Pediatric multiple choice questions with answers and explanation

Take a Quiz with following multiple choice questions from different topics in Pediatrics.

Click on the option to check your answers. Each MCQ is provided with an exaplanation inlcuding images.

1. Symptomatic Neonatal CNS involvement is most commonly seen in which group of congenital intrauterine infections?

Explanation

CNS involvement is a common feature of TORCH infection. The newborn is generally asymptomatic at birth and develops symptoms characteristic of the infection in the late neonatal period.

Symptomatic CNS manifestations are most common with herpes and rubella infections as compared to other TORCH groups of infections.


2. Which is the only glycogen storage disorder that is a lysosomal storage disorder?

Explanation

Pompe disease is a disorder of glycogenolysis resulting in glycogen accumulation in lysosomes. Engorged lysosomes rapture and cause tissue damage primarily in skeletal and cardiac muscle.

McArdle disease or Glycogen storage disease type V affects muscle metabolism. This is caused by the lack of an enzyme called muscle phosphorylase.

Anderson disease is caused by reduced activity of the glycogen-branching enzyme and results in the accumulation of abnormal glycogen in the liver, muscle, and/or other tissues.

Cori's disease is type 3 GSD. Mutations of the AGL gene cause GSD type 3. The gene produces glycogen debranching enzyme which is involved in the breakdown of glycogen, a major source of our stored energy.


3. Least common cause of neonatal sepsis in India-

Explanation

According to National Neonatal Perinatal Database India, these are the most common organism causing Neonatal sepsis

  1. Klebsiella,
  2. Staph.aureus,
  3. E-coli
  4. pseudomonas,
  5. SEnterobacter,
  6. Coagulase-negative staphylococcus,
  7. SAcenatobacter and Candida.

4. A neonate delivered at 37 wks of gestation with a birth weight of 1.9 kg develops intolerance to feed/ lethargy/abdominal distension on the 2nd day. The sepsis screen is negative. Physical examination is unremarkable. PCV is observed to be 72%. Which of the following represents with the best management

Explanation

Definition of Polycythemia - HCT or hemoglobin concentration >2 SD above the normal value for gestational and postnatal age.

A term infant is considered to be polycythemic if the HCT from a peripheral venous sample is >65 percent or the hemoglobin is >22 g/dL. In clinical circumstances.

The definition is based upon the HCT, rather than the hemoglobin concentration more commonly.

When to do Partial Exchange Transfusion in Neonates for polycythemia -

  1. Do NOT perform PET in an asymptomatic infant with Hct less than 0r =75%
  2. Consider PET in infants with Hct >65% who are symptomatic
  3. Consider PET in asymptomatic infants with Hct >75%, however, there is minimal data for benefit in asymptomatic infants.

Timing of Partial Exchange Transfusion

PET should be performed as soon as possible in symptomatic infants.


5. Manning score for fetal well being includes all except

Explanation

Fetal well being is tested as biophysical profile by antenatal ultrasound. It involves a scoring system called as Manning score.

Manning score can be remembered by pneumonic BATMAN as

  1. B = Breathing
  2. A= Amniotic fluid volume
  3. T = Tone
  4. M = Movements
  5. A = and
  6. N = NST

6.Sodium iodine symporter is absent in which of the following

Explanation

Sodium iodine symporter
Fig.1 - Soidum iodine symporter. Source [1]

Apart from thyroid cells, NIS is present, in other tissues like salivary glands, the gastric mucosa, the kidney, the placenta, the ovaries, and the mammary glands during pregnancy and lactation.

NIS expression in the mammary glands for the regulation of iodide in breast milk is the main source of iodine for a newborn.

TSH regulates NIS expression in the thyroid, while prolactin, oxytocin and β-estradion control its regulation in the mammary gland.


7. A 2 yrs old male child presents to pediatric emergency department with a history of fever x 2 wks. He has received multiple antibiotics. Blood tests for Typhoid, Malaria, Dengue are all negative. He however had sterile pyuria in one of the reports (urine C/s - sterile). BCG scar is indurated and H/o conjunctivitis, cheilitis and erythematous rash over body for initial 5 days of illness is obtained the most likely treatment of choice is:

Explanation

Kawasaki disease should be considered in the differential diagnosis of every child with an unexplained fever of several days duration accompanied by a rash and non-purulent conjunctivitis, especially in younger children less than 1-year-old. The diagnosis in such children is often missed.

Even though the option given here doesn't give a full picture of diagnosis, It is asked "most likely treatment of choice ?" and KD fits well.

  1. Read BMJ - BCG reactivation - a useful diagnostic tool even for incomplete Kawasaki disease.
  2. Read BMJ - what to do with incomplete KD

8. Zebra striped hair is characteristic of which deficiency

Explanation

menifestations of Zinc deficiency in children
Fig.2 - Clinical aspects of zinc deficiency. Source [2]

9. Generalised painless lymphadenopathy is seen in

Explanation

RMSF is caused by Rickettsia rickettsii and generalized LN pathy is not described.

Epidemic typhus is caused by Rickettsia prowazekii Epidemic and causes painful regional lymph nodes in and around the area of the bite and preauricular adenopathy (Parinaud's ocular glandular syndrome).

Q fever rarely described as causing enlarged glands.


10.Non shivering thermogenesis is mediated by

Explanation

Non shivering thermogenesis in neonates
Fig.3 - Non shivering thermogenesis in Newborn.Source [3]

11. Which of the following is a characteristic feature of Blount’s disease?

Explanation

Blount disease is a growth disorder of the tibia. The lower leg angles inward, resembling a bowleg. Also known as "tibia vara.

The closest DD is Rickets that can closely resemble the findings. To differentiate between Rickets and Blount's disease, it is important to correlate with laboratory findings like calcium, phosphorus, and alkaline phosphatase abnormalities.


12. Wide pulse pressure as an indicator of large left to right shunt is seen in?

Explanation

The wide pulse pressure occurs due to two reasons in PDA.

  1. A mild increase in systolic blood pressure to overcome the decrease in distal blood flow due to run-off through the PDA during diastole.
  2. Lower diastolic blood pressure from the run-off itself.

13. Gene for the congenital nephrotic syndrome are all except

Explanation

The majority of cases of late-onset Nephrotic syndrome are caused by Podocin gene mutations.


14. Drug given in cystic fibrosis is

Explanation

Ivacaftor decreases the production of the thick sticky mucus leading to problems in CF.

It can be given to patients, who have a G551D mutation. More about Ivacaftor in CF.


15. Yoyo reflex is seen in

Explanation

Yoyo reflex is the reflux of urine from normal caliber ureter to dilated ureter in partial duplication of ureters. It is also called as uretero-ureteric reflex and also seen in Hydronephrosis.

More MCQs

  1. MCQs in Pediatrics - Home : Collection of more than 1500 MCQs
  2. MCQ in Pediatric Cardiology

Image credits

  1. By Mikael Häggström, used with permission. - Mainly Own work Source image for nucleus derivative: (Public Domain license)
  2. Yanagisawa, H.: Clinical menifestations of zinc deficiency. The Journal of the Japan Medical Association 2002; 127(2): 261–268.
  3. ThermogeneseAdipozyten.svg: chris. derivative work: Burkhard, Public domain, via Wikimedia Commons
auhtor

About Author

Shailesh Gophane | DCH DNB Pediatrics

Shailesh completed his Pediatric residency from Port Trust Hospital Mumbai after completing DCH from J.J. Hospital, Mumbai.

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