Pediatrics
Q-1. An 18-month child weighing 11.5 kg comes to the PHC with fever and respiratory difficulty. On examination, the child is lethargic, with a respiratory rate of 46 bpm and no chest retractions. What is the most appropriate management of this child?
a) Prescribe oral antibiotics, warn of danger signs and send home
b) Give intravenous antibiotics and refer to a higher center
c) Intravenous fluids alone
d) Intravenous antibiotics and observation
Answer: Prescribe oral antibiotics, warn of danger signs and send home
Explanation:
Severe pneumonia:
Fast breathing
Lower chest wall indrawing
Stridor in calm child
Treatment:
Refer urgently
Give first dose of appropriate antibiotic
Non severe pneumonia:
Fast breathing
No chest indrawing
Treatment:
Give appropriate antibiotics
Fast breathing in children:
Age < 2 months: > 60 bpm
Age 2 months- 1 year: 50 bpm
Age 1 year- 5 years: 40 bpm
Q-2. A child has diarrhea for 1 day along with irritability and restlessness. There is no history of fever or blood in stools. On examination, eyes are sunken and skin pinch goes back slowly but within 2 seconds. On giving water, the child drinks readily. What will be the management of this patient?
a) Immediately start intravenous fluids for severe dehydration
b) Give Zinc supplementation and oral rehydration solution only and ask mother to come back if some danger signs develop
c) Administer intravenous antibiotic and immediately refer to a higher center
d) Start oral antibiotics and send the child home
Answer: Give Zinc supplementation and oral rehydration solution only and ask mother to come back if some danger signs develop
Explanation:
World Health Organization (WHO) scale for dehydration:
No hydration:
General appearance- Well and alert
Eyes: Normal
Skin turgor- Goes back quickly (< 1 second)
Thirst- Drink normally
Treatment: Plan-A (WHO IMNCI Protocol)
Some dehydration:
General appearance-Restless and lethargy
Eyes- Shrunken
Skin turgor- Goes back slowly (1-2 seconds)
Thirst- Thirsty, drink eagerly
Treatment: Plan-B (WHO IMNCI Protocol)
Severe dehydration:
General appearance- Lethargic, or unconscious
Eyes- Very shrunken
Skin turgor- Goes back very slowly (> 2 seconds)
Thirst- Drink poorly or not able to drink
Treatment: Plan-C (WHO IMNCI Protocol)
Plan-B (WHO IMNCI Protocol):
Give fluid, zinc supplement and food for some dehydration
Advice mother when to return immediately
Q-3. All of the following are sequelae of fetal alcohol syndrome except:
a) Macrocephaly
b) Microcephaly
c) Holo-prosencephaly
d) Short stature
Answer: Macrocephaly
Explanation:
Fetal alcohol syndrome:
Abnormal facial features
Lower-than-average height and weight
Microcephaly (Small head)
Important point:
Holo-prosencephaly along with midline hypospadias can occur in extreme form of fetal alcohol syndrome.
Q-4. Which of the following is true about trans-placental HCMV infection?
a) Mothers who transmit the virus are usually symptomatic
b) It is the most common cause of non-syndromic hearing loss
c) Diagnosed is by persistent presence of IgM antibody after 6 months age
d) All babies are symptomatic at birth
Answer: It is the most common cause of non-syndromic hearing loss
Explanation:
Congenital CMV is the most common cause of congenital, non-hereditary and non-syndromic sensori-neural hearing loss.
Diagnosis of CMV:
Virus isolation
PCR
Q-5. A 6 year old child presents with fever, pancytopenia, generalized weakness and weight loss. On examination, he is pale with generalized lymphadenopathy. Peripheral smear of the patient has been shown below. What is the likely diagnosis?
a) ALL
b) AML
c) JMML
d) Aplastic anemia
Answer: ALL
Explanation:
Characteristics of lymphoblast typically seen in ALL:
An abnormal immature cell with high nucleo-cytoplasmic ratio
Prominent nucleoli
Scanty and agranular cytoplasm