Professional Documents
Culture Documents
Amc Pediatrics 2005 To 2009
Amc Pediatrics 2005 To 2009
2005
Photograph 9: A young child with a patch of hair loss on the scalp. Some small flakes of
skin are present. What is your diagnosis?
a) Tinea
b) Psoriasis
c) Alopecia areata
d) Trichotillomania
e) SLE
Ans: A.
* A 15 months old child was found with ambiguous genitalia, while in karyotype analysis
46xy was diagnosed. WOF is the next appropriate IX?
2|PEDS ps
a) X- ray
b) 17 hydroxy progesterone---increased in Congenital Adrenal Hyperplasia
c) CT Scan
d) US of pelvic region
e) Testosterone level
Ans: B.
An 8-year-old boy presents with photophobia, irritability & neck stiffness. Lumbar
puncture findings show 50 neutrophils, 100 lymphocytes, proteins normal, glucose
normal. Which is the most likely diagnosis?
a) Tuberculosis meningitis
b) H. influenza
c) Echo virus
d) E. Coli
e) HSV encephalitis
Ans: E.
*A 5 month old baby unwell for a week is noticed by his parents to have episodes of
leaning forward and shaking his arms. His parents are concerned, because he is not
responding as he used to. What is the likely cause?
a) Infantile spasm
b) Febrile seizures
c) Breath holding spells
d) Infantile myoclonic seizures
e) Petit mal epilepsy
Ans: D.
These are generalised tonic seizures with sudden flexion of the arms, forward flexion of the
trunk and extension of the legs, lasting only a few seconds, with usual age onset between 3
and 7 months. They are usually restricted to the first 3 years of life and are replaced by
other forms of attacks. Prognosis for cognitive development is also unfavourable. The most
effective therapy is corticotrophin (ACTH) IM injection. Otherwise, oral prednisolone or
valproate can be used.
A 2 month old child has strawberry naevus on its back between the scapulae, 2 cm in size.
What is the most appropriate management?
a) Cryotherapy
b) Laser therapy
c) Observation
d) Injection of a sclerosing agent
e) Simple excision
ANS: Observation
Salmon patch also regresses automatically but port wine doesn’t regress automatically.
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A child with perorbital oedema and anararca, BP is normal. All of the following are true,
except?
Ans: C.
A fully breast feed baby, from a mother on a healthy, balanced diet, can have deficiency of
which vitamin?
a) Vitamin A
b) Vitamin B complex
c) Vitamin C
d) Vitamin D
e) Vitamin K
Ans: Vitamin K.
Vitamin k excess cause hemolysis, k deficiency cause bleeding, vitamin E deficiency causes
hemolysis.
(Kaplan p.23)
You can see an infant with subdural haematoma, bruising and multiple subperiosteal
sclerosing zones on x-ray of the limbs. What do you first think of?
a) Rickets
b) Vitamin C deficiency
c) Pagets disease
d) Non accidental injury
e) Haemophilia
Ans: Abuse
An 8-week-old baby presents with unilateral sticky eye. Similar episode before was
treated with antibiotics for 3 days and resolved. What is the most likely diagnosis?
a) Gonococcal conjunctivitis
b) Allergic conjunctivitis
c) Inadequate antibiotic treatment
d) Decreased Ig A in the tears
e) Blocked naso-lacrimal duct
Ans: E.
A neonate was born at full term with a birth weight of 1500 grams, was jittery on handling
noticed to have cyanosis on the hands & feet. The infant had normal temparature;
respiratory rate 40/min and lung & heart were normal on examination. The neonate has
been given oxygen. Which of following is your step in management?
Ans: D.
A child was recently vaccinated for polio, now presents with 1-week history of fever,
flaccid paralysis of both lower limbs with no reflexes. The most likely diagnosis is?
Ans: GB
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Which of the following is the least likely cause of iron deficiency anaemia in children?
a) Cows milk
b) Thalassemia
c) Prematurity
d) Coeliac disease
e) Multiple pregnancy (e.g. Twins)
Ans: C.
*A baby delivered by normal vaginal delivery, is well after birth. On the 4th day, the baby
is found collapsed in the cot, breathless and floppy. On examination there are no
murmurs. Possible cause could be -- ***
a) TOF
b) PDA
c) TGA with VSD
d) Pulmonary stenosis
e) L. Ventricular Hypertrophy
Ans: …………………………..
A 9-day-old baby with projective vomiting and dehydration with K 7.1, Na 125, Cl 80, &
HCO3 20. What is your diagnosis:
a) Pyloric stenosis
b) Dlactosemia
c) Sepsis
d) Hypoglycaemia
e) Congenital adrenal hypertrophy
Ans: E
A child with profuse diarrhoea for 5 days develops convulsions. Which of the following
blood test results would most likely cause this convulsion?
a) K 2.2
b) K 6.5
c) Na 132
d) Na 156
e) Cl 100
Ans: D.
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A 37-year-old female gives birth to her 2nd child. At the 10th day the child becomes
jaundiced. His mother tells the doctor that her first child had jaundice after birth and then
developed bilateral cataract after the jaundice. What is the diagnosis?
a) Congenital rubella
b) Neonatal hepatitis
c) Diabetes Mellitus
d) Syphilis
e) Galactosaemia
A child has trouble seeing the black board at school, but no problems when using the
computer. His vision is improved with pinhole test. What is your diagnosis?
a) Myopia
b) Hypermetropia
c) Cataract
d) Glaucoma
e) ?
Ans: A.
A child with headache and morning vomiting, ataxia and nystagmus for 6 weeks. His
school had a Chicken Pox 2 weeks ago. He has a family history migraine. What is the most
probable diagnosis?
a) Migraine
b) Varicella cerebellitis
c) Infratentorial Tumour
d) Friedrich’s ataxia
e) ?
Ans: C.
In child dizziness, headache, vomiting indicates posterior fossa tumor until proved
otherwise. (JM: Headache)
Chicken pox: The incubation period is typically 10-14 days, although it may extend to 21
days.
Chickenpox encephalitis classically presents with ataxia 3 to 4 days after onset of the rash,
but may sometimes present after 8 days.
The cerebellum is most commonly affected, but in some cases the cerebrum is involved, in
which case the prognosis is worse.
8|PEDS ps
80% make a full recovery, although there is a significant mortality and some are left with
morbidity such as mental retardation and seizures. Cerebellar ataxia specifically seen during
the recovery period. Most common clinical features tremor ataxia and nystagmus.
In Down’s syndrome, aside from the cardiac complications, all of the following are
associated with Down’s syndrome, except-
a) Acute leukaemia
b) Myopia
c) Hypothyroidism
d) Vesicoureteric reflux***
e) Deafness
f) Alzheirmer’s disease
Ans: D.
http://emedicine.medscape.com/article/943216-overview
A 15-month-old child is brought to you by his parents. He was born at 36 weeks by normal
vaginal delivery. At 8 months a mother child health centre test for hearing was done,
which was normal. The parents say that he babbles, but does not speak 2-3 word phrases
yet. On physical examination, the child appears normal. What will you do?***
Ans: Reassure.
A mother notices a lump in the right groin of her 2-year-old son, which disappeared after a
few hours. Despite a thorough examination you are unable to discover anything. The most
appropriate management would be?
(JM p.1089)
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An 8-year-old boy was stung by a bee. He had difficulty breathing and facial oedema.
What is the best treatment?
A child has tenderness & pain at upper tibia of the left leg and swelling of the knee which
is warm. He is febrile (39 degrees Celsius) and gets pain at 30 degrees flexion. What is your
diagnosis?
a) Osteomyelitis
b) Osteosarcoma
c) Septic arthritis
d) Fracture tibia
e) Irritable hip (Transient synovitis)
f) Thrombophlebitis/Cellulitis
Ans: Osteomyelitis.
Septic arthritis can be difficult to diagnose in the early stages of progression. Once
purulence has developed and a bulging effusion is noted, diagnosis is made easily. Typically,
the patient presents with fever and a joint that is hot, red, painful, distended, and has a
markedly decreased range of motion. Restriction of movement occurs to active and passive
attempts.
A 2-year-old child presents with a clean superficial laceration on the forehead. The child
has never been immunized. What is the most appropriate management?
a) Give antibiotics
b) Tetanus Toxoid***
c) Tetanus Immunoglobin
d) DTP vaccination***
e) Reassure & send home
Ans: D.
Contraindications:
2. Previous anaphylactic
reaction.
3. Encephalopathy within 7
5. Immunocompromised
eg. Chemotherapy or
corticosteroids more
than 2mg/kg/day.
6. OPV household
contacts
immunocompromised
7. MMR/Vericella: within
3 months of giving
blood products.
months apart.
All adult should receive an ADT every 10 years.
All women in their childbearing age should have their Not contraindication:
MMR antibody status reviewed.
1. Simple febrile convulsion in
Influenza vaccine annual basis: Chronic cardiac,
pulmonary, kidney, metabolic diseases, persons over the past or pre existing
65years and
Aboriginal over 50. neurological disease is not
Pneumococcal vaccine same as influenza.
a contraindication for
Hepatitis to high risk group.
Q fever vaccine for abattoir worker. pertusis
vaccine.
11 | P E D S ps
Ans: A.
Transient synovitis or irritable hip is the most common cause of hip pain and limp in
childhood. (JM p.697)
A 2-week-old baby gained 200 grams/week since birth. The mother complaints that the
child vomits milk soon after feeding, otherwise okey. What will you do?***
(GORD JM p.515)
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A child was born premature(30 weeks gestation), via vaginal delivery. APGAR 5 at 1 min. &
8 at 5 min. At 18 months, the child is brought by the mother with moderate mental
retardation. Which family history would be likely cause of the mental retardation?
Ans: A.
A 4-year-old child presents with sudden onset of cough, unilateral wheeze and decreased
respiratory movement on one side. There is no family history of atopy. What is the most
appropriate management?
a) Chest X ray
b) Full blood examination
c) CT of chest
d) Ultrasound
e) Inspiratory & expiratory chest X ray
An obese 8 yrs. Old boy came to you. O/E his weight was 48 kg, which is more than 98th
percentile and the height was 140 cm, which is more than 90th percentile, otherwise
normal. WOF is correct in relation to this boy---
Diabetes in this age group is IDDM and usually associated polyuria, polydipsia and weight
loss.
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(Kaplan Pedia)
Some relevant questions from Pre-test about Bone age and Chronological age: (frequently
asked topics)
430. A 13-year-old boy is below the third percentile for height (fiftiethpercentile for age
9). Which of the following would give him the best prognosis for normal adult height?
(Pediatrics Pre-test: p.294)
1776–1780, 1790–1791. Rudolph, 21/e, p 2015–2017, 2094.) The determination of bone age
by the radiographic examination of ossification centers provides a measure of a child’s
level of growth that is independent of his or her chronologic age. Height age is the age that
14 | P E D S ps
corresponds to the fiftieth percentile for a child’s height. When bone age and height age are
equally retarded several years behind chronologic age, a child is described as having
constitutional short stature. Such a child is usually shorter than peers in adolescence
because of the delayed growth spurt, but the prognosis for normal adult height is
excellent because there is still the potential for growth. Detailed questioning will usually
identify other family members with a history of delayed growth and sexual maturation but
with ultimately normal stature. Children with genetic or familial short stature grow at an
adequate rate, but remain small throughout life; their ultimate height is consistent with
predictions based on parental heights. Bone age is within the limits of normal for
chronologic age, and puberty occurs at the normal time. In all cases, a thorough history and
physical examination are necessary to identify any other cause of growth delay.
434. Bone age will be advanced in short stature caused by which of the following?
(Pediatrics Pre-test: Page: 295)
434. The answer is d. (Behrman, 16/e, pp 59–60, 1675–1680, 1698–1704, 1729–1736, 1738.
McMillan, 3/e, pp 1776–1780. Rudolph, 21/e, pp 7–9, 466, 2017–2021, 2038–2042, 2045.)
The appearance and union of the various centers of ossification follow a fairly definite
pattern and time schedule from birth through adolescence. This process provides, through
x-ray studies, a valuable criterion for estimating normal and abnormal growth. The skeletal
maturity of any person is known as the bone age. Bone maturation is particularly influenced
by the androgenic and estrogenic hormones. In congenital adrenal hyperplasia, a deficiency
of enzyme (21-hydroxylase in 80% of cases) causes an interruption in the pathway for
production of cortisol; the end result is hypersecretion of androgenic precursors and clinical
manifestations of virilism and protein anabolism. In both males and females, muscles are
well developed and there is rapid growth in stature, with marked acceleration of osseous
maturation. The result is early closure of epiphyses and failure to achieve full growth.
Thyroid hormone appears to act as a primary stimulant to skeletal maturation. Deficiency of
thyroxine results in marked retardation of bone age. Failure to thrive as a consequence of
profound environmental deprivation is characterized by very low levels of circulating
pituitary hormones and is associated with a delay in skeletal maturation. Removal of the
child from the abnormal environment results in dramatic catch-up growth and a rapid
return of hormone levels to normal. Glucocorticoid excess, either endogenous or
exogenous, is usually associated with a decrease in the rate of growth and a delay in the
onset of puberty, the exception being a case of glucocorticoid excess resulting in significant
virilization and rapid closure of growth plates. The effects of glucocorticoid excess appear to
be mediated at end-organ sites as part of the catabolic effects of these steroids.
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A baby is born a normal full term delivery. On examination of the newborn, which of the
following may normally be seen?
A mother brings her baby who is babbling and squeaking, is able to hold his head, move
from prone to supine position, is able to sit up unsupported, can reach for objects and
when supported, can stand and bounce. What is the possible age of this child?
a) 5 weeks
b) 2 weeks
c) 7 months
d) 10 months
e) 12 months
During 12 weeks of pregnancy Ultrasound shows nuchal thickness of the fetus. Keriotype
also done. Now your advice should be---
Ans: A.
Nuchal scan is performed between the 11th and 13th week of gestation, because the
accuracy is best in this period
After a difficult forceps delivery, it is noticed that the baby hangs his arm to the side, and
cannot move it. What is the likely cause?
a) Fracture humerus
b) Erbs palsy
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Ans: C 5,6,
C 8, T1 Klampke.
Six week old child initially was normal but after 3 wks she was not sucking milk. She
appeared as a floppy child, which was progressively getting worse. WOF is your diagnosis--
a) Botulism
b) Werdnig-hoffman disease(spinal muscular atrophy)
c) Cerebral pulsy
d) Myasthenia gravis
e)
Ans: A.
A 6 week old infant vomiting intermittently since birth. She looks thin, not gaining weight.
No abnormality on physical examination. What is your Dx : ***
a) cystic fibrosis
b) pyloric stenosis
c) subdural haematoma
d) phenyl ketonuria
e) regurgitation
f) UTI
Ans: E
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2006
Photo: A child with rash on the buttocks and legs .Both ankles swollen and tender, also
abdominal pain, but no fever. No neck stiffness.WOF is most common major complication-
(Dx:HS purpura ;AMC-286)
a. Nephritis
Photo: X-ray chest of a 8 months old infant with opacity in Rt lower zone and
pneumatoceles (Staph. Pneumonia).Rx- (AMC: Fig-119)
I/V Flucloxacillin
Photo: X-ray chest of a 9 months old infant as shown in AMC book (page-119). What is the
Dx? Staph. Pneumonia (But most common in this age group is Streptococcus pneumonia)
A baby has jaundice just after delivery. Mother is Rh –ve, baby also Rh –ve. Coomb’s Test
is –ve. What may be the Dx?
a. Autoimmune condition
b. ABO incompatibility
c. Rh incompatibility
Jaundice 1st day is pathological. Day 2 to day 7: may be pathological and the Br doesn’t go
beyond 12.5 to 15. Beyond 1 week it can be breast milk jaundice.
b. Cervical dilatation
c. Position relation to ischial spine
d. Moulding of the head
e. Cervical effacement
Notes:
Child with her mother in a Supermarket picked a packet of Balloon. His mum snatched it &
kept in place. The child started crying and at one stage he became unconscious but regain
consciousness within 45 seconds.WOF may be the cause-
a. Petitmal epilepsy
b. infantile spasm
c. Breath holding attack
d. Complex partial seizure
e. Grand mal seizure
Ans: C.
Six month old infant was brought by his parents. He had funny turns, sudden flexion of
upper and lower limbs for one week. Previously he had coryzal illness. Now child is not
responding like previously. Dx-
Infantile spasm: age- 4 to 8 months occurs during sleep or initial arousal. Presentation: Brief
symmetrical contraction of neck, trunk and extremities. Types: flexors, extensors or mixed.
EEG shows: Hypsarrhythmia. Treatment: ACTH and Prednisolone.
Ans: Meningitis
Mother came with her 3 month old baby, she told you that her baby cries a lot at evening
time. Mother wants to know does the baby cry when he becomes hungry or any other
cause and what she needs to do when her baby cries.
Colic or unexplained crying: self limited and benign condition and etiology is unexplained.
Gentle rocking movement, vibration, riding in a car can be helpful. See page 25 Kaplan
USMLE.
RHP p.149
A 3 yrs old child came with her mother. The child has been suffering an attack usually once
in a month. The attack lasts for 2-3 minutes and during the attack she is seen in spinning.
She does not loose conscious during that, but feels frightened & runs to her mother’s lap
for comfort.WOF is your Dx:
19 | P E D S ps
Ans: simple partial seizures. There is always loss of consciousness in complex partial seizures
along with automatism (Verbal or Motor). Benign positional vertigo is due to sudden change
in the head position causing vertigo.
An 11 yr old boy has difficulty climbing stairs and walking & running. O/E there is
weakness of both legs and loss of reflexes. All other examinations are normal.WOF
investigations will confirm the Dx?
a. CSF analysis
b. Forced vital capacity
c. MRI
d. Nerve conduction study
e. X-ray
Ans: Diagnosis is Gullianbarre syndrome also known as acute post infectious neuropathy
causing demyelination of motor and sensory nerves. Rubbery legs and areflexia are the
initial symtoms.
Infectious etiology: Campylobacter Jejuni, Mycoplasma Pneumoni, usually occurs 10 days
after viral infection.
Treatment: Glucocorticoids, IVIG and plasmapheresis. See page: 228 Kaplan USMLE.
An infant presents with a typical crowing noise on inspiration. The noise is more
noticeable on crying. There is no cough.WOF is the Dx-
a.Croup
b. Laryngomalacia
c. Bronchiolitis (Forrest-596 OHCS-558)
Ans: Croup is usually associated with typical inspiratory stridors and seal like coughing,
occurs in 3months to 5 years age group due to viral infection. Bronchiolitis is not associated
with stridor.
Laryngomalacia: http://emedicine.medscape.com/article/1002527-overview
(Kaplan p.136)
A 5 yr old boy brought by his parents, who is suffering from delayed development of
speech after a period of normal development. O/E he avoids eye contact. Parents give h/o
his unusual love for a toy Turtle.WOF is most probable Dx-
a. Autism
b. ADHD
c. Deafness
Parents of a 6 yr old boy complain that their son is overactive, not cooperative enough
with other children at kindergarten, also of destructive behaviour. But when kept alone,
was found to be playing happily with toys and other children.WOF is correct- ***
a. It is a normal variant
b. ADHD
c. Autism
d. Poor parenting
Ans: …………………………..
Ans: 5 to 7 yrs.
Behavioural therapy
http://www.emedicinehealth.com/attention_deficit_hyperactivity_disorder/page8_em.htm
A mother complains of her 10 months old baby who wakes up during night many times.
The baby is otherwise healthy and gaining weight properly. The mother is worried about
this. What is the Mx- ***
a. Urine culture
b. Give sedative to the baby
c. Tell the mother to cuddle the baby when he cries
Ans: c.
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A 12 yr old boy presented with painless lump in the scrotum for the last 6 months. He is
otherwise healthy grown up. What is the most likely Dx?
a. Hernia
b. Seminoma
c. Encysted hydrocele of the cord
d. Varicocele
e. Haematocele
Ans: Hernia
Seminoma: As noted above, germ cell tumors are the most common solid tumors in men aged 15-35
years. Seminoma (the most common germ cell tumor) occurs most commonly in the fourth decade
of life. Children represent only 2-5% of all patients with testicular cancer. Seminoma is considered a
postpubertal tumor, although it has been reported in a patient as young as 8 years.
A mother of a 4 yr old child noticed that there is a solid mass in the Rt. Loin area of her
child which she noticed for the first time with occasional blood in urine.WOF is your initial
Dx: OHCS-220
a.Neuroblastoma Wilm’s tumour: Commonest intra abdominal tumour of
b. Wilms tumour childhood. Haematuria not common, but fever, flank pain c
c.Hydronephrosis abdominal mass found. US-pelvicdisortion, hydronephrosis
d.Plycystic kidney disease .
Two months old child’s mother noticed a firm lump in her baby in the left side of upper
abdomen while bathing.Child has bilateral periorbital ecchymosis.what is the most likely
cause?
a.Neuroblastoma May-2000
b.Wilm’s tumour
Ans: A.
Mother of a 3 year old child noticed a mass in the abdomen on the left side.AOF could be
the cause,except-
a.Hydronephrosis October’96
b.Neuroblastoma
c.Nephroblastoma(Wilm’s tumour)
d.Poly cystic kidneys
e.Chr. constipation
Ans: E.
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A baby with Down’s syndrome is born to a couple who definitely refuse to take the child
home after failure to convince them. The most appropriate course of action:
Arrange temporary foster care
Sixty-five percent of primary neuroblastomas occur in the abdomen, with most of these
occurring in the adrenal gland. As a result, most children present with abdominal symptoms,
such as fullness or distension.
Symptoms are usually related to either an abdominal mass or bone pain secondary to
metastatic neuroblastoma. Reports of fatigue, bone pain, and changes in bowel or bladder
habits may contribute to an accurate diagnosis. Physical findings might include
hepatomegaly; blanching subcutaneous nodules; or a large, irregular, firm abdominal mass.
Neuroblastoma has been called the great mimicker because of its myriad clinical
presentations related to the site of the primary tumor, metastatic disease, and its metabolic
tumor by-products. Sixty-five percent of primary neuroblastomas occur in the abdomen,
with most of these occurring in the adrenal gland. As a result, most children present with
abdominal symptoms, such as fullness or distension.
Typically, children with localized disease are asymptomatic, whereas children with
disseminated neuroblastoma are generally sick and may have systemic manifestations,
including unexplained fevers, weight loss, anorexia, failure to thrive, general malaise,
irritability, and bone pain. The most common finding upon physical examination is a
nontender, firm, irregular abdominal mass that crosses the midline. In contrast, children
who present with Wilms tumor have a smooth mobile flank mass that typically does not
cross the midline.
example, in Horner syndrome (myosis, anhydrosis, and ptosis) or superior vena cava
syndrome. Older children typically present with abdominal symptoms because, as stated
above, more than 40% of neuroblastomas are adrenal in origin. Children who are preschool
aged should have working differential diagnoses for an abdominal mass, including
lymphoma,hepatoblastoma, rhabdomyosarcoma, renal cell carcinoma, and neuroblastoma.
More than 50% of patients who present with neuroblastoma have metastatic disease. The
fact that many other syndromes related to metastatic neuroblastoma are also common in
these patients is not surprising.
"Blueberry muffin" babies are infants in whom neuroblastoma has metastasized to random
subcutaneous sites. When provoked, the nodules become intensely red and subsequently
blanch for several minutes thereafter. The response is probably secondary to the release of
vasoconstrictive metabolic tumor by-products. These nodules can be diagnostic of
neuroblastoma, but leukemic infiltrates that metastasize to the skin should be considered in
the differential diagnoses when these children are evaluated.
Ans: A.
After his baby sister was born, a 6 yr old boy began suck his thumb and wetting his bed,
behaviour he had grown out of long before. This is an instance of-
a. Regression
A child has swollen joints and cries whenever the napkin is changed, irritable, ecchymoses
and hyperplastic gums. WOF is Dx ?
a.Rickets
b.Scurvy
Ans: ………………………
The infant is apprehensive, anxious, and progressively irritable. Upon handling and
changing of diapers, severe tenderness over the thighs is present. The excruciating
pain results in pseudoparalysis. The infant assumes the frog leg posture (ie, keeping
hips and knees slightly flexed and externally rotated) for comfort.
Hemorrhages of the gums usually involve the tissue around the upper incisors. The
gums have a bluish-purple hue and feel spongy. Gum hemorrhage occurs only if
teeth have erupted.
Subperiosteal hemorrhage is a typical finding of infantile scurvy. The lower ends of
the femur and tibia are the most frequently involved sites. The subperiosteal
hemorrhage is often palpable and tender in the acute phase.
Petechial hemorrhage of the skin and mucous membranes can occur. Rarely,
hematuria, hematochezia, and melena are noted.
Proptosis of the eyeball secondary to orbital hemorrhage is a sign of scurvy.
Costochondral beading or scorbutic rosary is a common finding. The scorbutic rosary
is distinguished from rickety rosary (which is knobby and nodular) by being more
angular and having a step-off at the costochondral junction. The sternum is typically
depressed.
Low-grade fever, anemia, and poor wound healing are signs of scurvy.
25 | P E D S ps
Hyperkeratosis, corkscrew hair, and sicca syndrome are typically observed in adult
scurvy but rarely occur in infantile scurvy.
26 | P E D S ps
Recently, an infant with diffuse nonscarring alopecia of the scalp and radiologic
features of scurvy was reported.4
2007
A sudanese boy came to you after administration of Co-timoxazole with the complaints of
pallor and increasing darkness of colour of urine. His reticulocyte count was 8%. His
Coomb's test was negative, no family history and on electrophoresis Type A hb was
detected. What is the Dx?
A child came with pallor, drooling of saliva and stridor. What will be your initial
management?
A. Admit to hospital
B. Give O2
C. Give antibiotics
D. Do cricothyriodotomy
Ans: A.
Epiglottitis:
The main alternative diagnosis is viral laryngotracheobronchitis (croup). There are, however,
significant clinical differences. Epiglottitis is characterised by fever, a soft voice, lack of a
harsh cough, a preference to sit quietly (rather than lie down) and especially by a soft
stridor with a sonorous expiratory component.
Croup is distinguished by a harsh inspiratory stridor, a hoarse voice and brassy cough. Other
differential diagnoses include tonsillitis, infectious mononucleosis and bacterial tracheitis.
The clinical features of croup and epiglottitis are compared in JM.
A child came shortly after birth when there was a murmur heard at the lest sternal border.
This was systolic in timing. 3 months later he was lying down in hospital bed with URTI
and there was no murmur. What could be the murmur?
A child came with a systolic murmur which radiated to the back and to the axilla. Femoral
pulse was weak. Dx?
A. CoA
B. VSD
C. AS
Ans: A.
A child came with pain and redness and swelling of one eye. He had fever and was
(probably) vomiting. i could diagnosis it as orbital cellulitis. Mn?
28 | P E D S ps
A. Ceftriaxon IV
B. Ampi + Genta IV
C. Cefurixime + metro
Ans: A
A woman came G1P2 with prevoius delivery of a 4200 gm baby at 42 wks with shoulder
dystocia. What do you do this time?
A. Induce at 38 wks
B. Induce prematurely
C. do x-ray pelvimetry at term
D. CS
Ans: A.
Ans: E.
An infant was brought who was vomiting from birth. He was pale, dehydrated and not
gainig weight. What is most likely to find?
A. Lump
B. Distension
C. Anuria
Ans: Distension.
b.inguinal hernia
c.tortion
A 4 year old child with lacerated wound after falling on garden bed. He has taken dtpa at 2
and 4 months. After that no vaccination was given. What will you do
a) Give antibiotics
b) Give immunoglobulins
c) Give dtpa and Ig
d) Give dtpa
e) dtpa and booster after 2 months
Ans: B.
All of the following occurs in the first few days of neonatal life except.
a.increase in right ventricular pressure
b.closure of ductus venoses
c.closure of ductus arterioses
d.decreased flow through foramen ovale
Ans: A.
Ans: ……………………….
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2009
Ans: C.
(JM: Allergy)
a.) sulphites
b.) benzyl benzoate
c.) lecithin
d.) terbutaline
e.) ephedrine
Ans: A
Previous Question
WOF is the most ill prognosis in a child who suffers from mealses in a developing
country?***
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Ans: C.
A young scientist has decided to study the causes of neonatal jaundice. He selects 150
babys with jaundice and 150 without, and examines there previous historiies looking for
factors that could have determined there jaundice. This kind of study is called?
Ans: B.
Studies:
A cohort study or panel study is a form of longitudinal study used in medicine, social
science and ecology. It is one type of study design and should be compared with a cross-
sectional study.
A cohort is a group of people who share a common characteristic or experience within a
defined period (e.g., are born, leave school, lose their job, are exposed to a drug or a
vaccine, etc.). Thus a group of people who were born on a day or in a particular period, say
1948, form a birth cohort. The comparison group may be the general population from
which the cohort is drawn, or it may be another cohort of persons thought to have had
little or no exposure to the substance under investigation, but otherwise similar.
Alternatively, subgroups within the cohort may be compared with each other.
A prospective cohort study is a cohort study that follows over time a group of similar
individuals ("cohort") who differ with respect to certain factors under study, in order to
determine how these factors affect rates of a certain outcome.
For example, one might follow a cohort of middle-aged truck drivers who vary in terms of
smoking habits, in order to test the hypothesis that the 20-year incidence rate of lung
cancer will be highest among heavy smokers, followed by moderate smokers, and then
non-smokers.
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The prospective study is important for research on the etiology of diseases and disorders
in humans because for ethical reasons people cannot be deliberately exposed to
suspected risk factors in controlled experiments.
A retrospective cohort study, also called a historic cohort study, is a medical research
study in which the medical records of groups of individuals who are alike in many ways but
differ by a certain characteristic (for example, female nurses who smoke and those who
do not smoke) are compared for a particular outcome (such as lung cancer).
Rather than using samples and following a rigid protocol to examine limited number of
variables, case study methods involve an in-depth, longitudinal examination of a single
instance or event: a case. They provide a systematic way of looking at events, collecting
data, analysing information, and reporting the results. As a result the researcher may gain
a sharpened understanding of why the instance happened as it did, and what might
become important to look at more extensively in future research. Case studies lend
themselves to both generating and testing hypotheses.
*One child with red eye, pain, fever and ophthalmoplegia presented in the emergency.
What is the best next investigation to do?
a. Eye swab
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b. CT scan
c. Blood culture
d. USG
Ans: CT scan
(JM and RHP)
A couple came to your surgery. Father is a carrier; mother is not having any effect. What is
the chance of getting a cystic fibrosis baby?
a. 0
b. 25%
c. 12.5%
d. 100%
Ans: 0
A boy was stung by bee and developed severe breathlessness and urticaria. What is the
management?
a. Adrenaline IM
b. Promethazine
c. Corticosteroids
During operation a boy who has history of atopy suddenly developed whhezing.
a. Iodine
b. Latex
c. Isoflurane
A boy while having milk shake ice cream suddenly develop urticaria and wheezing. What is
the cause?
a. Tertarazine
Ans: Tertarazine
A small child of 8 years of age was playing in the laundry and suddenly started crying.
Far=ther saw washing powder in his mouth. What is the most serious complication?
a. Esophageal stricture
b. Respiratory failure
c. Gastric perforation
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A one year old boy presented with fever, wheezing, retreaction of ICS. What is the
diagnosis?
a. Parainfluenza
b. RSV
c. RDS
A one year old boy presented with fever, wheezing, retreaction of ICS. What is the
management?
a. Nebulised sulbutamol
b. Nebulised corticosteroids
c. Nebulised adrenaline
A child presented with red tympanic membrane, no bulging and pain in the ear. What is the
management?
a. Amox
b. Cipro
c. Difluclox
A child presented with deafness. He has a history of AOM and antibiotics were given at 12
a. Drug reaction
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b. Serous OM
Ans: In children OM is most of the time bilateral. Gentamycin is rarely given to children for
AOM. (JM)
A boy from Vietnam is presenting 6 weeks after migrating to Australia with fever and
a. Malaria
b. EBV
c. HIV
A aboriginal boy presented with myelgia, arthralgia and rash. He was also having mild fever.
b. Chicken pox
c. EBV
A boy presented with petechie in few places of the body. There is a history of viral infection
b. INR
c. APTT
A baby was born with jaundice. Mother is Rh positive and baby too. What is the most
probable cause of jaundice (I think blood group was also given and it was compatible)?
a. Infection
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