PEDIATRIC MCQ 1

1. All of the following are example of peripheral neuropathies except?

A. Abetalipoproteinemia

B. Charcot-Marie-Tooth disease

C. Werdnig Hoffman disease

D. Dejerine Sottas disease

Correct answer : C. Werdnig Hoffman disease.

 Abetalipoproteinemia is a progressive ataxic neuropathy with retinitis pigmentosa and steatorrhoea.

 Charcot-Marie-Tooth disease is a hereditary motor and sensory neuropathy. It is characterised by weakness of extremities and hammer toe.

 Dejerine Sottas disease is also a hereditary motor and sensory neuropathy. It is associated with distal weakness and ataxia.

 Werdnig Hoffman disease is spinal muscular atrophy type 1. It presents within first 6 months of life. It presents with generalised symmetrical

weakness, more in proximal muscle groups with hypotonia.

2. Which of the following is an X linked disease?

A. Friedreich’s ataxia

B. Fabry’s disease

C. Osteogenesis imperfecta

D. Cystic fibrosis

Correct answer : B. Fabry’s disease

 Friedreich’s ataxia is an autosomal recessive disease.

 Osteogenesis imperfecta is an autosomal dominant disease.

 Cystic fibrosis is autosomal recessive

3. Least common cause of ambiguous genitalia in females?

A. 21 hydroxylase deficiency

B. 11 hydroxylase deficiency

C. WNT4 gene mutation

D. Foetal placental steroid sulfatase deficiency

Correct answer : D. Placental steroid sulfatase deficiency

 Foetal placental steroid sulfatase deficiency is a rare X-linked condition, and is seen only in males.

 It is not a cause for development of ambiguous genitalia in females.

 The most common cause of ambiguous genitalia in females is Congenital Adrenal Hyperplasia (CAH).

 It is responsible for about 70% of cases.

 21 hydroxylase deficiency and 11 hydroxylase deficiency are subtypes of CAH.

 Other causes include WNT4 mutation and foetal placental aromatase deficiency.

4. Differentiating an ASD from a VSD using a chest X-ray is by detection of?

A. Enlargement of pulmonary artery

B. Enlarged left atrium

C. Dilated aorta

D. Pulmonary plethora

Correct answer : B. Enlarged left atrium

DIFFERENTIATING AN ASD FROM A VSD USING A CHEST X-RAY

 Left atrium is not dilated in a case of atrial septal defect (ASD).

 It is dilated in patients with ventricular septal defect. (VSD).

 PEDIATRIC MCQ 2

 Pulmonary plethora is present in both ASD and VSD.

 Pulmonary artery is dilated in both.

 Size of the aorta is normal in both.

5. Earliest sign of pathological gastroesophageal reflux in infants is?

A. Upper GI bleeding

B. Respiratory symptoms

C. Oesophageal stricture

D. Postprandial regurgitation

Correct answer : B. Respiratory symptoms

Gastroesophageal reflux in infants can be of 2 types – Physiological or Pathological.

Physiological reflux

 The infant has regurgitation after feeding, but weight gain is normal.

 There are no respiratory symptoms / features of oesophagitis.

Pathological reflux (gastroesophageal reflux disease)

 Regurgitation is associated with refusal to eat, excessive vomiting, weight loss and failure to thrive.

 The infant has recurrent respiratory features like like wheezing, stridor, chronic cough, aspiration, sore throat, hoarseness and recurrent

pneumonitis.

 Features of oesophagitis may be present – upper GI bleeding, anemia and Sandifer syndrome (torticollis and dystonia associated with GERD).

 The most frequent complications are failure to thrive and recurrent respiratory symptoms.

Investigations

 Upper GI imaging series

 Upper GI endoscopy

 Esophageal pH monitoring

Management

 Conservative management

o Small frequent feeds thickened with cereal.

o Burping the infant.

o Hold the infant in an upright position for 20-30 minutes after feeding.

 Medical management

o H2 blockers like ranitidine.

o Proton pump inhibitors like omeprazole and pantoprazole.

o Antacids like magnesium hydroxide.

 Surgical management

o Gastrostomy or fundoplication is done in a very small minority.

6. A 12 year old Boy with hematemesis, melena and mild splenomegaly presented to the paediatrics OPD. Examination revealed absence of

jaundice / ascites. Most probable diagnosis is?

A. Extrahepatic Portal Venous Obstruction (EHPVO)

B. Cirrhosis

C. Non Cirrhotic Portal Fibrosis (NCPF)

D. Malaria with disseminated intravascular coagulation

Correct answer : A. Extrahepatic Portal Venous Obstruction (EHPVO)

 Hematemesis, melena and splenomegaly are suggestive of a diagnosis of portal hypertension

 PEDIATRIC MCQ 3

 The first three options can cause portal hypertension

 But considering the age and sex of the child, Extrahepatic Portal Venous Obstruction (EHPVO) is the most probable diagnosis

 Non Cirrhotic Portal Fibrosis (NCPF) is usually seen in adult females in the third or fourth decade

 Cirrhosis is not very common in children, and it is usually accompanied by jaundice / ascites

7. Most common malignant orbital tumor in children is?

A. Acute myeloid leukemia

B. Acute lymphoblastic leukemia

C. Rhabdomyosarcoma

D. Cavernous hemangioma

Correct answer : C. Rhabdomyosarcoma

 Most common malignant orbital tumor in children is rhabdomyosarcoma.

 Most common benign orbital tumor in children is dermoid cyst.

8. Right sided isomerism is found in association with?

A. Asplenia

B. Single spleen

C. Two spleens

D. Multiple spleens

Correct answer : A. Asplenia

 Alternate names – Ivemark syndrome / asplenia syndrome

 It is a type of situs anomaly

 Features : asplenia, malrotation of bowel, transverse liver, gall bladder agenesis, imperforate anus, horseshoe adrenal gland, urethral valves

 The patients are immunocompromised due to absence of spleen, most die before 1 year of age

9. Which of the following is the treatment of choice for true precocious puberty?

A. Surgical removal of hypothalamic tumor

B. GnRH

C. Androgen blocking agents

D. LH

Correct answer : B. GnRH

Treatment of precocious puberty :

Pulsatile secretion of Gonadotropin Releasing Hormone is responsible for the secretion of FSH and LH. By exogenous administration of GnRH, it

is possible to maintain a constant level of GnRH in the blood. This inhibits the release of FSH and LH.

10. Which of the following is the most common complication of mumps in children?

A. Orchitis

B. Conjunctivitis

C. Meningoencephalitis

D. Myocarditis

Correct answer : C. Meningoencephalitis

Meningoencephalitis is the most common complication of mumps in children.

11. Which is not used for the treatment of juvenile myoclonic epilepsy?

A. Zonisamide

B. Topiramate

C. Carbamazepine

D. Valproate
PEDIATRIC MCQ 4

Correct answer : C. Carbamazepine

Use of carbamazepine / phenytoin may increase myoclonus in juvenile myoclonic epilepsy.

12. Most common cause of meningoencephalitis in children is?

A. HSV

B. Measles

C. Arbobvirus

D. Enterovirus

Correct answer : D. Enterovirus

Enteroviruses are the most common cause of viral meningoencephalitis in children.

13. An eight year old boy presented to the casualty with high fever, pruritic erythematous rash, joint pain and lymph node enlargement. There

is a history of upper respiratory tract infection for which he was on cefaclor – 8 days completed of a 10 day course. The most likely diagnosis is?

A. Serum sickness like illness

B. HSP

C. Type III hypersensitivity

D. Kawasaki disease

Correct answer : A. Serum sickness like illness

Serum sickness like reaction can occur following the use of certain drugs, especially cefaclor in children. It presents with an urticarial / purpuric

rash, arthritis, lymphadenopathy and fever. But unlike true serum sickness (a type III hypersensitivity response), it is not caused by circulating

immune complexes.

14. A one year old child presented to the OPD with the history of short stature, tiredness and constipation. Examination revealed a palpable

goitre. Serum T4 was decreased and TSH levels were increased. Which is the most probable diagnosis?

A. Thyroid dysgenesis

B. Thyroid Dyshormonogenesis

C. TSH receptor blocking antibody

D. Central hypothyroidism

Correct answer : B. Thyroid Dyshormonogenesis

Among the options given, only Thyroid Dyshormonogenesis presents with a palpable goitre.

15. Most common tumour associated with Neurofibromatosis I in children is?

A. AML

B. CML

C. ALL

D. JMML (Juvenile myelomonocytic leukemia)

Correct answer : D. JMML (Juvenile myelomonocytic leukemia)

Children with NF1 have a 200-500 times increased incidence of JMML.

16. The protective effects of breast milk are known to be associated with:

A. IgM antibodies

B. Lysozyme

C. Mast cells

D. IgA antibodies

Correct answer : D. IgA antibodies

Although breast milk contains both breast milk and antibodies; antibodies play the major role in providing immunity. Breast fed babies have

lower incidence of diarrhoea, otitis media, pneumonia, bacteremia and meningitis.

 PEDIATRIC MCQ 5

17. All of the following therapies may be required in a 1 hour old infant with severe birth asphyxia except:

A. Glucose

B. Dexamethasone

C. Calcium gluconate

D. Normal saline

Correct answer : B. Dexamethasone

Steroids should not be used in management of infants with asphyxia.

18. The karyotype of a patient with Androgen Insensitivity Syndrome is:

A. 46XX

B. 46XY

C. 47XXY

D. 45XO

Correct answer : B. 46XY

Androgen insensitivity is seen in genetic males (XY) who exhibit a female phenotype.

19. Which one of the following drugs is used for fetal therapy of congenital adrenal hyperplasia?

A. Hydrocortisone

B. Prednisolone

C. Fludrocortisone

D. Dexamethasone

Correct answer : D. Dexamethasone

Dexamethasone acts by suppressing the secretion of steroids by fetal adrenals.

20. Blood specimen for neonatal thyroid screening is obtained on:

A. Cord blood

B. 24 hours after birth

C. 48 hours after birth

D. 72 hours after birth

Correct answer :D. 72 hours after birth

Update: The correct answer is 72 hours after birth.

When to screen:

 Normal hospital delivery at term – Filter paper collection ideally at 2-4 days of age or at time of discharge

 NICU / preterm home birth – Within 7 days of birth

 Maternal history of thyroid medication / family history of congenital hypothyroidism – cord blood for screening

Cord blood is to be used only if there is family history of hypothyroidism. In normal delivery, blood is taken at 2-4 days of age.

21. The appropriate approach to a neonate presenting with vaginal bleeding on day 4 or life is:

A. Administration of vitamin K

B. Investigation for bleeding disorder

C. No specific therapy

D. Administration of 10 ml/kg of fresh frozen plasma over 4 hours

Correct answer : C. No specific therapy

Vaginal bleeding can occur in 3rd – 7th day after birth. It occurs due to withdrawal of maternal hormones. It usually subsides in 2-3 days. No

specific treatment is required.

22. In unconjugated hyperbilirubinemia, the risk of kernicterus increases with the use of:

A. Ceftriaxone
PEDIATRIC MCQ 6

B. Phenobarbitone

C. Ampicillin

D. Sulphonamide

Correct answer : D. Sulphonamide

Sulphonamide can displace bilirubin from albumin.

23. The following bacteria are most often associated with acute neonatal meningitis except:

A. Escherichia coli

B. Streptococcus agalactiae

C. Neisseria meningitidis

D. Listeria monocytogenes

Correct answer : C. Neisseria meningitidis

Meningitis by Neisseria meningitidis is seen in 2months-12 years of age.

24. Which one of the following is the most common cause of congenital hydrocephalus?

A. Craniosynostosis

B. Intra uterine meningitis

C. Aqueductal stenosis

D. Malformations of great vein of Galen

Correct answer : C. Aqueductal stenosis

25. The most common malignant neoplasm of infancy is:

A. Malignant teratoma

B. Neuroblastoma

C. Wilms’ tumor

D. Hepatoblastoma

Correct answer : B. Neuroblastoma

26. The most common presentation of a child with Wilms tumor is:

A. An asymptomatic abdominal mass

B. Haematuria

C. Hypertension

D. Hemoptysis due to pulmonary secondary

Correct answer : A. An asymptomatic abdominal mass

27. ln a child, non functioning kidney is best diagnosed by:

A. Ultrasonography

B. IVU

C. DTPA renogram

D. Creatinine clearance

Correct answer : C. DTPA renogram

Isotope renogram is the best modality for renal function estimation.

28. The most common cause of renal scarring in a 3 year old child is:

A. Trauma

B. Tuberculosis

C. Vesicoureteral reflux induced pyelonephritis

D. Interstitial nephritis

Correct answer : C. Vesicoureteral reflux induced pyelonephritis

PEDIATRIC MCQ 7

29. A child with recurrent urinary tract infections is most likely to show:

A. Posterior urethral valves

B. Vesicoureteric reflux

C. Neurogenic bladder

D. Renal and ureteric calculi

Correct answer : B. Vesicoureteric reflux

Vesicoureteric reflux is the most common cause of urinary tract infections in childhood. (upto 50%)

30. Which of the following is the most common renal cystic disease in infants?

A. Polycystic kidney

B. Simple renal cyst

C. Unilateral renal dysplasia

D. Calyceal cyst

Correct answer : C. Unilateral renal dysplasia

31. One of the intestinal enzymes that is generally deficient in children following an attack of severe infectious enteritis is:

A. Lactase

B. Trypsin

C. Lipase

D. Amylase

Correct answer : A. Lactase

Even in the normal intestine, the lactase activity is limited. Hence it is most prone to become deficient following an attack of infectious

enteritis.

32. The most common type of total anomalous pulmonary venous connection is:

A. Supracardiac

B. Infracardiac

C. Mixed

D. Cardiac

Correct answer : A. Supracardiac

33. Eisenmenger syndrome is characterized by all except:

A. Return of left ventricle & right ventricle to normal size

B. Pulmonary veins not distended

C. Pruning of peripheral pulmonary arteries

D. Dilatation of central pulmonary arteries

Correct answer : A. Return of left ventricle & right ventricle to normal size

Right ventricular hypertrophy that develops in Eisenmenger syndrome will not return to normal size.

34. Diagnosis of beta Thalassemia is established by:

A. NESTROFT Test

B. HbA1c estimation

C. Hb electrophoresis

D. Target cells in peripheral smear

Correct answer : C. Hb electrophoresis

NESTROFT Test – Naked Eye Single Tube Red Cell Osmotic Fragility Test – used for screening for Thalassemia

HbA1c – Used to assess long term glycemic control in diabetics (blood sugar control over past 3 months)

Target cells – A feature of thalassemia, but not diagnostic

PEDIATRIC MCQ 8

35. The most common leukocytoclastic vasculitis affecting children is:

A. Takayasu disease

B. Mucocutaneous lymph node syndrome (Kawasaki disease)

C. Henoch–Schönlein purpura

D. Polyarteritis nodosa

Correct answer : C. Henoch–Schönlein purpura

HSP is the most common childhood vasculitis. It is produces leukocytoclastic vasculitis.

36. The coagulation profile in a 13-year old girl with Menorrhagia having von Willebrands disease is:

A. Isolated prolonged PTT with a normal PT

B. Isolated prolonged PT with a normal PTT

C. Prolongation of both PT and PTT

D. Prolongation of thrombin time

Correct answer : A. Isolated prolonged PTT with a normal PT

In VWF, there is impairment of intrinsic coagulation pathway. Hence there is isolated prolonged PTT.

37. Bart‘s hydrops fetalis is lethal because:

A. Hb Bart’s cannot bind oxygen

B. The excess alpha globin form insoluble precipitates

C. Hb Bart’s cannot release oxygen to fetal tssues

D. Microcytic red cells become trapped in the placenta

Correct answer : C. Hb Bart’s cannot release oxygen to fetal tssues

Hb Barts is formed of 4 gamma chains. The oxygen affinity is so high that it releases very little oxygen into the fetal tissues.

38. An affected male infant born to normal parents could be an example of all of the following, except

A. An Autosomal dominant disorder

B. An Autosomal recessive disorder

C. A polygenic disorder

D. A vertically transmitted disorder

Correct answer : A. An Autosomal dominant disorder

An autosomal dominant disorder if present in the parents will always express itself phenotypically. So it is not possible for normal parents to

have an child affected with an autosomal dominant disorder.

39. A child with a small head, minor anomalies of the face including a thin upper lip, growth delay, and developmental disability can have all of

the following, except:

A. A chromosomal syndrome

B. A teratogenic syndrome

C. A mendelian syndrome

D. A polygenic syndrome

Correct answer : D. A polygenic syndrome

The features given can occur as a part of a chromosomal / teratogenic / mendelian syndrome. Polygenic inheritance is the answer of exclusion.

In a polygenic inheritance, multiple genes are involved in the phenotypic expression. Some examples of polygenic inheritance are hypertension

and diabetes.

40. The process underlying differences in expression of a gene according to which parent has transmitted is called:

A. Anticipation

B. Mosaicism
 PEDIATRIC MCQ 9

C. Non penetrance

D. Genomic imprinting

Correct answer : D. Genomic imprinting

In genomic imprinting, a gene / group of genes on the paternal or maternal chromosome is selectively inactivated. The functional allele will be

provided by the counterpart.

Example:

 Angelman syndrome – deletion of maternal gene

 Prader Willi syndrome – deletion of paternal gene

41. A malignant tumor of childhood, that metastasizes to bones most often is:

A. Wilm’s tumor

B. Neuroblastoma

C. Adrenal gland tumors

D. Granulosa cell tumor of ovary

Correct answer : B. Neuroblastoma

60-70% of metastasis in case of neuroblastoma are skeletal metastasis.

42. The most important determinant of prognosis in Wilms tumor:

A. Stage of disease

B. Loss of heterozygosity of chromsome lp

C. Histology

D. Age less than one year at presentation

Correct answer : C. Histology

Histology and stage of disease are important prognostic factors. But histology is more important.

43. A 1 month old boy is referred for failure to thrive. On examination, he shows feature of congestive heart failure. The femoral pulses are

feeble as compared to branchial pulses. The most likely clinical diagnosis is:

A. Congenital aortic stenosis

B. Coarctation of aorta

C. Patent ductus arteriosus

D. Congenital aortoiliac disease

Correct answer : B. Coarctation of aorta

Feeble femoral pulses compared to brachial pulse indicates coarctation of aorta.

44. ln which of the following conditions left atrium is not enlarged:

A. Ventricular septal defect

B. Atrial septal defect

C. Aortopulmonary window

D. Patent ductus arteriosus

Correct answer : B. Atrial septal defect

Right atrium and ventricle is enlarged in ASD. Left atrium can enlarge once Eisenmenger’s syndrome develops.

45. Blalock and Taussig shunt is done between:

A. Aorta to pulmonary artery

B. Aorta to pulmonary vein

C. Subclavian artery to pulmonary vein

D. Subclavian vein to artery

Correct answer : A. Aorta to pulmonary artery

 PEDIATRIC MCQ
10

Blalock and Taussig shunt is used in the surgical management of tetralogy of fallot. It is shunts blood from the subclavian artery to the

pulmonary artery. That is not given among the list of options. As subclavian artery is a branch of aorta, the best answer would be ‘aorta to

pulmonary artery.’

46. The following features are true for tetralogy of Fallot, except:

A. Ventricular septal defect

B. Right ventricular hypertrophy

C. Atrial septal defect

D. Pulmonary stenosis

Correct answer : C. Atrial septal defect

Components of Tetralogy of Fallot:

 Pulmonary stenosis

 Overriding aorta

 Ventricular septal defect

 Right ventricular hypertrophy

47. Late onset hemorrhagic disease of newborn is characterized by all of the following features except:

A. Usually occurs in cow-milk fed babies

B. Onset occurs at 4-12 week of age

C. lntracranial hemorrhage can occur

D. Intramuscular vitamin K prophylaxis at birth has a protective role

Correct answer : A. Usually occurs in cow-milk fed babies

Haemorrhagic disease of newborn is more common in breast milk fed babies. (Breast milk is a poor source of Vitamin K)

48. With reference to mumps which of the following is true?

A. Meningoencephalitis can precede parotitis

B. Salivary gland involvement is limited to the parotids

C. The patient is not infectious prior to clinical parotid enlargement

D. Mumps orchitis frequency leads to infertility

Correct answer : A. Meningoencephalitis can precede parotitis

Meningoencephalitis can occur 1 week before onset of parotitis.

49. The earliest indicator of response after starting iron in a 6-year-old girl with iron deficiency is:

A. Increased reticulocyte count

B. Increased hemoglobin

C. Increased ferritin

D. Increased serum iron

Correct answer : A. Increased reticulocyte count

Sequence of changes during correction of iron deficiency:

 Clinical improvement in the child (increase in appetite, improvement in irritability)

 Inital bone marrow response

 Increased reticulocyte count

 Haemoglobin levels return to normal

 Body iron stores return to normal (ferritin levels)

50. The most common etiological agent for acute bronchiolitis in infancy is:

A. Influenza virus
 PEDIATRIC MCQ
11

B. Para influenza virus

C. Rhinovirus

D. Respiratory syncytial virus

Correct answer : D. Respiratory syncytial virus (It is responsible for more than 50% cases of bronchiolitis)

51. The sodium content of ReSoMal (rehydration solution for malnourished children) is:

A. 90 mmol/L

B. 60 mmol/L

C. 45 mmol/L

D. 30 mmol/L

Correct answer : C. 45 mmol/L

Components of of ReSoMal:

 Glucose 125 mmol/l

 Sodium 45 mmol/l

 Potassium 40 mmol/l

 Chloride 70 mmol/l

 Magnesium 3 mmol/l

 Zinc 0.3 mmol/l

 Copper 0.045 mmol/l

 Citrate 7 mmol/l

52. The requirement of potassium is a child is:

A. 1-2 mEq/kg

B. 4-7 mEq/kg

C. 10-12 mEq/kg

D. 13-14 mEq/kg

Correct answer : A. 1-2 mEq/kg

Daily recommended intake of potassium is 1-2mEq/kg.

53. Which of the following malformation in a newborn is specific for maternal insulin dependent diabetes mellitus?

A. Transposition of great arteries

B. Caudal regression

C. Holoprosencephaly

D. Meningmyelocele

Correct answer : B. Caudal regression

Caudal regression is the most specific anomaly in a child born to a diabetic mother.

54. All of the following may occur in Down’s syndrome except:

A. Hypothyroidism

B. Undescended testis

C. Ventricular septal defect

D. Brushfield`s spots

Correct answer : B. Undescended testis

55. The following are characteristic of autism except:

A. Onset after 6 years of age

B. Repetitive behavior
 PEDIATRIC MCQ
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C. Delayed language development

D. Severe deficit in social interaction

Correct answer : A. Onset after 6 years of age

Features of autism usually appear before 3 years of age. (OP Ghai)

56. Which of the following is the principal mode of heat exchange in an infant incubator?

A. Radiation

B. Evaporation

C. Convection

D. Conduction

Correct answer : C. Convection

57. A 15-year old female presented to the emergency department with history of recurrent epistaxis, hematuria and hematochezia. There was a

history of profuse bleeding from the umbilicus stump at birth. Previous investigations revealed normal prothrombin time, activated partial

thromboplastin time, thrombin time and fibrinogen levels. Her platelet counts as well as platelet function tests were normal but urea clot lysis

test was positive. Which one of the following clotting factor is most likely to be deficient?

a) Factor X

b) Factor XI

c) Factor XII

d) Factor XIII

Correct answer : d) Factor XIII

58. Which one of the following in the characteristic feature of juvenile myoclonic epilepsy?

a) Myoclonic seizures frequently occur in the morning

b) Complete remission is common

c) Response to anticonvulsants is poor

d) Associated absence seizures are present in majority of patients

Correct answer : a) Myoclonic seizures frequently occur in the morning

59. Which of the following haemoglobin (Hb) estimation will be diagnostically helpful in a case of beta thalassemia trait?

a) HbF

b) HbA1c

c) HbA2

d) HbH

Correct answer : c) HbA2

Normal hemoglobin is composed predominantly of HbA1 – which is composed of 2 alpha chains and 2 beta chains. In beta thalassemia trait,

there is decrease in production of beta chains of hemoglobin. But since the defect is minor, they will not have any clinical features and the

peripheral smear may be normal. But there will be a compensatory increase in HbA2 which is composed of 2 alpha chains and 2 delta chains.

Normally HbA2 constitutes about 1.5 to 3.5% of total hemoglobin. But in beta thalassemia trait, this increases to about 3.6 to 8%.

60. Which of the following does not establish a diagnosis of congenital CMV infection in a neonate?

a) Urine culture of CMV

b) IgG CMV antibodies in blood

c) lntra nuclear inclusion bodies in hepatocytes

d) CMV viral DNA in blood by polymerase chain reaction

Correct answer : b) IgG CMV antibodies in blood

 PEDIATRIC MCQ
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Maternal IgG antibodies can pass into fetal circulation. Hence it is not possible to establish a diagnosis of congenital CMV infection in a neonate

just by demonstrating the presence of IgG antibodies

61. All of the following are true of Beta thalassemia major, except:

a) Splenomegaly

b) Target cells on peripheral smear

c) Microcytic hypochromic anemia

d) Increased osmotic fragility

Correct answer : d) Increased osmotic fragility

Osmotic fragility is decreases in Thalassemia. Increased osmotic fragility is seen in hereditary spherocytosis.

62. A 3-year-old boy presents with fever; dysuria and gross hematuria. Physical examination shows a prominent suprapubic area which is dull

on percussion. Urinalysis reveals red blood cells but no proteinuria. Which of the following is the most likely diagnosis?

a) Acute glomerulonephritis

b) Urinary tract infection

c) Posterior urethral valves

d) Teratoma

Correct answer :

c) Posterior urethral valves

Lets analyse the question. There is fever, dysuria and gross hematuria – indicates urinary tract infection. But urinary tract infections are

uncommon in boys unless there is some congenital anomaly of the urogenital tract. Physical examination shows a prominent suprapubic area

which is dull on percussion – due to enlarged bladder – indicating obstruction below the level of bladder. Posterior urethral valve is the most

common cause of obstructive uropathy in a male child.

63. Enzyme replacement therapy is available for which of the following disorders?

a) Gaucher disease

b) Niemann Pick disease

c) Mucolipidosis

d) Metachromatic leukodystrophy

Correct answer :

a) Gaucher disease

Cerezyme is used for treating Gaucher Disease with Enzyme Replacement Therapy. Cerezyme acts like naturally occurring glucocerebrosidases

64. A premature infant is born with a patent ductus arteriosus. In closure can be stimulated by administration of:

a) Prostaglandin analogue

b) Estrogen

c) Anti-estrogen compounds

d) Prostaglandin inhibitors

Correct answer : d) Prostaglandin inhibitors

Normally ductus arteriosus closes soon after birth. Vasodilatory effect of prostaglandin is what maintains the patency of ductus arteriosus in

intrauterine life. Hence in cases of delayed closure of ductus arteriosus, we can use prostaglandin inhibitors to induce its closure.

65. Administration of glucose solution is prescribed for all of the following situations except:

a) Neonates

b) Child of a diabetic mother

c) History of unconsciousness

d) History of hypoglycemia
 PEDIATRIC MCQ
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Correct answer : c) History of unconsciousness

66. All of the following are the complications in the newborn of a diabetic mother except:

a) Hyper bilirubinemia

b) Hyperglycemia

c) Hypocalcemia

d) Hypomagnesemia

Correct answer : b) Hyperglycemia

67. Which organ is the primary site of hematopoiesis in the fetus before midpregnancy?

a) Bone

b) Liver

c) Spleen

d) Lung

Correct answer : b) Liver

Primary site of hematopoiesis in the fetus before midpregnancy is liver.

68. ln SCHWARTZ formula for calculation of creatinine clearance in a child, the constant depends on the following except :

a) Age

b) Method of estimation of creatinine

c) Mass

d) Severity of renal failure

Correct answer : d) Severity of renal failure

Schwartz formula:Creatinine clearance = K x height / creatinine (K = a constant which depends on age, muscle mass and method of creatinine

estimation)

69. The important fatty acid present in breast milk which is important for growth is

a) Docosahexaenoic acid

b) Palmitic acid

c) Linoleic acid

d) Linolenic acid

Correct answer : a) Docosahexaenoic acid

It is required for development of nervous system and vision in the first 6 months of life.

70. Single gene defect causing multiple unrelated problems

a) Pleiotropism

b) Pseudodominance

c) Penetrance

d) Anticipation

Correct answer : a) Pleiotropism

71. A baby presenting with multiple deformities, cleft lip, cleft palate, microcephaly, small eyes, scalp defect and polydactyly. Probable

diagnosis is?

a) Trisomy 13

b) Trisomy 18

c) Trisomy 21

d) Monosomy 2

Correct answer : a) Trisomy 13

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The clinical features are suggestive of Patau syndrome – trisomy 13.

72. All the following can occur in a neonate for heat production except :

a) Shivering

b) Breakdown of brownfat with adrenaline secretion

c) Universal flexion like a fetus

d) Cutaneous vasoconstriction

Correct answer : a) Shivering

73. Best indicator for nutritional status for a child is

a) Mid arm circumference

b) Head circumference

c) Rate of increase of height and weight

d) Chest circumference

Correct answer : c) Rate of increase of height and weight

74. A newborn presents with congestive heart failure, on examination has bulging anterior fontanellae with a bruit on ausculation.

Transfontanella USG shows a hypoechoic midline mass with dilated lateral ventricles. Most likely diagnosis is –

a) Medulloblastoma

b) Encephalocele

c) Vein of Galen malformation

d) Arachnoid cyst

Correct answer : c) Vein of Galen malformation

75. True about cow’s milk are all except :

a) Cow’s milk contains 80% whey protein not casein

b) Cow milk has less carbohydrate than mothers milk

c) Has more K+ and Na+ than infant formula feeds

d) Has more protein than breast milk

Correct answer : a) Cow’s milk contains 80% whey protein not casein

76. A year 6 old child with IQ of 50. Which of the following can the child do?

a) Identify colours

b) Read a sentence

c) Ride a bicycle

d) Copy a triangle

Correct answer : a) Identify colours

77. A 5 year old boy comes with overnight petechial spots 2 weeks back he had history of abdominal pain and no hepatosplenomegaly.

Diagnosis is

a) Acute lymphatic leukemia

b) Aplastic anemia

c) ldiopathic thrombocytopenic purpura

d) Acute viral infection

Correct answer : c) ldiopathic thrombocytopenic purpura

78. Drug of choice for Rheumatic fever prophylaxis in penicillin allergic patient

a) Erythromycin

b) Clindamycin
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c) Vancomycin

d) Gentamycin

Correct answer : a) Erythromycin

79. Drug of choice for Rheumatic fever prophylaxis in penicillin allergic patient

a) Erythromycin

b) Clindamycin

c) Vancomycin

d) Gentamycin

Correct answer : a) Erythromycin

80. A 3 month old child has moderate fever and non productive cough and mild dyspnea. After course of mild antibiotic the condition of the

child improved transiently but he again develops high fever, productive cough and increased respiratory distress. Chest X ray shows

hyperlucency and PFT shows obstructive pattem. Most probable

diagnosis is

a) Alveolar microlithiasis

b) Post viral syndrome

c) Follicular bronchitis

d) Bronchiolitis obliterans

Correct answer : d) Bronchiolitis obliterans

81. A term neonate with unconjugated hyperbilirubinemia of 18 mg/dl on 20th day. All are common causes except :

a) Breast milk jaundice

b) Congenital cholangiopathy

c) G6PD deficiency

d) Hypothyroidism

Correct answer : b) Congenital cholangiopathy

82. Most common cause of Neonatal sepsis in hospitals in India is

a) Escherichia coli

b) Klebsiella

c) Staph aureus

d) Listeria monocytogenes

Correct answer : b) Klebsiella

83. A newborn baby presented with profuse bleeding from umbilical stump after birth. Probable diagnosis is

a) Factor XIII deficiency

b) VWF deficiency

c) Factor XII deficiency

d) Glanzmann thrombosthenia

Correct answer : a) Factor XIII deficiency

84. Most common cause of renal artery stenosis in children in India is

a) Takayasu Aortoarteritis

b) Fibromedial hypertrophy

c) Fibrointimal hyperplasia

d) Polyarteritis Nodosa

Correct answer : a) Takayasu Aortoarteritis

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85. A 3 year old boy with normal developmental milestones with delayed speech and difficulty in communication and concentration. He is not

making friends. Most probable diagnosis is

a) Autism

b) ADHD

c) Mental retardation

d) Specific leaming disability

Correct answer : a) Autism

86. Persistence of Moro’s reflex is abnormal beyond the age of

a) 3rd month

b) 4th month

c) 5th month

d) 6th month

Correct answer : d) 6th month

87. Reflex which is not present in child at birth is

a) Moro’s reflex

b) Symmetric tonic neck reflex

c) Crossed extensor reflex

d) Asymmetric tonic neck reflex

Correct answer : b) Symmetric tonic neck reflex

88. Myopathy is seen in all except

a) X-linked hypophosphatemic rickets

b) Oncogenic osteomalacia

c) Nutritional osteomalacia

d) Cushing syndrome

Correct answer : a) X-linked hypophosphatemic rickets

89. A baby has recently developed mouthing, but has not developed stranger anxiety, likes and dislikes for food. What is the most appropriate

age for this baby?

A. 3 months

B. 5 months

C. 7 months

D. 9 months

Correct answer : 5 months

90. All of the following are good prognostic factors in childhood ALL except?

A. Hyperdiploidy

B. Female sex

C. Pre B cell ALL

D. t(12:21) translocation

Correct answer : Pre B cell ALL