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Questions and Answers
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?
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.
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Match the congenital heart diseases with their associated anomalies:
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Infective endocarditis is most commonly seen in __
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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 __
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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 __
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The most common type of ventricular septal defect is __
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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?
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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 __
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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?
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Investigation of choice of diphtheria carrier is __
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Which of the following is true regarding diphtheria?
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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?
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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?
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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?
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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.
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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?
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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?
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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.
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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?
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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?
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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?
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Hepatic fibrosis is associated with which kidney condition?
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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.
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Unilateral renal agenesis is associated with
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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?
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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?
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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?
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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?
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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?
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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 __ _
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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 __
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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?
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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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Description
A quiz on pediatric urology covering topics such as urinary incontinence, ureteral abnormalities, and vesicoureteric reflux. Test your knowledge on diagnosis and investigation methods.
