PEDIATRICS

LAST RESORT REVISION

FOR FMGE
Dr Meenakshi Bothra
Q. A baby was born limp and having apnea. What will you
do next?

a. Start chest compressions

b. Give oxygen neonate
x a
c. Umbilical vein catheterisationX In
d. Bag and mask ventilation

g
 2800
250
0
o

mask
D Bag
too
38
Q. According to neonatal resuscitation protocol, How much
oxygen to give in a term neonate with apnea and
bradycardia initially?

a. 21%
b. 30%
c. 50%
d. 100%
Q. According to neonatal resuscitation protocol, chest
compression is initiated at HR below?

a. 80/min
1 10,03
b. 75/min
Adr of
c. 70/min Ing dose
d. 60/min milk dose
O I kg
01mg
o
or
Q. Identify the abnormality in the following X ray of a
newborn with respiratory distress:

CDH is an absolute CII for

B MV
a. Congenital diaphragmatic hernia at it

b. Tracheo esophageal fistula

c. Hiatal hernia
d. Congenital cystic TEE
adenomatoid malformation adenomatoid malformation
Q. What is the amount of milk given to a term baby
weighing 2800g in the first 24 hours after
delivery?
how much amount
a. 40ml/kg milk is to be given
of
to this
b. 50ml/kg perfeed baby
in 1st 24 hrs

c. 60ml/kg 1st 24ms 60 me 60 3

ly
d. 80ml/kg 8om 2hr I

TEI5mOfeed IV
1st 48hrs3 lot Dextrose
fluid
 beyond
Itwithmendlioon
60mgday 150m44 day
1500g

isoog 80m44 day

Q. All are signs of adequate breast feeding in a 2 month old
infant EXCEPT?

a. Baby Sleeps for 2-37 hours after feeding

b. Urinates 6-8 times per day
c. Gains weight
d. Has normal hemoglobin level level
Q . A neonate is unable to open the eyelid. Identify the
condition given in the image below?

a. Capillary hemangioma d
b. Mongolian spot
c. Milia
d. Erythema toxicum neonatorum
1 Epstein
palate
mouth
 t d

mongosgoes
 O
Q. Infant of diabetic mother is at risk of development
of which of the following?
Mat hyperglycemia
d
a.
After
Hypoglycemia fetal hyperglycemic
I
b. Hyperglycemia
to produce excess Insulin
c. Anemia i iÉ

d. Diarrhea

polycythemia
Macrosomia
Problems in Infant of Diabetic mother Ibm
CVS Red chip
MC CHD in IDM VSD
A most specific ID S TGA
Neurological NTD
Me a
most specific Sacral agenesis
caudal Regression
Renal synch
Renal agenesis
Duplication of ureter Hyhonephrois
GI colon synch
lazy left
Long term Blindness
obesity Diabetes
Q. Which is the first tooth to appear in a child?

a. Lower central incisor

b. First molar
c. Upper central incisor
d. Canine
 teeth teeth
Milk
PRIMARY DENTITION
fermanent
SECONDARY DENTITION

Begins at? 6 7 months 6 yrs

1st tooth? lower central incisor 1st molar

Last tooth? 2nd molar 3rd molar

except 3rd
3 yr molar
Completes by 242 12g 25yd
or wisdom 18
teeth
Total number 20 28 32

Dynatron
Q. Which of the following statements are true?

a. First hand to hand transfer appears, then palmer reflex

disappears X
b. First Palmer reflex disappears, then hand to hand transfer
3m 7m
appears
c. Both Palmer reflex and hand to hand transfer appears at the
same time X
d. Both disappear at the same time x
 Rules of Development

Cephalo caudal

Proximal to distal

Some primitive reflexes disappear

milestones appear

Sequence remains same

 Primitive Neonatal Reflexes
Present at birth in a term neonates

Reflex Appears by Disappears by

Rooting R 32Wh Begins to disappear

by Image
Begins 28M 5 Gmos
Moro's Reflex
completely
appffek
Palmar grasp R 28Wh 3m

AT NR Asymmetric 35Wh 5 Gram

Tonic Neck
R
Causes of Asymmetric Moro Reflex

Be neurology
clavicle Erb's palsy

Shoulder it Cong Hemiplegia

dislock
 THAppety
Q. When does handedness get established?

Established 3 yr
a. 6 to 12 months
b. 15 to 18 months
c. 18 to 24 months
d. 36 to 40 months
IMPORTANT GROSS MOTOR MILESTONES
Milestones Usual age
Neck control Partial 3m complete 5m
Sitting with support Gm
Sitting without support 8m
Standing with support 9m
Creeping 10 11m
Standing without support 12m
Walking with support 12m
Walking without support 13m

D 3
Rides a tricycle
yr
IMPORTANT FINE MOTOR MILESTONES
Milestones Usual age
Hand regard
3mi
Bi-dextrous grasp 5m
Palmar grasp
Gm
unidextont
If

Transfers objects Am
Immature Pincer Grasp am
Mature Pincer Grasp 12m
Scribbles spontaneously I 5m
Tower of 6-7 cubes Z yr
Handedness appears
2W
Handedness established 3 yr
 DRAWING SKILLS OF A CHILD
corn 2 yr

a
3m
4 yr t
Syr X
Gyr
IMPORTANT SOCIAL MILESTONES
Milestones Usual age
Social smile 2m
Mirror play Gm
Stranger anxiety 7m
Waves bye bye
am
Plays peek a boo 10m
Plays a simple ball game I 2m
Points to objects 15m
Domestic mimicry
Dry during daytime
Parallel play
Joins in play
IMPORTANT LANGUAGE MILESTONES
Milestones Usual age
Vocalises 2m
Cooing 3m
Mono-syllablic babbling GM
Bi-syllablic babbling 9m
2-3 words with meaning yr
Jargon speech 15m
10 words with meaning 18M
2 word sentences 2 yr
3 word sentences 3 yr
Q. Within how many hours can breast feeding be initiated in a
perfectly healthy child with no anatomical problems?

a. 1 hr
b. 4 hrs
c. 24 hrs
d. 48 hrs
Q. Exclusive Breast feeding should be continued for minimum
how many months?

a. 6 months
b. 2 months
c. 12 month
d. 5 months
Q. Absolute contraindication to breastfeeding?

a. Galactosemia in the infant

b. Maternal Hepatitis C x
c. Maternal CMV
x
d. Herpes not involving the breast
x
 Contraindications to Breast feeding

Baby
Confirmed another
Galactosemia
montane related
Lactose mat HN
cong intolerance
chemotherapy met TB
Radiotherapy met herpes
varicella
Q. All are true about human colostrum except?

a. Thick and yellow color

b. IgA high
c. High amino acids and minerals
d. High sugar and fat
 1st Immune
Breast milk
of bary
1st 72 hrs Colostrum
thick yellowish
Rich in
IgA fat
Lactose is less
Next 2 wk Transitional Milk
that mature milk
After
 Content Breast milk BM Cow milk
W 4.5gal
Carbohydrate 7gal
I lesser load on 3 5gal V
Proteins gldl kidneys
BM is richer in wheyprotein vs Casein in cm
BM is richer in Cysteine Taurine Methionine
Lipids BM is richer
in Docosahexaenoic
PUFA DHA acid
Ca P ratio
Minerals farms
Ca abserpt

AHBM Contain adeg ant of all vitamins

Vitamins Vit D Vit K
except in strict vegan
Biz
Cit mater
Q. Nutrient deficient in breast milk is?

a. Vitamin A
b. Vitamin B
c. Vitamin C
d. Vitamin K
Q. Pearly white lesions with foamy appearance are seen
on the sclera of a child. Which of the following other
symptoms are related to the deficiency of the same
micronutrient causing the mentioned lesion?

A
a. Conjunctival xerosis
Biter
b. Angular stomatitis Is

c. Glossitis x
d. Photosensitive rash x
Vitamin A deficiency
ist symptom of Vita def
4
istsignT
Treatment of Vitamin A deficiency
Age Oral Vit A Dose
< 6 months 50,000 In dose
6-12 months I Lac Iu dose
> 1 year 2 Lac IU
Hor wt 8kg

adf.im 3ot
Q. A child’s Ht for age is < - 2 SD. This child will be classified
under which of the following categories?

a. Wasting
b. Normal
c. Stunting
d. SAM (Severe Acute Malnutrition))
WHO Classification of Malnutrition - Edema Edematous

Weight for Height

Between -2 to -3 z score or
Between 70-79 % of expected
a
Height for age
Between -2 to -3 z score or
Between 85-89 % of expected

waif
< -3 z score or < -3 z score or
< 70 % of expected
80 < 85 % of expected

Severe wasting Serenfunting

Q. For severe malnutrition, mid arm circumference will be
less than?

a. 14.5 cm
b. 13.5 cm
c. 12.5 cm
d. 11.5 cm
Definition of Severe Acute Malnutrition (SAM)

MMG
presence of
child
l or
6m
more
syr
of
L 37 sane
ht for Ht 2707 of exp or

MAC 11 5 am
or
bipedal edema of
Symmetric
nutritional origin
Q. A 3 years old child presented to OPD with his mother. His
mother reports exclusive breast feeding till 2 years age.
Now child has decreased appetite. On examination
malnutrition was found along with edema. What is the
diagnosis?

a. Kwashiorkor
b. Marasmus x
c. Wasting
x
d. Stunting
x
WELLCOME TRUST CLASSIFICATION

Weight for age Edema Category

60-80 % of expected Absent Undernutrition
60-80 % of expected Present kwashiorkor
< 60 % of expected Absent
Marasmus
< 60 % of expected Present
Marasmichiaker
 KWASHIORKOR MARASMUS

Edema t Suffppeerema

Appetite Poor v Good

irritable
lethargy Alert I
or
CNS changes Apathy

fattynepatomegaly tie

Skin flaky paint More common

dermatosis
hair
changes flag
sign protein def Caloriedet
mainly
Q. A boy presents with features of shock and cold, clammy
skin. The next step in management is?
8.97 Nad
NS boluses 20 me kg
boluses
a. IV Normal saline 1 upto 3
b. IV Dextrose Start 02
Antibiotics
c. Inj Adrenaline Gie IV
d. IV Ringer lactate
Q. A child presented with severe vomiting and dehydration.
A,B,C,D,E was performed. What does D stand for?

A Airway
a. Disability B Breathing
b. Dehydration X
C Circuit
D Disability
c. Dementia
d. Diarrhea E Exposure
Q. A 16-year-old girl presents with short height, primary
amenorrhea with widely spaced nipples. Her probable
karyotype is?

Twingway seen

a. 45, XO in females
b. 46, XO
c. 47, XXX
d. 46, XY
 0
451

Klinefelter
I
47 XXY
Q. A 1 month old exclusively breastfed male baby
was brought with persistent jaundice, abdominal
distension, vomiting and recurrent episodes of
seizures. On examination bilateral oil drop
cataract was seen. The baby was also found to
have hypoglycemia and urine Benedicts test
positive. Diagnosis? substance
reducing
a. Von Gierke disease
b. Gaucher disease X
c. Hereditary fructose intolerance x
d. Galactosemia
Epimerase
 Q. A 2 year old girl presented with history of recurrent
episodes of early morning lethargy and seizures. On
examination, the child had doll like facies and
hepatomegaly. Investigations revealed hypoglycemia, lactic
acidosis and hyperlipidemia. Which enzyme is deficient?

VonGierked
a. Glucose 6 phosphatase
b. Muscle phosphorylase McArdle Is
c. Glucose 6 phosphate dehydrogenase Hemolytic
A
d. Alpha glucosidase Pompe ds
AM
Q. A child is brought to the OPD with complain of change
in colour of urine after some time. Mother gives history
that she noticed a dark black colour on diapers when
her baby was few months old. Which enzyme
deficiency is present in the given patient?

a.
pPkU Alkalpton
Phenylalanine hydroxylase
b.
c.
in
Homogentisic acid oxidase
Tyrosine aminotransferase
d. 4-hydroxy phenyl pyruvate dioxygenase Tyrosinemie
Q. A 5-year-old child develops a fever with rash. Also had
cough, conjunctivitis and coryza. The image of the child
is given below. What is the diagnosis?

a. Measles
b. Chicken pox x
c. Erythema infectiosumX
r
d. Hand foot mouth disease
• Measles Engh maculo papules Koplin
spots

• Chicken pox Pleomorphic

• Erythema infectiosum Slapped cheek

• Hand foot mouth disease blisters

reside
Q. An 18 month old child presented with runny nose & fever.
On examination, there was a rash seen on face. What is the
probable diagnosis? B 19
Panov
a. Erythema infectiosum
b. Hand, foot and mouth disease

y
c. Rubella X
d. Measles Cheek
Slapped
Q. Koplik spots are seen in?

a. Mumps
X
b. Measles
c. Rubella x
d. Varicella x
Q. Subacute Sclerosing Panencephalitis is a rare and
dangerous complication of?

Ts

a. Measles
b. Mumps x
c. Rubella
x
d. Varicella
x
Q. Which vaccines are given at birth?

a. BCG, OPV birth dose, Hep B birth dose

b. BCG, Hep B birth dose, MR birth dose
a

c. BCG, Hep B birth dose, DPT birth dose

d. IPV birth dose, Hep B birth dose, DPT birth dose
r
National Immunization Schedule of India
A
Age Vaccines given
Birth BCG, OPV-0 dose. Hepatitis B birth dose
6 Weeks OPV-1, Rotavirus Vaccine (RVV)-1
Pentavalent-1, Fractional Inactivated Polio Vaccine (fIPV)-1
Pneumococcal Conjugate Vaccine (PCV) -1

10 weeks OPV-2, RVV-2, Pentavalent-2

14 weeks OPV-3, RVV-3, Pentavalent-3, fIPV-2, PCV-2
9-12 months Measles & Rubella (MR)-1, PCV-Booster, f-IPV-3
Japanese Encephalitis (JE)-1* [in endemic Districts only]

16-24 months MR-2, DPT-Booster-1, OPV – Booster, JE-2*

5-6 years DPT-Booster-2

I
10 yrs & 16 yrs Tetanus & adult Diphtheria (Td)
Q. First dose of measles vaccine was given on 7 month of
age due to some reason. When will you schedule the
child for next dose?

a. Next dose at 16 -24 months

b. 1st dose at 9 months and next at 16-24 months
c. No dose at 9 months
d. Booster at 9 months
 E
Q. 2 open vials of pentavalent vaccine and one open vial of
MMR vaccine is given back after an immunization
x session. What should be done with those vials?

a. Both should be discarded

b. Pentavalent can be used and MMR must be discarded
c. MMR can be used and Pentavalent should be discarded
d. Both vials can be reused
 Open vial policy
used
Allows prollycontaintains
multidoserials of
4kconditions provided
certain
arent
Points to be checked as per “Open vial policy”

vaccinemvidter

O O
 X
I
 I

8
o
Q. A child presents with abdominal pain, hematuria and
palpable purpura over leg as given in image. His skin
lesions show IgA deposition, on biopsy. What is the
diagnosis? Arthritis

a. Idiopathic Thrombocytopenic Purpura

b. Henoch schonlein purpura No thrombocytopenic
c. Acute Leukemia X
d. Post Streptococcal Glomerulonephritis x
Q. A child with Celiac disease should be asked to
avoid all of the following in diet EXCEPT?

a. Rice

b. Wheat x
Glutensensitivity
c. Oat wheat
x
d. Sooji (Semolina) BROW what
Bayffoats
 Guidelines
latest
Yoko
screeningtin

again
Q. A 5 year old child who has taken 10 Iron tablets
presents with nausea and abdominal pain. What is the
antidote of Iron poisoning?

a. Penicillamine
b. Trientine
Copperchefffwinen
J

c. Zinc
d. Desferrioxamine
Drugs used for Iron chelation in Thalassemia:

Parenteral
Desferrioxamine
Deferiprone
Deferasirox orally
Q. A 3 year old child with diarrhea for 2 days, was
irritable and extremely thirsty. There was no history
of vomiting. What is the next step?
jWM

a. IV Normal saline
b. IV Ringer lactate
c. Oral rehydration solution
d. Oral Juices
 A
How to assess dehydration in a child with Diarrhea?
Assessment of dehydration in a child with
Diarrhea:
No Some Severe
Parameters
dehydration dehydration dehydration

Attributing
Sensorium
Eyes Normal Sunken V Sunken
Tears Normal Absent Absent
Mucosa Normal moist
Dry very dry
Difabio
Thirst

a
vsya
Skin pinch
Treatment of dehydration in a child with Diarrhea:

Category Fluid
No
5 10 me kg loose stool
dehydration

Some 4 hrs
75 mykg over
dehydration St DX
IV RL in RL
ORS
Severe IV
Dehydration too mykg
Fluid therapy in severe dehydration: 100mL
lg
Age 1st 30 ml/kg Next 70 ml/kg Total time

< 1 year the shr G hrs

> 1 year
42hr 242hr 3hr
Treatment of Acute Diarrhea in a child:

Prevention Rx of Dehydro't

Zinc 2 6ms 10mgday o m

dam
76ms 20mgday

centinneNormeldiet
 Reduced
Osmolarity
Composition of WHO ORS

4smosy
T.FI

t
Q. A 6 year old girl child presented with a boil on the leg 3
weeks ago and is now presenting with cola coloured
urine and peri orbital puffiness. On examination, she
was found to have a blood pressure of 158/92 mm Hg.
What is the probable diagnosis?
Hypertension
I

a. Minimal change disease mn

b. IgA Nephropathy
Nephritic
m
c. Post Streptococcal Glomerulonephritis
d. Nodular Glomerulosclerosis
Q. Generalised edema and massive proteinuria is most
commonly seen in:
2
Up Ua
dipstick 7,3T
Upr by
a. Nephrotic syndrome
b. Acute post-streptococcal glomerulonephritis
c. Renal tubular acidosis Hypoalbiminemia
d. Nephrolithiasis Hyperlipideme
 mistimed

Rofchox
3min

Prednisone
Gnkflb
daily zingly 6Wh
Dfw alt
day singly
i

SANI Calcineurin inhibited

Tacrolimus
cyclosporine
Q. Renal agenesis in a baby is associated with –

a. Single umbilical vein

b. Single umbilical artery
c. Polyhydramnios
d. Maternal anemia
Q. A newborn with ambiguous genitalia was being
worked up. Investigations revealed hyperkalemia,
high 17 hydroxyprogesterone, progesterone &
DHEA levels. Which enzyme deficiency is this baby
e
suffering from?
nartyperted
Mcfly
a. 21 hydroxylase
b. 17 beta hydroxylase
c. 11 hydroxylase
d. 17 alpha hydroxylase
 ÉÉÉ

of

Hyperkalemia
 RACY

Hydrocortisone
cortisone

fludro
Q. Which is the most common seizure found in the age
group of < 5 years?
West synch
III
Intansptisms
a. Myoclonic seizures Juvenile myoclonic
Epilepsy
b. Subtle seizure
M in Neena
type
c. Petit mal seizures
d. Febrile seizure
 St
febrile
child with
a
too 4 F
7
significant fever
without any 40
CNS infection 5y
in age grof6m
 YES
grid

Generalised
minutes
C 15min Pfifteen or longer

Single episode frequenty

Q. A child has presented with a birth defect as
shown in the image. What is the diagnosis?

DO
a. Anencephaly
b. Myelomeningocele
c. Encephalocele
d. Craniorachischisis
PTydomeningoale
Occipital
Encephalocele
Q. Identify this congenital CNS abnormality:

Thenophed
Q. A baby was born with neural tube defect. What should
have been done to prevent this condition?

she be given to
400mg day child bearing age
a. Folic acid
all women
of
b. Iron t
c. Thiamine Sh be started
I month
at least conception
d. Riboflavin
before
risk 4000 ng
High
arumefday
Q. A 3 months old baby presents with fever and respiratory
rate of 68/min. He is feeding well, and has no stridor, no
chest indrawing, no convulsions. Diagnosis?

I
Tamati

a. Pneumonia
b. Severe pneumonia
c. Very severe pneumonia
d. No Pneumonia
 Neonatal
Integrated management of childhood
IM NCI Classification illnesses
f

canst
Gendanger
y
IIItiates

commit 7501min
lethargy 2 12m
7401mn
to feed 1 Syr
Inability
Tomiting Persistent
o Inconseims
calm child
a
in
Strider
 Gen Classic Ry
demesignterty tetany
severe pneumonia 1st dose
I I or severe parenteral
very
disease antibiotics
refer
t Pneumonia oral antibiotics
5 days
or both for at home
F up after 2dam
No pneumonia Home
cold based
Gough
only supportive
care
Q. Most common cause of inspiratory stridor in an infant is :

I hoped
a. Laryngomalacia Epiglottis
b. Parainfluenza
X
c. Epiglottitis
X
d. Vocal cord paralysis
X
 O
Q. A child with difficulty in breathing had steeple sign on
X ray. There was low grade fever and stridor only on
crying. What is the treatment?

Croup Acute LTB

I
a. Antibiotic with Steroid and Oxygen
b. Oral Steroid

I
c. Antibiotic, Cough suppressant with decongestant
d. Reassure the patient
 Croup Acute Epiglottitis
Viral Bacterial
Mcs Parainfluent
Etiology gymes Streptococcus
Viral prodrome Highgradefner
Clinical low go farer coryza gickftoxiclooky
presentation malaise
of Salm
strider trappers proofing
Strife Thumb
X ray picture steeple
signdgpiglitt
sign
am IV3rdgen
sinpedosetgmg.mg
Treatment Coral Nebulised

Sup
care
serves
urd.to
Nordeofantibian
onns
 2
TWTR
gupte
sir
Spight
a
 ALL THE BEST!
dr.meenakshi.pediatrician@gmail.com