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Questions and Answers
In a cystic fibrosis patient, infection by which of the following organisms has increased mortality?
In a cystic fibrosis patient, infection by which of the following organisms has increased mortality?
Which of the following is most likely complication in a cystic fibrosis child, at birth?
Which of the following is most likely complication in a cystic fibrosis child, at birth?
What is the usual dose of vitamin K administered to newborn infants at birth?
What is the usual dose of vitamin K administered to newborn infants at birth?
0.5 - 1 mg IM
Neonatal period is defined as the first __ days after birth.
Neonatal period is defined as the first __ days after birth.
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Match the congenital heart diseases with their associated anomalies:
Match the congenital heart diseases with their associated anomalies:
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Infective endocarditis is most commonly seen in __
Infective endocarditis is most commonly seen in __
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Surgical closure of ventricular septal defect is indicated in all except __
Surgical closure of ventricular septal defect is indicated in all except __
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An infant with a small muscular ventricular septal defect should undergo __
An infant with a small muscular ventricular septal defect should undergo __
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Which of the following is false regarding the chest x-ray findings of ventricular septal defect?
Which of the following is false regarding the chest x-ray findings of ventricular septal defect?
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All of the following are true about ventricular septal defect except __
All of the following are true about ventricular septal defect except __
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The most common type of ventricular septal defect is __
The most common type of ventricular septal defect is __
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NADA's major criteria include __
NADA's major criteria include __
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An infant born to a mother with congenital rubella infection is least likely to have which heart lesion?
An infant born to a mother with congenital rubella infection is least likely to have which heart lesion?
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Which among the following is the commonest congenital heart disease?
Which among the following is the commonest congenital heart disease?
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The most common mode of inheritance of congenital heart disease is __
The most common mode of inheritance of congenital heart disease is __
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Infection with which of the following helminths is most likely in a case of rectal prolapse accompanied by worms on visualisation of the rectum?
Infection with which of the following helminths is most likely in a case of rectal prolapse accompanied by worms on visualisation of the rectum?
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Investigation of choice of diphtheria carrier is __
Investigation of choice of diphtheria carrier is __
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Which of the following is true regarding diphtheria?
Which of the following is true regarding diphtheria?
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Which of the following is false regarding neonatal tetanus?
Which of the following is false regarding neonatal tetanus?
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How is the newborn of a mother with active tuberculosis on anti-tubercular therapy (ATT) managed?
How is the newborn of a mother with active tuberculosis on anti-tubercular therapy (ATT) managed?
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Which of the following is a major criterion in the revised Jones criteria used for the diagnosis of acute rheumatic fever in high-risk populations?
Which of the following is a major criterion in the revised Jones criteria used for the diagnosis of acute rheumatic fever in high-risk populations?
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The most important organ involved in congenital tuberculosis is the ____
The most important organ involved in congenital tuberculosis is the ____
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Which of the following conditions can present as a painless swelling of the knee joint?
Which of the following conditions can present as a painless swelling of the knee joint?
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Which of the following is not a component of Hutchinson's triad in congenital syphilis?
Which of the following is not a component of Hutchinson's triad in congenital syphilis?
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PANDAS, a pediatric neuropsychiatric disorder, is associated with ____ infection.
PANDAS, a pediatric neuropsychiatric disorder, is associated with ____ infection.
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Which of the following toxins is responsible for causing scarlet fever?
Which of the following toxins is responsible for causing scarlet fever?
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What is the most likely diagnosis for a young girl with continuous dribbling of urine since birth, who also voids normally?
What is the most likely diagnosis for a young girl with continuous dribbling of urine since birth, who also voids normally?
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What is the investigation of choice for a girl with suspected vesicoureteric reflux and recurrent urinary tract infections?
What is the investigation of choice for a girl with suspected vesicoureteric reflux and recurrent urinary tract infections?
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Under which grade of vesicoureteral reflux is a 6-month-old girl with recurrent UTI and reflux of urine into upper collecting systems without dilation classified?
Under which grade of vesicoureteral reflux is a 6-month-old girl with recurrent UTI and reflux of urine into upper collecting systems without dilation classified?
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Antenatal hydronephrosis due to PUJ obstruction is defined as the anteroposterior diameter of the renal pelvis of more than __ in the third trimester.
Antenatal hydronephrosis due to PUJ obstruction is defined as the anteroposterior diameter of the renal pelvis of more than __ in the third trimester.
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The most common anomaly in a child presenting with recurrent urinary tract infections is:
The most common anomaly in a child presenting with recurrent urinary tract infections is:
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What is the most likely diagnosis for a 12-year-old girl presenting with hematuria, headache, blurring of vision, hypertension, broad casts in urine, and mild renal scarring?
What is the most likely diagnosis for a 12-year-old girl presenting with hematuria, headache, blurring of vision, hypertension, broad casts in urine, and mild renal scarring?
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What is the recommended first-line imaging investigation for a 9-month-old girl with high fever, vomiting, mild dehydration, and a positive urine culture indicating a UTI?
What is the recommended first-line imaging investigation for a 9-month-old girl with high fever, vomiting, mild dehydration, and a positive urine culture indicating a UTI?
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What is the most common cause of urinary tract infection in children?
What is the most common cause of urinary tract infection in children?
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Which chromosomes are associated with autosomal-dominant polycystic kidney disease?
Which chromosomes are associated with autosomal-dominant polycystic kidney disease?
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Hepatic fibrosis is associated with which kidney condition?
Hepatic fibrosis is associated with which kidney condition?
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Recurrent gross hematuria is seen in all of the following conditions except _
Recurrent gross hematuria is seen in all of the following conditions except _
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Hematuria in children is defined as the presence of at least ___ RBCs per high power field in uncentrifuged urine.
Hematuria in children is defined as the presence of at least ___ RBCs per high power field in uncentrifuged urine.
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Unilateral renal agenesis is associated with
Unilateral renal agenesis is associated with
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Which of the following is true regarding Gower sign?
Which of the following is true regarding Gower sign?
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Pinku, a 9-year-old girl, has difficulty in combing her hair and climbing up stairs since 6 months. What is the next appropriate investigation to be done?
Pinku, a 9-year-old girl, has difficulty in combing her hair and climbing up stairs since 6 months. What is the next appropriate investigation to be done?
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All of the following are radiological signs of scurvy except
All of the following are radiological signs of scurvy except
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A 7-year-old boy with progressive muscle weakness and walking difficulties presented with the following finding. What is the probable diagnosis?
A 7-year-old boy with progressive muscle weakness and walking difficulties presented with the following finding. What is the probable diagnosis?
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The image below shows the model of a skeletal muscle fiber. Which of the following structures is affected in Duchenne muscular dystrophy?
The image below shows the model of a skeletal muscle fiber. Which of the following structures is affected in Duchenne muscular dystrophy?
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An infant presents with hypotonia and hyporeflexia with significant prenatal history of polyhydramnios and decreased fetal movements. What do you suspect?
An infant presents with hypotonia and hyporeflexia with significant prenatal history of polyhydramnios and decreased fetal movements. What do you suspect?
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Which of the following is false about Duchenne muscular dystrophy?
Which of the following is false about Duchenne muscular dystrophy?
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Which of the following is not an indicator of fetal lung maturity?
Which of the following is not an indicator of fetal lung maturity?
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The chest X-ray image of a term baby born with meconium aspiration shows ____
The chest X-ray image of a term baby born with meconium aspiration shows ____
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All are true about congenital diaphragmatic hernia except __ _
All are true about congenital diaphragmatic hernia except __ _
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All of the following are true about apnea of prematurity (AOP) except __ _
All of the following are true about apnea of prematurity (AOP) except __ _
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The major limiting factor for survival in congenital diaphragmatic hernia is __
The major limiting factor for survival in congenital diaphragmatic hernia is __
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A newborn baby has been referred to the casualty as a case of congenital diaphragmatic hernia. Which of the following is an initial clinical intervention?
A newborn baby has been referred to the casualty as a case of congenital diaphragmatic hernia. Which of the following is an initial clinical intervention?
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Study Notes
Pediatric Urology
- A young girl with continuous dribbling of urine and normal voiding may have an Ectopic ureter, which is the most likely diagnosis.
- In a girl with recurring UTIs, Voiding cystourethrogram (VCUG) is the investigation of choice to suspect vesicoureteric reflux.
- Grade III of vesicoureteral reflux is characterized by reflux of urine into the upper collecting systems without any dilation.
- Antenatal hydronephrosis due to PUJ obstruction is defined as an anteroposterior diameter of the renal pelvis of more than 15 mm in the third trimester.
- The most common anomaly in a child presenting with recurrent UTIs is Vesicoureteric reflux.
- A child with features of hematuria, headache, and blurring of vision, with a past history of recurrent UTI in childhood, may have Reflux uropathy with chronic renal failure.
- In a child with a UTI, Ultrasonogram is the 1st line imaging investigation.
Pediatric Nephrology
- A child with steroid-dependent nephrotic syndrome should receive all killed vaccines under NIS, and live vaccines are contraindicated.
- A child with a chronic hepatitis B infection and nephrotic syndrome is likely to have Membranous nephropathy.
- Steroid-resistant nephrotic syndrome is defined as failure to achieve remission after 8 weeks of corticosteroid therapy.
- FSGS (Focal Segmental Glomerular Sclerosis) is caused by mutations in the NPHS 2 (podocin) gene.
- Congenital nephrotic syndrome is defined as nephrotic syndrome manifesting at birth or within 3 months of life.
- Finnish-type congenital nephrotic syndrome is caused by a mutation in the NPHS 1 (nephrin) gene.
- The initial treatment of choice for a child with nephrotic syndrome is Prednisolone.
- Hypercoagulability in nephrotic syndrome is due to vascular stasis, increase in hepatic production of fibrinogen, and urinary loss of antithrombin III and protein S.
- Minimal change disease is due to Flattening of podocytes.
- The most common cause of nephrotic syndrome in children is Minimal change disease.
Musculoskeletal Disorders
- In a child with Gower sign, the diagnosis is likely to be Duchenne muscular dystrophy.
- Unilateral renal agenesis is associated with Single umbilical artery.
- Duchenne muscular dystrophy is an X-linked recessive disorder, and intellectual impairment is common.
- In a child with Facioscapulohumeral dystrophy, the diagnosis is likely to be Facioscapulohumeral muscular dystrophy.
Neonatal Respiratory Disorders
- Fetal lung maturity is assessed by Lecithin-sphingomyelin ratio.
- Congenital diaphragmatic hernia is a major limiting factor for survival, and the major limitation is pulmonary hypoplasia.
- In a newborn with Apnea of prematurity, the treatment is Caffeine or theophylline.
- Downe's score includes cyanosis, nasal flaring, air entry, and respiratory rate.
- Silverman Anderson score assesses the severity of respiratory distress in a newborn.
- Meconium aspiration can lead to obstructive emphysema.
- Transient tachypnea of the newborn is characterized by interlobar fissure effusion, and respiratory distress resolves in 2 weeks.
- Hyaline membrane seen in the lung is composed of Fibrin.
- Fetal lung maturity is assessed by Amniocentesis.Here are the study notes:
- Neonatal Respiratory Distress Syndrome (NRDS)*
- NRDS is a condition that occurs in newborns, especially those born prematurely
- It is characterized by dyspnea, cyanosis, and respiratory distress
- Surfactant therapy can be given prophylactically to all neonates at <31 weeks gestation, or as rescue treatment when RDS develops
- Repeated dosing is given every 6-12 hours for a total of 2-4 doses
- Risk Factors for NRDS*
- Prematurity is the most important risk factor for NRDS
- Other risk factors include asphyxia, twin pregnancy, and diabetic mother
- Childhood Respiratory Disorders*
- Treatment for a 1.5-year-old child with breathlessness, fever, cough, and cold may include oral antibiotics, warm reassurance, and sending home
- The most common mediastinal mass in children is neurogenic tumors
- Kartagener triad consists of situs inversus totals, chronic sinusitis, and male infertility, but not bronchiectasis
- Cystic Fibrosis*
- Sweat chloride values >38 mEq/L are diagnostic of cystic fibrosis
- Infection by Pseudomonas aerogenes has increased mortality in cystic fibrosis patients
- Meconium ileus is a likely complication in a cystic fibrosis child at birth
- Neonatal Resuscitation*
- The correct order of suctioning is mouth-nose, then nose-esophagus
- Vitamin K is administered to newborns at birth at a dose of 0.5-1 mg IM
- Neonatal Diseases*
- Perinatal period refers to the time from 37 weeks of gestation to 28 days after birth
- A very low birth weight (VLBW) baby is one whose birth weight is less than 1.5 kg
- Neonatal sepsis screen includes immature to total neutrophil ratio, C-reactive protein, and absolute eosinophil count
- Late-onset neonatal sepsis often presents with meningitis, pneumonia, or disseminated intravascular coagulation
- Cardiovascular Diseases*
- Acyanotic congenital heart diseases include atrial septal defects, ventricular septal defects, patent ductus arteriosus, and coarctation of the aorta
- Cyanotic congenital heart diseases include tetralogy of Fallot, tricuspid atresia, and transposition of the great vessels
- Patent ductus arteriosus is diagnosed with a continuous murmur on auscultation
- Atrial septal defects often present with a wide fixed splitting of the second heart sound
- Ventricular septal defects are associated with a systolic murmur and may require surgical closure
- Congenital heart disease is often associated with rubella infection during pregnancy and can be inherited in an autosomal dominant pattern### Congenital Heart Diseases
- Transposition of Great Arteries: a diagnosis likely in a 24-year-old woman with bipolar disorder on lithium therapy who intends to conceive, as lithium poses a risk to the fetus.
- Ebstein anomaly: a condition associated with maternal lithium intake, characterized by a lesion commonly seen in this condition, i.e., Tricuspid regurgitation.
- Total Anomalous Pulmonary Venous Return (TAPVR): a condition diagnosed based on a chest X-ray image, characterized by increased pulmonary blood flow, a narrow vascular pedicle, right atrial enlargement, and pulmonary venous hypertension.
- Tetralogy of Fallot: a condition diagnosed in a neonate on day 7 of life with heart failure, characterized by a chest X-ray image showing increased pulmonary blood flow and a narrow vascular pedicle; it is the most common cyanotic congenital heart disease.
- Truncus arteriosus: a condition that can be diagnosed in a cyanotic infant with a chest X-ray image showing a "snowman" appearance of the cardiac silhouette.
- Total Anomalous Pulmonary Venous Connection (TAPVC): a condition diagnosed in a cyanotic infant with a chest X-ray image showing a "snowman" appearance of the cardiac silhouette; the most common type of TAPVC is supracardiac.
Pediatric Bacterial and Parasitic Infections
- Hutchinson triad: a condition characterized by interstitial keratitis, 8th nerve deafness, and Hutchinson molars.
- Diphtheria:
- A 5-year-old child who received vaccination 22 months back does not need further action if exposed to diphtheria.
- Maternal antibodies do not provide significant immunity to diphtheria in a neonate.
- The daily dosage of ethambutol for an adolescent is 15-20 mg/kg.
- Toxoplasmosis:
- The most common manifestation is Hydrocephalus.
- It occurs through hematogenous dissemination to the placenta.
- Intestinal parasites:
- Trichuris trichura: causes seizures in a child who consumes uncooked pork.
- Taenia solium: responsible for seizures in a child who consumes uncooked pork.
- Ancylostoma duodenale: enters the human body through penetration of skin.
Tuberculosis
- A 24-year-old woman with active tuberculosis on ATT delivered a healthy male baby at term; the newborn is managed with BCG + INH for 6 months + breastfeeding.
- Revised Jones criteria for the diagnosis of acute rheumatic fever in high-risk populations:
- Polyarthralgia is not a major criterion.
- ESR ≥30 mm, CRP ≥3.0 mg/dl, and fever (≥38°C/100.4°F) are not major criteria.
Miscellaneous
- Congenital syphilis:
- Presents as a painless swelling of the knee joint.
- A component of Hutchinson's triad is Interstitial keratitis, not Saber shin.
- PANDAS: a pediatric neuropsychiatric disorder associated with Streptococcus pyogenes infection.
- Scarlet fever: caused by pyrogenic exotoxin produced by Streptococcus pyogenes.
- Polio:
- Hand, knee gait in polio paralysis is due to weakness of the Gluteus medius.
- The 90-90-90 target of UNAIDS is 90% of people living with HIV knowing their status, 90% of those with diagnosed HIV receiving antiretroviral therapy, and 90% of those on therapy achieving viral suppression.
- AIDS:
- An infant born to an HIV-positive mother at term with a positive HIV DNA PCR test at 6 weeks should have CD4 counts monitored; all vaccines are recommended except OPV.
- WHO recommends starting ART in children with HIV, regardless of clinical stage or CD4 count.
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A quiz on pediatric urology covering topics such as urinary incontinence, ureteral abnormalities, and vesicoureteric reflux. Test your knowledge on diagnosis and investigation methods.
