggers of an attack of asthma.) TRUE: Exercise induced asthma occurs in genetically susceptible individuals with hyper reactive airways because of loss of water and heat from the respiratory tract following exercise. Water loss induces mucosal hyperosmolarity which stimulates mediator cell release from mast cells. (Essentialpaediatrics, OP Ghai 7th edition, page 359-Triggers of an attack of asthma.) FALSE:Management of asthma is step-wise, the first step does not require steroid as treatment. IE: In intermittent asthma, (defined as <1 times daytime symptoms in a week for 3 months, <2 nocturnal symptoms/month, and PEFR >80% predicted; variability <20%) inhaled short acting B-agonist is used as and when required during an asthma attack. (Essential paediatrics, OP Ghai 7th edition, page 363- Table 13.6 and 13.7) FALSE: Pneumothorax is not one of its complications. (Essential paediatrics, OP Ghai 7th edition, page 358-367)

22.

TRUE regarding Proten Energy Malnutrition (PEM): A. Marasmic children are apathetic

B. Skin changes in Kwashiokor causes castles collar appearance. C. Return of social smile is the first sign of recovery. D. Feeds in Severe Acute Malnutrition (SAM) is initiated with F100. E. Symptomatic hypoglycaemia in Severe Acute Malnutrition is treated with 5ml/kg of 10% Dextrose. ANSWER: FALSE: Kwashiorkor children are apathetic, irritable or sad. In marasmus, an affected child may appear to be alert despite of their condition.(Essential paediatrics, OP Ghai 7th edition, page 67.) FALSE:Castles collar appearance is not amongst the skin changes in kwashiorkor. (Clinical Pediatrics 3rd edition, Lippincott Williams & Wilkins AruchamyLakshmanaswamy, page 209) TRUE:Amongst the first signs of recovery is return of social smile and interaction with parents. Other signs are return of appetite and disappearance of oedema. (Clinical Pediatrics 3rd edition, Lippincott Williams & Wilkins AruchamyLakshmanaswamy, page 212- Table 5.43) FALSE: Feeds in severe acute malnutrition is started with F75 (Essential paediatrics, OP Ghai 7th edition, page 70-71- Step 1: Treat/Prevent hypoglycaemia) TRUE: In symptomatic hypoglycaemia, 5ml/kg 10% dextrose is given IV followed by 50 ml of 10% dextrose or sucrose solution by nasogastric tube.Blood glucose levels must be estimated every 30 minutes, once stable, the 2 hourly feeding regimen should be started with starter F-75.(Essential paediatrics, OP Ghai 7th edition, page 70-71- Step 1: Treat/Prevent hypoglycaemia)

23.

TRUE regarding infantile pyloric stenosis: A. It is more common in boys. B. Projectile vomiting is a feature. C. Vomitus is bile stained. D. Ultrasound abdomen is often diagnostic.

D. Air enema sometimes cures this condition. ANSWER: TRUE: Congenital pyloric stenosis is classically seen in first born male babies. Male to female ratio is 4:1 (A Concise Textbook Of Surgery, S. Das. 6thedition.Page 711- congenital pyloric stenosis) TRUE: Projectile vomiting is a feature of infantile pyloric stenosis. (A Concise Textbook Of Surgery, S. Das. 6th edition.Page 711- congenital pyloric stenosis) FALSE: The vomit in this condition is non-bilious. It is characteristic of upper G.I obstruction.(A Concise Textbook Of Surgery, S. Das. 6th edition.Page 711- congenital pyloric stenosis) TRUE: USG allows for observation of peristaltic activity thus differentiating betweenpylorospasm and true infantile hypertrophic pyloric stenosis. The sonographic hallmark of infantile pyloric stenosis is the thickened pyloric muscle. (Medscape- Pediatric Pyloric Stenosis) FALSE:Air enema has no role in treatment of infantile pyloric stenosis. Pylorotomy is the treatment of choice in all patients. Non-surgical treatment is reserved for poor surgical candidates .This involve giving atropine sulphate or atropine methynitrate orally via nasogastric tube. ( A Concise Textbook Of Surgery, S. Das. 6th edition. Page 711- congenital pyloric stenosis; Medscape-Pediatric pyloric stenosis)

24.

The followings are TRUE regarding attention deficit hyperactivity disorder: A. The child is easily distracted by external stimuli. B. The child is often forgetful in daily activities. C. The child sits in one place for a long time. D The child blurts out answers to questions. E. The child finishes schoolwork on time.

ANSWER:

TRUE: An ADHD child is easily distracted by external stimuli. (JAYPEE PUBLISHER A Short Textbook of Psychiatry, NirajAhuja, 7 th edition. Page 166- Attention Deficit Disorder (Hyperkinetic disorder)) TRUE: The child is often distracted, loses and forgets things. (JAYPEE PUBLISHER A Short Textbook of Psychiatry, NirajAhuja, 7th edition. Page 166- Attention Deficit Disorder (Hyperkinetic disorder)) FALSE: An ADHD child is fidgety and has difficulty in sitting at one place for long. (JAYPEE PUBLISHER A Short Textbook of Psychiatry, NirajAhuja, 7th edition. Page 166- Attention Deficit Disorder (Hyperkinetic disorder)) TRUE: An ADHD child acts without thinking and on spur of the moment hence he blurts out answers to questions. (JAYPEE PUBLISHER A Short Textbook of Psychiatry, NirajAhuja, 7th edition. Page 166- Attention Deficit Disorder (Hyperkinetic disorder)) FALSE: The child will have difficulty finishing a task. (JAYPEE PUBLISHER A Short Textbook of Psychiatry, NirajAhuja, 7th edition. Page 166- Attention Deficit Disorder (Hyperkinetic disorder))

25.

Regarding Nephrotic Syndrome in children: A. It is associated with hypocolestrolemia. B. Loss of immunoglobulins in urine predisposes the child to infection. C. Age of presentation less than 1 year is an indication for pediatric nephrology referral. D. Response to steroids is the highest in focal segmental glomerulosclerosis. E. Steroid resistance is an indication for renal biopsy. Answer A. FALSE. Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia and edema and associated with hyperlipidemia. (Essential Paediatrics 7th Edition, OP Ghai, page 450) B. TRUE. Infection is the major complication of nephrotic syndrome. Children in relapse have increased susceptibility to bacterial infections because of urinary losses of immunoglobulins and properdin factor B, defective cell-mediated immunity, immunosuppressive therapy, malnutrition, and edema/ascites acting as a potential culture medium. (Textbook of Paediatrics 18 th Edition, Nelson, chapter 527.1) C. TRUE. Children with onset of nephrotic syndrome between 1 and 8 yr of age are likely to have steroid-responsive MCNS; steroid therapy may be initiated without diagnostic renal biopsy. Children with features that make MCNS less

likely (hematuria, hypertension, renal insufficiency, hypocomplementemia, age <1 yr or >8 yr) should be considered for renal biopsy before treatment. (Textbook of Paediatrics 18th Edition, Nelson, chapter 527.1) D. FALSE. Only 20% of patients with FSGS respond to prednisone. (Textbook of Paediatrics 18th Edition, Nelson, chapter 527.1) E. FALSE. Children with steroid-resistant nephrotic syndrome develop progressive renal insufficiency, ultimately leading to end-stage renal disease requiring dialysis or renal transplantation. (Textbook of Paediatrics 18 th Edition, Nelson, chapter 527.1)

26.

Regarding Acute Renal Failure (ARF) in children: A. Pre-renal failure is due to fluid loss. B. Acute Glomerulonephritis (AGN) is a known cause. C. Urine spot sodium is more than 40mmol/L in intrinsic renal failure. D. Tall T waves are seen in hyperkalemia. E. Dialysis is the first line treatment of ARF.

Answer A. TRUE. Common causes of prerenal ARF include dehydration, sepsis, hemorrhage, severe hypoalbuminemia, and cardiac failure. (Textbook of Paediatrics 18th Edition, Nelson, chapter 535.1) B. TRUE. Many forms of glomerulonephritis, including postinfectious glomerulonephritis, lupus nephritis, Henoch-Schnlein purpura nephritis, membranoproliferative glomerulonephritis, and antiglomerular basement membrane nephritis, may cause ARF. (Essential Paediatrics 7 th Edition, OP Ghai, page 459) C. TRUE. Patients whose urine shows a specific gravity of <1.010, low urine osmolality (UOsm < 350 mOsm/kg), high urine sodium (UNa > 40 mEq/L), and FENa greater than 2% (>10% in neonates) most likely have intrinsic ARF. (Essential Paediatrics 7th Edition, OP Ghai, page 460) D. TRUE. The earliest electrocardiographic change seen in patients with developing hyperkalemia is the appearance of peaked T waves. (Textbook of Paediatrics 18th Edition, Nelson, chapter 535.1) E. FALSE. Dialysis is indicated in: Volume overload with evidence of hypertension and/or pulmonary edema refractory to diuretic therapy, persistent hyperkalemia, severe metabolic acidosis unresponsive to medical

management, blood urea nitrogen greater than 100150 mg/dL (or lower if rapidly rising), calcium/phosphorus imbalance, with hypocalcemic tetany. (Essential Paediatrics 7th Edition, OP Ghai, page 462)

27.

A 5 years old child with Downs syndrome would present with the following features: A. Undescended testis. B. Mongolian spots. C. Ventricular septal defects. D. Hypothyroidism. E. Mental retardation.

Answer A. FALSE. B. FALSE. C. FALSE. VSD common in Trisomy 13 (patau Syndrome) D. TRUE. About 13-54% of children with Down Syndrome have hypothyroidism. E. TRUE. Patients with Down Syndrome have mental and physical retardation. (All from Essential Paediatrics 7th Edition, OP Ghai, page 613)

28.

The expected defects in a baby with Maternal Rubella Syndrome are: A. Deafness. B. Cataract. C. Cardiac defects. D. Hydrocephalus. E. Renal cysts.

Answer

Deafness Ocular Cataracts Retinopathy Heart disease Patent ductus arteriosus Right pulmonary artery stenosis Left pulmonary artery stenosis Valvular pulmonic stenosis Low birthweight Psychomotor retardation Neonatal purpura Death

67% 71% 29% 39% 48% 78% 70% 56% 40% 60% 45% 23% 35%

A. B. C. D. E.

TRUE. TRUE. TRUE. FALSE. FALSE.

(All from Textbook of Paediatrics 18th Edition, Nelson, chapter 244)

29.

TRUE regarding childhood diabetes mellitus: A. It is most commonly type 1. B. Polyuria is one of the features. C. HbA1c measurement is done every month. D. Oral hypoglycemic agents are commonly used. E. Hypothyroid is a known associated problem.

Answer

A. TRUE. T1DM is the most common endocrine-metabolic disorder of childhood and adolescence. (Textbook of Paediatrics 18 th Edition, Nelson, chapter 590) B. TRUE. Symptoms of T1DM include polyuria, nocturia, polydipsia, recent weight loss, polyphagia and fatigue. (Essential Paediatrics 7 th Edition, OP Ghai, page 511) C. FALSE. HbA1C allows an estimate of the duration of hyperglycemia and provides an initial value by which to compare the effectiveness of subsequent therapy. But not completely reliable when dealing with mild elevation of blood sugar. (Textbook of Paediatrics 18th Edition, Nelson, chapter 590) D. FALSE. Continuous subcutaneous injection infusion. (Essential Paediatrics 7 th Edition, OP Ghai, page 511) E. FALSE. DKA is the most common complication. (Essential Paediatrics 7 th Edition, OP Ghai, page 511)

30.

Regarding Oral Rehydration Therapy (ORT): A. sodium absorption is coupled with glucose absorption in the gut. B. It is the treatment of choice in severe dehydration (Plan C). C. Persistent vomiting decreases the effectiveness of ORT. D. Incorrect preparation often leads to hypernatremia. E. Tea without sugar is a form of ORT.

Answer A. TRUE. (Essential Paediatrics 7th Edition, OP Ghai, page 263) B. FALSE. In plan C should start IV fluids immediately. Best solution to give is Ringers Lactate. (Essential Paediatrics 7th Edition, OP Ghai, page 265) C. TRUE. ORT is ineffective when there is high stool purge, persistent vomiting, incorrect preparation, abdominal distention and glucose malabsorption. (Essential Paediatrics 7th Edition, OP Ghai, page 265) D. TRUE. (Textbook of Paediatrics 18th Edition, Nelson, chapter 54) E. FALSE. Fluids without salt and sugar and fluids consumed in small quantities like tea are not ORT. (Essential Paediatrics 7 th Edition, OP Ghai, page 263)