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

20 - Paediatrics Mcqs - 152 to 165

152 - Which of the following does not establish a diagnosis of congenital CMV infection in a neonate?
A. Urine culture of CMV
B. IgG CMV antibodies in blood
C. Intra-nuclear inclusion bodies in hepatocytes
D. CMV viral DNA in blood by polymerase chain reaction

answer b. IgG CMV antibodies in blood.

(Ref: Cloherty’s Manual of Neonatal Care 5th Ed/P-257)

153 - All of the following are true of β thalassemia major, except:
A. Splenomegaly
B. Target cells on peripheral smear
C. Microcytic hypochromic anemia
D. Increased osmotic fragility

answer d. Increased osmotic fragility.

(Ref: Manual of Pediatric Hematology and Oncology, 4th Ed/P-184)

154 - Transient synovitis (toxic synovitis) of the hip is characterized by all of the following, except:
A. May follow upper respiratory infection
B. ESR and white blood cell counts are usually normal
C. Ultrasound of the joint reveals widening of the joint space
D. The hip is typically held in adduction and internal rotation

answer d. The hip is typically held in ...

(Ref: Nelson’s Textbook of Pediatrics 17th Ed, Ch. 148, P-809)

155 - A 3-year-old boy presents with fever, dysuria and gross hematuria. Physical examination shows a prominent suprapubic area which is dull to percussion. Urinalysis reveals red blood cells but no proteinuria. Which of the following is the most likely diagnosis?
A. Acute glomerulonephritis
B. Urinary tract infection
C. Posterior urethral valves
D. Teratoma

answer b. Urinary tract infection.

156 - Which of the following statements is true of primary grade IV-V vesicoureteric reflux in young children?
A. Renal scarring usually begins in the midpolar regions
B. Postnatal scarring may occur even in the absence of urinary tract infections
C. Long-term outcome is comparable in patients treated with either antibiotic prophylaxis or surgery
D. Oral amoxicillin is the choice antibiotic for prophylaxis

answer b.Postnatal scarring may occur even in the absence of UTI.

(Ref: Nelson’s Textbook of Pediatrics 17th Ed—Ch. 531-Vesicoureteric Reflux, P-1791-1793)

157 - 15-year-old boy presented with one day history of bleeding gums, subconjunctival bleed and purpuric rash. Investigations revealed the following results:
Hb-6.4 gm/dL; TLC-26,500/mm3 Platelet-35,000/mm3; prothrombin time–20 sec with a control of 13 sec; partial thromboplastin time-50 sec; and Fibrinogen 10 mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely?
A. Myeloblastic leukemia without maturation
B. Myeloblastic leukemia with maturation
C. Promyelocytic leukemia
D. Myelomonscytic leukemia

answer c. Promyelocytic leukemia.

*The type of AML, which is most commonly associated with DIC is AML M3.
(Ref: Manual of Pediatric Hematology and Oncology, 4th Ed/P-306, 443)

158 - The defective migration of neural crest cells results in:
A. Congenital megacolon
B. Albinism
C. Adrenogenital hypoplasia
D. Dentinogenesis imperfecta

answer a. Congenital megacolon

(Ref: Schwartz’s Principles of Surgery 8th Ed. 2005— Part II- Specific Considerations; Ch. 38-Pediatric Surgery)

159 - A premature infant is born with a patent ductus arteriosus. Its closure can be stimulated by administration of:
A. Prostaglandin analogue
B. Estrogen
C. Anti-estrogen compounds
D. Prostaglandin inhibitors

answer d. Prostaglandin inhibitors.

160 - The loading dose of Aminophylline is:
A. 50-75 ug/kg
B. 0.5-1.0 mg/kg
C. 2.0-3.5 mg/kg
D. 5-6 mg/kg

answer d. 5-6 mg/kg.

161 - Cushing’s Triad includes all except:
A. Hypertension
B. Bradycardia
C. Hypothermia
D. Irregular respiration

answer c. Hypothermia.

(Ref: Current Pediatric Diagnosis and Treatment 17th Ed. 2005—Ch. 11-Emergencies and Injuries)

162 - All of the following drugs are used for managing status epilepticus except:
A. Phenytoin
B. Diazepam
C. Thiopentone sodium
D. Carbamazepine

answer d.Carbamazepine.

(Ref: Current Pediatric Diagnosis and Treatment 17th Ed. 2005—Ch. 23-Neurologic and Muscular Disorders; Table 23.9-Status epilepticus treatment)

163 - Administration of glucose solution is prescribed for all of the following situations except:
A. Neonates
B. Child of a diabetic mother
C. History of unconsciousness
D. History of hypoglycemia

answer c. History of unconsciousness.

(Ref: Rudolph’s Pediatrics 21st Ed. 2003—24. The Endocrine System; 24.9-Hypoglycemia)

164 - Which organ is the primary site of hematopoiesis in the fetus before midpregnancy?
A. Bone
B. Liver
C. Spleen
D. Lung

answer b. LIVER.

(Ref: Nelson’s Textbook of Pediatrics 17th Ed/
P-1599)

165 - All of the following are the complications in the new born of a diabetic mother except:
A. Hyperbilirubinemia
B. Hyperglycemia
C. Hypocalcemia
D. Hypomagnesemia

answer b. Hyperglycemia.

(Ref: Cloherty’s Manual of Neonatal Care 5th Ed./P-13-1.

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)

19 - Paediatrics Mcqs - 141 to 151

141 - Conjugated hyperbilirubinemia is seen in:
A. Gilbert’s syndrome
B. Griggler Najjar syndrome
C. Breast milk jaundice
D. Dubin Johnson syndrome

Ans. (D) Dubin Johnson syndrome
(Ref: Nelson’s Textbook of Pediatrics 17th Ed, Ch. 338, P-1321)

142 - A 15-year-old female presented to the emergency department with history of recurrent epistaxis, hematuria and hematochezia. There was a history of profuse bleeding from the umbilicus stump at birth. Previous investigations revealed normal prothrombin time, activated partial thromboplastin time, thrombin time and fibrinogen levels. Her platelet counts as well as platelet function tests were normal but urea c1ot Jt. positive. Which one of the following clotting factor is most likely to be deficient?
A. Factor X
B. Factor XI
C. Factor XII
D. Factor XIII

Ans. (D) Factor XIII
(Ref: Nelson Pediatrics 17th Ed/P-1661)

143 - Which one of the following is the characteristic feature of juvenile myoclonic epilepsy?
A. Myoclonic seizures frequently occur in morning
B. Complete remission is common
C. Response to anticonvulsants is poor
D. Associated absence seizures are present in majority of patients

Ans. (A) Myoclonic seizures frequently occur in the morning
(Ref: Harrison’s Principles of Internal Medicine 16th Ed. 2005—Part XV-Neurologic Disorders;Sec. 2-Diseases of the Central Nervous System;Ch. 348-Seizures and Epilepsy)
*Here is a short notes on Juvenile Myoclonic Epilepsy (Janz syndrome)

144 - Plethoric lung fields are seen in all of the following conditions, except:
A. Atrial septal defect (ASD)
B. TAPVC (Total Anomalous Pulmonary venous connection)
C. Ebstein’s anomaly
D. Ventricular septal defect

Ans. (C) Ebstein’s anomaly
(Ref: Review of Radiology 3rd Ed/p-42-43)

145 - Which of the following is an example of disorders of sex chromosomes?
A. Marfan’s syndrome
B. Testicular feminization syndrome
C. Klinefelter’ s syndrome
D. Down’s syndrome

Ans. (C) Klinefelter’ s syndrome
(Ref: Robbins and Cotrans’s Pathologic Basis of Disease 7th Ed/P-145)

146 - Which of the following haemoglobin (Hb) estimation will be diagnostically helpful in a case of beta thalassemia trait?
A. Hb-F 
B. Hb1C
C. Hb-A2 
D. Hb-H

Ans. (C) Hb-A2
(Ref: Nelsons Pediatrics 17th Ed/P-1633)

147 - Which of the following circulating antibodies has the best sensitivity and specificity for the diagnosis of celiac disease?
A. Anti-endomysial antibody
B. Anti-tissue transglutaminase antibody
C. Anti-gliadin antibody
D. Anti-reticulin antibody

Ans. (A) Anti-endomysial antibody
(Ref: Nelsons Pediatrics 17th Ed/P-1265)

148 - A couple has two children affected with tuberous sclerosis. On detailed clinical and laboratory evaluation (including molecular studies) both parents are normal. Which one of the following explains the two affected children in this family?
A. Non penetrance
B. Uniparental diasomy
C. Genomic imprinting
D. Germline mosaicism

Ans. (D) Germline Mosaicism
(Ref: Journal of Child Neurology/Vol. 19, No. 9, Sept. 2004)

149 - Cardiomyopathy may be seen in all of the following except:
A. Duchenne muscular dystrophy
B. Friedreich’s ataxia
C. Type II glycogen storage disease
D. Alkaptonuria

Ans. (D) Alkaptonuria

150 - Enzyme replacement therapy is available for which of the following disorders?
A. Gaucher disease
B. Niemann Pick disease
C. Mucolipidosis
D. Metachromatic leukodystrophy

Ans. (A) Gaucher’s disease.

151 - In a child with acute liver failure, the most important prognostic factor for death is:
A. Increasing transaminases
B. Increasing bilirubin
C. Increasing prothrombin time
D. Gram negative sepsis

Ans. (C) Prothrombin time.
(Ref: Diseases of the liver and the biliary system 11th Ed, Ch. 8-Acute Liver Failure, P-118)