Pediatrics and

Neonatology

Most Recent Questions

R1. Five years old male child came with history of fever and respiratory distress. Physician had a suspicion of
pneumonia. Chest X-ray was ordered. Most likely organism will be [AIIMS May 2017]

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Ans.
R1. b

a. Mycoplasma pneumonia
b. Staphylococcus
c. Klebsiella pneumonia
d. Streptococcus pneumonia

Explanations of the question is given at the end of the subject

Topic-wise Questions
1. 4 year old admitted in ward with pneumonia. He 3. Identify the Instrument shown in the Photograph
develops sudden onset of breathlessness. What is  [Recent Question 2013]
the next step in management [AIIMS May 2016]

a. Salter scale
b. Spring balance
c. Electronic weighing scale
d. Beam balance

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a. Intercostal drainage tube insertion 4. Milestone shown in Photograph appears at age of


b.
c.
Emergency needle thoracotomy
Decrease mechanical ventilation settings
,3 …………. [Recent Question 2012]

d. Increase mechanical ventilation settings

20
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2. 
Graph shown in Photograph depicts growth of
……….. tissue/ organ
ot
Ph

a. 3 months b. 4 months
c. 5 months d. 6 months Ans.
1. b
2. c
3. d
5. Diagnose the Underlying Nutritional disorder as 4. c
shown in Photograph 5. c

a. Brain growth
b. Somatic growth
c. Lymphoid growth
d. Gonadal growth a. Mild malnurtion
b. Kwashiorkor
c. Marasmus
d. Marasmic-Kwashiorkar

Explanations of the questions are given at the end of the subject

 634 General Paediatrics, Nutrition, Growth & Development
PHOTON 20

6. Diagnose the Underlying Condition as shown in 9. A child is able to draw figure shown in Photograph
Photograph at age of …  [Recent Question 2014]

a. 2 years b. 3 years
c. 4 years d. 5 years
a. Dolichocephaly b. Macrocephaly
c. Plagiocephaly d. Scaphocephaly

10. 
Technique used in Pediatrics as shown in
7. 
Identify the Reflex shown (First stage) in the Photograph is known as

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Photograph [Recent Question 2014]

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a. Laryngoscopy
b. Bag and Mask ventilation
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a. Tonic neck reflex b. Moro’s reflex c. Mouth-to-mouth resuscitation

Ans. c. Parachute reflex d. Rooting reflex d. Slit lamp examination
6. b
7. b
8. b 8. 
Condition shown in Photograph occur due to 11. Milestone shown in Photograph appears at age of
9. c administration of …………. During Pregnancy …………. [Recent Question 2013]
10. b
11. c

a. 4-6 weeks b. 6-8 weeks

a. Phenytoin b. Warfarin c. 8-10 weeks d. 10-12 weeks
c. Thalidomide d. Isoniazid

Explanations of the questions are given at the end of the subject

 General Pediatrics, Nutrition, Growth & Development 635

PEDIATRICS AND NEONATOLOGY

12.  Instrument shown in Photograph is known as 15.  Neonatal reflex shown in the Photograph is

a. Moro’s reflex
b. Crossed extension reflex
c. Tonic neck reflex
a. Otoscope b. Ophthalmoscope
d. Grasp reflex
c. Refractometer d. None of the above

13. Facies shown in Photograph are generally seen in 16.  Paediatric disorder as shown in Photograph is
malformations of

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a. Respiratory system a. Meconium aspiration

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b. Cardiovascular system b. Necrotising enterocolitis

c. Nervous system c. Diaphragmatic hernia
d. Renal system d. Celiac disease Ans.
12. c
13. d
14. Physical characteristic shown in Photograph is 17. Milestone shown in Photograph appears at age of 14. b
seen in  [Recent Question 2012] …………. [Recent Question 2014] 15. b
16. b
17. d

a. Pre-term neonate
b. Term neonate
c. Post-term neonate a. 3 months b. 5 months
d. Cannot be determined c. 7 months d. 10 months

Explanations of the questions are given at the end of the subject

 636 General Pediatrics, Nutrition, Growth & Development
PHOTON 20

18. 
Defect as shown in the Photograph will be 21. 
Instrument shown in Photograph is used for
diagnosed as [Recent Question 2013] Estimation of

a. Anencephaly b. Meningomyelocoele a. Hemoglbin

c. Down’s syndrome d. Holoprosencephaly b. Serum bilirubin
c. Blood glucose
d. Urine Specific gravity

19.  Diagnose the Deformity shown in Photograph

/e
 [Recent Question 2012] 22. Diagnose the Underlying disorder based on X-ray
Photograph
,3 [Recent Question 2012]
20
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a. Talipes cavis
b. Talipes equino valgus a. Annular pancreas b. Jejunal atresia
Ans. c. Talipes equino varus c. Intestinal perforation d. Splenic trauma
18. a d. Talipes calcaneo valgus
19. c
20. a
21. c 23. Milestone shown in Photograph appears at age of
22. a 20. Milestone shown in Photograph appears at age of ………….
23. b ………….  [Recent Question 2014]

a. 6 months b. 9 months
c. 12 months d. 18 months a. 8 months b. 12 months
c. 16 months d. 24 months

Explanations of the questions are given at the end of the subject

 General Pediatrics, Nutrition, Growth & Development 637

PEDIATRICS AND NEONATOLOGY

24.  Paediatric disorder as shown in Photograph is 27. Most common cause of Condition (Arrow)
shown in Photograph is

a. Rectal prolapse
a. Staphylococcus aureus
b. Neuroblastoma
b. Streptococcus pneumoniae
c. Sacrococcygeal teratoma
c. Hemophilus influenzae
d. Nephroblastoma
d. E. coli

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25.  Neonatal reflex shown in the Photograph is 28. Physical characteristic shown in Photograph is
seen in
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a. Moro’s reflex a. Pre-term neonate

b. Crossed extension reflex b. Term neonate Ans.
c. Tonic neck reflex c. Post-term neonate 24. c
d. Grasp reflex d. Cannot be determined 25. c
26. a
27. a
26. Milestone shown in Photograph appears at age of 29. Milestone shown in Photograph appears at age of 28. b
………….  [Recent Question 2012] ………….  [Recent Question 2014] 29. c

a. 2 months b. 4 months a. 3 months b. 4 months

c. 6 months d. 12 months c. 6 months d. 10 months

Explanations of the questions are given at the end of the subject

 638 Systemic Pediatrics
PHOTON 20

30. Sign shown in Abdominal X-ray (Photograph) is 33. 

Diagnose the Oesophageal Condition
seen in [Recent Question 2012, 2016] (Photograph) based on Sign shown (Arrow)

a. Reflux Oesophagitis
a. Pyloric obstruction b. Duodenal atresia
b. Oesophageal Stenosis
c. Jejunal atresia d. All of the above
c. Achalasia cardia
d. Corkscrew oesophagus

31.  Paediatric disorder as shown in Photograph is

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34. Identify the Condition (Photograph) seen on an
Otoscope
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a. Rectal prolapse
a. Anterior perforation
Ph

b. Imperforate anus
c. Sacrococcygeal teratoma b. Posterior perforation
Ans. d. Nephroblastoma c. Subtotal central perforation
30. c d. Total perforation
31. b
32. d 32. 
Diagnose the Neonatal Disorder shown in
33. c Photograph 35. Identify the Hematological disorder shown in
34. c Photograph [Recent Question 2014]
35. b

a. Meconium aspiration syndrome a. Iron deficiency anemia

b. Respiratory distress syndrome b. Megaloblastic anemia
c. Pneumonia c. Thalassemia
d. Tension pneumothorax t d. Lead poisoning

Explanations of the questions are given at the end of the subject

 Systemic Pediatrics 639

PEDIATRICS AND NEONATOLOGY

36.  Identify the Type of Cast seen on Urine Microscopy 39. Identify Renal stones based on morphology of
(Photograph) Urine crystals shown (Photograph)

a. WBC cast b. RBC cast a. Oxalate dihydrate b. Calcium phosphate

c. Hyaline cast d. Granular cast c. Triple phosphate d. Cystine

40. Diagnose the Neuromuscular disorder seen in

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37. Most common cause of Lesion (Arrow) shown in Child with Motor delay (Photograph)
Contrast CT Photograph is
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a. Spinal Muscular Atrophy 1

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b. Hereditary neuropathy
c. Guillain Barre Syndrome Ans.
a. Neurocysticercosis b. Leprosy d. Poliomyelitis
36. c
c. CMV d. Echinococcosis 37. a
38. d
41. 
Diagnose the Condition (Box) seen in X-ray 39. b
38. Secondary manifestation shown in Photograph Photograph 40. a
may be due to 41. a

a. Marfan’s syndrome
b. Ehler Danlos syndrome
c. Phenylketonuria a. Adenoid hypertrophy b. Tonsil hypertrophy
d. Retinoblastoma c. Ethmoid sinusitis d. Fracture maxilla

Explanations of the questions are given at the end of the subject

 640 Systemic Pediatrics
PHOTON 20

42. 
Grade of Vesico-ureteric reflux shown in 45. 
Diagnose the Condition based on the Sign
Photograph is (Arrow) in Photograph [Recent Question 2012]

a. Grade I b. Grade II a. Stomach carcinoma

c. Grade III d. Grade V b. Ileocaecal TB
c. Ulcerative colitis
d. Hypertrophic pyloric stenosis

/e
43.  Identify the GIT disorder shown in Photograph
46. 
Identify the Hematological disorder shown in
 [Recent Question 2012]
Photograph
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Ph

a. Acute appendicitis b. Intussusception

a. Iron deficiency anemia
c. Malrotation d. Choledochal cyst
Ans. b. Megaloblastic anemia
c. Thalassemia
42. d
d. Lead poisoning
43. c
44. b 44. Diagnose the Disorder based on Sign (Arrows)
45. d shown in the Neck X-ray Photograph
46. a 47. 
Diagnose the Disorder shown in Photograph
47. b based on Sign (Arrows) shown

a. Laryngomalacia a. Myasthenia gravis

b. Larynotracheobronchitis b. Duchenne muscular dystrophy
c. Retropharyngeal abscess c. Poliomyelitis
d. Subglottic Stenosis d. Guillain Barre Syndrome

Explanations of the questions are given at the end of the subject

 Skin Disorders 641

PEDIATRICS AND NEONATOLOGY

48. Diagnose the Skin disorder shown in Photograph 51. 
Identify the Hematological disorder shown in
 [Recent Question 2014] Photograph

a. Iron deficiency anemia

a. Scabies b. Vitiligo b. Megaloblastic anemia
c. Ichthyosis d. Hemangioma c. Thalassemia
d. Lead poisoning

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49. Identify the Morphology of Skin lesion shown in 52. 
Diagnose the Vascular birthmark shown in
Photograph [Recent Question 2012]
,3 Photograph [Recent Question 2013, 2016]
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a. Infantile hemangioma b. Salmon patch

Ans.
a. Wheal b. Papule c. Port wine stain d. Lymphangioma
48. c
c. Plaque d. Blister
49. d
50. c
53. 
Diagnose the Type of Dermatitis shown in 51. c
50. Identify the Morphology of Skin lesion shown in Photograph 52. c
Photograph 53. c

a. Atopic dermatitis
b. Seborrhoeic dermatitis
c. Diaper dermatitis
a. Macule b. Papule
d. Acne vulgaris
c. Nodule d. Plaque

Explanations of the questions are given at the end of the subject

 642 Skin Disorders
PHOTON 20

54. Identify the Morphology of Skin lesion shown in 57. 

Diagnose the Skin disorder as shown in
Photograph Photograph

a. Tinea capitis
a. Wheal b. Scale
b. Seborrhoeic dermatitis
c. Plaque d. Blister
c. Lichen planus
d. Kerion

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55. 
Diagnose the Type of disorder shown in
58. 
Diagnose the Skin disorder as shown in
Photograph
Photograph [Recent Question 2014]
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a. Alopecia areata b. Miliaria rubra a. Miliria profunda

c. Alopecia totalis d. Miliaria profunda b. Seborrhoeic dermatitis
Ans. c. Lichen planus
54. c d. Vitiligo
55. c
56. d 56. 
Diagnose the Skin disorder as shown in
57. a 59. 
Diagnose the Skin disorder as shown in
Photograph [Recent Question 2013]
58. c Photograph [Recent Question 2013]
59. d

a. Miliria profunda a. Burn injury

b. Seborrhoeic dermatitis b. Seborrhoeic dermatitis
c. Lichen planus c. Leprosy
d. Pustular psoriasis d. Vitiligo

Explanations of the questions are given at the end of the subject

Answers & Explanations
R1. Ans. (b)  Staphylococcus
Topper’s edge..................................................
[Ref. Nelson Textbook of Pediatrics, 20/e p2090]
•• Chest X-ray (Photograph) shows right sided pneumonia
GROWTH RATE OF ORGANS IN CHILDREN
with the presence of characteristic multiple air filled spaces
Organ growth Age
(Pneumatocoeles)
ƒƒ Staphylococcus aureus is the most likely organism to Brain 90% by 3 years age
present Gonadal 90% by 13-15 years age
•• Staphylococcus aureus Pneumonia: Somatic 100% by 18 years age
ƒƒ Manifests as confluent bronchopneumonia
Lymphoid Exceeds 100% by 7 years age, then
ƒƒ Often unilateral
declines and normalizes by 18 years age
ƒƒ Extensive areas of hemorrhagic necrosis
ƒƒ Irregular areas of cavitation of the lung parenchyma
ƒƒ Pneumatoceles 3. Ans. (d)  Beam balance
ƒƒ Empyema
[Ref. Ghai, 8/e, p11]
ƒƒ Bronchopulmonary fistulas
•• Weight Measurement of weight is an easy and routine
procedure using an electronic digital scale or a beam
Topper’s edge.................................................. balance (Photograph)
•• Ideally, infants should be weighed nude and children

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PNEUMATOCOELES
wearing just a dry nappy or pants
•• Intrapulmonary air-filled cystic spaces that can have a
•• All the scales should be adjusted to zero before using
variety of sizes and appearances
•• May contain air-fluid levels and are usually the result
of ventilator inducted lung injury in neonates or post-
,3
4. Ans. (c)  5 months
20
pneumonic [Ref. Ghai, 8/e p45]
•• Most frequently encountered in infancy
•• Infant lifts head when the child is pulled up at 5 months of
•• Causative agents include Staphylococcus aureus (MC),
Streptococcus pneumonia, Haemophilus influenza, age (Arrow in Photograph)
on

Escherichia coli, Group A streptococci, Klebsiella pneumonia,

Adenovirus, Primary pulmonary tuberculosis Age Milestone development
3 months Infant develops neck holding
ot

5 months Rolls over, lifts head when pulled

Topic-wise Answers
6 months Sits with own support (tripod position)
Ph

1. Ans. (b)  Emergency needle thoracotomy 8 months Sits with out support
9 months Stands with support
[Ref. Emergency Procedures and Techniques by Simon, 4/e p172]
12 months Creeps well, stands without support,
•• This child is having pneumonia and developing sudden
walks but falls
onset of breathlessness while on mechanical ventilation
15 months Creeps upstairs, walks alone
•• Chest X shows hyperlucency without vascular markings on
right side with mediastinal shift to left suggestive of right 18 months Baby starts to run
pneumothorax (Photograph) 2 years 2 feet/ step, jumps
•• The next step in management is to do emergency needle 3 years Rides tricycle, alternate feet going
thoracotomy in the right second intercostals space in mid upstairs
clavicular line, simultaneously preparing for intercostals 4 years Walks downstairs with alternate feet,
drainage tube insertion which is the definite management hops on one foot

2. Ans. (c)  Lymphoid growth 5. Ans. (c)  Marasmus

[Ref. Ghai, 8/e p10, 11] [Ref. Ghai, 8/e p99]
•• Graph shown in Photograph depicts the growth of MARASMUS (PHOTOGRAPH)
lymphoid tissue •• Marked wasting of fat & muscle
•• Frequent finding in 4-8yrs children would be large tonsils & •• Severe wasting
palpable lymph node •• Monkey facies
 Answers & Explanations 657
•• Baggy pant appearance 10. Ans. (b)  Bag and Mask ventilation

PEDIATRICS AND NEONATOLOGY

•• Dull lusterless sparse hair
•• Anxious look [Ref. Ghai, 8/e p51]
•• Loss of buccal fat
BAG & MASK VENTILATION (PHOTOGRAPH)
•• Edema is absent
•• Preferred technique for emergency ventilation during initial
6. Ans. (b)  Macrocephaly steps of resuscitation
•• Bag-mask ventilation is a highly effective way to deliver
[Ref. Ghai, 8/e p137] assisted ventilation to a child during resuscitation and
MACROCEPHALY (PHOTOGRAPH) transport
•• Large head of baby
•• Causes include cerebral parenchymal disease & 11. Ans. (c)  8-10 weeks
hydrocephalus [Ref. Ghai, 8/e p45]
•• Ventral suspension, head in line with trunk at 8-10 weeks
Topper’s edge.................................................. (Photograph)
•• Head circumference is measured by placing a tape just 12. Ans. (c)  Refractometer
above the eye brown & measuring the largest circumference
over the occiput which is 33-37 cm in term baby. Diagram [Ref. Ophthalmology by Khurana, 3/e p69]
shows a. •• Refractometer (Optometry) is an objective method of
finding out the error of refraction by use of an equipment

/e
7. Ans. (b)  Moro’s reflex called refractometer (Optometer)
•• Refractometry (Photograph) utilizes the principles of
[Ref. Ghai, 8/e p143]

MORO’S REFLEX
,3 Indirect ophthalmoscopy

•• Elicited by sudden dropping of baby’s head in relation to 13. Ans. (d)  Renal system
20
trunk
ƒƒ First stage response: Abduction, Extension (Photograph)
[Ref. Nelson, 17/e p1783]
ƒƒ Second stage response: Adduction, Flexion POTTER FACIES (PHOTOGRAPH)
•• Reflex disappears by 3-6 months in normal infant
on

•• Bilateral renal agenesis is incompatible with life

•• Babies have pulmonary hypoplasia
Topper’s edge.................................................. •• Condition is termed as Potter syndrome
ot

•• Characteristic facial appearance, termed as Potter facies

•• MCC of Depressed/ absent Moro’s reflex: Generalized
disturbance of CNS
Ph

14. Ans. (b)  Term neonate

•• Asymmetrical Moro’s reflex: Brachial plexus injury
[Ref. Ghai, 8/e p124, 140]
8. Ans. (b)  Warfarin •• A neonate born between 37-42 weeks of gestation
•• In case of term baby well-formed breast bud > 5 mm
[Ref: Nelson’s textbook of pediatrics, 17/e, p.543]
(Photograph) is seen where as in case of preterm baby
WARFARIN EMBRYOPATHY breast buds are poorly developed
•• Nasal bridge hypoplasia (Box in Photograph)
•• Teratogenic effect of warfarin acts on developing cartilage, 15. Ans. (b)  Crossed extension reflex
especially on the nasal cartilage, hence should avoided in
[Ref. Nelson, 17/e p1779]
pregnant females between 6-12 weeks of POG
•• Warfarin has to be replaced with heparin •• Crossed extensor reflex is a withdrawal reflex
•• When the reflex occurs the flexors in the withdrawing limb
9. Ans. (c)  4 years contract and the extensors relax, while in the other limb, the
opposite occurs (Photograph)
[Ref. Ghai, 8/e p51]

DRAWING SKILLS MILESTONES 16. Ans. (b)  Necrotising enterocolitis (Sign shown: Pneumatosis
intestinalis)
Age Drawing skill
[Ref. Ghai, 8/e p165]
3 years Circle
4½ years Square (Photograph) NECROTISING ENTEROCOLITIS
5 years Triangle •• Seen in premature infants <32 weeks
•• X-ray of abdomen showing Pneumatosis intestinalis (gas in
6 years Rhomboid
the intestinal wall) & dilation of intestines seen in stage II of
15 months Scribbles NEC (Photograph)
 658 Answers & Explanations

17. Ans. (d)  10 months 24. Ans. (c)  Sacrococcygeal teratoma

PHOTON 20

[Ref. Ghai, 8/e p45] [Ref. Nelson, 17/e p1724]

•• Creep position is seen at 10 months (Photograph) SACROCOCCYGEAL TERATOMA (PHOTOGRAPH)
•• Occur most commonly in infants and may be diagnosed in
18. Ans. (a)  Anencephaly
utero, or at birth, with the majority arising in females
[Ref. Nelson, 17/e p1986] •• Type of tumor known as a teratoma that develops at the base
•• An anencephalic infant presents a distinctive appearance of the coccyx (tailbone) and is thought to be derived from
with a large defect of the calvarium, meninges, and scalp the primitive streak
associated with a rudimentary brain, which results from
failure of closure of the rostral neuropore (Photograph) 25. Ans. (c)  Tonic neck reflex
[Ref. Nelson, 17/e p1979]
19. Ans. (c)  Talipes equino varus
[Ref. Nelson, 17/e p2256] Age Primitive refluxes
•• Congenital form of Clubfoot (Photograph) is characterized Begins at 28-32 weeks fully developed Palmar grasp
by variable rigidity of the foot, mild calf atrophy, and mild Begins 32-36 weeks fully developed Rooting
hypoplasia of the tibia, fibula, and bones of the foot.
Begins 28-37 weeks fully developed Moro
20. Ans. (a)  6 months Begins 35 weeks to 1 month Tonic neck reflux

/e
(Photograph)
[Ref. Ghai, 8/e p49, 50, 152]
Begins 7 month (Fully developed 10-11 Parachute
Suckling reflux
Rooting reflux
14 weeks of gestation
Develops by 28 weeks
,3 months)

26. Ans. (a)  2 months

Palmar grasp Develop by 28 wks disappears by 4
20
months (Photograph) [Ref. Ghai, 8/e p52]

KEY SOCIAL & ADAPTIVE MILESTONES

21. Ans. (c)  Blood glucose
on

[Ref. Nelson, 17/e p2256] Age Mile stone

•• Instrument shown on color plate is glucometer used to 2 months Social smile (Photograph)
ot

measure the blood sugar levels 3 months Recognizes mother, anticipate feeds
•• Glucose meter (or Glucometer) is a medical device for
6 months Stranger anxiety
Ph

determining the approximate concentration of glucose in

the blood (Photograph) 9 months Waves bye-bye
•• Home blood glucose monitoring (HBGM) by people with 12 months Plays simple ball game
diabetes mellitus or hypoglycemia 15 months Jargon
ƒƒ A small drop of blood, obtained by pricking the skin with
2 years Ask for food, drinks pulls people to show
a lancet, is placed on a disposable test strip that the meter
toys
reads and uses to calculate the blood glucose level
ƒƒ The meter then displays the level in units of mg/dl or 3 years Shares toys knows full name & gender
mmol/l 4 years Goes to toilet alone; plays in group
5 years Dresses & undresses helps in household
22. Ans. (a)  Annular pancreas
tasks
[Ref. Nelson, 17/e p1298]
27. Ans. (a)  Staphylococcus aureus
ANNULAR PANCREAS
•• Results from incomplete rotation of the left (ventral) [Ref. Ghai, 8/e p378]
pancreatic anlage PNEUMATOCOELE
•• X-ray abdomen showing radiological sign as “Double
•• Diagnosis of Staphylococcal pneumonia in a suspected new
bubble sign” (Photograph)
born can be done with x-ray, characteristic presentation
23. Ans. (b)  12 months would be presence of Pneumatocoele (Photograph)
•• Pneumatocele/ Pneumatocyst is a cavity in the lungs filled
[Ref. Ghai, 8/e p45] with air
•• A child stands well without support by 12 months of age •• They persists as thin walled asymptomatic cysts for several
(Photograph) weeks
 Answers & Explanations 659

28. Ans. (b)  Term neonate 35. Ans. (b)  Megaloblastic anemia

PEDIATRICS AND NEONATOLOGY

[Ref. Ghai, 8/e p124, 140] [Ref. Ghai, 8/e p336]
•• Term neonate show well pigmented & pendulous scrotal •• Classical feature of megaloblastic anemia includes,
sacs, with fully descended testes (Photograph) macrocytic red cells (usually>110fl) and cytopenias
•• Preterm baby show light pigmentation & testes are not yet •• Peripheral smear examination reveals hyper segmented
descended neutrophils (nucleus with 6 or more lobes) (Photograph)

29. Ans. (c)  6 months 36. Ans. (c)  Hyaline cast

[Ref. Ghai, 8/e p45] [Ref. Ghai, 8/e p469]
•• Sitting with support of hands (Tripod position) HYALINE CASTS (PHOTOGRAPH)
(Photograph) is seen at 6 months •• Translucent, colorless proteinaceous structures frequently
found in normal urine sediment
30. Ans. (c)  Jejunal atresia
•• Low refractive index makes them difficult to discern using
[Ref. Nelson, 17/e p546] ordinary bright-field microscopy
•• Hyaline casts are most common type
JEJUNAL ATRESIA (JA)
•• A congenital anomaly characterized by closure of the 37. Ans. (a)  Neurocysticercosis
jejunum
[Ref. Ghai, 8/e p277]

/e
•• Site of the atresia can be anywhere from the ligament of
Treitz to the junction of the jejunum and ileum •• Neurocysticercosis is the most common parasitic infection
of the CNS
•• Consists of a dilated stomach, dilated duodenum, and
dilated jejunum just proximal to atretic segment
•• Radiological sign: Triple bubble sign (Photograph)
,3 •• CECT shows the cranial ring enhancement lesion (Arrow
in Photograph)
20
31. Ans. (b)  Imperforate anus
Topper’s edge..................................................
[Ref. Nelson, 17/e p1288]
CAUSES OF CRANIAL RING ENHANCEMENT LESION
on

IMPERFORATE ANUS (PHOTOGRAPH) •• Cerebral abscess

•• Defect that is present from birth (congenital) •• Tuberculoma
•• Neurocysticercosis
ot

•• Opening to the anus is missing or blocked

•• Metastasis
32. Ans. (d)  Tension pneumothorax •• Glioblastoma
Ph

•• Subacute infarct/ haemorrhage / contusion

[Ref. Nelson, 17/e p586] •• Demyelination (incomplete ring)
•• Tumefactive demyelinating lesion (incomplete ring)
TENSION PNEUMOTHORAX •• Radiation necrosis
•• Accumulation of air within the pleural space is sufficient to •• Postoperative change
elevate intrapleural pressure above atmospheric pressure •• Lymphoma
•• Unilateral tension pneumothorax results in impaired
ventilation not only in the collapsed lung but also in 38. Ans. (d)  Retinoblastoma
the normal lung by a mediastinal shift to the other side
(Photograph) [Ref. Ghai, 8/e p669]

LEUKOCORIA
33. Ans. (c)  Achalasia cardia
•• White pupil seen in retinoblastoma
[Ref. Ghai, 8/e p282] •• Seen as a white-coloured pupillary reflex when an
•• Achalasia Cardia is characterized by loss of esophageal ophthalmoscope light is shone at the pupil (Photograph)
peristalsis, increased in IES pressure & absent or incomplete
39. Ans. (b)  Calcium phosphate
relaxation of LES with swallow.
•• Barium swallow shows the esophageal dilation with beak- [Ref. Ghai, 8/e p503]
like narrowing at LES called as Rat tail sign (Arrow in •• Renal calculi (Florets of crystals) is a typical feature of
Photograph) calcium phosphate stones (Photograph)

34. Ans. (c)  Subtotal central perforation 40. Ans. (a)  Spinal Muscular Atrophy 1
[Ref. Clinical Manual of Surgery by Rao, 1/e p307] [Ref. Ghai, 8/e p588]
 660 Answers & Explanations

SPINAL MUSCULAR ATROPHY HYPERTROPHIC PYLORIC STENOSIS

PHOTON 20

•• Autosomal recessive disease caused by mutation in SMN •• Pylorus is thickened & elongated with narrowing of its
1 gene, encoding the SMN protein essential for survival of lumen due to hypertrophy of circular muscle fibers
anterior motor horn cells •• USG abdomen is diagnostic whereas barium study shows
•• Present with motor delay & characterized by “frog-like” consistent elongation of the pyloric channel as String sign
posture & sub-coastal retractions (Photograph) due to (Arrow in Photograph)
respiratory muscle weakness
46. Ans. (a)  Iron deficiency anemia
41. Ans. (a)  Adenoid hypertrophy
[Ref. Ghai, 8/e p595]
[Ref. Ghai, 8/e p365]
•• Iron deficiency anemia peripheral blood smear revealing
•• Lateral radiograph of the neck showing adenoid hypertrophy microcytosis, hypochromic, thrombocytosis, & few
occluding the nasopharyngeal airway, which results in ovalocytes & tear drop cells (moderate anisopoikilocytosis)
chronic mouth breathing (Photograph) (Photograph)

42. Ans. (d)  Grade V 47. Ans. (b)  Duchenne muscular dystrophy
[Ref. Ghai, 8/e p485] [Ref. Ghai, 8/e p595]
GRADING OF VUR ON MICTURITION CYSTOURETHRO- DUCHENNE MUSCULAR DYSTROPHY
GRAM •• MC dystrophinopathy due to mutation in the dystrophin
gene

/e
Grades Features
•• Classical features include waddling gait, gower sign, calf
Grade I VUR doesn’t reach the renal pelvis muscle pseudo muscle hypertrophy
Grade II VUR extending up to renal pelvis without dilation
of pelvis or calyceal fornices
,3 •• Hypertrophy of deltoid & infraspinatus with wasting of
posterior axially fold muscles (Valley sign) (Photograph)
20
Grade III VUR extending up to kidney, with mild dilation or
tortuosity of ureter & renal pelvis & no or minor 48. Ans. (c)  Ichthyosis
blunting of calyceal fornices [Ref. DVT by Thappa, 4/, p228]
Grade IV Moderate dilation or tortuosity of ureter & renal
on

pelvis, calyceal fornices but normal appearance ICHTHYOSIS

of papillary impressions •• A group of hereditary & acquired disorders characterized
by excessive scaling
Grade V Gross dilatation & tortuosity of ureter/ renal-
ot

pelvis/ calyces; loss of papillary impression on •• Main feature of this disorder is mild scaling on extensor
calyces (Photograph) aspects of the limbs more often than trunk (Photograph)
Ph

43. Ans. (c)  Malrotation 49. Ans. (d)  Blister

[Ref. Ghai, 8/e p288] [Ref. DVT by Thappa, 4/e p16]

MALROTATION BLISTERS (PHOTOGRAPH)

•• Abnormality developing during the maturation of gut •• Circumscribed elevated lesions containing free fluid called
causes recurrent obstruction, occurring as either volvulus a blister
or ladd’s band. ƒƒ < 0.5 cm is called Vesicle
•• Photograph shows an abnormally positioned caecum & ƒƒ > 0.5 cm is a Bull
small bowel loops on right side of abdomen •• They may be tense (sub-epidermal in location) or flaccid
(Intra epidermal in location)
44. Ans. (b)  Larynotracheobronchitis
50. Ans. (c)  Nodule
[Ref. Ghai, 8/e p368]
[Ref. DVT by Thappa, 4/e p16]
CROUP (LARYNOTRACHEOBRONCHITIS)
•• Nodule (Photograph) is a discrete circumscribed solid
•• A viral upper respiratory tract infection characterized by
biphasic stridor, barking cough & low grade fever elevated lesion, which is more felt from top
•• Cheast X-ray revels a characteristic narrowing of sub-glottic •• It may develop from a papule
region known as Steeple sign (Arrow in Photograph)
51. Ans. (c)  Thalassemia
45. Ans. (d)  Hypertrophic pyloric stenosis (Sign shown: String [Ref. Ghai, 8/e p342]
sign)
•• Thalassemia peripheral smear findings include
[Ref. Ghai, 8/e p279] Anisopoikilocytosis, Microcytosis, Hypochromasia,
 Answers & Explanations 661
Polychromatophilia, nucleated RBC, few fragmented VITILIGO

PEDIATRICS AND NEONATOLOGY

erythrocytes (Photograph) •• Depigmented macule with sharp scalloped margins, which
may coalesce to form geographical patters
52. Ans. (c)  Port wine stain •• Acrofacial vitiligo involve face & acral parts (Photograph)
[Ref. Dermatology by Bolognia, 1/e p824]
60. Ans. (a)  Freckles
PORT WINE STAINS (PHOTOGRAPH)
[Ref. Ghai, 8/e p687]
•• Mosaic activating mutations in the GNAQ gene, which
encodes a G protein alpha subunit, underlie both non- •• Freckles: Discrete hyper-pigmented macules with
syndromic PWSs and Sturge Weber syndrome variegation in color on face (Photograph)
•• PWSs present at birth as pinkish-red macules and patches,
often in a segmental pattern
•• Skin may be smooth & lesion persists 61. Ans. (a)  Impetigo contagiosa
[Ref. DVT by Mohan, 4/e p49, 50]
53. Ans. (c)  Diaper dermatitis
[Ref. Ghai, 8/e p682] IMPETIGO CONTAGIOSA
•• Thick, honey colored crust covering superficial erosion
DIAPER DERMATITIS (PHOTOGRAPH) (Photograph), following the rupture of a thin walled
•• An irritant dermatitis in infants due to prolonged contact superficial vesicle or pustule with erythematous halo
with feces & ammonia •• An occasional squeal of impetigo is acute glomerulonephritis
•• Moist, glazed erythematous lesion with sparing of depth of
•• Etiology includes S. aureus/ S. pyogenes or both

/e
folds
62. Ans. (d)  Bullous impetigo
54. Ans. (c)  Plaque
[Ref. Ghai, 8/e p673]
,3 [Ref. Ghai, 8/e p689]

•• A plaque can be depressed or elevated or flat BULLOUS IMPETIGO

20
•• It is an arear of altered skin consistency, the surface area of •• Thin walled flaccid bullae with little or no surrounding
which is greater than its depth (Photograph) erythema
•• Contents of bullae are clear at first later turn turbid
on

55. Ans. (c)  Alopecia totalis •• Bullae of 1-2 cm persists for 2-3 days and then rupture
[Ref. Ghai, 8/e p683] •• A thin flat, honey-coloured “varnish” like crust may appear
in the center overlying superficial erosion (Photograph)
•• Alopecia totalis: Total absence of terminal hair on scalp
ot

•• Caused by group II phage type 70 & 71 Staphylococci

(Photograph)
Ph

63. Ans. (d)  Molluscum contagiosum

56. Ans. (d)  Pustular psoriasis
[Ref. Ghai, 8/e p691]
[Ref. Ghai, 8/e p684]
•• Pustular psoriasis: Sudden onset fiery red erythema rapidly •• Molluscum contagiosum: Multiple pearly white, dome
covered by cluster of very creamy white pustules, which shaped papules with central umbilication (Photograph)
form Circinate or annular lesions (Photograph)
64. Ans. (a)  Incubator
57. Ans. (a)  Tinea capitis [Ref. Ghai, 8/e p145]
[Ref. Ghai, 8/e p693] •• Incubator is a transparent acrylic cabin which has warm air
•• Tinea Capitis (Photograph): It is characterized as a patch of circulating around the baby to keep him warm
alopecia with marked scaling at the periphery •• Abdominal skin temperature that have to be maintained
between 36.5-37 degrees C depending on birth weight of
58. Ans. (c)  Lichen planus baby
[Ref. DVT by Mohan, 4/e p129]
65. Ans. (b)  Metered dose inhaler with Spacer
LICHEN PLANUS
[Ref. Ghai, 8/e p388]
•• A unique papulo-squamous disorder of unknown etiology
•• 9 P’s Pruritic, Plane-topped, Polyangular, Purple colored, •• Metered dose inhaler with spacer (Photograph): Encourages
Papules (Photograph), Plaque, heal by Pigmentation, to install large proportion of medication in lungs, with less
Pterygium ungium, Peniile annular lesions impaction in oropharynx.

59. Ans. (d)  Vitiligo 66. Ans. (c)  Radiant warmer

[Ref. Ghai, 8/e p686] [Ref. Ghai, 8/e p145]