Pediatrics MCQs (With Explanations)

Pediatrics Demo Test With Explanations

Q 01: Which of the following congenital heart conditions is characterized by a distinctive boot-shaped heart appearance on X-rays in a 7-year-old patient? (Question Id: 652002)

Atrial Septal Defect (ASD)

Transposition of the Great Arteries (TGA)

Tetralogy of Fallot (TOF)

Turner Syndrome (Turner's)

(Option C) Tetralogy of Fallot (TOF): Tetralogy of Fallot is a congenital heart defect that involves four distinct abnormalities within the heart's structure. One of the characteristic features of TOF is the "boot-shaped" heart appearance on X-rays. This is due to the combination of several structural issues within the heart, including:

Ventricular Septal Defect (VSD): This is a hole in the wall that separates the two lower chambers (ventricles) of the heart. It allows oxygen-rich and oxygen-poor blood to mix, which can lead to reduced oxygen levels in the body.
Pulmonary Stenosis: This refers to the narrowing or constriction of the pulmonary valve or the pulmonary artery. This narrowing obstructs the flow of blood from the right ventricle to the lungs, leading to reduced blood flow to the lungs for oxygenation.
Right Ventricular Hypertrophy: The right ventricle becomes thicker and more muscular because of working harder to pump blood against the narrowed pulmonary valve. This can contribute to the distinctive "boot-shaped" appearance on X-rays.
Overriding Aorta: In TOF, the aorta, which is normally connected to the left ventricle, is positioned in such a way that it partially overrides the ventricular septal defect. This allows oxygen-poor blood from the right ventricle to be pumped into the aorta and distributed to the body.

(Option A) Atrial Septal Defect (ASD): An ASD is a hole in the wall between the two upper chambers (atria) of the heart. This would not typically lead to a boot-shaped heart appearance on X-rays.

(Option B) Transposition of the Great Arteries (TGA): TGA is a condition where the positions of the two main arteries, the aorta and the pulmonary artery, are switched. This results in two separate circulatory systems—one for oxygen-poor blood and one for oxygen-rich blood. While TGA can cause significant health issues, it doesn't typically result in a boot-shaped heart appearance on X-rays.

(Option D) Turner Syndrome (Turner's): Turner Syndrome is a genetic disorder that affects females and is caused by the absence or abnormality of one of the X chromosomes. While it can be associated with certain heart defects, it is not specifically known for causing a boot-shaped heart appearance on X-rays.

Subject: Pediatrics

System: CVS

Topic: Congenital Heart Disorders

Congenital Heart Disorders are structural and functional abnormalities of the heart that exist at birth. These conditions result from irregular development during fetal growth and can impact the heart's chambers, valves, or major blood vessels. These disorders can vary widely in severity, ranging from minor issues that may not require treatment to complex and life-threatening conditions. Common examples include Ventricular Septal Defects (VSDs), Atrial Septal Defects (ASDs), Tetralogy of Fallot, and Transposition of the Great Arteries.

Disorder	Description	Key Features
Atrial Septal Defect (ASD)	Hole in the wall between the heart's upper chambers	Asymptomatic, heart murmur, fatigue, shortness of breath
Ventricular Septal Defect (VSD)	Hole in the wall between the heart's lower chambers	Heart murmur, poor weight gain, respiratory infections
Tetralogy of Fallot (TOF)	Combination of four heart abnormalities	Cyanosis, heart murmur, squatting posture, clubbing of fingers
Transposition of the Great Arteries (TGA)	Reversal of the connections of the two main arteries	Cyanosis, heart murmur, poor feeding, breathlessness
Coarctation of the Aorta	Narrowing of the aorta, the major blood vessel	High blood pressure in arms, weak pulses in lower body
Hypoplastic Left Heart Syndrome (HLHS)	Underdeveloped left side of the heart	Cyanosis, rapid breathing, poor feeding, cold extremities
Patent Ductus Arteriosus (PDA)	Persistence of a fetal blood vessel that should close after birth	Heart murmur, increased heart rate, respiratory issues
Ebstein's Anomaly	Malformation of the tricuspid valve	Cyanosis, heart murmur, arrhythmias, enlarged heart
Tricuspid Atresia	Absence of the tricuspid valve	Cyanosis, poor growth, difficulty breathing, heart murmur
Pulmonary Stenosis	Narrowing of the pulmonary valve	Heart murmur, cyanosis, fatigue, fainting
Hypoplastic Right Heart Syndrome	Underdeveloped right side of the heart	Cyanosis, difficulty breathing, poor growth, weak pulses
Total Anomalous Pulmonary Venous Connection (TAPVC)	Abnormal connections of the pulmonary veins to the heart	Cyanosis, difficulty breathing, poor feeding, heart murmur

Q 02: A 5-year-old boy has been brought to the outpatient department (OPD) due to complaints of increased frequency of urination and heightened appetite persisting for the past four months. During the examination, the child appears thin and emaciated. What is the most suitable initial investigation in this case? (Question Id: 653001)

Arterial blood gases

Blood sugar

Chest x-ray

Complete blood count

(Option B) Blood sugar: A blood sugar test is used to measure the amount of glucose (sugar) in the blood. This test is relevant as the patient is presenting with symptoms of increased appetite and weight loss. These symptoms may indicate hyperglycemia (high blood sugar), which can be indicative of diabetes.

(Option A) Arterial blood gases: Arterial blood gases are used to measure the oxygen and carbon dioxide levels in the blood. They are not relevant as the patient is presenting with symptoms of increased micturition and increased appetite, which are not indicative of respiratory distress or failure.

(Option C) Chest x-ray: A chest x-ray is used to visualize the structures within the chest, including the lungs and heart. This test is not relevant as the patient is not presenting with symptoms of respiratory distress or cardiovascular disease.

(Option D) Complete blood count: A complete blood count is used to measure the number of red blood cells, white blood cells, and platelets in the blood. This test is not relevant as the patient is presenting with symptoms of increased micturition and increased appetite, which are not indicative of a hematological disorder.

Subject: Pediatrics

System: Endocrine

Topic: Pediatric Diabetes

Aspect	Description
Definition	Diabetes in children and adolescents.
Types	Type 1 Diabetes: Autoimmune condition where the immune system destroys insulin-producing beta cells in the pancreas. Type 2 Diabetes: Often associated with obesity and insulin resistance. Less common in children but becoming more prevalent.
Symptoms	Increased thirst Frequent urination Increased hunger Weight loss (despite increased appetite) Fatigue Blurred vision Slow wound healing
Diagnosis	Fasting blood sugar test Oral glucose tolerance test Hemoglobin A1c test Random blood sugar test
Management	Insulin therapy (Type 1) Lifestyle modifications (diet and exercise) Oral medications (Type 2, if needed) Blood sugar monitoring Regular medical check-ups
Complications	Hypoglycemia (low blood sugar) Hyperglycemia (high blood sugar) Diabetic ketoacidosis (DKA) Long-term complications: kidney disease, eye problems, nerve damage, cardiovascular issues
Prevention	Type 1 diabetes cannot be prevented. Type 2 diabetes prevention includes maintaining a healthy weight and lifestyle.

Q 03: A 2- month-old male infant has come to your hospital with a history of repeated non - bilious vomiting after feeds for two weeks. On examination, there is visible peristalsis after a feed. You diagnose him with infantile pyloric stenosis and schedule him for surgery. What is the next most important step in pre-operative resuscitative measures? (Question Id: 655015)

Build nutrition per oral

Correction of fluid and electrolytes IV

Nasogastric decompression

Correcting acid-base imbalance

(Option B) Correction of fluid and electrolytes IV: This is the most important step in pre-operative resuscitative measures for an infant with pyloric stenosis. The repeated vomiting has likely caused dehydration and electrolyte imbalances in the baby. Intravenous (IV) fluids are essential to rehydrate the infant and correct any imbalances in electrolytes such as sodium, potassium, and chloride. Stabilizing the baby's fluid and electrolyte levels is crucial before proceeding with surgery to ensure the baby is in the best possible condition for the operation.

(Option A) Build nutrition per oral: This option is not the most important step in pre-operative resuscitative measures for an infant with infantile pyloric stenosis. The baby is experiencing repeated non-bilious vomiting after feeds, which indicates a blockage at the pylorus (the outlet of the stomach). Trying to feed the baby orally at this stage may exacerbate the vomiting and lead to further dehydration and electrolyte imbalances.

(Option C) Nasogastric decompression: Nasogastric decompression involves inserting a tube through the baby's nose and into the stomach to remove any accumulated air and fluid. While this can be helpful in relieving immediate discomfort and reducing the risk of aspiration, it is not the most important step in pre-operative resuscitative measures. Fluid and electrolyte correction takes priority in this situation.

(Option D) Correcting acid-base imbalance: Acid-base imbalances may occur due to the repeated vomiting and loss of fluids. While addressing acid-base imbalances is important, it is not the immediate priority. Fluid and electrolyte correction is more critical to stabilize the baby's condition before surgery.

Subject: Pediatrics

System: GIT

Topic: Infantile Pyloric Stenosis Resuscitative Measures

Topic	Description
Definition	Infantile Pyloric Stenosis is a condition in which there is a narrowing or obstruction of the pylorus, the opening between the stomach and the small intestine, leading to difficulty in stomach emptying.
Age of Onset	Typically occurs in the first few weeks to months of life, most commonly between 3 to 6 weeks of age.
Presentation	Non-bilious projectile vomiting after feeds.
	Visible peristalsis (wave-like movements) of the stomach.
	Persistent hunger and irritability.
Diagnosis	Clinical evaluation and physical examination.
Diagnosis	Ultrasound of the abdomen is often used to confirm the diagnosis.
Treatment	Surgical intervention (pyloromyotomy) is the primary treatment.
Treatment	Intravenous (IV) fluids may be administered preoperatively to correct dehydration and electrolyte imbalances.
Complications	Dehydration and electrolyte imbalances.
	Failure to thrive.
	Metabolic alkalosis due to vomiting.

Q 04: An 8-year-old boy presents to the emergency room with a one-day history of fever (39°C) and drowsiness. Upon examination, he exhibits neck rigidity. A lumbar puncture is performed, and Gram's stain of the cerebrospinal fluid (CSF) reveals the presence of numerous pus cells and cocci. Which of the following organisms is the most likely causative agent? (Question Id: 661009)

Neisseria gonorrhoeae

Neisseria menigitidis

Streptococcus pyogenes

Staphylococcus aureus

(Option B) Neisseria menigitidis: Neisseria meningitidis is a gram-negative diplococcus bacterium and a common cause of bacterial meningitis, especially in children and young adults. The clinical presentation of fever, drowsiness, and positive neck stiffness is consistent with meningitis.

(Option A) Neisseria gonorrhoeae: Neisseria gonorrhoeae is also a gram-negative diplococcus, but it is primarily responsible for sexually transmitted infections, particularly gonorrhea. It is not a common cause of meningitis, especially in children.

(Option C) Streptococcus pyogenes: Streptococcus pyogenes, also known as Group A Streptococcus, is a gram-positive bacterium that causes various infections, including strep throat and skin infections. While it can cause invasive diseases such as cellulitis and necrotizing fasciitis, it is not a common cause of meningitis.

(Option D) Staphylococcus aureus: Staphylococcus aureus is a gram-positive bacterium responsible for various infections, including skin and soft tissue infections, pneumonia, and bloodstream infections. It can rarely cause meningitis, but it is not as common as Neisseria meningitidis.

Subject: Pediatrics

System: Infectious Disease

Topic: Pediatric Bacterial Meningitis

Aspect of Pediatric Bacterial Meningitis	Description
Definition	Inflammation of the meninges (the protective membranes covering the brain and spinal cord) caused by bacterial infection in pediatric patients.
Common Causative Bacteria	Streptococcus pneumoniae (pneumococcus) Neisseria meningitidis (meningococcus) Haemophilus influenzae type b (Hib) Group B Streptococcus (GBS) in neonates
Age Group Affected	Infants, children, and adolescents, but it can occur at any age.
Clinical Presentation	Fever Headache Neck stiffness (positive neck rigidity) Irritability Vomiting Seizures Altered mental status
Diagnosis	Lumbar puncture (CSF analysis: elevated white blood cells, decreased glucose, elevated protein) Blood cultures Imaging (CT or MRI) to assess for complications
Treatment	Prompt initiation of antibiotics (based on suspected pathogen and local resistance patterns) Supportive care (IV fluids, pain management, anticonvulsants) Hospitalization often required
Complications	Brain abscess Hydrocephalus Hearing loss Neurological deficits Death if untreated or delayed treatment
Prevention	Vaccination (Hib, pneumococcal, meningococcal vaccines) Prophylactic antibiotics for close contacts of meningococcal cases

Q 05: A 6-month-old boy is brought to the emergency room due to a three-day history of cough, congestion, low-grade fever, and reduced feeding. Upon examination, the infant appears pale with a temperature of 100°F, a pulse rate of 170/min, a respiratory rate of 80/min, and an oxygen saturation of 88%. Nasal flaring, intercostal and subcostal retractions, and diffuse wheezing are observed upon auscultation. Cardiovascular examination reveals tachycardia with no murmurs. Which of the following is the most appropriate initial step in the management of this patient? (Question Id: 655007)

Initiate oxygen therapy

Administer normal saline

Provide Dextrose Water

Administer a bronchodilator such as albuterol

(Option A) Initiate oxygen therapy: This is the correct initial step. The infant has a low oxygen saturation of 88%, indicating that he is not getting enough oxygen. The presence of nasal flaring, retractions, and wheezing suggests respiratory distress. Oxygen therapy will help improve oxygenation and alleviate respiratory distress, which is crucial in this situation.

(Option B) Administer normal saline: Normal saline is typically used for rehydration and would not address the immediate issue of low oxygen saturation and respiratory distress. While rehydration may be necessary in some cases, it is not the first step in this scenario.

(Option C) Provide Dextrose Water: Dextrose water is a solution of glucose and water and is typically used for hydration or as a source of energy. It is not indicated as the initial step in the management of a patient with respiratory distress and low oxygen saturation.

(Option D) Administer a bronchodilator such as albuterol: Bronchodilators like albuterol are used to treat conditions like asthma or bronchiolitis, but their use should be guided by a proper assessment of the patient's condition. In this case, the primary concern is the low oxygen saturation, and oxygen therapy should be initiated first. The use of bronchodilators may be considered later if there is evidence of bronchoconstriction or wheezing after initial stabilization with oxygen.

Subject: Pediatrics

System: Respiratory

Topic: Pediatric Respiratory Distress

Aspect	Description
Definition	Pediatric respiratory distress refers to a condition in which a child experiences difficulty breathing, which may manifest as increased work of breathing and decreased oxygen saturation.
Common Causes	Infections (e.g., bronchiolitis, pneumonia)
	Asthma exacerbations
	Foreign body aspiration
	Allergic reactions
	Congenital heart defects
Clinical Presentation	Tachypnea (increased respiratory rate)
	Retractions (visible sinking of the skin between the ribs, above the collarbone, and below the ribcage during inhalation)
	Nasal flaring
	Grunting (a sound made during exhalation)
	Wheezing or stridor (high-pitched sounds heard during breathing)
	Cyanosis (bluish discoloration of the skin and mucous membranes) if severe
Diagnosis	Clinical assessment
	Pulse oximetry to measure oxygen saturation
	Chest X-ray (if indicated, to identify structural issues or pneumonia)
Management	Administer supplemental oxygen
	Address the underlying cause (e.g., antibiotics for infections, bronchodilators for asthma)
	Provide fluids if there's dehydration
	Sometimes mechanical ventilation may be necessary in severe cases

Q 06: A 6-month-old infant presents with developmental delay, hypotonia, and a cherry-red spot on fundoscopy. Which genetic disorder should be suspected? (Question Id: 667001)

Cystic fibrosis

Phenylketonuria (PKU)

Niemann-Pick disease type A

Tay-Sachs disease

(Option D) Tay-Sachs disease: Tay-Sachs disease is a rare genetic disorder that primarily affects the nervous system. It is characterized by the accumulation of GM2 ganglioside in cells, leading to progressive neurological degeneration. Infants with Tay-Sachs disease often have developmental delay, hypotonia (weak muscle tone), and a cherry-red spot on fundoscopy, which is a characteristic finding. Unfortunately, Tay-Sachs disease is a severe condition with no cure, and affected individuals typically do not survive beyond early childhood.

(Option A) Cystic fibrosis: Cystic fibrosis is a genetic disorder that primarily affects the respiratory and digestive systems, leading to thick mucus production and respiratory symptoms, as well as digestive issues. It does not typically present with developmental delay, hypotonia, or a cherry-red spot on fundoscopy.

(Option B) Phenylketonuria (PKU): Phenylketonuria is a metabolic disorder caused by the inability to break down the amino acid phenylalanine. It can lead to intellectual disability if left untreated but usually presents with symptoms related to metabolism rather than hypotonia and a cherry-red spot on fundoscopy.

(Option C) Niemann-Pick disease type A: Niemann-Pick disease type A is a lysosomal storage disorder characterized by the accumulation of sphingomyelin in cells. It can lead to hepatosplenomegaly, neurological symptoms, and developmental delay, but it typically does not present with a cherry-red spot on fundoscopy.

Subject: Pediatrics

System: Genetics

Topic: Pediatric Genetic Disorders

Some common Pediatric Genetic Disorders

Genetic Disorder	Description	Key Features and Symptoms	Treatment/Management
Down Syndrome	Trisomy 21, chromosomal disorder	Intellectual disability, facial features, heart defects	Early intervention programs, medical management of associated conditions
Cystic Fibrosis	Autosomal recessive disorder	Respiratory issues, digestive problems, salty skin	Airway clearance techniques, medications, lung transplant (in severe cases)
Phenylketonuria (PKU)	Autosomal recessive disorder	Intellectual disability, musty odor, dietary phenylalanine control	Low-phenylalanine diet, medical supervision, dietary management
Tay-Sachs Disease	Autosomal recessive disorder	Neurodegeneration, cherry-red spot on the retina, hypotonia	Supportive care, symptomatic treatment, no cure
Duchenne Muscular Dystrophy	X-linked recessive disorder	Progressive muscle weakness, difficulty walking, heart problems	Physical therapy, corticosteroids, supportive care
Spinal Muscular Atrophy (SMA)	Autosomal recessive disorder	Muscle weakness, difficulty breathing, loss of motor function	Disease-modifying therapies, respiratory support
Cystic Fibrosis	Autosomal recessive disorder	Respiratory issues, digestive problems, salty skin	Airway clearance techniques, medications, lung transplant (in severe cases)
Sickle Cell Anemia	Autosomal recessive disorder	Anemia, pain crises, organ damage	Blood transfusions, pain management, hydroxyurea
Marfan Syndrome	Autosomal dominant disorder	Tall stature, long limbs, heart defects	Regular check-ups, surgical intervention, medications
Neurofibromatosis (NF1)	Autosomal dominant disorder	Café-au-lait spots, neurofibromas, learning disabilities	Monitoring, surgical removal of tumors, management of symptoms

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