bis.- Principio de libre competencia

Q 1. A neonate delivered at 37 wks of gestation with a birth weight of 1.9 kg develops intolerance to feed/ lethargy/abdominal distension on 2nd day. Sepsis screens is negative. Physical examination is unremarkable. PCV is observed to be 72%. Which of the following represents with best management option:

a. Hydration with IV fluids b. Partial exchange transfusion c. Presumptive treatment for sepsis

d. Medical management for intestinal obstruction

Q 2. A premature baby born at 33 wks of gestation with a birth weight of 1500 gm has stable vitals. Which of the following you will choose as initial feeding method of choice:

a. Intravenous fluids

b. Intravenous fluids and oral feeding c. Orogastric tube/ alternate oral route d. Total parenteral nutrition

Q 3. A 2 yrs old male child presents to paediatric emergency department with history of fever x 2 wks. He has received multiple antibiotics. Blood tests for Typhoid, Malaria, Dengue are all negative.

He however had sterile pyuria in one of reports (urine C/s - sterile).

BCG scar is indurated and H/o conjunctivitis, chelitis and erythematous rash over body for initial 5 days of illness is obtained the most likely treatment of choice is:

a. Cyclosporin b. Prednosolone c. Methotrexate d. IvIg

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Q 4. A child presented with intermittent episodes of left sided flank pain. USG KUB reveals a large hydronephrosis with dilated renal pelvis and cortical thinning with a normal ureter. Kidney differential function was observed to be 19%, which of the following is the best management:

a. Nephrectomy b. Pyeloplasty c. External drainage d. Endopylostomy

Q 5. Which of the following statements about neuroblastoma is false:

a. Most common extracranial solid tumor in children b. >50% present with metastasis at the time of diagnosis c. Lung metastasis is common

d. Often encase aorta and its branches at time of diagnosis Q 6. A very low birth weight preterm baby is on ventilator for respiratory distress. Baby presents with clinical features of necrotizing enterocolitis with perforation. What is the appropriate management?

a. Conservative management b. Immediate laparotomy

c. Extra corporeal membrane oxygenation with surgery after stabilization

d. Peritoneal drainage

Q 7. A child with 3 days history of upper respiratory tract infection presents with moderate respiratory distress and stridor at rest. What is the most appropriate management?

a. A single daily dose of I/V ceftriaxone b. Mechanical ventilation

c. Hospitalization and Nebulization with racemic epinephrine diluted with water.

d. Reassure parents and advise on symptomatic treatment for fever.

Q 8. A child is brought with drowsiness, decreased deep tendon reflexes and seizures. On examination the child has a blue line on gums. There is a history of constipation. Which will be most appropriate drug that should be used in this child?

a. EDTA b. DMSA c. BAL

d. Pencillamine

Q 9. A 7 yr old girl is bought with complaints of generalized swelling of body. Urinary examination reveals grade 3 proteinuria and the presence of hyaline and fatty casts. She has no history of hematuria, which of the following statements about her condition is true:

a. No IgG deposits or C3 deposits on renal biopsy b. L3 level will be low

c. IgA nephropathy is the likely diagnosis d. Alport's syndrome is the likely diagnosis

Q 10. A 8 yr old male presents to paediatric casualty with non blanching rashes on skin, swelling of knee joint x 2 days, Malena associated with abdominal pain x 1 day. Platelet count, prothrombin time are normal. Urine R/M shows 2+ protein, hematuria. What should be your line of management?

a. Symptomatic treatment with rest and analgesia b. Short course of steroids

c. Steroids with immunosuppressive d. Skin biopsy and orthopaedic referral

Q 11. A 2 yrs old boy presents with short stature and bowing of legs.

X-ray knee shows evidence of rickets. He has been given Vit D twice 2 months back. Blood investigation shows S.calcium 9 mg/dL, S.

Phosphate 2 mg/dL, S. Alkaline phosphatase 1030 µg/dL, S.PTH and S. Bicarbonate levels are normal. What should be the next line of management?

a. Give calcitriol in very large doses b. Oral phosphate and Vit D supplements c. Oral calcium and phosphate supplements

d. Restrict phosphate, give calcium and vit D supplements Q 12. A six months old girl is having recurrent UTI. Ultrasound abdomen shows bilateral hydronephrosis. MCU (Micturating cysts urethrogram) shows bilateral grade IV vesicoureteral reflux. The treatment of choice is:

a. Endoscopic injection of polyteflon at uretic orifice b. Uretric reimplantation

c. Bilateral ureterostomy d. Prophylactic antibiotics

Q 13. A 10 months old boy, weighing 3 kg has polyuria, polydipsia and delayed motor milestones. Investigations show blood level of creatinine 0.5 mg/dL, potassium 3 meq.L, sodium 125 meq/L, chloride

88 meq/L calcium 8.8 mg/dL, PH 7.46 and bicarbonate 26 meq/L Ultrasonography shows medullary nephrocalcinosis. The most likely diagnosis is:

a. Renal tubular acidosis b. Diabetes syndrome c. Bartter syndrome

d. Pseudohypoaldosteronism

Q 14. A 3 yr old child with acute onset of fever of 104⁰F developed febrile seizures and was treated. He had similar episode at 2, 2 ½ yr of age. Which of the following statements is false?

a. The risk of epilepsy is 4% in this case b. Long term phenytoin is required

c. Intermittent clobazan and paracetamol should be used d. Consider EEG and imaging

Q 15. A 14 yr old boy has history of frequent myoclonic jerks on awakening, making hair combing and tooth brushing difficult for past 6 months. Now, he has presented to casualty with generalised tonic clonic seizure. Neurological examination is normal, which of the following statements is true?

a. Drug of choice is carbamazepine

b. Carbamazepine can be discontinued after complete remission c. Response to anticonvulsants is poor

d. EEG in this condition shows a 4-6/ sec irregular spike and wave pattern, which is enhanced by photic stimulation.

Q 16. A 2 yr old child is bought by parents with history of seizures and development delay. He has multiple hypopigmented macules over the back. What is the most probable diagnosis?

a. Neurofibromatosis type I b. Tuberous sclerosis c. Struge Weber's syndrome d. Vao Nippel Lindau disease

Q 17. A 5yr old child is admitted with headache, vomiting and difficulty in walking. Physical findings include truncal ataxia, papilledema and left lateral rectus palsy. Finger to nose test was normal. The most likely diagnosis is:

a. Dandy Walker syndrome b. Syringobulbia

c. Arnold Chiari malformation d. Medulloblastoma.

Q 18. A 5 months old formula fed infant has been brought with complaints of watery diarrhoea of 2 days duration and irritability of one day. Physical examination reveals a markedly irritable child with a rather doughy skin and rapid pulse, borderline CFT. Which of the following statements is true?

a. Give I/V bolus of normal saline b. Give I/V bolus of ringer lactate

c. Calculate water deficit and replace over 24 hrs at a rate of 0.5 meq/L/hr.

d. Treat as any dehydration and give moderate dehydration correction.

Q 19. Study the following inheritance pattern Which of the following statements is true?

a. Autosomal dominant b. Mito chondrial c. Autosomal recessive d. X-linked dominant

Q 20. A newborn is born to a HIV positive woman an ART. He was given Nevirapine at birth. Which of the following statements regarding future management is false?

a. Start Cotrimoxazole prophylaxis at 1 month till HIV infection can be ruledout.

b. Advise exclusive top feeding or exclusive breast feeding c. Perform DNA PCR for HIV at 6-8 wks of age.

d. Do not give OPV and BCG at birth.

Q 21. A. Assertion: An infant presents with hypotonia and areflexia.

During his intrauterine period there was polyhydramnios and decreased fetal movements. He is diagnosed as floppy infant.

B. Reasoning: Electromyography will show a decremental response on repetitive stimulation and muscle biopsy will be normal.

a. Both statement A and B are true, and B is the correct explanation of A

b. Statement A is true while statement B is false.

c. Statement A is false while statement B is true.

d. Both statements A and B are true but B is not the correct explanation of A.

Q 22. Previously well newborn discharged as "healthy" from the nursery at D1 of life presented casualty at D7 of life with poor feeding, poor pulses, tacycardia, an ashen appearance. He was immediately intubated and put on inotropic support. Sepsis serum was negative.

Urgent echo done was suggestive of small left ventricle with atretic mitral valve. Prostaglandin E1 infusion was immediately started. He fails to improve with same. What should be next line f management?

a. Increase inotropic support and continue same management b. Emergency atrial septostomy

c. Corrective surgery d. Upgrade antibiotics

Q 23. A 1 ½ yr old child presents to paediatric casualty with irritability, restlessness, severe respiratory distress and cyanosis. Mother gives history of vigorous crying ½ hr back. On auscultation, a short systolic murmur and soft 2nd heart sound are heard in left 3rd and 4th parasternal spaces. What should be the immediately intervention?

a. Assurance of mother that nothing should be done and he will become alright spontaneously.

b. An urgent echo and chest x-ray is planned.

c. Knee-chest position, oxygen and Inj. Morphine administration d.  agonists like Isoxuprine administration

Q 24. A 1 yr old infant presented to paediatric casualty with excessive crying, irritability and billous vomiting. Mother gives history of passage of blood per rectum once mixed with stools. He is hemodynamically stable but not allowing examination. X-ray abdomen shows ascites with distended bowel loops.What should be next line of management:

a. Manage as a case of acute invasive gastroenteritis with I.V.

antibiotics and I.V. fluids

b. Send PT, aPTT and give Inj Vit K

c. Do urgent USG and perform hydrostatic reduction.

d. Do urgent USG and prepare for urgent laparotomy

Q 25. A 8 day old breast fed male baby presents with vomiting, poor feeding and loose stools. On examination the heart rate is 190/min, blood pressure 50/30 mmHg, respiratory rate 72 breaths/ minute and capillary refill time of 4 sec. Investigations show Hb 15 gm/dL, SNa+

- 120 meq/L K+ - 6.8 meq/L, Cl- 81 meq/L, bicarbonate 15 meq/L, creatinine 0.6 mg/dL. The most likely diagnosis is:

a. 21 hydroxylase deficiency b. 3- hydroxy steroid deficiency c. 11 hydroxylase deficiency d. Aldosterone synthase deficiency

Q 26. A. Assertion: A 8 day old child presents yellow sclera, whitish stool and turmeric colour urine with reducing substance positive on 3rd day of septicaemia on broad spectrum antibiotics.

R. Reasoning: This is a case of severe sepsis and antibiotics should be immediately upgraded

a. A and R both correct and R is explanation of A b. A and R both correct but R is not explanation of A c. A correct R wrong

d. A wrong R correct

Q 27. A: Assertion: A 1 month baby presents with history of jaundice, turmeric colored urine and pale stools since birth. Examination reveals liver span of 10 cm TORCH IgM is positive for Rubella.

R: Reasoning: A liver biopsy should be done to differentiate neonatal hepatitis from biliary atresia

a. A and R both correct and R is explanation of A b. A and R both correct but R is not explanation of A c. A correct R wrong

d. A wrong R correct

Q 28. 30 yr old lady delivered a healthy baby at 37 wk of gestation, she was positive for HBSAg but negative for HB_CAg. Which of the following is the most appropriate treatment for the baby:

a. Both active and passive immunization soon after birth b. Passive immunization soon after birth and active immunization

at 1 yr of age.

c. Only passive immunization soon after birth d. Only active immunization soon after birth

Q 29. A 7 yr old girl presents to casualty with history of fever x 4 days, epistaxis and vomiting. She is diagnosed to be Dengue Heorrhagic fever (DHF), which of the following does not constitute the diagnosis of DHF?

a. Thrombocytopenia b. Hypoalbuminemia c. Pleural effusion d. Decreased hematocrit

Q 30. A child died soon after birth. On examination there was pallor, hepato splenomegally and edema all over body. Most probable diagnosis is:

a.  - Thalassemia b.  - Thalassemia c. Herditary spherocytosis

d. ABO in computability/ sickle cell anemia AIIMS MAY 2012

Q 1. Which of the following will favour the diagnosis RDS in newborn?

(AIIMS Nov 2010)

a. Reciept of antenatal steroids b. Air bronchogram in chest x-ray c. Manifests after 6 hours

d. Occurs after term gestation

Q 2. All the following can occur in a neonate for heat production except (AIIMS Nov 2006)

a. Shivering

b. Universal flexion like a fetus

c. Breakdown of brown fat with adrenaline secretion

d. Cutaneous Vasoconstriction

Q 3. Due to advances in Cancer treatment the prognosis of which of the following has become better?

a. Glioblastoma multiforme b. Esophageal carcinoma c. ALL in children d. Cholangio carcinoma

Q 4. A newborn baby presented with profuse bleeding from the umbilical stump after birth. Rest of the examination and PT, APTT are within normal limits. Most probable diagnosis is:

a. Factor X deficiency

b. Glanzmann thrombasthenia c. Van Willebrand disease d. Bernard Soullier disease

ALL INDIA PG MEDICAL ENTRANCE EXAMINATION