47 - Staging of Wilms' Tumor

*Usually any tumor is staged before surgery, but Wilms' tumor is staged after surgery.

*Based on the stage of the tumor after surgery, the decision whether to give adjuvant chemotherapy or not is usually taken. (This is the typical practice in North America).

*In europe, oncologists first take a biopsy before surgery and confirm the tumor. Then before attempting surgery they try to shrink the tumor (the tumors are usually very large at presentation) by giving chemotherapy to the patient.

*In both the cases the tumor is staged only after surgery.

*It has to be noted that because the European oncologists use chemotherapy and markedly shrink the tumor before surgery, the postoperative staging is more of Stage I and Stage II variety in this case. The prognosis is excellent in both approaches and the overall relapse free survival is also almost the same with both approaches.

*So simply put the Pathologist decides the stage rather than the radiologist or the surgeon.

*STAGING OF WILMS' TUMOR :

- StageI : The tumor is confined to the kidney with capsular or vascular invasion.

- Stage II : The tumor has extended beyond the renal capsule, infiltration of vessels. The cases where biopsy has been performed before surgery are grade II, as well as those cases where the tumor has ruptured intraoperatively.

- Stage III : Positive Lymph nodes in the abdomen or pelvis, peritoneal invasion, or residual tumor at surgical margins.

- Stage IV : Metastatic disease outside the abdomen or pelvis.

- Stage V : Bilateral tumors at original diagnosis.

* Below is a beautiful video (Contrast Enhanced CT Scan) of Wilms' tumor in the right kidney of a 13 month old patient.
- Note the large size and poor heterogenous enhancement of the tumor in a Pediatric patient that is typical of Wilms' tumor.

46 - Neonatology Mcqs - part 3

21q: The number of fontanelles present in newborn are
a. 1
b. 2
c. 3
d. 6

answer d. 6. Fontanelles palpable at birth are 2.

22q: At birth the normal heart rate is
a. 60-80/min
b. 80-110/min
c. 70-120/min
d. 110-150/min

answer d. 110-150/min

23q: For neonate, lower limit of poor perfusion, in terms of systolic BP is
a. Less than 60 mm Hg
b. Less than 70 mm Hg
c. Less than 80 mm Hg
d. Less than 90 mm Hg

answer a. Less than 60 mm Hg.

24q: In neonate, chest compression:ventilation relationship is
a. 3:1
b. 5:1
c. 2:1
d. 4:1

answer a. 3:1.

25q: Characteristics of caput succedaneum include all of the following except
a. Crosses midline
b. Crosses suture line
c. It does not disappear within 2-3 days
d. It is a diffuse oedematous swelling of soft tissues of scalp

answer c. It does not disappear within 2-3 days.

26q: Umbilical cord usually falls after
a. 5-10 days
b. 15-20 days
c. 1-5 days
d. None of the above

answer a. 5-10 days.

27q: 99% of neonates void within
a. 24 hours
b. 48 hours
c. 8 hours
d. 12 hours

answer b. 48 hours.

28q: Transition stools in neonate
a. Stool passed in first 2-3 days
b. Stool passed on 4th-5th day
c. Stool passed after 7 days of birth
d. Stool passed in first 24 hours

answer b. Stool passed on 4th-5th day

29q: Radiologically gas is demonstrated in colon after how many hours of birth
a. Half hour
b. One hour
c. Two hours
d. Three hours

answer d. 3 hours.

30q: Low birth weight baby is defined as
a. BW less than anticipated from period of gestation
b. Gestation of less than 37 weeks
c. BW less than average of country
d. BW less than 2.5 kg

answer d. BW less than 2.5 kg.

Essential Pediatric McQs
MCQs in Pediatrics 2nd edition
MCQs in Pediatrics ; Over 600 Questions with Explanatory Notes

45 - Neonatology Mcqs - part 2

11q: What should be measured in a newborn who presents with hyperbilirubinemia?
a. Total and direct bilirubin
b. Total bilirubin
c. Direct bilirubin
d. Conjugated bilirubin only

answer a. Total and direct bilirubin.

12q: Following features may be seen in cold injury of neonate except
a. Bradycardia
b. Uncontrolled shivering
c. Sclerema
d. Metabolic acidosis

answer b. Uncontrolled shivering.

13q: Commonest cause of neonatal death in India is
a. Prematurity
b. Congenital malformations
c. Metabolic diseases
d. Birth injury

answer a. prematurity.

14q: All are criteria for perinatal mortality rate except
a. Late foetal deaths + early neonatal deaths
b. Gestational age of 28 weeks or more
c. Birth weight 1000 grams or more
d. Body length between 25 and 35 cms

answer d. Body length between 25 and 35 cms.

15q: Still birth constitutes
a. Early foetal death
b. Late foetal death
c. Early + Intermediate foetal death
d. Intermediate + Late foetal death

answer d. Intermediate + Late foetal death.

16q: Abortus means
a. Early foetal deaths
b. Intermediate foetal deaths
c. Late foetal deaths
d. Early + intermediate deaths

answer a. Early foetal deaths.

17q: Extended perinatal mortality includes
a. Late foetal death + early neonatal deaths
b. Late foetal death + early neonatal deaths + Intermediate stillbirth
c. Early + Intermediate foetal death
d. Intermediate + late foetal death

answer b. LFD + END + ISB

18q: Capacity of stomach of newborn is
a. 20 mL
b. 30 mL
c. 50 mL
d. 100 mL

answer b. 30 mL

19q: Post-term babies are those with
a. 294 days
b. 294 days or more
c. 259-293 days
d. None of the above

answer b. 294 days or more.

20q: Foetal scalp blood pH is abnormal when
a. pH less than 7.25
b. pH less than 7.3
c. pH less than 7.35
d. pH less than 7.4

answer a. pH less than 7.25

Essential Paediatric McQs
McQs in Paediatrics (Pocket MCQs)
Paediatric McQs for Postgraduate Examinations: Practice Examinations

44 - Neonatology Mcqs - part 1

1q: All of the following are features of prematurity in a neonate except
a. No creases on sole
b. Abundant lanugo
c. Thick ear cartilage
d. Empty scrotum

answer c. Thick ear cartilage.

2q: All of the following therapies may be required in one hour old infant with severe birth asphyxia except
a. Glucose
b. Dexamethasone
c. Calcium gluconate
d. Normal saline

answer b. Dexamethasone.

3q: Appropriate therapy for neonate wiith vaginal bleeding on 4th day of life
a. Administration of vitamin K
b. Investigate the case for bleeding disorder
c. Use of FFP
d. No specific therapy

answer d. No specific therapy.

4q: In unconjugated hyperbilirubinemia, kernicterus increases with the use of
a. Ceftriaxone
b. Phenobarbitone
c. Ampicillin
d. Sulphonamides

answer d. Sulphonamides.

5q: A 25 year old woman had premature rupture of membrane and delivered male child who was lethargic and apneoic on first day of birth and went into shock. The mother had previous history of abortion 1 year back. On vaginal swab culture, growth of beta haemolytic colonies on blood agar was found. On staining these were found to be gram positive cocci. Which of the following is most likely diagnosis?
a. Streptococcus pyogenes
b. Streptococcus agalactiae
c. Peptostreptococci
d. E.faecium

answer b. Streptococcus agalactiae.

6q: Neonate presents with jaundice and clay white stools. On liver biopsy giant cells are seen. Most likely diagnosis is
a. Physiological jaundice
b. Neonatal hepatitis with extrabiliary atresia
c. Neonatal hepatitis with physiological jaundice
d. Extrabiliary atresia

answer b. Neonatal hepatitis with extrabiliary atresia.

7q: Most common cause of cholestatic jaundice of newborn is
a. Hypoplasia of biliary tract
b. Neonatal hepatitis
c. Choledochal cyst
d. Physiological jaundice

answer b. Neonatal hepatitis

8q: A newborn has drooling after feeds. He has respiratory distress and froth at mouth. Diagnosis is
a. Tracheo-oesophageal fistula
b. TOF
c. Respiratory distress syndrome
d. None of the above

answer a. Tracheo-oesophageal fistula

9q: Full term small for date babies are at high risk for
a. Hypoglycemia
b. IVH
c. Bronchopulmonary dysplasia
d. Hyperthermia

answer a. Hypoglycemia

10q: True statement regarding IUGR babies is
a. Hepatomegaly is due to fatty infiltration
b. Head circumference is 3 cm greater than chest circumference
c. HMD is common
d. Hypothermia does not occur due to good shivering mechanism

answer b. Head circumference ......

43 - Features of Prematurity

*Premature babies are those babies who are born before 37 completed weeks.

*Physical criteria of prematurity :
- Skin texture : Shiny gelatinous, thin, plethoric skin.
- Lanugo : abundant.
- Plantar creases : Single deep crease over anterior 1/3rd of sole or no deep creases. Sole may be full of superficial creases.
- Genitals : Males : Both testes are at external inguinal ring or above. Empty scrotum with scanty rugosities.
- Genitals : Females : Labia majora are widely separated with labia minora fully exposed with hypertrophied clitoris.
- Breast nodules : Lesser than 5 mm and nipple is small or absent.
- Ear cartilage : Cartilage is deficient or absent with poor recoil.
- Hair : Brownish-black, fuzzy or woolly.

*Neurological criteria :
- Posture : Hypotonic, arms and legs extended.
- Arm recoil : No recoil or returns to incomplete flexion.
- Popliteal angle : Usually greater than 90 degrees. (120-180 degrees).
- Scarf sign : Elbow usually crosses the midline of chest. (video below)
- Square window : Degree of flexion at wrist limited.
- Head lag
- Various neonatal reflexes absent or incomplete.

*Video of SCARF sign:

42 - Brachycephaly

Brachycephaly, also known as flat-head syndrome, is a type of cephalic disorder. This occurs when the coronal suture fuses prematurely, causing a shortened front-to-back diameter of the skull. The coronal suture is the fibrous joint that unites the frontal bone with the two parietal bones of the skull. The parietal bones form the top and sides of the skull. This feature can be seen in Down Syndrome.

The incidence of brachycephaly has increased dramatically since the advent of Sudden Infant Death Syndrome recommendations for parents to keep their babies on their backs. Many pediatricians remain unaware of the issue and possible treatments.

Treatments range from a simple repositioning of babies below the age of 5 months or more involved treatment with a helmet for children under the age of 18 months.
Brachycephaly also describes a developmentally normal type of skull with a low cephalic index, such as in snub-nosed breeds of dog.

McQs in Paediatrics (Pocket MCQs)
Paediatric McQs for Postgraduate Examinations: Practice Examinations
McQs in Paediatrics: With a Tactical Guide on How to Approach Clinical Examinations (PMCQ)

41 - Differential diagnosis of Neonatal Jaundice

A. Jaundice consisting of either direct or indirect  bilirubin, that is present at birth or appears with in the first 24 hours of life causes :
*Erythroblastosis fetalis (high direct bilirubin - in infants who were given intrauterine transfusions)
*Concealed hemorrhage
*Sepsis
*Congenital infections like syphilis, CMV, rubella and toxoplasmosis
*Jaundice secondary to extensive eccymosis or blood extravasation may occur during the first day or later, especially in premature infants


B. Jaundice which first appears on the second or third day causes :
*Physiological jaundice
*Familial non-hemolytic icterus (Crigler-Najjar syndrome)
*Early onset breast feeding jaundice

C.Jaundice appearing after the third and within 1 week causes :
*Bacterial sepsis
*Urinary tract infection
*Infections like syphilis, toxoplasmosis, CMV or enterovirus

D. Jaundice first recongnised after the first week of life causes :
*Breast milk jaundice
*Septicemia
*Congenital atresia or paucity of the bile ducts
*Hepatitis
*Galactosemia
*Hypothyroidism
*Cystic fibrosis
*Congenital hemolytic anemia crises related to red cell morphology and enzyme deficiencies


E. Persistant jaundice during the first month of life causes :
*Hyperalimentation associated cholestasis
*Hepatitis
*Cytomegalic inclusion disease
*Syphilis
*Toxoplasmosis
*Familial non-hemolytic icterus
*Congenital atresia of the bile ducts
*Galactosemia
*Inspissated bile syndrome following hemolytic disease of newborn
*Rarely physiologic jaundice may be prolonged for several weeks, as in infants with hypothyroidism or pyloric stenosis.

P.S: Polycythemia may also lead to early jaundice.

40 - Treatment of Vesicoureteral reflux in children

Grade I	Reflux into a non-dilated ureter
Grade II	Reflux into the upper collecting system without dilatation
Grade III	Reflux into dilater ureter and/or blunting of calyceal fornices
Grade IV	Reflux into a grossly dilated ureter
Grade V	Gross dilatation of the ureter, renal pelvis and calyces: Calyces show loss of papillary impression

*TREATMENT RECOMENDATION FOR VUR diagnosed following a UTI :

GRADE	AGE(YRS)	SCARRING	INITIAL TREATMENT	FOLLOW-UP
I-II	Any	-	Antibiotic prophylaxis	-
III-IV	0-5	-	Antibiotic prophylaxis	Surgery
III-IV	6-10	-	U/L: Antibiotic prophylaxis	Surgery
III-IV	6-10	-	B/L: Surgery
V	less than 1	-	Antibiotic prophylaxis	Surgery
V	1-5	No	U/L: Antibiotic prophylaxis	Surgery
V	1-5	No	B/L: Surgery
V	1-5	Yes	Surgery
V	6-0	-	Surgery

39 - Live and Killed vaccines

*All the live attenuated vaccines are contraindicated in pregnancy.

38 - Tracheo-oesophageal fistulas

 

 

*As u can see above there are five types of Tracheo-oesophageal fistulas . They are type a, type b, type c, type d, and type e.

*Another type called type f, has been recognised which has no fistula but is characterised by oesophageal narrowing.

*TYPE C is the most common type of tracheo-oesophageal fistula, followed by TYPE A and TYPE E.

*TYPE E, is also called the H TYPE fistula, because of its resemblance to the english alphabet H.

*TYPE E ( Tracheo-oesophageal fistula without atresia or H type fistula ) is associated with refractory bronchospasm and recurrent pneumonias.

37 - Nephrotic Syndrome Mcqs with answers part 2

18q: In a patient presenting with features of NS , diagnosis other than MCNS should be considered in the presence of ?
a. Age less than 1 year
b. A family history
c. Extrarenal findings ( arthritis, rash and anemia )
d. Hypertension
e. Pulmonary edema
f. Acute or chronic renal insufficiency
g. Hematuria

answer a, b, c, d, e, f, g, . all are true .

19q: all of the following are true regarding the lab findings of idiopathic nephrotic syndrome except ?
a. Microscopic hematuria may be present in 20 % of children
b. Urinalysis reveals 3+ or 4+ proteinuria
c. Spot urine protein/ creatinine ratio exceeds 2.0
d. Urinary protein excretion exceeds 3.5 gm/24 hr in adults and 40 mg/sq.m/hr in children
e. Serum creatinine value is decreased

answer e. serum creatinine value is usually normal , but it may be increased because of diminished renal perfusion resulting from contraction of the intravascular volume .

20q: all of the following are true regarding the lab findings of idiopathic nephrotic syndrome except ?
a. Serum albumin level is generally less than 2.5 g/dL
b. Serum cholesterol and triglyceride levels are elevated
c. C3 and C4 are elevated
d. Renal biopsy is not required for diagnosis in most children

answer c. C3 and C4 are normal and not elevated .

21q: What is the most frequent type of infection which occurs as a complication of Nephrotic syndrome?
a. Pneumonia
b. Spontaneous bacterial peritonitis
c. Cellulitis
d. Urinary tract infections

answer b. spontaneous bacterial peritonitis .

22q: Which is the most common organism causing peritonitis in a nephrotic syndrome patient?
a. E.Coli
b. Streptococcus pneumoniae
c. Staphylococcus
d. Mycoplasma

answer b. streptococcus pneumoniae

23q: All of the following are true about nephrotic syndrome except ?
a. All children with nephrotic syndrome should receive polyvalent pneumococcal vaccine
b. Influenza vaccine should be given on a yearly basis
c. Children with NS are at increased risk for thromboembolic events
d. Prophylactic anticoagulation is recommended in all children with NS

answer d. prophylactic anticoagulation is recommended only in children with nephrotic syndrome who had a previous thromboembolic episode .

24q: Example of a malignancy in which the renal pathology most often resembles Minimal change nephrotic syndrome ( MCNS ) ?
a. Lung carcinoma
b. Hodgkin lymphoma
c. Non-hodgkin lymphoma
d. GIT cancers

answer b. Hodgkin’s lymphoma .

25q: Drugs which cause nephrotic syndrome with a histological picture of MCNS are ?
a. Probenecid
b. Ethosuximide
c. Methimazole
d. Lithium

answer a, b, c, d . all are true .

26q: Drugs which cause nephrotic syndrome with a histological picture of membranous glomerulopathy are all except ?
a. Pencillamine
b. Captopril
c. Gold
d. NSAIDs
e. Mercury compounds
f. procainamide

answer f. procainamide . this drug causes NS with a proliferative glomerulonephritis histological picture.

27q: Drugs which cause nephrotic syndrome with a histological picture of proliferative glomerulonephritis are
a. procainamide
b. chlorpropamide
c. phenytoin
d. trimethadone
e. paramethadione

answer a, b, c, d, e . all are true .

28q: Infants who develop nephrotic syndrome within the first ----- months of life are considered to have congenital nephrotic syndrome ?
a. first 3 months
b. first 6 months
c. first 9 months
d. first 12 months

answer a. first 3 months .

29q: what is the most common cause of congenital nephrotic syndrome ?
a. Denys-Drash syndrome
b. Finnish type of congenital NS
c. Nail patella syndrome
d. Frasier’s syndrome

answer b. Finnish type of Congenital nephrotic syndrome .

30q: Major features of the finnish type of congenital nephrotic syndrome are all except ?
a. Dilatation of the proximal tubules
b. Dilatation of the distal tubules
c. Mesangial hypercellularity
d. Glomerular sclerosis

answer b. dilatation of distal tubules is not a feature of finnish type of NS .

31q: All of the following are true about finnish type of congenital NS except ?
a. Infants present with large placenta and marked edema
b. Prematurity and respiratory distress are seen in these infants
c. Separation of cranial sutures and massive proteinuria is seen in these infants
d. Corticosteroids are very helpful in the treatment

answer d. corticosteroids and immunosuppressive agents are not useful in the treatment .

32q: All of the following are true about finnish type of congenital NS except ?
a. Progressive renal failure with death by the age of 5 years
b. This disease is detectable in utero by increased alpha fetoprotein levels
c. Inheritance is autosomal dominant type
d. Most common in populations of Scandinavian descent ( 1: 8000 incidence )
e. Mutation in the NPHS1 gene which produces nephrin

answer c. inheritance is of autosomal recessive type not AD .

33q: all of the following are true about Denys-Drash syndrome except ?

a. Mutation in WT1 gene
b. Wilm’s tumor is a feature of it
c. Male pseudohermaphroditism is seen in it
d. Diffuse mesangial sclerosis is characteristic
e. WT1 gene is located on chromosome 13

answer e. WT1 gene is located on 11th chromosome not 13th.

34q: Which of the following drugs are used in the treatment of Idiopathic nephrotic syndrome ?
a. Prednisone
b. Cyclophosphamide
c. Methylprednisolone
d. Cyclosporine
e. Tacrolimus
f. Mycophenolate

answer a, b, c, d, e, f . all are true . ACE inhibitors and angiotensin II blockers may also be helpful as adjunct therapy to reduce proteinuria in steroid-resistant patients .

35q: In the presence of which of the following features do u suspect the presence of secondary nephrotic syndrome ?
a. Age greater than 8 years
b. Hypertension and hematuria
c. Renal dysfunction
d. Extrarenal symptomatology ( rash, arthralgias, fever )
e. Raised serum complement levels

answer a,b,c,d only . depressed serum complement levels suggest secondary Nephrotic Syndrome and not raised levels complement levels .

36q: Drugs causing nephrotic syndrome are ?
a. Gold
b. Pamidronate
c. Interferon
d. Heroin

answer a, b, c , d. all of them cause nephrotic syndrome .

37q: Steps taken to ameliorate nephrotic state in a patient with congenital nephrotic syndrome are all except ?
a. ACE inhibitors
b. Indomethacin
c. Unilateral nephrectomy
d. Corticosteroids

answer d. corticosteroids . they are of no use here .

36 - Nephrotic Syndrome Mcqs with answers part 1

1q: Nephrotic syndrome is how many times more common in children than adults ?
a. 5 times
b. 10 times
c. 15 times
d. 20 times

answer c . 15 times

2q: what is the incidence of nephrotic syndrome ?
a. 2-3/100000 children per year
b. 20-30/100000 children per year
c. 200-300/100000 children per year
d. 2000-3000/100000 children per year

answer a. 2-3 / 100000 children per year

3q: The characteristic features of nephrotic syndrome are ?
a. Heavy proteinuria ( greater than 3.5 g/24 hr in adults or 40 mg/sq.m/hr in children )
b. Hypoalbunemia ( less than 2.5 g/dL )
c. Edema
d. Hyperlipidemia
e. All the above

answer e. all the above

4q: Which of the following statements about nephrotic syndrome are true ?
a. Most children ( 90 % ) with nephrotic syndrome have a form of idiopathic nephrotic syndrome
b. Minimal change disease ( 85 % ) is the most common cause of idiopathic nephrotic syndrome
c. Focal segmental glomerulo sclerosis ( 10 % ) and mesangial proliferation ( 5 % ) are the next common causes of idiopathic nephrotic syndrome
d. The remaining 10 % who do not have idiopathic NS have secondary NS related to systemic or glomerular diseases such as membranous nephropathy or membranoproliferative glomerulonephritis
 e. All the above statements are true

answer e. all the above

5q: Which of the following causes nephrotic syndrome which is steroid responsive ?
a. Minimal change nephrotic syndrome
b. FSGS
c. Denys-drash syndrome with diffuse mesangial sclerosis
d. Nail-patella syndrome
e. Finnish type of congenital NS

answer a. MCNS , rest of them are steroid resistant .

6q: All of the following are true about nephrin except ?
a. It is a product of the gene NPHS1
b. Location of the gene is on 1q25
c. The inheritance is of recessive type
d. A defect in the production of nephrin causes finnish type of congenital nephrotic syndrome
e. The NS produced by nephrin defect is steroid resistant

answer b. the location of the NPHS1 gene is on 19q13.1 NPHS2 is located on 1q25 which produces Podocin.

7q: Alpha actinin-4 is a product of which gene ?
a. NPHS1
b. NPHS2
c. FSGS1
d. FSGS2
e. WT1

answer c. FSGS1 .

8q: All of the following are true about podocin except ?
a. It is product of the gene LMX1B
b. Inheritance is of recessive type
c. A defect in podocin production is associated with FSGS
d. Gene location is on chromosome 1q25

answer a. it is product of NPHS2 gene and not LMX1B.

9q: gene for alpha-actinin-4 ( FSGS1 ) is located on which chromosome ?
a. 19q13
b. 1q25
c. 2q35
d. 9q34

answer a. 19q13

10q: What is the renal disease causing steroid resistant nephrotic syndrome associated with the defect in gene LMX1B which produces the protein LIM-homeodomain ?
a. Denys-Drash syndrome with diffuse mesangial sclerosis
b. Nail patella syndrome
c. FSGS
d. MCNS

answer b. Nail patella syndrome .

11q: In the nephrotic state , serum lipid levels ( cholesterol, triglycerides ) are elevated for the following reason ?
a. Hypoalbuminemia stimulates generalized hepatic protein synthesis, including synthesis of lipoproteins
b. Lipid catabolism is diminished, as a result of reduced plasma levels of lipoprotein lipase, related to increased urinary losses of this enzyme
c. Both a and b
d. None

answer c. both a and b

12q: How much percentage of children with Minimal Change Nephrotic Syndrome respond to corticosteroid therapy ?
a. 95 %
b. 50 %
c. 20 %
d. 5 %

answer a. 95 %

13q: Electron microscopy of a patient with FSGS shows segmental scarring of the glomerular tuft with obliteration of the glomerular capillary lumen . A similar lesion may be seen with ?
a. HIV infection
b. Vesicoureteric reflux
c. Intravenous heroin abuse
d. All the above

answer d. all the above

14q: All of the following are true about FSGS associated nephrotic syndrome except ?
a. FSGS involves 85 % of all the cases presenting with idiopathic NS
b. 20 % of these cases respond to prednisone
c. Immunofluorence microscopy shows IgM and C3 staining in areas of segmental sclerosis
d. Electron microscopy shows segmental scarring of the glomerula tuft with obliteration of the glomerular capillary lumen
e. FSGS is frequently progressive, ultimately involving all glomeruli , and leads to end-stage renal disease in most patients

answer a is false because FSGS involves only 10 % of cases presenting with idiopathic NS

15q: Which of the following are uncommon findings in a patient with idiopathic nephrotic syndrome ?
a. Abdominal pain
b. Diarrhea
c. Anorexia and Irritability
d. Hypertension
e. Gross hematuria

answer d and e are uncommon . hypertension and gross hematuria .

16q: what is the differential diagnosis of a child with marked edema ?
a. Protein-losing enteropathy
b. Hepatic failure
c. Congestive heart failure
d. Acute or chronic glomerulonephritis
e. Protein malnutrition
f. All the above

answer f. all the above

17q: All of the following are true about idiopathic nephrotic syndrome except ?
a. More common in females than in males ( 2:1 )
b. Most commonly appears between the ages of 2 and 6 years
c. MCNS is present in 85-90 % of patients of less than 6 years of age
d. FSGS develops in older children
e. 20 -30 % of adolescents have MCNS

answer a is false because males are more commonly affected than females at a ratio of 2:1 .

MCQs in Pediatrics 2nd edition
MCQs in Pediatrics ; Over 600 Questions with Explanatory Notes

35 - Juvenile Myoclonic Epilepsy ( Janz syndrome )

Here are some important points about Juvenile Myoclonic Epilepsy :

1. Juvenile Myoclonic Epilepsy is otherwise called Janz syndrome .

2. It usually begins between the ages of 12 and 16 year .

3. It accounts for approximately 5 % of all the epilepsies .

4. Patients note frequent myoclonic jerks on awakening , making hair combing and tooth-brushing difficult .

5. As the myoclonus tends to abate later in the morning, most patients do not seek medical advice at this stage and some deny the episodes .

6. A few years later, early morning generalized tonic-clonic seizures develop in association with the myoclonus.

7. The EEG shows a 4-6/sec irregular spike and wave pattern, which is enhanced by photic stimulation .

8. The neurologic examination is normal.

9. Majority of the patients respond dramatically to valproate, which is required lifelong .

10. Discontinuance of the drug causes a high rate of recurrence of seizures .

MCQs in Pediatrics 2nd edition
MCQs in Pediatrics ; Over 600 Questions with Explanatory Notes

34 - PGI Chandigarh december 2007 mcqs part 2

8q: True statements about juvenile myoclonic epilepsy ?
a. DOC is sodium valproate
b. mental retardation
c. seizure can develop
d. neurological examination is abnormal
e. life long treatment needed

answer a, c, e.

Click here to read a short notes on Juvenile Myoclonic Epilepsy .

9q: A child presented in the casualty with fever , unconscious and papilloedema . what is the next step/s to be done ?
a. intubation
b. oxygenation
c. CT scan
d. lumbar puncture

answer a,b,c,d .

10q: A child with jaundice is being given food intravenously . which of the following can occur out of it ?
a. infection
b. malnutrition
c. diarrhea
d. hyperglycemia
e. metabolic acidosis

answer a, d, e .

11q: Most common cardiac tumor in childhood ?
a. rhabdomyoma
b. lymphoma
c. atrial myxoma
d. sarcoma
e. fibroma

answer a, c, e .

12q: loss of pulmonary surfactant in premature infant ?
a. pulmonary edema
b. collapse of alveoli
c. elastic recoil of lungs
d. all the above

answer d. all the above

13q: unconjugated hyperbilirubinemia is seen in ?
a. physiological jaundice
b. breast milk jaundice
c. gilbert syndrome
d. biliary atresia
e. rotor syndrome

answer a, b, c

Essential Pediatric McQs
MCQs in Pediatrics 2nd edition
MCQs in Pediatrics ; Over 600 Questions with Explanatory Notes

33 - PGI Chandigarh december 2007 mcqs part 1

1q: What is meant by a " suppositious child " ?
a. second born out of a twin pregnancy
b. child born out of wed lock
c. child reared by a woman and she claims the child
d. heterozygous mother and father
e. homozygous mother and father

answer c. child reared by a woman and she claims the child

2q: An adolescent child complains of night pains in the knee . It could be due to ?
a. juvenile rheumatoid arthritis
b. idiopathic growth pain
c. osteosarcoma
d. paget's disease
e. osteomyelitis

answer a and b .

3q: Infants of diabetic mother manifests ?
a. hyperglycemia
b. hypoglycemia
c. hypocalcemia
d. increased fetal defects
e. hyperbilirubinemia

answer b, c, d and e .

4q: 7 day old baby presented in the emergency department with unconsciousness, blue in appearance with 85 % in oxygen saturation . the diagnosis ?
a. tetralogy of fallot
b. TGA
c. TAPVC
d. PDA

answer b. TGA

5q: Oral glucose tolerance test in children is done with ?
a. 1.5 gm/kg glucose
b. 1.75 gm/kg glucose
c. 2 gm/kg glucose
d. 2.5 gm/kg glucose
e. 75 gms as an adult

answer b. 1.75 gm/kg glucose

6q: A new born of 7 days old presented with meningitis . most common cause ?
a. E.coli
b. streptococcal pneumonia
c. N.meningitides
d. streptococcal agalactiae
e. H.influenzae

answer a, b and d . streptococcal agalactiae is the other name group-B streptococcus

7q: Still born child is defined by ?
a. greater than 20 weeks
b. greater than 24 weeks
c. greater than 28 weeks
d. greater than 32 weeks
e. greater than 1300 grams of weight

answer c. greater than 28 weeks

McQs in Paediatrics (Pocket MCQs)
Paediatric McQs for Postgraduate Examinations: Practice Examinations
McQs in Paediatrics: With a Tactical Guide on How to Approach Clinical Examinations (PMCQ)

32 - Idiopathic Thrombocytopenic Purpura ( ITP ) Mcqs part 2

11q: In adolescents with new onset ITP , an antinuclear antibody test should be done to evaluate for ?
a. HIV
b. SLE
c. Kawasaki disease
d. Evan’s syndrome

answer b. SLE

12q: What is the test to be done in an ITP patient with unexplained anemia to rule out Evan’s syndrome?
a. ELISA
b. Coomb’s test
c. Blood smear
d. Bone marrow aspiration

answer b. coomb's test

13q: Differential diagnosis of ITP are ?
a. Exposure to medication that induces drug-dependent antibodies
b. Splenic sequestration due to previously unappreciated portal hypertension
c. Early aplastic processes such as fanconi anemia
d. Amegakaryocytic thrombocytopenia
e. Thrombocytopenia-absent radius ( TAR ) syndrome
f. All the above

answer f. all the above

14q: What is the disease that should be considered in young males found to have low platelet counts , particularly if there is a history of eczema and recurrent infection ?
a. SLE
b. HIV
c. Wiskott-aldrich syndrome
d. Hemolytic uremic syndrome

answer c. wiskott-aldrich syndrome

15q: All are true regarding the treatment of ITP except ?
a. There is no data showing that treatment affects either short- or long-term clinical outcome of ITP
b. Compared with untreated control subjects , treatment appears to be capable of inducing a more rapid rise in platelet count to the theoretically safe level of greater than 2 lakh/ cubic mm
c. Platelet transfusion in ITP is usually contraindicated unless life threatening bleeding is present
d. There is enough data to show that early therapy prevents intracranial hemorrhage

answer d. actually there is no data to show that early therapy prevents intracranial hemorrhage

16q: What is the best treatment for a case of ITP with minimal, mild or moderate symptoms ?
a. No therapy other than education and counselling of the family and patient
b. Intravenous immunoglobulin ( IVIG ) at a dose of 0.8-1.0 g/kg/day for 1-2 days
c. Intravenous anti-D therapy at a dose of 50-75 micrograms/kg
d. Prednisone at a dose of 1-4 mg/kg/24 hr

answer a. no therapy other than education and counselling of family and patient.

17q: What is the dose of IVIG given to a patient of ITP that induces a rapid rise in platelet count ( usually greater than 2 lakh/cubic mm ) in 95 % of patients with 48 hrs ?
a. 0.8-1.0 g/kg/day for 1-2 days
b. 1.0-1.5 g/kg/ day for 1-2 days
c. 0.8-1.0 g/kg/day for 4 days
d. 1.0-1.5 g/kg/day for 4 days

answer a. 0.8-1.0 g/kg/day for 1-2 days

18q: The role of splenectomy in ITP should be reserved for which of the following circumstances ?
a. The older child ( greater than or equal to 4 years of age ) with severe ITP that has lasted greater than 1 year ( chronic ITP ) and whose symptoms are not easily controlled with therapy
b. When life threatening hemorrhage ( intracranial hemorrhage ) complicated acute ITP, if the platelet count cannot be corrected rapidly with transfusion of platelets and administration of IVIG and corticosteroids
c. Both of the above
d. none of the above

answer c. both a and b

19q: In ITP , which is the primary site of both antiplatelet antibody synthesis and platelet destruction ?
a. Liver
b. Spleen
c. Gall bladder
d. pancreas

answer b. spleen

20q: All of the following are true about chronic ITP except ?
a. Approximately 50 % of patients who present with acute ITP have persistent thrombocytopenia for greater than 6 months and are said to have chronic ITP
b. Splenectomy is successful in inducing complete remission in 64-88 % of children with chronic ITP
c. Before splenectomy the child should receive pneumococcal and meningococcal vaccines
d. After splenectomy the child should receive pencillin prophylaxis

answer a. it is 20 % and not 50 % .

Essential Pediatric McQs
MCQs in Pediatrics 2nd edition
MCQs in Pediatrics ; Over 600 Questions with Explanatory Notes

31 - Idiopathic Thrombocytopenic Purpura ( ITP ) Mcqs part 1

1q: What is the most common cause of acute onset of thrombocytopenia in an otherwise well child ?
a. SLE
b. Wiskott-Aldrich syndrome
c. HIV
d. ( autoimmune )ITP

answer d. (autoimmune) ITP

2q: All of the following statements are true about Idiopathic Thrombocytopenic Purpura (ITP) except ?
a. A recent history of viral illness is described in 50-65% of cases of childhood ITP
b. Autoantibodies directed against the platelet surface develops
c. EBV related ITP is usually of short duration and HIV associated ITP is usually chronic
d. Splenomegaly is frequently seen

answer d. splenomegaly . It is rarely seen .

3q: Which of the following is a classical presentation of ITP ?
a. Previously healthy 1-4 year old child who has sudden onset of bleeding from gums and mucous membranes
b. Previously healthy 1-4 year old child who has sudden onset of generalized petechiae and purpura
c. Previously healthy 1-4 year old child presents with splenomegaly
d. Previously healthy 1-4 year old child presents with lymphadenopathy

answer b. child with sudden onset of generalized petechiae and purpura. Though bleeding from gums and mucous membranes is also frequently seen, petechiae and purpura is the classical presentation.

4q: What is the normal platelet count ?
a. 150 – 450 X 10 power 9 / Litre
b. 150 – 450 X 10 power 3 / cubic mm
c. Both a and b are true
d. None of them

answer c. Both a and b are true

5q: Thrombocytopenia refers to a reduction in platelet count to ?
a. Less than 1.5 lakh/cubic mm
b. Less than 2 lakh / cubic mm
c. Less than 1 lakh / cubic mm
d. Less than 2.5 lakh / cubic mm

answer a. less than 1.5 lakh /cubic mm

6q: In 70-80 % of children who present with acute ITP , spontaneous resolution occurs within ?
a. 3 months
b. 6 months
c. 9 months
d. 1 year

answer b. 6 months.

7q: All of the following are true about ITP except ?
a. Therapy does not appear to affect the natural history of the illness
b. Fewer than 1 % of patients have intracranial haemorrhage
c. 80 % of children who present with acute ITP go on to have chronic ITP
d. Severe thrombocytopenia ( platelet count less than 20 x 10 power 9 / litre ) is common

answer c. only 20 % go on to have chronic ITP and not 80 %

8q: Autoimmune hemolytic anemia and thrombocytopenia is otherwise called ?
a. Tourette’s syndrome
b. Evans syndrome
c. Capgras syndrome
d. None

answer b. Evan's syndrome

9q: All are true about acute ITP except ?
a. The hemoglobin value is normal or may be decreased if there have been profuse nosebleeds or menorrhagia
b. WBC count is decreased
c. Differential count is normal
d. Bone marrow examination shows normal granulocytic and erythrocytic series with characteristically normal or increased numbers of megakaryocytes
e. Platelet antibody testing is seldom useful in acute ITP

answer b. WBC count is normal and not decreased.

10q: What are the indications for bone marrow aspiration in ITP ?
a. An abnormal WBC count
b. An abnormal differential count
c. Unexplained anemia
d. Findings suggestive of bone marrow disease on history and physical examination
e. All the above

answer e. all the above

30 - Nadas criteria

The assessment of a child for the presence or absence of heart disease can be done with the help of some guidelines suggested by nadas and are called "nadas criteria" . the criteria are divided into major and minor criteria. Presence of one major and two minor criteria are essential for indicating the presence of heart disease.

The major criteria are :

1. systolic murmur grade 3 or more specially with a thrill
2. diastolic murmur
3. cyanosis
4. congestive cardiac failure

The minor criteria are :

1. systolic murmur less than grade 3 in intensity
2. abnormal second heart sound ( S2)
3. abnormal ECG
4. abnormal X-ray
5. abnormal blood pressure

29 - AIIMS november 2008 pediatrics mcqs - part 2

157.  a 7 yr old girl with non productive cough, mild stridor for 3 months duration. patient is improving but suddenly developed wheeze productive cough mild fever and hyperlucency on cxr and pft shows obstructive curve.diagnosis is? 

A. Bronchiolitis obliterans 
b. Hemosiderosis 
c. Pulmonary alveolar microlithiasis 
d. Follicular bronchitis 

 Answer: 

158. 3.5 kg term male baby born of uncomplicated pregnancy developed respiratory distress at birth not responded to surfactant, echo is normal, cxr shows ground glass appearance. Culture negative.apgar score 4 and 5 at 1 and 5 min.hostory of i month female sibling died before.diagnosis? 

A. Tapvc 
b. Meconium aspiration 
c. Neonatal plmonary alveolar proteinosis 
d. Diffuse herpes simplex infection 

 Answer: 

159. All are true about congenital rubella except? 
A. Igg persists for more than 6 months 
b. Igm antibody is present at birth 
c. Most common anomalies are hearing and heart defects 
d. Increased congenital malformation if infection after 16 weeks 

 Answer: 

160. A 10 yr old child is always restless inattentive to study and always wants to play outside.parents are extremely distressed.what would you advise? 

A. It’s a normalbehaviour 
b. Behaviour therapy 
c. It’s a serious illness requires medical treatment 
d. Needs change in environment 

Answer:

161.a 2yr old child brought to emergency at 3 am .child has barky cough and stridor only while crying. narmal hydration rr-36/min t-39.6 c .what will be your next step? 

a. racemic epinephrine nebulisation 
b. high dose dexamethasone inj 
c. nasal was for influenza/rsv 
d. antibiotics and blood culture 

 Answer: 

162.bad prognostic factor for all is? 

a. age 2-8 years 
b. TLC greater than 50000
c. hyperdiploidy 
d. t(9:22), t(8:14),t(4:11) 

 answer:

to view the all the 200 aiims november 2008 mcqs click here

28 - AIIMS November 2008 Pediatrics mcqs - part 1

1Q: which of these statements is not correct ?
A. Neomycin is used as a preservative for BCG
B. kanamycin is use as a preservative for measles
C. magnesium chloride is used as a stabilizer for OPV
D. thimerosal is used as a preservative for DPT

answer: A .

let us analyse the options one by one

NEOMYCIN IS USED AS A PRESERVATIVE FOR BCG

The statement is FALSE

BCG contains glycerine, asparagine, citric acid, potassium phosphate, magnesium sulphate, and iron ammonium citrate. The final preparation prior to freeze-drying also contains lactose.

Sodium glutamate and chloride are also used as preservatives.

There is no neomycin

KANAMYCIN IS USE AS A PRESERVATIVE FOR MEASLES

The statement is TRUE

Yes , measles vaccine contains the antibiotics erythromycin and kanamycin.

Therefore , “kanamycin allergy is a definite contra indication to the measles vaccine ”

MAGNESIUM CHLORIDE IS USED AS A STABILISER IN OPV

That’s TRUE

Also remember

“Injectable polio vaccines do contain the antibiotics neomycin , streptomycin and polymyxin B but not oral polio vaccine !!! ”

Who knows …… this might be the question of 2009 !

THIMEROSAL IS USED AS A PRESERVATIVE IN DPT

YES that’s also true.

Thimerosal is a mercury derivative and hence raising a lot of controversies. It is used in certain other vaccines too.

WHAT IS SO CONTROVERSIAL ABOUT IT ?

Statistics indicate that AUTISM is on the rise. Researchers say that the use of thimerosal in several vaccines, especially DPT is directly related to the rise in autism !!!!

Composition of vaccines :

DPT: Aluminium phosphate, formaldehyde, ammonium sulphate, washed sheep red blood cells, glycerol, sodium chloride, thimerosal

Polio:
IPOL: 3 types of polio
virus, formaldehyde, henoxyethanol (antifreeze), neomycin, streptomycin, polymyxin B;
Orimune: using 3 types of attenuated polioviruses, streptomycin, neomycin, calf serum, sorbitol

HIB: polyribosylribitol, ammonium sulfate, thimerosal.

MMR: sorbitol, neomycin, hydrolyzed gelatin.

BCG: glycerine, asparagine, citric acid, potassium phosphate, magnesium sulphate, and iron ammonium citrate. The final preparation prior to freeze-drying also contains lactose.