DMA's PEDATRICS PG Q & A 16 - 12 - 2017
Published on Dec. 16, 2017, 11:48 a.m.

 

1) All are helpful in the evaluation of an infant with bronchopul­monary dysplasia EXCEPT

 

(A) Sleeping respiratory rate      

 

(B) Oxygen saturation

 

(C) Chest x-ray                         

 

(D) Sweat test

 

2. A nurse believes that a 12-hour-old infant has experienced a seizure lasting 2 minutes. Labor history includes rupture of the fetal membranes 24 hours before delivery and a difficult delivery with forceps. The Apgar score was 7 at 1 minute and 8 at 5 minutes. The nurse reports that the infant had been feeding poorly and was lethargic before the seizure. The differential diagnosis includes all EXCEPT:

 

(A) Asphyxia                

 

(B) Meningitis

 

(C) Kernicterus             

 

(D) Intracranial hemorrhage

 

3. A 6-year-old boy is shorter than all of his classmates. Diagnostic testing supports a diag­nosis of idiopathic isolated growth hormone (GH) deficiency. All of the following are expected clinical findings in this patient EXCEPT

 

(A) Normal body proportions    

 

(B) A growth velocity of 3 cm/yr

 

(C) Mild truncal obesity          

 

(D) Hypertension

 

4. Toxic shock syndrome is associ­ated with all the following findings EXCEPT.

 

(A) Vomiting and diarrhea         

 

(B) Disorientation

 

(C) Increased platelet count       

 

(D) Abnormal LFT

 

5. All of the following are feature of normal children of 12- 18 month of age except:

 

A. Decreasing growth rate

 

B. Increasing appetite

 

C. Decrease in sleep time

 

D. Exaggerated lumbar lord sis

 

6. Which of the following children will require stringent developmental and physical assessment

 

A. Six month old taking every thing in to the mouth

 

B. An eight month old right handed child

 

C. Five month old not sitting unsupported

 

D. Ten month old month walking independently 

 

7. Triceps skin fold thickness is a measure of :

 

A. Muscle nutrition        

 

B. Muscle power

 

C. Body adiposity        

 

D. Body stature

 

8. Stature is best measured using :

 

A. Inch tape                 

 

B. Swing arm measuring sticks

 

C. Herpendens caliper  

 

D. Stadiometer

 

9. Commonest cause of delayed tooth eruption is:

 

A. Hypothyroidism       

 

B. Familial

 

C. Malnutrition              

 

D. Idiopathic

 

10. The condition in which physical symptoms are induced by parents in their children is :

 

A. Over anxious parents           

 

B. Conversion disorder

 

C. Hypochondriasis        

 

D. Munchausen’s by proxy syndrome


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1. Ans.  (D)

 

The sweat test is used in the diagnosis of cystic fibrosis but is not helpful in assessing children with bronchopulmonary dysplasia. In the eval­uation of children with bronchopulmonary dysplasia, the sleeping respiratory rate, oxygen saturation (obtained by oximetry), and' hest x-ray all provide valuable information. The severity of the lung disease also is assessed by the rate of growth and the number of calo­ries needed to produce good growth. The electrocardiogram is helpful when looking for signs of right ventricular hypertrophy secondary to pulmonary hypertension from chronic hypoxemia.

 

2. Ans.  (C)

 

The two impor­tant point in the history described in the ques­tion are the length of time between the rupture of the fetal membranes and delivery, which increases the risk for infection, and the use of forceps, which is associated with intracranial trauma and hemorrhage. Although asphyxia is a major cause of seizures. during the first day of life, there is nothing in the history to suggest its occurrence (i.e., there has been no history of abnormal fetal heart tracing or meconium­stained fluid,: and the Apgar score was normal). Clinical signs of kernicterus are not seen at 12 hours of age.

 

3. Ans.  (D)

 

Idiopathic growth hormone (GH) deficiency accounts for most cases of GH defi­ciency. Typical features include short stature, slow growth velocity « 5 cm/yr in older children), 'mild truncal adiposity, and delayed skeletal maturation. Body proportions are nor­mal, in contrast to the immature proportions seen in congenital hypothyroidism: Hyperten­sion is not associated with idiopathic GH defi­ciency, although it is a common feature of Cushing syndrome, another cause of slow growth during childhood.

 

4. Ans.  (C)

 

Toxic shock syndrome (TSS) is a total body response to the release of endotoxin from a Staphylococcus aureus infection. The platelet count decreases to less than 100,000/mm3. Treatment requires the removal of the causative agent, such as a tampon or a diaphragm, and treatment with systemic antibiotics. Prevention requires the limited and careful use of diaphragms and tampons and the recognition of the symptoms associated with TSS.

 

5. Ans. (B)

 

Although weight and height increases, growth rate decreases progressively after birth during whole childhood until the onset of puberty. Appetite also decreases during second year of life as nutritional requirement relatively decreases, so option 2 is correct.

 

6. Ans. (B)

 

Option 1 is age appropriate. 3 and 4 are achieved at ages of about 7months and 15-18 months respectively. An 8 month old child using his right hand predominantly should be examined carefully as handedness usually develops after 2 years (established by 3 year.) this child may be suffering from monoplegia or hemiplegia and requires careful evaluation.

 

7. Ans .(C)

 

skin fold thickness at the region of triceps muscle is a measure of subcutaneous fat (adiposity).

Muscle nutrition is measured by taking circumferences of arm, forearm, thighs etc. Power is tested as described in examination of CNS. Body stature is determined by measuring height .

 

8. Ans . (D)

 

a’ and ‘b’ are unreliable. ‘c’ is used for measuring skin fold thickness.

 

 

 

9. Ans . (D)

 

Delayed tooth eruption is considered when no tooth erupts by 13 months of age . Most of the time the cause could not be determined.

 

10. Ans . (D)

 

Conversion reactions and hypochondriasis are somatoform disorders in which somatic complaints or dysfunction are not under conscious control and for which there is no demonstrable organic cause  Multidisciplinary by proxy syndrome is a factitious disorder in which physical symptoms are induced by parents in their children. It is considered as a form of child abuse and requires multidisciplinary approach along with separation from the parents.