Pediatric Quiz (March 2010)

1. A child has presented with a palpable asymptomatic midline neck mass below the level of the hyoid bone. The mass on the neck moves during swallowing or on protrusion of the tongue. What is the most likely diagnosis

Thyroglossal Cyst

Ranula

Cystic Hygroma

Branchial Cleft Cyst

The most likely diagnosis for a palpable asymptomatic midline neck mass below the level of the hyoid bone that moves during swallowing or on protrusion of the tongue is a Thyroglossal Cyst. A thyroglossal cyst is a congenital anomaly that occurs due to the persistence of a remnant of the thyroglossal duct. It typically presents as a painless, fluctuant midline neck mass that moves with swallowing or tongue protrusion. This is in contrast to other options such as ranula (a cyst in the floor of the mouth), cystic hygroma (a lymphatic malformation), or branchial cleft cyst (a cyst in the lateral neck).

Explanation

The most likely diagnosis for a palpable asymptomatic midline neck mass below the level of the hyoid bone that moves during swallowing or on protrusion of the tongue is a Thyroglossal Cyst. A thyroglossal cyst is a congenital anomaly that occurs due to the persistence of a remnant of the thyroglossal duct. It typically presents as a painless, fluctuant midline neck mass that moves with swallowing or tongue protrusion. This is in contrast to other options such as ranula (a cyst in the floor of the mouth), cystic hygroma (a lymphatic malformation), or branchial cleft cyst (a cyst in the lateral neck).

2. A 11 months old child presents with respiratory distress. On examination, there is B/L crepitations and rhonchi. Which of the following is most likely cause

Pneumionia

Rhinovirus

Adenovirus

Respiratory Syncitial Virus

Respiratory syncytial virus (RSV) is the most likely cause in this scenario because it is a common cause of respiratory distress in infants. The presence of bilateral crepitations and rhonchi on examination suggests lower respiratory tract involvement, which is commonly seen in RSV infections. Pneumonia could also be a cause of respiratory distress, but the specific findings of crepitations and rhonchi point more towards RSV. Rhinovirus and adenovirus can cause respiratory symptoms, but they are less commonly associated with significant respiratory distress in young infants compared to RSV.

Explanation

Respiratory syncytial virus (RSV) is the most likely cause in this scenario because it is a common cause of respiratory distress in infants. The presence of bilateral crepitations and rhonchi on examination suggests lower respiratory tract involvement, which is commonly seen in RSV infections. Pneumonia could also be a cause of respiratory distress, but the specific findings of crepitations and rhonchi point more towards RSV. Rhinovirus and adenovirus can cause respiratory symptoms, but they are less commonly associated with significant respiratory distress in young infants compared to RSV.

3. One of the following statements is true regarding Hearing Loss in child

Parents will know if their child has hearing loss by the time their child is 2-3 months age

Parents can identify hearing loss by clapping the hand behind the child’s head

Hearing loss identified beyond 6 months age can have speech and language delays

Children younger than 12 months can’t be fitted with hearing aids

Hearing loss that is identified beyond 6 months of age can have speech and language delays. This means that if a child's hearing loss is not identified and treated before the age of 6 months, it can potentially affect their ability to develop speech and language skills. Therefore, early identification and intervention for hearing loss is crucial in order to prevent or minimize any delays in speech and language development.

Explanation

Hearing loss that is identified beyond 6 months of age can have speech and language delays. This means that if a child's hearing loss is not identified and treated before the age of 6 months, it can potentially affect their ability to develop speech and language skills. Therefore, early identification and intervention for hearing loss is crucial in order to prevent or minimize any delays in speech and language development.

4. One of the following statement is not true regarding Acute Bronchiolitis:

Most common organism is RSV

It is essentially a clinical diagnosis

Use of Dexamethasone has been proved to be much beneficial in recovery

Nebulized epinephrine results in significant clinical improvement

Oxygen is drug of choice for hypoxic child with respiratory distress

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Explanation

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5. A 3 years old child is diagnosed to have Hib Meningitis. The investigation to be done before discharge is

MRI of head

Physiotherapist’s consultation

BERA

Test for cerebellar functions

The correct investigation to be done before discharge for a 3-year-old child diagnosed with Hib Meningitis is BERA (Brainstem Evoked Response Audiometry). Hib Meningitis can cause damage to the auditory nerve, leading to hearing loss. BERA is a test that measures the electrical activity of the auditory nerve and brainstem in response to sound stimuli, helping to assess the child's hearing function. This test is important to ensure early detection and intervention for any hearing impairment caused by the meningitis.

Explanation

The correct investigation to be done before discharge for a 3-year-old child diagnosed with Hib Meningitis is BERA (Brainstem Evoked Response Audiometry). Hib Meningitis can cause damage to the auditory nerve, leading to hearing loss. BERA is a test that measures the electrical activity of the auditory nerve and brainstem in response to sound stimuli, helping to assess the child's hearing function. This test is important to ensure early detection and intervention for any hearing impairment caused by the meningitis.

6. One of the following statement is not true regarding Pertusis

The illness usually is milder in adults than in children, but the duration of the paroxysmal cough is just as long as in children

When treatment is initiated during the catarrhal stage, symptoms may be less severe

Adults and adolescents are the primary reservoir for pertussis.

It is usually diagnosed during paroxysmal stage

Treatment with an effective antibiotic doesn’t shorten the infectious period but generally alters the outcome of the disease

Pertussis, also known as whooping cough, is a respiratory infection caused by the bacterium Bordetella pertussis. The illness usually presents with a paroxysmal cough, which can last for several weeks. While the illness is generally milder in adults than in children, the duration of the paroxysmal cough is just as long. Treatment with an effective antibiotic can help alleviate symptoms and reduce the severity of the disease, but it does not shorten the infectious period. Instead, it generally alters the outcome of the disease by preventing complications and reducing the risk of transmission to others.

Explanation

Pertussis, also known as whooping cough, is a respiratory infection caused by the bacterium Bordetella pertussis. The illness usually presents with a paroxysmal cough, which can last for several weeks. While the illness is generally milder in adults than in children, the duration of the paroxysmal cough is just as long. Treatment with an effective antibiotic can help alleviate symptoms and reduce the severity of the disease, but it does not shorten the infectious period. Instead, it generally alters the outcome of the disease by preventing complications and reducing the risk of transmission to others.

7. Acute flaccid paralysis is reported in age group

0-1 years

0-2 years

1-10 years

0-15 years

Acute flaccid paralysis can occur in individuals within the age range of 0-15 years. This means that children from birth up to the age of 15 can experience sudden weakness or loss of muscle tone. It is important to note that acute flaccid paralysis can have various causes, including viral infections like polio, Guillain-Barré syndrome, or other neurological conditions. Therefore, it is crucial to consider this condition in children of all ages within the specified range.

Explanation

Acute flaccid paralysis can occur in individuals within the age range of 0-15 years. This means that children from birth up to the age of 15 can experience sudden weakness or loss of muscle tone. It is important to note that acute flaccid paralysis can have various causes, including viral infections like polio, Guillain-Barré syndrome, or other neurological conditions. Therefore, it is crucial to consider this condition in children of all ages within the specified range.

8. One of the following statement is not true regarding Thumb Sucking

It can start start as early as 15 weeks of gestation

It is not harmful to teeth and jaws until eruption of permanent teeth

Only few children suck their thumbs or fingers at some time in their early life

The only time it might cause concern is if it goes on beyond 6 to 8 years of age or affects the shape of the child's mouth and the position of teeth.

The given statement is not true because thumb sucking is a common behavior among children, and many children suck their thumbs or fingers at some point in their early life.

Explanation

The given statement is not true because thumb sucking is a common behavior among children, and many children suck their thumbs or fingers at some point in their early life.

9. One of the following is not the risk factor for sensorineural hearing loss in infant

Severe birth asphyxia

Birth wt less than 1500 gms

Family H/O deafness

TORCH infections

Cleft Palate

Birth weight less than 1500 gms is not a risk factor for sensorineural hearing loss in infants. Sensorineural hearing loss can be caused by various factors such as severe birth asphyxia, family history of deafness, TORCH infections, and cleft palate. However, low birth weight alone is not considered a risk factor for sensorineural hearing loss.

Explanation

Birth weight less than 1500 gms is not a risk factor for sensorineural hearing loss in infants. Sensorineural hearing loss can be caused by various factors such as severe birth asphyxia, family history of deafness, TORCH infections, and cleft palate. However, low birth weight alone is not considered a risk factor for sensorineural hearing loss.

10. Follwing are causes of Hypothyroidism in a 3 months old child Except

Congenital Hypothyroidism

Graves Disease

Hoshimoto’s Thyroiditis

Abnormal development of brain

Hoshimoto's Thyroiditis is not a cause of hypothyroidism in a 3-month-old child. Hoshimoto's Thyroiditis is an autoimmune disorder that affects the thyroid gland, leading to inflammation and eventual destruction of the thyroid tissue. It is more commonly seen in older children and adults, rather than infants. Therefore, it is not a likely cause of hypothyroidism in a 3-month-old child.

Explanation

Hoshimoto's Thyroiditis is not a cause of hypothyroidism in a 3-month-old child. Hoshimoto's Thyroiditis is an autoimmune disorder that affects the thyroid gland, leading to inflammation and eventual destruction of the thyroid tissue. It is more commonly seen in older children and adults, rather than infants. Therefore, it is not a likely cause of hypothyroidism in a 3-month-old child.