Pg Blazer - Online Test Series 18 - Paediatrics

1. The following are characteristic of autism except:

Onset after 6 years of age

Repetitive behavior

Delayed language development

Severe deficit in social interaction

Features of autism usually appear before 3 years of age. (OP Ghai)

Explanation

Features of autism usually appear before 3 years of age. (OP Ghai)

2. All of the following are features of prematurity in a neonate, except:

No creases on sole

Abundant lanugo

Thick ear cartilage

Empty scrotum

Features of prematurity in a neonate:
Flat and soft pinna, cartilage not reaching upto periphery
Lightly pigmented scrotum with undescended testes
Absence of deep creases on sole
Poorly formed breast bud
Fuzzy hair
Prominent labia minora and clitoris (Labia majora are separated)

Explanation

Features of prematurity in a neonate:
Flat and soft pinna, cartilage not reaching upto periphery
Lightly pigmented scrotum with undescended testes
Absence of deep creases on sole
Poorly formed breast bud
Fuzzy hair
Prominent labia minora and clitoris (Labia majora are separated)

3. A child is below the third percentile for height. His growth velocity is normal. But chronological age is more than skeletal age. The most likely diagnosis is:

Constitutional delay in growth

Genetic short stature

Primordial dwarfism

Hypopituitarism

The growth velocity and height for age in early childhood will be lower than normal in case of constitutional growth delay. But the final height attained will be normal. The skeletal maturation will be lower than expected for age.

Explanation

The growth velocity and height for age in early childhood will be lower than normal in case of constitutional growth delay. But the final height attained will be normal. The skeletal maturation will be lower than expected for age.

4. 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 clot lysis test was positive. Which one of the following clotting factor is most likely to be deficient?

Factor X

Factor XI

Factor XII

Factor XIII

Clinical features of Factor XIII deficiency :-
History of prolonged bleeding from umbilical stump
Delayed bleeding
Recurrent abortions

Diagnosis (Investigations) :-
Prothrombin time and Activated partial thromboplastin time are normal
--Factor XIII is needed for stabilization of fibrin clot
--Intrinsic and extrinsic pathways are not affected
Clot stability in 5M urea – qualitative test
--Normal clot remains stable in 5M urea
--But in cases of Factor XIII deficiency, the clot dissolves
--But it becomes positive only in very severe deficiency
Quantitative factor XIII assay – using photometry

Explanation

Clinical features of Factor XIII deficiency :-
History of prolonged bleeding from umbilical stump
Delayed bleeding
Recurrent abortions

Diagnosis (Investigations) :-
Prothrombin time and Activated partial thromboplastin time are normal
--Factor XIII is needed for stabilization of fibrin clot
--Intrinsic and extrinsic pathways are not affected
Clot stability in 5M urea – qualitative test
--Normal clot remains stable in 5M urea
--But in cases of Factor XIII deficiency, the clot dissolves
--But it becomes positive only in very severe deficiency
Quantitative factor XIII assay – using photometry

5. All of the following are true of Beta thalassemia major, except:

Splenomegaly

Target cells on peripheral smear

Microcytic hypochromic anemia

Increased osmotic fragility

Osmotic fragility is decreases in Thalassemia. Increased osmotic fragility is seen in hereditary spherocytosis.

Explanation

Osmotic fragility is decreases in Thalassemia. Increased osmotic fragility is seen in hereditary spherocytosis.

6. A normally developing 10 month old child should be able to do all of the following except:

Stand alone

Play peek a boo

Pick up a pellet with thumb and index finger

Build a tower of 3-4 cubes

A normal child can make a tower of 3 cubes by 18 months of age.

Explanation

A normal child can make a tower of 3 cubes by 18 months of age.

7. Which of the following does not establish a diagnosis of congenital CMV infection in a neonate?

Urine culture of CMV

IgG CMV antibodies in blood

Lntra nuclear inclusion bodies in hepatocytes

CMV viral DNA in blood by polymerase chain reaction

Maternal IgG antibodies can pass into fetal circulation. Hence it is not possible to establish a diagnosis of congenital CMV infection in a neonate just by demonstrating the presence of IgG antibodies.

Explanation

Maternal IgG antibodies can pass into fetal circulation. Hence it is not possible to establish a diagnosis of congenital CMV infection in a neonate just by demonstrating the presence of IgG antibodies.

8. Which of the following haemoglobin (Hb) estimation will be diagnostically helpful in a case of beta thalassemia trait?

HbF

HbA1c

HbA2

HbH

Normal hemoglobin is composed predominantly of HbA1 – which is composed of 2 alpha chains and 2 beta chains. In beta thalassemia trait, there is decrease in production of beta chains of hemoglobin. But since the defect is minor, they will not have any clinical features and the peripheral smear may be normal. But there will be a compensatory increase in HbA2 which is composed of 2 alpha chains and 2 delta chains. Normally HbA2 constitutes about 1.5 to 3.5% of total hemoglobin. But in beta thalassemia trait, this increases to about 3.6 to 8%.

Explanation

Normal hemoglobin is composed predominantly of HbA1 – which is composed of 2 alpha chains and 2 beta chains. In beta thalassemia trait, there is decrease in production of beta chains of hemoglobin. But since the defect is minor, they will not have any clinical features and the peripheral smear may be normal. But there will be a compensatory increase in HbA2 which is composed of 2 alpha chains and 2 delta chains. Normally HbA2 constitutes about 1.5 to 3.5% of total hemoglobin. But in beta thalassemia trait, this increases to about 3.6 to 8%.

9. Which of the following is the principal mode of heat exchange in an infant incubator?

Radiation

Evaporation

Convection

Conduction

Convection is the principal mode of heat exchange in an infant incubator. Convection involves the transfer of heat through the movement of fluids or gases. In an incubator, warm air is circulated around the infant to maintain a constant temperature. This circulation of warm air helps to distribute heat evenly and maintain a stable environment for the baby. Therefore, convection is the most important mode of heat exchange in an infant incubator.

Explanation

Convection is the principal mode of heat exchange in an infant incubator. Convection involves the transfer of heat through the movement of fluids or gases. In an incubator, warm air is circulated around the infant to maintain a constant temperature. This circulation of warm air helps to distribute heat evenly and maintain a stable environment for the baby. Therefore, convection is the most important mode of heat exchange in an infant incubator.

10. Which one of the following in the characteristic feature of juvenile myoclonic epilepsy?

Myoclonic seizures frequently occur in the morning

Complete remission is common

Response to anticonvulsants is poor

Associated absence seizures are present in majority of patients

Juvenile myoclonic epilepsy – Clinical features, treatment

It starts in early adolescence
Bilateral myoclonic jerks are seen
Mostly in the morning
Precipitated by sleep deprivation
The patient usually remains conscious during the episode
Associated with absence seizures and generalised tonic clonic seizures
Benign condition
Complete remission is uncommon
Positive family history may be present
Responds well to anticonvulsants
Drug of choice – Valproate

Explanation

Juvenile myoclonic epilepsy – Clinical features, treatment

It starts in early adolescence
Bilateral myoclonic jerks are seen
Mostly in the morning
Precipitated by sleep deprivation
The patient usually remains conscious during the episode
Associated with absence seizures and generalised tonic clonic seizures
Benign condition
Complete remission is uncommon
Positive family history may be present
Responds well to anticonvulsants
Drug of choice – Valproate