. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}", "cop": 3, "opa": "12 months", "opb": "15 months", "opc": "18 months", "opd": "24 months", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "75b19c75-01aa-48c2-9ad1-88e773e69ecd", "choice_type": "single"}
+{"question": "The Most common cause of meningitis in children aged 5 years is", "exp": "Several kinds of bacteria can cause bacterial meningitis. The most common ones in the U.S. are: problems) A bacteria called Haemophilus influenzaetype b (Hib) was a common cause of meningitis in babies and young children until the Hib Neisseria meningitidis and Streptococcus pneumoniae. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "H-influenzae", "opb": "N-meningitides", "opc": "Strep pneumonia", "opd": "Staph. aureus", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "62cf391a-92ff-46ec-bd58-ca3460210c02", "choice_type": "single"}
+{"question": "Breastfeeding is contraindicated in", "exp": "Contraindications of breastfeedingGalactosemiaActive untreated tuberculosis-only in the initial periodHIV positive mother-especially in a developed country; In India its not contraindicatedSome medication(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 287)", "cop": 1, "opa": "Galactosemia", "opb": "Tuberculosis history", "opc": "Hepatitis B positive mother", "opd": "Low bih weight infant", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "714a6fa3-f1ec-4cd4-881d-28b22e1f2d63", "choice_type": "single"}
+{"question": "Most common cause of fresh bleeding per rectum in a 5 years old child is", "exp": "(D) (Juvenile rectal polyp)* Fresh bleeding indicates bleeding from anal canal or rectum.* Whenever a child comes with bleeding per anum, a diagnosis of rectal polyp should be made until it is excludes by rectal examination.* According to C.P.P.T. common causes of bright red bleeding in a children 2-12 year old in decreasing order frequency are-- Anal fissure- Solitary rectal ulcer- Juvenile polyp- Lymphonodular hyperplasia.Differential diagnosis of bright red bleeding from rectum InfantChild (2-12 yrs)Adolescent >12Hematochezia with diarrhea and crampy abdominal painInfectious colitisPseudomembranous colitisEosinophilic coliisHirschsprung's entrocolitisInfectious colitis pseudomembranous colitisHemolytic uremic syndromeH.S. purpuraLymphonodular hyperplasiaInfectious colitisPseudomembranouscolitisGranulomatous colitisH.U.SH.S.P.Hematochezia without diarrhoea and abdominal painAnal fissure Eosinophilic colitis Rectal gastric mucosa, heterotropiaColonic hemangiomasAnal fissureSolitary rectal ulcerJuvenile polypLymphonodular hyperplasiaAnal fissure HemorrhoidSolitary rectal ulcerColonic A-V malformationThe aetiology and man and management of rectal bleeding depends on the age of the child, the type and quantity of bleeding and the associated symptoms. Unlike adults malignancy is exceptionally rare. In infants an anal fissure, necrotizing enterocolitis, intussusceptions and allergic enterocolitis are possible causes. In older children, more common causes includes an anal fissure, a juvenile polyp and certain gastroenteritides (e.g. Campylobacter infection); Meckel's diverticulum, duplication cyst and inflammatory bowel disease are less common. - Bailey and Love.Juvenile polyps are the most common type of childhood polyp, occurring in up to 1% of preschool children. The solitary polyps found in the rectum which most commonly present with rectal bleeding.These are hamartomatous polyps, which are usually pedunculated but can be sessile. The typical child with a juvenile polyp is 4 to 6 years of age, presents with intermittent painless rectal bleeding with bowel movements. - Rudolph's PediatricsJuvenile polyps are usually are not premalignant. Because the gross appearance of these polyps is identical to adenomatous polyps, these lesions should also be treated by polypectomy.Juvenile polyposis is a term used when more 5 to 10 juvenile polyps develop.Juvenile polyposis coli applies if the polyps are limited to the colon, whereas generalzed juvenile polyposis describes the presence of polyps throughout the GI tract, both have a significant malignant potential.Mentioned options are rare in childrenFamilial adenomatous polyposis (FAP) patients present in 2nd to 3rd decade.Rectal ulcer (solitary rectal ulcer) is commonly seen in 20 to 40 yrs age group.Piles are rare in children. (Ref: Rudolp'spediatrics, 21/e chapter 17.22)* MC solid tumor in childhood- Brain tumors* MC extracranial solid tumor in childhood - Neuroblastoma* MC intraabdominal solid tumor in childhood - NeuroblastomaCauses of Recurrent Gross Haematuria (2169-Nelson '8th)1. IgA Nephropathy - (MC cause)2. Alport's syndrome3. Thin glomerular basement membrane disease4. Hypercalciuria5. Urolithiasis* MCC of vasculitis in children is Henoch- schonlein prupura (HSP)* MC tumors in children are Leukaemia* MC solid tumors in children are CNS tumors* MC site of brain tumors in children is Infratentorial (cerebellar)* MC site of brain tumors in neonates is supratentorialMC posterior fossa tumour in children is cerebellar Astrocytoma* The Leukemias (ALL) are the most common malignant neoplasms in childhood", "cop": 4, "opa": "Volvulus", "opb": "Trauma", "opc": "Worm infestation", "opd": "Juvenile rectal polyp", "subject_name": "Pediatrics", "topic_name": "Gastro Intestinal System", "id": "abcbd7de-01ac-497a-a83a-c4b760a1075f", "choice_type": "single"}
+{"question": "Drug of choice for Absence attacks is", "exp": "- DOC for Absent seizures: Typical - Ethosuximide Atypical & in India - Sodium valproate If nothing is mentioned in question then DOC is Ethosuximide Drug of choice for: Focal seizures : oxcarbamazepine and carbamazepine; Juvenile myoclonic epilepsy: valproate and lamotrigine; Lennox-Gastaut syndrome: clobazam, valproate, topiramate, lamotrigine, and, most recently, as add on, rufinamide Infantile spasms: adrenocoicotropic hormone (ACTH).", "cop": 3, "opa": "Phenytoin", "opb": "Primidone", "opc": "Ethosuximide", "opd": "Phenobarbitone", "subject_name": "Pediatrics", "topic_name": "Epilepsy", "id": "a9a04416-32c3-4966-8ef0-2ca5f7818126", "choice_type": "single"}
+{"question": "A neonate is suspected to be suffering from necrotizing enterocolitis (NEC). On fuher examination and investigation, he is diagnosed to be Bell's stage I NEC. The management of choice would be", "exp": "Ans. c. Conservative management with IV fluids and antibiotics The management of choice for Bell's Stage I necrotizing enterocolitis is conservative management with IV fluids and antibiotics. Treatment of Bell's Stage I Necrotizing Enterocolitis: NPO, II/fluids and Antibiotics for 3 days", "cop": 3, "opa": "Laparotomy and proceed", "opb": "Inseion of bilateral pelvic drains", "opc": "Conservative management with IV fluids and antibiotics", "opd": "Initial conservative management and laparotomy after 24 hours", "subject_name": "Pediatrics", "topic_name": null, "id": "cba8d965-79e8-4577-b3ad-9d178cfcdfc1", "choice_type": "single"}
+{"question": "Commonest cause of obstructive hydrocephalus in children", "exp": "Aqueducts stenosis is most common cause of obstructive hydrocephalus in children. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Acqueductal stenosis", "opb": "Aquaductal gliosis", "opc": "Subarachnoid hemorrhage", "opd": "Tubercular meningitis", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "ff4fa443-2059-4f45-8528-52294e33e624", "choice_type": "single"}
+{"question": "Commonest type of seizure in newborn", "exp": "Hypoxic-ischemic encephalopathy : It is an impoant cause of neonatal seizures. Seizures resulting from hypoxic-ischemic encephalopathy may be seen in term and prematureinfants. They frequently present within the first 72 hours of life.Seizures may include subtle, clonic, or generalized seizures. These are subtle seizure . There are 4 major types of seizures in neonates: Subtle seizures are relatively common in the neonatal period and are more often encountered in the preterm than full term infant. Such seizures include oral-buccal-lingual movements, ceain ocular phenomena, peculiar limb movements, autonomic alterations and apnea. Clonic seizures include focal and multifocal varieties which may migrate to another pa of the body in a non-ordered fashion. Tonic seizures include focal episodes (less common) and generalized episodes (more common). Generalized tonic seizures may mimic decerebrate and decoicate posturing. Myclonic seizures may be focal, multifocal or generalized and are the least common of the four varieties during the neonatal period. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Clonic", "opb": "Tonic", "opc": "Subtle", "opd": "Myoclonic", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "37abb69d-6306-484d-b7a2-a22c830e2f48", "choice_type": "single"}
+{"question": "Manifestations of vitamin C deficiency are", "exp": "In Vitamin C deficiency, bones are tender and the infant is reluctant to move his limbs, which are kept in a frog-like position. This may be mistaken for paralysis. Page 127, Ghai essential pediatrics; 6th edition", "cop": 1, "opa": "Pseudoparalysis", "opb": "Sabre tibia", "opc": "Epistaxis", "opd": "Craniotabes", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "0162fdf3-b7a4-4a23-87a6-121a84c48fd5", "choice_type": "single"}
+{"question": "A premature infant born at 34 weeks presented with acute onset lethargy and cessation of feeding. The imaging modality of choice to screen for intraventricular haemorrhage is", "exp": "Intraventricular hemorrhage (IVH) is a major complication of prematurity. IVH typically initiates in the germinal matrix, which is a richly vascularized collection of neuronal-glial precursor cells in the developing brain. The etiology of IVH is multifactorial and is primarily attributed to the intrinsic fragility of the germinal matrix vasculature and the disturbance in the cerebral blood flow. While this review broadly describes the mechanism underlying IVH, the main focus is on the recent development in molecular mechanisms that elucidates the fragility of the germinal matrix vasculature. The microvasculature of the germinal matrix is frail because of an abundance of angiogenic blood vessels that exhibit paucity of pericytes, immaturity of basal lamina and deficiency of glial fibrillary acidic protein (GFAP) in the ensheathing astrocytes-endfeet. High VEGF and angiopoietin-2 levels activate a rapid angiogenesis in the germinal matrix. The elevation of these growth factors may be ascribed to a relative hypoxia of the germinal matrix perhaps resulting from high metabolic activity and oxygen consumption of the neural-progenitor cells. Hence, the rapid stabilization of the angiogenic vessels and the restoration of normal cerebral blood flow on the first day of life are potential strategies to prevent IVH in premature infants. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "NCCT", "opb": "Transcranial USG", "opc": "MRI", "opd": "Plain radiograph", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "47465d28-195f-4050-a6d5-a9f24bc73000", "choice_type": "single"}
+{"question": "Male pseudohermaphroditism is seen in", "exp": "5 alpha reductase conve testosterone to dihydrotestosterone,which is required for external genital devolopment in male.deficiency of it leads to development of mullerian duct into fallopian tube,Uterus and upper third of vagina. Reference : Ghai essential of pediatrics, eighth edition, p.no:538", "cop": 1, "opa": "5- a redutase deficiency", "opb": "21 hydroxylase deficiency", "opc": "17 hydroxylase deficiency", "opd": "Gonadal dysgenesis", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "0a8c2b79-6524-44b4-928a-978fa18b5fbe", "choice_type": "single"}
+{"question": "Most common soft tissue sarcoma in children is", "exp": "Rhabdomyosarcoma is the Most common Pediatric soft tissue sarcoma.", "cop": 3, "opa": "Liposarcoma", "opb": "Myosarcoma", "opc": "Rhabdomyosarcoma", "opd": "Sacro - occygeal teratoma", "subject_name": "Pediatrics", "topic_name": null, "id": "1b627fb1-54f4-46c9-93b5-0d08d9ca15c3", "choice_type": "single"}
+{"question": "Maple syrup urine is due to defective decarboxylation of", "exp": null, "cop": 1, "opa": "Branched chain amino acids", "opb": "Sulfur containing amino acids", "opc": "Hydroxyl amino acids", "opd": "Unbranched chain amino acids", "subject_name": "Pediatrics", "topic_name": null, "id": "f7d79536-a071-4731-bb6c-78dfbba59db2", "choice_type": "single"}
+{"question": "A 10 months old baby boy presented with inability to feed since 1 day. He had a prior history of cough, fever and hurried breathing since 3 days. On examination the child had a Respiratory rate of 56/min. The line of management is", "exp": "Inability to feed is one of the danger signs of pneumonia.\nHence the child can be categorised as Severe pneumonia and needs hospital admission and treatment with injectable antibiotics.", "cop": 3, "opa": "Home management with Paracetamol", "opb": "Home management with Amoxycillin", "opc": "Hospital management with antibiotics", "opd": "Reassurance", "subject_name": "Pediatrics", "topic_name": null, "id": "2e6fd178-f93e-4dba-a2cb-c382e2d7f01f", "choice_type": "single"}
+{"question": "A 2 year old child presents with scattered lesions in the skull. Biopsy revealed Langerhans giant cells. The most commonly associated is marker with this candition will be", "exp": "In Langerhans cell histiocytosis,the hallmark feature is the presence of Birbeck granules on electron microscopy and positivity for S-100 protein and CD 1a. Reference:Essential pediatrics-Ghai,8th edition,page no:620.", "cop": 1, "opa": "CD 1a", "opb": "CD 57", "opc": "CD 3", "opd": "CD 68", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "63ba2249-5630-48af-bd50-cb30fcccc7e1", "choice_type": "single"}
+{"question": "Bart hemoglobin consist of", "exp": "Bart hemoglobin is tetramer of four γ chains.", "cop": 1, "opa": "Four γ chains", "opb": "Four β chains", "opc": "Two γ chains + Two β chains", "opd": "Two α chains + Two γ chains", "subject_name": "Pediatrics", "topic_name": null, "id": "cf22cc8e-b242-4e07-87d2-f0a21139394d", "choice_type": "single"}
+{"question": "The most characteristic radiographic sign in a child with leukemia is", "exp": "The most characteristic radiological signs in a child with leukemia are metaphyseal lucent band,reduced bone density,lytic bone lesions,metaphyseal coical bone erosions,collapsed veebrae,widening of sutures,and periosteal reactions. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Osteoclerosis of the metaphysic", "opb": "Metaphseal translucencieas", "opc": "Perios", "opd": "Osteolytic lesion", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "34ba634e-b20e-43ff-9d5d-40fa56386fc4", "choice_type": "single"}
+{"question": "Malformations of the following organ system of the fetus are found to be most commonly associated with Single umbilical aery .", "exp": "Malformation of the genitourinary system is generally associated with the single umbilical aery. Paediatric complications associated with single umbilical aery include: An isolated SUA is associated with renal malformations in 7-9 per cent of infants. Vesicoureteric reflux (VUR) is the most common abnormality occurring in 4 per cent of infants with an isolated SUA. In a meta analysis of 26 studies the incidence of any renal abnormality associated with isolated SUA was 8 per cent, with only 4 per cent requiring treatment of the abnormality. From this meta analysis the investigation of 14 cases of isolated SUA would yield one patient requiring treatment. In another study VUR was also the most common abnormality requiring treatment and three out of five of their patients had a urinary tract infection (UTI) before the age of three months. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Central nervous system", "opb": "Cardiovascular", "opc": "Genitourinary", "opd": "Skeletal", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "7f17ac2e-67f7-4615-a179-363c44caf307", "choice_type": "single"}
+{"question": "The gold standard lab test for diagnosis of paroxysmal nocturnal Hemoglobinuria is", "exp": "Flow cytometry\n\nIt is gold standard test for diagnosis of PNW\nIt shows absence of CD55 and CD59 on RBC", "cop": 4, "opa": "Ham test", "opb": "Nestroft test", "opc": "Sucrose lysis test", "opd": "Flow cytometry", "subject_name": "Pediatrics", "topic_name": null, "id": "3a565cfe-b9a9-4799-a0d4-1a8bdb30286c", "choice_type": "single"}
+{"question": "The normal resting hea rate for a newborn is", "exp": "The normal resting hea rate in the newborn is 110-140bpm but may vary from 90 beats /min in a relaxed state to 180 bpm during activity.", "cop": 3, "opa": "75 -115 bpm", "opb": "85-125 bpm", "opc": "110-150 bpm", "opd": "140-200 bpm", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "4b4c4d6d-dfd3-4d5e-8d9b-826e60b83106", "choice_type": "single"}
+{"question": "Early onset sepsis in a neonate occurs within", "exp": "Early-onset sepsis (EOS) (less than 72 hr) infections are caused by organisms prevalent in the maternal genital tract or in the delivery area.Late-onset sepsis (LOS) (72 hr or later) infections are caused by the organisms thriving in the external environment of the home or the hospital. The infection is often transmitted through the hands of the care providers.Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 163", "cop": 4, "opa": "12 hours", "opb": "24 hours", "opc": "48 hours", "opd": "72 hours", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "e5be868c-90fe-47d4-a312-7e46e81deb3e", "choice_type": "single"}
+{"question": "Best indicator of acute malnutrition", "exp": "Ans. is 'a' i.e., Weight for height Severe acute malnutrition is defined by a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema.", "cop": 1, "opa": "Weight for height", "opb": "Weight for age", "opc": "Height for age", "opd": "BMI < 2 SD", "subject_name": "Pediatrics", "topic_name": null, "id": "3c6d4127-efca-49ff-86e2-a3f323820e9b", "choice_type": "single"}
+{"question": "Differential cyanosis occurs in", "exp": "Differential cyanosis is present when the preductal (right upper extremity) oxygen saturation is higher than the postductal(lower extremity) saturation.ETIOLOGY:- PDA with reversal of shunt.- Persistent pulmonary hypeension of the newborn.Reverse differential cyanosis:In this condition only the upper pa of the body is cyanosed and the lower pa is pink.ETIOLOGY:PDA +TGV+severe pulmonary hypeensionPDA+TGV+preductal coarctation of the aoa", "cop": 1, "opa": "PDA", "opb": "TGA", "opc": "Tricuspid stenosis", "opd": "VSD", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "74a93338-7182-493f-86ad-95c12881cac1", "choice_type": "single"}
+{"question": "Iron supplementation in a healthy term breastfed baby should be staed at the age of", "exp": ".However, human milk contains littleiron, so infants who are exclusively breastfed are at increased risk ofiron deficiency after 4 months of age. The clinical repo recommends giving breastfed infants 1 mg/kg/day of a liquid iron supplement until solid foods, such as iron-foified cereals, are introduced.", "cop": 4, "opa": "2 weeks", "opb": "4 weeks", "opc": "6 weeks", "opd": "8 weeks", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "ccb11749-a559-4e76-8e86-50be75aeb294", "choice_type": "single"}
+{"question": "Edema in nephrotic syndrome is due to", "exp": "NEPHROTIC SYNDROME:- Characterised by massive proteinuria, hypoalbuminemua and edema, hyperlipidemia is often associated. Some patients show hematuria and hypeension. Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl). The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin angiotensin aldosterone axis and ADH secretion that enhances sodium and water retention. Hypoalbuminemia also induces hepatic synthesis of beta lipoproteins resulting in hypercholesterolemia. Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy. Steroid sensitive nephrotic syndrome:- MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non specific obliteration of epithelial foot processes. Immunofluorescence studies shows deposits of occassional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia impa a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated. Low serum calcium level. Steroid resistant nephrotic syndrome:- Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and wilms tumor(WT1) genes. Reference: GHAI essential Paediatrics", "cop": 3, "opa": "Sodium & water retention", "opb": "Increased venous pressure", "opc": "Hypoalbuminemia", "opd": "Hyperlipidemia", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "6e00ef20-15f3-4de7-9573-7a61de2cbc65", "choice_type": "single"}
+{"question": "ACTH secretion is highest during", "exp": "High levels of ACTH are detected by the adrenal gland receptors which stimulate the secretion of coisol, causing blood levels of coisol to rise. As the coisol levels rise, they sta to slow down the release of coicotrophin-releasing hormone from the hypothalamus and ACTH from the pituitary gland. Ref : Nelson", "cop": 3, "opa": "Noon", "opb": "Evening", "opc": "Morning", "opd": "Night", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "0dffe44f-2574-4138-87f6-b6d902e69964", "choice_type": "single"}
+{"question": "The best indicator of the nutritional status of a child is", "exp": "The best indicator of the nutritional status of a child is the rate of increase in height & weight. Rest of them are age independent indices.", "cop": 2, "opa": "Mid arm circumference", "opb": "Rate of increase in height and weight", "opc": "Head circumference", "opd": "Chest circumference", "subject_name": "Pediatrics", "topic_name": null, "id": "75c73381-eecf-447b-a014-41dd8ee9936b", "choice_type": "single"}
+{"question": "Amount of ORS given in 5kg child with diarrhoea with some dehydration", "exp": "For some dehydration, amount of ORS given is 75ml/kg over 4 hours, hence 75×5 = 375 ml over 4 hours.", "cop": 3, "opa": "300ml over 2 hours", "opb": "350ml over 1 hour", "opc": "375ml over 4 hours", "opd": "400ml over 6 hours", "subject_name": "Pediatrics", "topic_name": null, "id": "aae5e837-b93d-4915-b536-aee969831fb0", "choice_type": "single"}
+{"question": "In newborn, cold stress implies", "exp": "Classification of Neonatal hypothermia\nCold stress 36 - 36.4o C\nModerate hypothermia 32 - 35.9o C\nSevere hypothermia < 32o C", "cop": 2, "opa": "35 - 35.4 oC", "opb": "36 - 36.4 oC", "opc": "34 - 34.6 oC", "opd": "37 - 37.6 oC", "subject_name": "Pediatrics", "topic_name": null, "id": "36e9db6d-2a5b-4219-805e-9fff69fdd234", "choice_type": "single"}
+{"question": "Chemotherapy agents used for Retinoblastoma includes", "exp": "Vincristine, Etoposide, Carboplatin are used to treat Retinoblastoma.", "cop": 1, "opa": "Vincristine, Etoposide, Carboplatin", "opb": "Vincristine, Doxorubicin, Carboplatin", "opc": "Doxorubicin, Etoposide, Carboplatin", "opd": "Actinomycin, Doxorubicin, Carboplatin", "subject_name": "Pediatrics", "topic_name": null, "id": "82d724fb-22f8-4fd2-b01b-57d683f0f411", "choice_type": "single"}
+{"question": "A child admitted to emergency with urinary incontinence, miosis, sweating, salivation.... poisoning likely by", "exp": "(A) Carbamates > Diagnosis of organic insecticide (Carbamate) poisoning was made on the basis of definite clinical picture such as bradycardia, rhinorrhea, vomiting, diarrhoea, urinary incontinence, miosis, sweating, muscle fasciculations, altered neurological status and a typical smell of insecticide.", "cop": 1, "opa": "Carbamates", "opb": "Arsenic", "opc": "Lead", "opd": "Opioid", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "72d44358-6822-4641-b026-1f96c2387d76", "choice_type": "single"}
+{"question": "Febrile convulsions", "exp": "(B) Show an increase in familial incidence # Characteristics of simple benign febrile convulsions:> Fits occurs within 24 hour of the onset of fever, last less than 10 minutes, usually single per febrile episode.> Convulsions are generalized, a small proportion (4-18%) of case may show focal convulsions.> There is no postictal neurological deficit and electroencephalogram a few days after the seizure is normal.> There may be a family history of febrile convulsions in the sibling.> Febrile convulsions are unusual before the age of six months and after 5 years.> Vast majority of patients do not require treatment for either their acute presentation with a seizure or for recurrences.>Best way to manage is to control the temperature with acetaminophen (Paracetamol) or by sponging. When anticonvulsant therapy is judged by a doctor to be indicated, anticonvulsants can be prescribed.> Sodium valproate or clonazepam are active against febrile seizures, with sodium valproate showing superiority over clonazepam.", "cop": 2, "opa": "Are best treated with Sodium Valproate", "opb": "Show an increase in familial incidence", "opc": "May associates with low fever", "opd": "Occur in 2-5% of children", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "47b6eb7c-1469-4a43-a7fc-9d18f04e23fe", "choice_type": "single"}
+{"question": "The Sodium content of ReSoMal (rehydration solution for malnourished children) is", "exp": "The sodium content in ResOMal is 45 mmol/l. Therapeutic action - Oral rehydration salts with high potassium and low sodium contents Indications - Prevention and treatment of dehydration, in patients suffering from complicated acute malnutrition only Forms and strengths - Sachet containing 84 g of powder, to be diluted in 2 litres of clean, boiled and cooled water. Dosage and duration - Prevention of dehydration Child under 2 years: 50 to 100 ml after each loose stool as long as diarrhoea persists Child over 2 years: 100 to 200 ml after each loose stool as long as diarrhoea persists Adult: 200 to 400 ml after each loose stool as long as diarrhoea persists - Treatment of dehydration Child and adult: 5 ml/kg every 30 minutes over the first 2 hours, then 5 to 10 ml/kg/hour for the next 4 to 10 hours, until dehydration is corrected. Contra-indications, adverse effects, precautions - Do not administer to patients with cholera or uncomplicated acute malnutrition: use standard ORS instead. - May cause: hea failure when administered too rapidly. During treatment, closely monitor the rate of administration in order to avoid overhydration. Increase in respiratory and pulse rates and appearance or increase of oedema are signs of over rapid rehydration. In this event, stop ReSoMal for one hour then reassess the patient's condition. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "90 mmol/L", "opb": "60 mmol/L", "opc": "45 mmol/L", "opd": "30 mmol/L", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "70862d9a-1e2e-4534-ab3a-3ad5d36842cf", "choice_type": "single"}
+{"question": "Amount of ORS to be given in the first 4 hours to a child with some dehydration is", "exp": "Treatment plan B: in case of some dehydration 75 ml/kg of ORS in the first 4 hours.use child&;s age when you donot know the weight. The signs of dehydration disappears in 4 hours.after this maintainance fluid therapy can be done. Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:265,7 th edition", "cop": 2, "opa": "50 ml/kg body wt.", "opb": "75 ml/kg body wt.", "opc": "100 ml/kg body wt.", "opd": "200 ml/kg body wt.", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "e6377bbb-bf34-46c0-a1a5-1355c467782b", "choice_type": "single"}
+{"question": "After premature delivery, mother&;s milk is low in", "exp": "Preterm milk contains more energy, protein, fat, sodium, zinc, anti-infective factors, and macrophages and has a lower content of lactose, calcium, and phosphorus. Ref: Page 98; Ghai essential pediatrics; 6th edition", "cop": 1, "opa": "Lactose", "opb": "Fat", "opc": "Protein", "opd": "Sodium", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "0d2d7202-502d-4ad0-a16f-cd92d6181830", "choice_type": "single"}
+{"question": "Congenital hea lesion (s) in rubella are", "exp": "Cardiac abnormalities occur in half of the children infected during the 1st 8 wk of gestation. Patent ductus aeriosus is the most frequently repoed cardiac defect followed by lesions of the pulmonary aeries and valvular disease. Reference: Nelson textbook of pediatrics 19th edition Page 1077", "cop": 1, "opa": "VSD", "opb": "ASD", "opc": "Aoic stenosis", "opd": "Coarctation of aoa", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "7cf4a876-5e1f-435e-87d3-9f249ffd7649", "choice_type": "single"}
+{"question": "Primary cause of hyaline membrane disease is", "exp": "Ans. d (Surfactant deficiency). (Ref. Nelson, Textbook of Paediatrics, 18th/731)HYALINE MEMBRANE DISEASE# Common in premature, IDM and infants delivered by caesarean section.# Clinically manifests shortly after birth (dyspnoea and cyanotic attacks).# X-ray chest shows \"ground glass\" mottling.# As HMD progresses, influx of plasma renders the lungs more radio-opaque, reticulogranular shadowing becomes more confluent & ground glass haziness is seen with loss of clarity of diaphragm & heart.# Mortality 33%# Hyaline membrane is a homogenous eosinophilic membrane plastering the alveolar ducts and terminal bronchiole in HMD.# Rx .-Timely steroids, exogenous surfactant therapy and oxygen (not 100 %) are useful in treatment.", "cop": 4, "opa": "Prematurity", "opb": "Oxygen toxicity", "opc": "Alveolar inflammation", "opd": "Surfactant deficiency", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "2b8a3961-bacc-4d6d-bd77-14258285bb24", "choice_type": "single"}
+{"question": "A 2 year old male baby presents with cough, high grade fever, fast breathing since 7 days. On examination respiratory rate is 50/min and visible chest indrawing present. Next line of management is", "exp": "Diagnosis can be made as Pneumonia. Pneumonia without any danger sign can be treated at home with Oral antibiotic. In case of presence of any danger signs, the patient has to admitted to the hospital or to be referred to higher center.", "cop": 2, "opa": "Home management with Paracetamol", "opb": "Home management with Amoxycillin", "opc": "Hospital management with antibiotics", "opd": "Reassurance", "subject_name": "Pediatrics", "topic_name": null, "id": "a3236da0-5e1a-4d97-a56c-9fa348da18aa", "choice_type": "single"}
+{"question": "Second most common neoplasm seen in children is", "exp": "Also called low-grade gliomas, these are the most common brain tumors in children. Medulloblastomas are the most common type of childhood brain cancer. Most medulloblastomas occur before age 10. Ependymomas are a type of childhood brain tumor that can be benign (noncancerous) or malignant (cancerous). The most common cancers of children are: Leukemia. Brain and spinal cord tumors. Neuroblastoma. Wilms tumor. Lymphoma (including both Hodgkin and non-Hodgkin) Rhabdomyosarcoma. Retinoblastoma. Bone cancer (including osteosarcoma and Ewing sarcoma) Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Lyphoma", "opb": "Brain tumor", "opc": "Wilm's tumor", "opd": "Neuroblastoma", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "f670b943-4493-4004-88d5-52a74e841c2c", "choice_type": "single"}
+{"question": "For the prevention of parent to child transmission of HIV, the NACO's recommendation is to give", "exp": "Single dose nevirapine,given once to the mother in labor and once to the newborn infant during 48-72 hrs of life reduces perinatal transmission by 50%. A sho term regime consisting of 300 mg BD zidovudine from 36 weeks of pregnancy and 300 mg every 3 hourly during delivery also offers a 50% reduction in transmission. Reference: Ghai essential pediatrics 9 th edition Page 230", "cop": 3, "opa": "Nevirapine 200 mg in active labour to mother", "opb": "Nevirapine 200 mg, four hours after rupture to membranes, to mother", "opc": "Nevirapine 200 mg in active about to mother and syrup nevirapine 2 mg/kg body weight to newborn with 72 hours of delivery", "opd": "Syrup nevirapine 2 mg/kg body weight to newborn within 72 hours of bih", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "e57a25e8-5412-467f-b4fa-aa1f634cce1f", "choice_type": "single"}
+{"question": "Sweaty feet odor is seen in", "exp": "Sweaty feat odor - Isovaleric AcidemiaSmoky sweat - MSUDMousy or Musty - PhenylketonuriaBoiled cabbage - TyrosinemiaIn alkaptonuria - urine becomes darkish brown when exposed to air while purplish brown in porphyria(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 651)", "cop": 3, "opa": "Maple syrup urine disease", "opb": "Gauchers disease", "opc": "Isovaleric acidemia", "opd": "Phenylketonuria", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "a73b56db-a712-42b9-a8ef-037ef08423e1", "choice_type": "single"}
+{"question": "Bronchitis in children is caused by", "exp": "Breathing tubes (bronchi) in the lungs. In children, the most common cause of acutebronchitis is a virus. A cough, fever, runny nose, and body aches are common symptoms. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "H. influenzae", "opb": "R.S.V", "opc": "Myocoplasma", "opd": "E B V", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "2291f182-0579-4686-94a5-66a5d71c081f", "choice_type": "single"}
+{"question": "Commonest feature of hypothyroidism in children is", "exp": "Ans. is 'c' i.e., Cold extremities o Amongst the given options cold extremities is the best answer. o Prolongation of physiological jaundice is the earliest sign.", "cop": 3, "opa": "Cataract", "opb": "Recurrent seizures", "opc": "Cold extremities", "opd": "Laryngospasms", "subject_name": "Pediatrics", "topic_name": null, "id": "d17a2408-d240-411b-9193-c7ef57a14cd8", "choice_type": "single"}
+{"question": "Breast milk at room temperature is stored for", "exp": "Expressed Breast milk (EBM) can be stored at room temperature for 6-8 hrs. Ref: Page 155, Ghai essential pediatrics; 8th edition", "cop": 1, "opa": "4 hrs", "opb": "8 hrs", "opc": "12 hrs", "opd": "24 hrs", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "5812b6e3-30a5-4bc4-8f9f-81e88c7f3ef8", "choice_type": "single"}
+{"question": "Breast feeding is contraindicated in", "exp": "Contraindications to breastfeeding are those conditions that could compromise the health of the infant if breast milk from their mother is consumed. One example of this is galactosemia. This is. If the mother has HIVor antiviral therapy, untreated active tuberculosis, Human T-lymphotropic virus 1or II, uses illicit drugs, or mothers undergoing chemotherapy or radiation treatment. Breastfeeding contraindication are situations where the mother has conditions such as an addiction or disease that would make it harmful to the baby, should the baby be breastfed. Breast milk contains many nutrients that formulas in store shelves do not have which makes breast feeding a healthier and ideal way to feed an infant. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Mother in failure", "opb": "Mother with Hep B", "opc": "Mother with TB", "opd": "Mother with Leukemia", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "f6f17cd9-699a-44bd-97ef-ae71ecc773be", "choice_type": "single"}
+{"question": "Most common cause of Seizures during Neonatal Period includes", "exp": "(A) Hypoxic Ischemic Encephalopathy # HYPOXIC ISCHEMIC ENCEPHALOPATHY (HIE) It is a type of brain damage that occurs when an infant's brain doesn't receive enough oxygen and blood. It is a dangerous condition that requires immediate medical intervention. HIE affects 20 out of every 1000 full term births; the incidence rate in premature babies is 60% of all live births.# Causes of Neonatal Seizures:> Seizures resulting from hypoxic-ischemic encephalopathy Seen in both term and premature infants. Present within the first 72 hours of life. Seizures may include subtle, clonic, or generalized seizures.> Intracranial hemorrhage: Occurs more frequently in premature than in term infants. Distinguishing infants with pure hypoxic-ischemic encephalopathy from those with intracranial hemorrhage often is difficult.> Subarachnoid hemorrhage: More common in term infants. Type of hemorrhage occurs frequently and is not clinically significant. Typically, infants with subarachnoid hemorrhage appear remarkably well.> Germinal matrix-intraventricular hemorrhage: Is seen more frequently in premature than in term infants, particularly in infants born prior to 34 weeks' gestation. Subtle seizures are seen frequently with this type of hemorrhage.> Subdural hemorrhage: Is seen in association with cerebral contusion. It is more common in term infants.> Metabolic disturbances: Include Hypoglycemia, Hypocalcemia, & Hypomagnesemia. Less frequent metabolic disorders, such as inborn errors of metabolism, are seen more commonly in infants who are older than 72 hours. Typically, they may be seen after the infant starts feeding.> Intracranial infections (which should be ruled out vigorously) that are important causes of neonatal seizures include Meningitis, Encephalitis (including herpes encephalitis), Toxoplasmosis, and Cytomegalovirus (CMV) infections. Most common bacterial pathogens include Escherichia coli and Streptococcus pneumoniae.> Most cerebral malformations present with seizures at a later age, major malformation syndromes are important to consider.> Lissencephaly, pachygyria, polymicrogyria, and linear sebaceous nevus syndrome can present with seizures in the neonatal period.", "cop": 1, "opa": "Hypoxic Ischemic Encephalopathy", "opb": "Brain haemorrhage", "opc": "Tetanus", "opd": "Nutrient deficiency", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "9f873efc-cdd7-4fb6-9e3d-3c15ddb30e4d", "choice_type": "single"}
+{"question": "Handedness develops by age of", "exp": "Handedness is usually established by the 3rd year. Frustration may result from attempts to change children's hand preference, Variations in fine motor development reflect both individual proclivities and different oppounities for learning. Children who are seldom allowed to use crayons, for example, develop a mature pencil grasp later.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 77)", "cop": 2, "opa": "2 years", "opb": "3 years", "opc": "4 years", "opd": "5 years", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "71c81302-ca5e-4abe-9dea-29d7c3da41ce", "choice_type": "single"}
+{"question": "Mean head circumference at birth is", "exp": "Head circumference:-\n\n Measured with a nonstretchable tape passing through the maximum point of occipital protuberance posteriorly and at a point just above the glabella anteriorly.\n\nHead circumference must be compared with that of mother to know any familial variations.\nIf the head circumference is more than expected, always measure the both parents' head circumference, for benign familial megalencephaly is common.\nAt birth , it is around 34 cm.HC increases 2cm/ month for the first 3 months, 1cm/month for next three months and 0.5 cm per month for next 6 months.", "cop": 4, "opa": "48-51 cm", "opb": "38-40 cm", "opc": "42-45 cm", "opd": "33-35 cm", "subject_name": "Pediatrics", "topic_name": null, "id": "cf780ade-30c3-4c43-b56f-0608bdf588f1", "choice_type": "single"}
+{"question": "Subluxated lens, thin elongated, hyperextensible extremities and aortic aneurysm are the characteristic clinical features of", "exp": "(A) Marfan's syndrome # MARFAN'S SYNDROME is a disorder of connective tissue (elastin). The gene called fibrillin is on chromosome 15. Inheritance is autosomal ominant. Sporadic cases may occur. The patients are tall and slender. Extremities especially the fingers and toes are long and thin. The muscles are markedly hypotonic and joints are hyperextendible. At times the disorder may be associated with arthrogryposis (contraction of joints in flexion due to fibrous ankylosis). There may be subluxation of the lens and other ocular abnormalities e.g., cataract, coloboma, squint, nystagmus and megalocornea. Deformities of the chest and spine may be present. Other associated anomalies include aortic cystic medionecrosis leading to aortic dilatation and other valvular deformities. Intelligence is normal. It should be distinguished from cases of homocystinuria, which also may present with ectopia lentis and similar bone changes, but has associated mental retardation. The basic manifestations are joint hypermobility, skin hyperextensibility, dystrophic scarring of the skin and easy bruising, and connective tissue fragility. Wound healing is delayed and there are freely movable subcutaneous nodules. Molecular genetics has helped to characterize 11 different types of Ehlers-Danlos syndrome. Homocystinuria is a relatively common metabolic error with autosomal recessive inheritance. In the most common situation, Type 1, cystathionine is not synthesized from homocysteine and serine because the enzyme cystathionine synthetase in the liver is deficient. Although the precursor, homocysteine accumulates in the tissues, it is rapidly oxidized to homocystine. The usual age of presentation is 3-4 years. The patients develop subluxation of the lens, recurrent thromboembolic episodes and have marfanoid features. Klinefelter syndrome is characterized by tall thin stature, small testes and small phallus, with the chromosomal karyotype of 47 XXY. Behavioral and psychiatric disorders and mental retardation are common.", "cop": 1, "opa": "Marfan's syndrome", "opb": "Ehler Danlos syndrome", "opc": "Homocystienuria", "opd": "Klienfelter's syndrome.", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "d0d12b8b-bae6-4394-99ac-35ca1a6082a6", "choice_type": "single"}
+{"question": "Penile growth occurs during SMR stage", "exp": "In males, the first visible sign of pubey and the hallmark of SMR2 is the testicular enlargement. Penile growth occurs during stage 3.Reference: Nelson Textbook of Paediatrics; 20th edition", "cop": 3, "opa": "1", "opb": "2", "opc": "3", "opd": "4", "subject_name": "Pediatrics", "topic_name": "Adolescence", "id": "6be7b0a9-a170-49d8-8cf4-2bd76e05c9c9", "choice_type": "single"}
+{"question": "The most common site of brain metastasis is", "exp": "MC site of brain metastases (85%) CEREBRUM2nd MC site of brain metastases- CEREBELLUM LUNG, BREAST, MELANOMA (SKIN CANCER), COLON AND KIDNEY cancers commonly spread to the brain.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2460)", "cop": 1, "opa": "Cerebrum", "opb": "Cerebellum", "opc": "Medulla oblongata", "opd": "Pons", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "c6417cf2-291a-4eb1-ae5a-daf3b7c7d7c6", "choice_type": "single"}
+{"question": "Major criteria for jones classification is", "exp": "i.e. (Chorea): (380 - Ghai 7th)JONES CRITERIA FOR RHEUMATIC FEVERMajor Criteria Minor Criteria* Carditis* Arthritis* Subcutaneous nodule* Chorea* Erythema marginatumA. Clinicali. Feverii. Arthralgiaiii. Previous rheumatic fever rheumatic heart diseaseB. Laboratoryi. Acute phase reactants leukocytosis, elevated ESR and CRPii. Prolonged PR interval on ECGEssential criteriaEvidence for recent streptococcal infection as evidenced bya. Increased antistreptolycin 'O' titerb. Positive throat culturec. Recent scarlet feverTwo major qr one major and two minor criteria are required in the presence of essential criteria to diagnose acute rheumatic feverAssessment for Presence of Heart DiseaseNadas' CriteriaMajor Minor* Systolic murmur* Systolic murmur less than grade III* Grade III or more* Abnormal second sound* Diastolic murmur* Abnormal ECG* Cyanosis* Abnormal X-ray* CHF* Abnormal blood pressurePresence of one major or two minor criteria indicate heart disease (399- Ghai 7th)", "cop": 3, "opa": "Fever", "opb": "Arthralgia", "opc": "Chorea", "opd": "TPR Interval", "subject_name": "Pediatrics", "topic_name": "C.V.S.", "id": "493d426b-ae0c-45e0-a116-fb9bba4e325a", "choice_type": "single"}
+{"question": "Common presentations of juvenile Hypothyroidism", "exp": "Most common presentation of juvenile hypothyroidism is growth retardation. others include delayed skeletal maturation,delayed dental development,delayed pubey, myopathy and pseudohyperophy,enlarged sella,pseudomotor cerebri. Usually due to hormonal synthesis defect such as TPO or to c -erb A mutation PE : goiter, delayed maturation, testicular enlargement/precocious menarche NOT usually MR- recovery is general rule with thyroxine Reference: OP Ghai ,essential paediatrics ,8 th edition.page no 517", "cop": 1, "opa": "Growth retardation", "opb": "Mental retardation within 2 years", "opc": "Delayed pubey", "opd": "Umbilical Hernia", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "1012a8f1-bb16-4953-bf52-77612fc24af0", "choice_type": "single"}
+{"question": "An infant should be exclusively breastfed till", "exp": "An infant should be exclusively breastfed till six months of age Cardinal principles of breastfeeding practice Initiation of breastfeeding within an hour after bih Exclusive breastfeeding up to 6 months of age Continuation of breastfeeding along with complementary feeding for up to 2 yr of age Reference: Paediatrics; O.P Ghai; 8th edition; Page no: 90", "cop": 2, "opa": "4 months", "opb": "6 months", "opc": "12 months", "opd": "24 months", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "69014cd2-d43f-4d21-a856-8894a265aec1", "choice_type": "single"}
+{"question": "In a 3 year old most common cause of Hepatitis B is", "exp": "*HBV is transmitted through contact with blood and body fluids of an infected person . *In highly endemic areas , HBV infections occur mainly due to perinatal transmission resulting from carrier mothers to their infants during first 5 years of life. * It may also occur through horizontal transmission from casual contact . * HBV is not transmitted by breastfeeding Reference : OP Ghai pgno 217 9th edition.", "cop": 3, "opa": "Pin prick", "opb": "Saliva exchange", "opc": "Perinatal", "opd": "Blood transfusion", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "f24f5a9f-0033-47a0-9ce7-fbaeb3d85ef0", "choice_type": "single"}
+{"question": "Most common cause of Nephrotic Syndrome in Children", "exp": "NEPHROTIC SYNDROME:- Characterised by massive proteinuria, hypoalbuminemua and edema, hyperlipidemia is often associated. Some patients show hematuria and hypeension. Heavy proteinuria( more than 1g/metre square/day) is the underlying abnormality leading to hypoalbuminemia ( serum albumin below 2.5g/dl). The resultant fall in plasma oncotic pressure leads to interstitial edema and hypovolemia. This stimulates the renin angiotensin aldosterone axis and ADH secretion that enhances sodium and water retention. Hypoalbuminemia also induces hepatic synthesis of beta lipoproteins resulting in hypercholesterolemia. Main cause of nephrotic syndrome in children is associated with minimal change disease. Other causes include amyloidosis, vasculitis, SLE, postinfectious glomerulonephritis, and hepatitis B nephropathy. Steroid sensitive nephrotic syndrome:- MCNS accounts for 80% cases of nephrotic syndrome. Electron microscopy shows non specific obliteration of epithelial foot processes. Immunofluorescence studies shows deposits of occassional mesangial IgM. Lab findings- urine examination shows heavy proteinuria. Hyaline and granular casts are present. Serum albumin is low. Hypercholesterolemia impa a milky appearance to plasma. Blood urea and creatinine values within normal range. Blood levels if IgG low and IgM elevated. Low serum calcium level. Steroid resistant nephrotic stndrome:- Homozygous or complete heterozygous mutations in genes encoding podocyte proteins, including podocin(NPHS2), nephrin(NPHS1) and wilms tumor(WT1) genes. Reference: GHAI essential Paediatrics", "cop": 1, "opa": "Minimal change disease", "opb": "IgA nephropathy", "opc": "Mesangial GN", "opd": "FSGN", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "235d5da2-efb5-41b6-9093-0f852d1e9cba", "choice_type": "single"}
+{"question": "In the management of severe acute malnutrition (SAM) child, iron should be started", "exp": "Do not given Iron is Stabilization Phase. If given Iron releases free radical, causing injury to GIT.\nIron should be started in Rehabilitation Phase (after day 7)", "cop": 3, "opa": "Immediately", "opb": "On day 2 start of stabilization phase", "opc": "In Rehabilitation Phase, after fever subside", "opd": "Iron should never be given", "subject_name": "Pediatrics", "topic_name": null, "id": "8c07d78b-fb08-4341-ac6b-6b7fb489cddf", "choice_type": "single"}
+{"question": "A solid renal mass detected during prenatal ultrasound is most likely a", "exp": "Mesoblastic nephroma is the most common solid renal tumor identified in the neonatal period and the most frequent benign renal tumor in childhood. It represents 3-10% of all pediatric renal tumors. Many cases are diagnosed with prenatal ultrasound and can manifest as polyhydramnios, hydrops, and premature delivery. Most of the patients are diagnosed before 3 mo of age, whereas WT is rarely diagnosed before 6 mo of age. Radical nephrectomy is the treatment of choice and may be sufficient by itself. Local recurrence is uncommon. Reference: Nelson; Neuroblastoma; Page no: 2467", "cop": 4, "opa": "Wilm's tumor", "opb": "Neuroblastoma", "opc": "Clear cell sarcoma", "opd": "Mesoblastic nephroma", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "ceadecae-8317-4425-a667-403532c99629", "choice_type": "single"}
+{"question": "In breastfeeding, hindmilk poion is richer in", "exp": "Hind milk is rich in fat and provides more energy and satisfies the hunger of the baby. It comes towards the end of the feed.", "cop": 1, "opa": "Fats", "opb": "Lactose", "opc": "Vitamins", "opd": "Proteins", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "9b74df3d-e629-4548-abcb-17db0e8c4be9", "choice_type": "single"}
+{"question": "Drug of choice for pertussis in children is", "exp": null, "cop": 4, "opa": "Penicillin", "opb": "Erythromycin", "opc": "Ampicillin", "opd": "Azithromycin", "subject_name": "Pediatrics", "topic_name": null, "id": "e7be6379-64dd-4e55-beca-9ea41f6c9d43", "choice_type": "single"}
+{"question": "The most common etiology of short stature is", "exp": "Short Stature\nDefined as height below the third centile or more than 2 standard deviations below the median height for age and gender according to the population standard. Children whose statures more than 3 SD below the population mean for age and gender are more likely to be suffering from pathological short stature as compared to those with stature between -2 and -3SD, who are more likely to be affected by familial or constitutional short stature.\nCAUSES:-\n\nThe most common cause is constitutional.\nFamilial\nPathological causes include:\n\tUndernutrition\n\tChronic systemic illness\n\tCerebral palsy\n\tCongenital heart disease\n\tCystic fibrosis, asthma\n\tMalabsorption\n\tAcquired immunodeficiency syndrome\nEndocrine causes include:\n Psychosocial dwarfism.\nChildren born small for gestational age.\nSkeletal dysplasia; achondroplasia, rickets.\nGenetic syndrome; Turner, Down syndrome.", "cop": 3, "opa": "Thyroxine deficiency", "opb": "Growth hormone deficiency", "opc": "Constitutional growth delay", "opd": "Systemic diseases", "subject_name": "Pediatrics", "topic_name": null, "id": "764d540d-38c4-4682-9e3d-cee67fd26345", "choice_type": "single"}
+{"question": "Most common urinary tumour in children is", "exp": "(Wilm's tumour) (2143 -Nelson 18th) (591-Ghai 7th)1. Rhabdomyosarcoma is the most common soft tissue sarcoma in children 15 years (MC site head & neck region)2. Wilm s tumor or nephroblastoma is the most common malignant tumour of the kidney (Under 5years of age)3. Neuroblastoma is the most common intra- abdominal solid tumor in childhood (Before 6 years of age)4. Retinoblastoma is the most common primary ocular tumor of childhood (White reflex is MC sign)* Wilms tumour associated with syndrome - WAGR, Denys- Drash, Backwith - Wiedemann syndrome others hemihypertrophy sporadic aniridia, neurofibromatosis (Von Recklinghausen disease) and Von Wille brand diseaseGenitourinary anomalies most commonly associated Wilms tumour are hypoplasia, fusion and ectopia of the kidney, duplications of collecting systems, hypospadias and cryptorchildism", "cop": 3, "opa": "Rhabdomyosarcoma", "opb": "Leomyoma", "opc": "Wilm's tumour", "opd": "Nephrogenic rests", "subject_name": "Pediatrics", "topic_name": "Childhood Tumors", "id": "da31af72-1e60-44eb-b3c3-8b2eaa167415", "choice_type": "single"}
+{"question": "Ba&;s hydrops fetalis is lethal because", "exp": "Ba hydrops fetalis is a lethal complication of alpha thalassemia trait where oxygen can&;t release from hemoglobin. Hb Bas is formed of 4 gamma chains. The oxygen affinity is so high that it releases very little oxygen into the fetal tissues. Reference: Ghai essential of pediatrics, eighth edition, p.no:342", "cop": 3, "opa": "Hb Ba's cannot bind oxygen", "opb": "The excess a - globin form insoluble precipitates", "opc": "Hb Ba's cannot release oxygen to fetal tissues", "opd": "Microcytic red cells become trapped in the placental", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "878c57c1-e00e-4fa1-a8ae-dd4db8bfb121", "choice_type": "single"}
+{"question": "A patient with VSD develops pulmonary hypeension, the characterstic feature will be", "exp": "Pulmonary hypeension in VSD lead to cyanosis. Ref : Ghai essential of pediatrics, eighth edition, p.no: 417", "cop": 2, "opa": "ESM in pulmonary area", "opb": "Cyanosis", "opc": "Inveed 'T' wave in ECG", "opd": "Clubbing", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "f1264d97-e7b5-41da-9f5f-e20ef7c9c705", "choice_type": "single"}
+{"question": "Anterior fontanelle is closed at", "exp": "[Cl (12-18 months) Ref: 525, 1974-Nelson 17,h1. Anterior fontanelle: Formed by joining of four sutures in the midline, Diamond shape, 2 by 2 cm measurements* The floor is formed by membranous and it becomes ossified 18 month after birth. It becomes pathological, if it fails to ossify even after 24 months (84 - Dutta 6th)* The average time of closure is 18 months but the fontanel may normally close as early as 9 months. The fontanele is normally slightly depressed and pulsatile and is best evaluated when an infant is held upright while asleep or feeding (1974-Nelson 17th)Disorders associated with a large anterior fontanel* Achondroplasia* IUGR* Apert syndrome* Kenny syndrome* Athyrotic hypothyroidism* Osteogenesis imperfecta* Cleidocranial dysostosis* Prematurity* Congenital rubella syndrome* Pyknodysostosis* Hallermann-Streiff syndrome* Russell - Silver syndrome* Hydrocephaly* 13 - 18, 21 trisomies* Hypophosphatasia* Vitamin D deficiency ricketsPersistently small fontanels suggest microcephaly, cranio synostosis congenital hyperthyroidism or wormian bones2. Posterior fontanelle: between the intersection of the occipital and parietal bones that may be closed at birth or at the most admit the tip of finger. The posterior fontanele is usually closed and nonpalpable after the first 6- 8 weeks of life.Its persistence suggests underlying hydrocephalus or possibility of congenital hypothyroidism", "cop": 3, "opa": "< 3 months", "opb": "12 months", "opc": "12-18 months", "opd": "> 3 years", "subject_name": "Pediatrics", "topic_name": "Growth, Development, and Behavior", "id": "dcce700e-f96d-4357-a08d-e5d209afdd06", "choice_type": "single"}
+{"question": "A 1 & 1/2 yr child can do", "exp": "Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 15months : vocabulary of 6 words 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Build tower of 6 blocks", "opb": "Speak of 10-25 meaningful word", "opc": "Scribble", "opd": "points 3-4 body pas", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "f486c6fd-f8f8-4302-947f-7c159d5c6a5b", "choice_type": "single"}
+{"question": "Profuse watery diarrhea in an immune compromised child is due to", "exp": ".Giardiasis caused by Giardia lamblia is a major cause of diarrhoea in children and travellers Individuals with malnutrition,humoral immunodefeciencies,and cystic fibrosis are paicularly susceptible. Features:acute diarrhoea with sudden onset of explosive,watery foul smelling stools, along with nausea and anorexia,abdominal distension,flatulence,epigastric camps and mild fever. ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:244,7th edition", "cop": 3, "opa": "Cryptococcus", "opb": "Amoeba", "opc": "Giardia", "opd": "Lactose intolerance", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "2d93a6c5-aad2-4309-8eae-fa7fa59418ca", "choice_type": "single"}
+{"question": "A child presents with sho episodes of vacant stare several times a day. The vacant episode begins abruptly and the child remains unresponsive during the episode. There is no associated history of aura or postictal confusion and the child is otherwise normal. The likely diagnosis is", "exp": "Answer is B (Absence seizures): Presence of multiple sho episodes of vacant stare (absence) in an otherwise normal child with no history of aura or postictal confusion suggests the diagnosis of typical absence seizures. Absence seizures versus Dav dreaming Absence seizures can easily be confused with episodes day dreaming however there are ceain clues that can help differentiate these two conditions Day dreaming is usually not associated with automatism while automatism is common in seizures. Day dreaming can often be 'broken' with stimulation while seizures can usually not be 'broken'. Day dreaming usually occurs when child is tired /bored or involved in a monotonous activity but seizures can sta abruptly at any time (for example in the middle of a sentence). Abrupt onset of vacant episodes and the fact that the child remains unresponsive during the episode (cannot be broken) ours a diagnosis of absence seizures in this child. Absence seizures versus complex paial seizures Complex paial seizures are frequently associated with aura and postictal confusion. Absence of these features ours a diagnosis of 'Absence seizures' Absence seizures must primarily be differentiated from complex paial seizures and Day dreaming Clinical data Absence Complex paial Daydreaming Frequency/day Multiple Rarely over 1-2 Mutiple; situation-dependent Duration Frequently < 10 sec (Rarely longer than 30 sec) Average duration ober 1 min, 10 sec Seconds to minutes; rarely more rarely less Aura Never Frequently' No Eye blinking Common Occasionally No Automatism Common Frequently No Postictal impairment None Frequently No Seizures activated by 1-11p er yen ti la tio n Very frequently Occassionallv No Photic Frequently Rarely No EEG ktul Generalized spike and wave Usually unilateral or bilateral temporal frontal discharges Normal Interictal Usually normal Variable; may be spikes or sharp waves in frontal or temporal lobes Normal", "cop": 2, "opa": "Grandmal seizures", "opb": "Absence seizures", "opc": "Complex paial seizures", "opd": "Day dreaming", "subject_name": "Pediatrics", "topic_name": null, "id": "f6dea44b-fd89-4db3-84c2-d2500a2a59b0", "choice_type": "single"}
+{"question": "Features of cystic fibrosis", "exp": "The sweat chloride is high(>60 mEq/L) Defect in long arm of chromosome 7 Autosomal recessive condition. Ref : Essential pediatrics,O.P.Ghai,7 th edition,pg no:369", "cop": 1, "opa": "Lung normal at bih", "opb": "Low sweat choride tests", "opc": "Autosomal dominant", "opd": "Defect in Chromosome 11", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "e9af0380-c45e-4739-8d71-b106645cac08", "choice_type": "single"}
+{"question": "In a fetus highest O2 concentration found in", "exp": "Highest o2 concentration umblical vien > ivc > svc> =ra=rv > umblical aery Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "svc", "opb": "ivc", "opc": "right ventricle", "opd": "aoa", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "a77222e6-83a9-4a87-a01e-a99fef985e21", "choice_type": "single"}
+{"question": "6 months old baby brought to OPD with complaitns of loud, noisy breathing since birth after feeding on supine position. Baby birth history is insignificant. Treatment for the condition is", "exp": "The given case scenario is laryngomalacia. It is the most common anamoly of Larynx. The baby presents with stridor in supine position and relieved on prone position. The condition is self resolving by 1 year.", "cop": 3, "opa": "3rd generation cephalosporins", "opb": "Heimlich's maneuver", "opc": "Reassurance", "opd": "Single dose of Dexamethasome", "subject_name": "Pediatrics", "topic_name": null, "id": "816f52cb-2f9c-4440-82b7-5ed58fa180f4", "choice_type": "single"}
+{"question": "6 years old drowsy child is brought to emergency with a history of vomitings and loose motion for 3 days. On examination, he had sunken eyes, hypothermia, skin on pinching taken very long time to reve. Diagnosis is", "exp": "A child with severe dehydration will have at least two of the following four signs: sensorium is abnormally sleepy or lethargic, sunken eyes, drinking poorly or not at all, and a very slow skin pinchA child with some signs of dehydration will have two of the following: restlessness or irritability, sunken eyes, drinking eagerly or slow skin pinchA child with either one or none of these signs is classified as having dehydration.(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 265)", "cop": 4, "opa": "No dehydration", "opb": "Mild dehydration", "opc": "Some dehydration", "opd": "Severe dehydration", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "b718234c-249c-4446-96f3-82ca011cc85c", "choice_type": "single"}
+{"question": "Best method of estimation of amount of proteinuria in a 2 year old child with nephrotic syndrome is", "exp": null, "cop": 4, "opa": "Dipstick test", "opb": "24 hr urine protein", "opc": "Microalbuminuria", "opd": "Spot urine sample for Protein/ Creatinine ratio", "subject_name": "Pediatrics", "topic_name": null, "id": "b8c9d80e-b612-4e50-ab84-c928825336db", "choice_type": "single"}
+{"question": "10 days old baby develops swelling left in posterior cervical area, bluish in appearance, increase in size on crying and brilliently transilluminant", "exp": "Ans. is 'c' i.e., Cystic hygroma Cystic hygroma Usually present in neonate or early infancy. Filled with lymph Commonly present in posterior cervical area, axilla, mediastinum, parotid, floor of mouth. Soft & paially compressible Size increase during crying, coughing Brilliently transilluminant Sometimes size increase with age or during infection. Treatment is complete excision.", "cop": 3, "opa": "Parotiditis", "opb": "Hemangioma", "opc": "Cystic hygroma", "opd": "Lymph node", "subject_name": "Pediatrics", "topic_name": null, "id": "6b4f0681-8559-4b40-b702-21083db35b52", "choice_type": "single"}
+{"question": "Chest radiographs of children with foreign body aspiration", "exp": "In foreign body aspiration a radiograph is vital as the object may be radio opaque. often its not radio opaque or is obscured by the cardiac shadow or the inflammatory response. over inflation of affectedlung due to inflammatory response. Ref : BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,24 th edition ,PG NO:852", "cop": 2, "opa": "Are always abnormal", "opb": "May show over inflation of the involved lung", "opc": "Always show the foreign body", "opd": "Commonly show pneumothorax", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "6912d946-d0b3-4ffd-b3c0-b58ff597adca", "choice_type": "single"}
+{"question": "A child is having nocturnal asthmatic attacks 2 times in a week and day time attacks 3 times or more. This child is categorized to be having", "exp": ".intermittent :<1 time a week ,asymptomatic,normal PEFR between attack,nocturnal attack less than or equal to 2 per month mild persistant :>1 time a week but less than 1 time a day,noctunal attack>2 /month moderate persistant :daily use beta 2 agonist, attack affect activity,nocturnal attack>1/week severe persistant :continuous, limited physical activity,nocturnal attack frequent Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:363, 7th edition", "cop": 4, "opa": "Mild persistent asthma", "opb": "Mild intermittent asthma", "opc": "Severe persistent asthma", "opd": "Moderate persistent asthma", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "60a05266-2365-4174-815b-650b4016c56e", "choice_type": "single"}
+{"question": "Feature of Down syndrome is", "exp": "Ans) c (Trisomy 21) Ref Nelson 18th ed p 508Down syndrome is the most common chromosome disorder and the single most common genetic cause of moderate mental retardation. The incidence of Down syndrome in live births is approximately 1 in 750. The occurrence of trisomy 21 as well as other autosomal trisomies increases with advanced maternal age (> 35 yr)In approximately 95% of the cases of Down syndrome there are 3 copies of chromosome 21. The parental origin of the supernumerary chromosome 21 is maternal in 97% of the cases. Approximately 1 % of individuals are mosaics with some cells having 46 chromosomes, while another 4% of individuals have a translocation that involves chromosome 21.The majority of translocations in Down syndrome are fusions at the centromere between chromosomes 13, 14, 15, or 21, known as Robertsonian translocations. The translocations can be de novo or inherited.Down syndrome patients without a visible chromosome abnonnality are the least common.It is not possible to distinguish the phenotypes of individuals with full trisomy 21 and those with a translocation.Patients who are mosaic tend to have a milder phenotype.", "cop": 3, "opa": "18 trisomy", "opb": "14/21 translocation", "opc": "21 trisomy", "opd": "Trisomy 13", "subject_name": "Pediatrics", "topic_name": "Genetics And Genetic Disorders", "id": "d211a20c-5291-4cb0-a11b-d969f9f9fc65", "choice_type": "single"}
+{"question": "Commonest cardiac lesion in tuberous sclerosis is", "exp": "Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome with a high incidence of sporadic cases and variable clinical expression. It has an estimated frequency of 1/6000. Major manifestations of TSC include skin lesions in more than 95%, autism and seizures in 85%, kidney disease in 60%, mental retardation in 50%, and cardiac rhabdomyoma in 50%.Mental retardation and autism are more in TSC patients who presents with generalized seizures including infantile spasms in the first 2 years of life. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "SD", "opb": "VSD", "opc": "Mitral stenosis", "opd": "Rhabdomyoma", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "5f5d9279-8c85-42ad-8275-da8883f1eed5", "choice_type": "single"}
+{"question": "Most commonly, ductus aeriosus is", "exp": "Most commonly, the ductus aeriosus is just distal to the subclan, and the ductus enters the pulmonary aery at its bifurcation. Ref: Nelson textbook of pediatrics 21st edition Pgno: 2344", "cop": 2, "opa": "Just proximal to the left common carotid", "opb": "Just distal to the left subclan", "opc": "Just distal to the left common carotid", "opd": "Just proximal to the left subclan", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "2947c9f6-0da0-4282-bef3-4c0c204f29ae", "choice_type": "single"}
+{"question": "Congenital wilson&;s disease is characterized by", "exp": "Wilson disease is an inborn error of metabolism due to toxic accumulation of copper in liver,brain,cornea and other tissues.Manifestations are more likely to be hepatic in early childhood & neurological in adolescents or adults.The spectrum of hepatic manifestations include all forms of acute or chronic liver disease,i.e.,&;viral hepatitis&; like illness,acute liver failure,chronic hepatitis,poal hypeension,cirrhosis or asymptomatic hepatomegaly.KF (Kayser-Fleischer)/rings are most common in children with neurological(96%) than hepatic(60%) Wilson disease. Wilson disease is characterised by decreased serum ceruloplasmin & increased urinary copper excretion with increased hepatic copper stores. Reference:Essential pediatrics-Ghai,8th edition,page no:320,321", "cop": 2, "opa": "KF ring is present at bih", "opb": "May present as acute hepatitis", "opc": "Decreased Urinary copper excretion", "opd": "Decreased hepatic copper concentration", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "c5213958-6c4b-43a5-ae5f-1d10123787e2", "choice_type": "single"}
+{"question": "Single gene defect causing multiple unrelated problems", "exp": "Pleiotropism : A gene that has multiple phenotypic effects It is a special interest because it helps in understanding the relationships between different organisms of the same individuals Examples: I. Drosophila bar eyed individuals may be significantly altered by the wing nature II. Seed coat colour gene of sweet pea controls flower colour and also red spot in leaf axils II. Sickle cell anemia in human . Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Pleiotropism", "opb": "Pseudodominance", "opc": "Penetrance", "opd": "Anticiaption", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "791f904b-6d99-4052-913a-ea93f94cda02", "choice_type": "single"}
+{"question": "A child has presented with a BP of 190/110, pedal edema++, facial edema, gross hematuria and absent ascites, The most probable diagnosis is", "exp": "Glomerulonephritis signs and symptoms include: Pink or cola-colored urine from red blood cells in your urine (hematuria) Foamy urine due to excess protein (proteinuria) High blood pressure (hypeension) Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen. Causes of Acute Glomerulonephritis 1.Non-infectious 2.Infectious # Numerous infectious organisms, include fungi, bacteria, rickettsia, virus, especially influenza, and parasites could induce PAGN. # However, APSGN accounts for 80 to 90% of such cases and is used as the prototype for this group of disorder. # APSGN is a classic example of the acute nephritic syndrome Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Acute glomerulonephritis", "opb": "Minimal change nephritis syndrome", "opc": "Renal vein thrombosis", "opd": "Renal amyloidosis", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "4e058de7-f4ee-47a4-a4ae-821ce65cc213", "choice_type": "single"}
+{"question": "Periventricular Leukomalacia most commonly causes", "exp": "Pathology\nCerebral Palsy subtype\n\n\n\n\nPeriventricular\n\t\t\t\tLeukomalacia\n\n\nSpastic diplegia\n\n\n\n\nParasaggital brain injury\n\n\nSpastic quadriparesis\n\n\n\n\nMiddle cerebral artery (MCA) teritory infarction\n\n\nSpastic hemiplegia\n\n\n\n\nBasal ganglia\n\n\nDyskinetic cerebral palsy", "cop": 3, "opa": "Spastic quadriplegia", "opb": "Hypotonic Cerebral palsy", "opc": "Spastic diplegia", "opd": "Dyskinetic cerebral palsy", "subject_name": "Pediatrics", "topic_name": null, "id": "4794d606-0acc-489b-96b7-3beb081002ee", "choice_type": "single"}
+{"question": "Concentration of epinephrine used in neonatal resuscitation is", "exp": "Medications: indication, dosage and effects MedicationIndicationEffectsConcentration administeredDose of prepared solutionRouteEpinephrine (1:1000)HR <60 / min after 30 sec of effective PPV and chest compressions Inotropic; chronotropic; peripheral vasoconstrictor 1:100000.1-0.3 ml/kgIV; through umbilical vein (endotracheal route if no IV access) Normal salineRinger lactateAcute bleeding with hypovolemia Increased intravascular volume improves perfusion 10 ml/kgUmbilical vein Naloxone (0.4 mg/ml) Respiratory depression with maternal history of narcotic use within 4 hr of bihNarcotic antagonist 0.4 mg/ml 0.25 ml/kgIV preferred; delayed onset of action with intramuscular use; administer only after restoring ventilationSodium bicarbonate is administered only if prolonged asphyxia is associated with metabolic acidosis despite use of epinephrine and volume expanders.IV intravenous; PPV positive pressure ventilation Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 132", "cop": 3, "opa": "0.111111111", "opb": "0.736111111", "opc": "1 : 10000", "opd": "1 : 100000", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "a74e5da4-efa5-48e7-9551-eee5ceef4bb1", "choice_type": "single"}
+{"question": "Split skin grafts in children should be harvested from", "exp": "A split-thickness skin graft(STSG) is a skin graft including the epidermis and pa of the dermis. Its thickness depends on the donor site and the needs of the person receiving the graft.A full-thickness skin graft consists of the epidermis and the entire thickness of the dermis. Split skin grafts in children should be harvested from Buttocks. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Buttocks", "opb": "Thigh", "opc": "Trunk", "opd": "Upper limb", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "d1c3b1f3-3463-4fc9-98e9-52a4a4a6f86b", "choice_type": "single"}
+{"question": "Number of primary teeth;", "exp": "there are total of 20 primary teeth PRIMARY/ MILK/ TEMPORARY TEETH SECONDARY/ PERMANENT TEETH BEGIN AT 6-7 months 6 years 1st tooth to erupt Lower central incisor 1st molar Last tooth Second molar 3rd molar or wisdom tooth Completes at 2 and half - 3 years 12 years except the 3rd molar Total no. of teeth 20 28-32", "cop": 1, "opa": "20", "opb": "24", "opc": "16", "opd": "32", "subject_name": "Pediatrics", "topic_name": "FMGE 2019", "id": "b7695889-6913-44bb-9ef2-9d68d13494cb", "choice_type": "single"}
+{"question": "Screening of neonatal thyroid disease is done by", "exp": "Since the neonates are asymptomatic at bih all newborns are screened for neonatal hypothyroidism. TSH is estimated either in cord blood at the time of bih (preferred) or blood obtained from heel prick after 2 days of bih.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2669 - 2773)", "cop": 3, "opa": "T4", "opb": "T3", "opc": "TSH", "opd": "TPO antibodies", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "453400f4-8772-45e6-9e35-63e9e32f11f1", "choice_type": "single"}
+{"question": "Sho stature, secondary to growth hormone deficiency is associated with", "exp": "sho stature : Defined as height below third centile or more than 2 standard detions below the median height for age and gender according to the population standard. Children whose stature s more than 3 SD below the population mean for age and gender are more likely to be suffering from pathological sho stature as compared to those with stature between -2 and -3SD , who are more likely to be affected by familial or constitutional sho stature. CAUSES:- 1. Most common cause is constitutional. 2. Familial 3. Pathological causes include: Undernutrition Chronic systemic illness Cerebral palsy Congenital hea disease Cystic fibrosis,asthma Malabsorption Acquired immunodeficiency syndrome 4. Endocrine causes include: Growth hormone deficiency Hypothyroidism Cushing syndrome Pseudohypoparathyroidism Precocious or delayed pubey 5. Psychosocial dwarfism 6. Children born small for gestational age. 7. Skeletal dysplasia; achondroplasia, rickets. 8. Genetic syndrome; Turner, Down syndrome. Growth hormone deficiency:- Growth hormone deficiency may be caused by congenital CNS malformations, genetic defects or acquired neurological insults. These children have normal growth at bih. Growth retardation become apparent around 1 year of age. Midfacial crowding, round facies, mild obesity,depressed nasal bridge,single central incisor tooth and micropenis are common. Body propoions are normal. Development of tooth delayed.Facial appearance is doll like. These children look much younger than their actual age. Bone age is delayed. Newborns may present with severe hypoglycemic seizures due to concomitant ACTH deficiency. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Normal body propoion", "opb": "Low bih weight", "opc": "Normal epiphyseal development", "opd": "Height age equal to skeletal age", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "f53ca41d-6e30-426d-adb9-eac0b7dd7e72", "choice_type": "single"}
+{"question": "Most common cause of Neonatal Hypothyroidism is", "exp": "Iodine deficiency is the commonest cause of congenital hypothyroidism in ceain pas of India, while thyroid dysgenesis is the most common aetiology in non-endemic areas (75% of all cases). Thyroid scan pictures showing different types of thyroid dysgenesis. At upper panel hypoplasia (A), hemiagenesis (B), ectopia (C), double ectopia (D), and athyreosis (E) compared with normal thyroid (G) shown at lower panel. Panel F showing scintigraphy performed at the time of diagnosis (F1 and F2) repoed as hemiagenesis while repeated scintigraphy at the time of the study (at 12 years age) showed ectopia (F3). Radiopharmaceutical uptake by thyroid tissue is shown by black arrows and salivary glands by empty arrows. Reference: Ghai essential of paediatrics, eighth edition, p.no:516", "cop": 1, "opa": "Throid dysgenesis", "opb": "Transplacental maternal thyroid antibodies", "opc": "Inherited genetic disorders", "opd": "Decreased thyroglubin", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "8fabfd5f-9c07-4a4c-9e7d-1bb042a3ba2a", "choice_type": "single"}
+{"question": "Transient myleoproliferative disorder of the newborn is seen in association with", "exp": "Approximately 10% of children with Down syndrome develop a preleukemic clone,transient myeloproliferative disorder,with somatic mutations in hematopoietic transcription factor GATA1.These children have a high leukocyte count,circulating blasts in peripheral blood,hepatosplenomegaly,effusions,anemia and thrombocytopenia in the neonatal period,which resolves by 3 months.About 20% of children with transient myeloproliferative disorder develop AML. Reference:Essential pediatrics-Ghai,8th edition,page no:605.", "cop": 2, "opa": "Turnur's syndrome", "opb": "Down's syndrome", "opc": "Neurofibromatosis", "opd": "Ataxia telangiectasia", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "d24dfd87-6573-4dc4-8f75-f04051a74482", "choice_type": "single"}
+{"question": "Chromosome involved in Wilm's tumor is", "exp": "WTl is the best characterized Wilms tumor gene. It is located at chromosome llp13 and encodes for a transcription factor that is critical for normal development of kidneys and gonads. WT2 is localized to a cluster of genes at llpl5. Reference: Essential paediatrics; O.P.Ghai; Childhood Malignancies; Page no: 617", "cop": 1, "opa": "11", "opb": "13", "opc": "18", "opd": "22", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "9efce15d-8682-4927-b158-6927e4fd276e", "choice_type": "single"}
+{"question": "Maximum growth spu is seen in girls at time of", "exp": "Adolescence: Stage of transmission from childhood to adulthood. During this stage, there will be an appearance of sexual characters with changes in cognition and psychology. Adolescence refers to this entire process, pubey refers to the physical aspect. Age 10-19 year is considered a period of adolescence and pubey marks the early half of adolescence. Pubey in girls stas with breast development( thelarche) anytime between 8-13 years. This is followed by an appearance of pubic hair ( pubarche) and subsequently, menstruation ( menarche), occurring at an average of 12.6 years. Menarche occurs after 2-21/2 years of thelarche. In boys, the earliest change is an increase in testicular size( testicular volume reaching 4 ml) and this occurs between 9-14 years. This is followed by an appearance of pubic hair and lengthening of the penis. Spermarche( sperm production) stas during mid-adolescence. Laryngeal growth, manifesting as cracking of voice, begins in boys in mid-pubey, deepening of voice is complete by end of pubey. During pubey, boys gain 20-30 cm and girls 16-28 cm of height. Peak growth velocity in girls occurs before attainment of menarche. Boys have their peak growth in later stages of pubey. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Pubarche", "opb": "Thelarche", "opc": "Menarche", "opd": "Adrenarche", "subject_name": "Pediatrics", "topic_name": "Adolescence", "id": "eb7ddba8-137e-482a-9c7f-625b381c67cc", "choice_type": "single"}
+{"question": "The commonest cardiac lesion in Tuberous sclerosis is", "exp": "MAJOR FEATURES OF TUBEROUS SCLEROSIS COMPLEX:Coical tubersSubependymal noduleSubependymal giant cell astrocytomaFacial angiofibroma Periungual fibromaHypomelanotic macules (>3) Shagreen patchMultiple retinal hamaomasCardiac rhabdomyomaRenal angiomyolipomaPulmonary lymphangioleiomyomatosisApproximately 50% of children with tuberous sclerosis have cardiac rhabdomyoma.Most common cardiac lesion: cardiac rhabdomyomaMost common renal lesion: angiomyolipomaMost common skin lesion: hypomelanotic maculeMost common CNS lesion: coical tubersMost common pulmonary lesion: lymphangiomyomatosis", "cop": 4, "opa": "ASD", "opb": "VSD", "opc": "Mitral stenosis", "opd": "Rhabdomyoma", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "61b7a908-a477-4e4a-9ec4-1842a689a6cd", "choice_type": "single"}
+{"question": "In newborn, the aery used for palpation of the pulse is", "exp": "Radial, brachial and carotid aeries are difficult to palpate in a newborn baby.The femoral aery is easily palpable in the newborn.Bilateral femoral pulse should be palpated and indicates the degree of volume status in newborn.In coarctation of the aoa, the femoral pulse will be absent.", "cop": 4, "opa": "Carotid", "opb": "Brachial", "opc": "Radial", "opd": "Femoral", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "e672ac60-1a3a-4528-bde3-e3ebf45188a6", "choice_type": "single"}
+{"question": "Edward syndrome is", "exp": "Edward syndrome is trisomy 18 . It is due to non dysfunction of chromosomes during meiosis Trisomy 21 is down symdrome and trisomy 13 is patau syndrome. Reference: Nelson TB of pediatrics pg 404 edi 19.", "cop": 2, "opa": "Trisomy 13", "opb": "Trisomy 18", "opc": "Trisomy 21", "opd": "Trisomy 20", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "5631586c-28c3-4691-bd12-b8bc06a26080", "choice_type": "single"}
+{"question": "Conjugated hyperbilirubinemia", "exp": "Ans. is 'a' i.e., Dubin johnson syndrome Breast milk jaundice - Decrease bilirubin uptake across hepathocyte membrane. Entero-hepatic recirculation. Leads to indirect hyperbilirubinemia. Crigler naj jar & Gilbe syndrome (deficiency of glucuronyl transferase) . Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning.copies circle. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}", "cop": 4, "opa": "12 months", "opb": "24 months", "opc": "30 months", "opd": "36 months", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "37905b25-3a39-4662-b3f1-5cd5cd46991f", "choice_type": "single"}
+{"question": "Birth length is double at the age of", "exp": "D. i.e. (4 years) (4 Ghai 6th) (6 - Ghai 7th)WeightLength or heightHead circumference*birth - about =3 kg*birth50 cm*Birth34 cm5 month(Doubles)6 kg1 years75 cm1 years45 cm1 years9 kg2years85 cm2years47 cm2 years12 kg3 years95 cm 3 years14 kg4 years(doubles)100 cm3 years49 cm4 years16 kg 4 years50 cm* A useful guide for normal range is target height + 7 cm for girls and target height + 8.5 cm for boys", "cop": 4, "opa": "1 years", "opb": "2 years", "opc": "3 years", "opd": "4 years", "subject_name": "Pediatrics", "topic_name": "Growth, Development, and Behavior", "id": "cedc5f48-d74b-4848-bbf6-5772f264b4f2", "choice_type": "single"}
+{"question": "Most common indication of liver transplant in children is", "exp": "Biliary atresia is the most common indication for liver transplantation in India, followed by metabolic and inborn disorders.", "cop": 2, "opa": "Chronic Viral hepatitis", "opb": "Biliary atresia", "opc": "Tyrosinemia", "opd": "Von Gierce disease", "subject_name": "Pediatrics", "topic_name": null, "id": "acf56383-97de-400e-85a5-e0bc9a1e6e3c", "choice_type": "single"}
+{"question": "Most common gene involved in Noonan syndrome", "exp": "NOONAN SYNDROME: - Autosomal dominant, Normal karyotype - MC gene involved --> PTPN 11 - Seen in both boys & girls --> FEILE - FEATURES: Sho stature webbed neck Anti-mongoloid slant eyes (Opposite of Down syndrome) Cubitus valgus Clinodactyly, Cryptorchidism cardiac anomalies: Supra valvular Pulmonary Stenosis -->, HOCM, ASD Presence of Intellectual disability", "cop": 2, "opa": "PTCN 11", "opb": "PTPN 11", "opc": "PTPN 22", "opd": "PTCN 22", "subject_name": "Pediatrics", "topic_name": "Other hea diseases in children", "id": "5041af6f-2dee-4e57-ad4a-f8291de7f3d9", "choice_type": "single"}
+{"question": "The dose of betamethasone in prenatal to prevent respiratory distress syndrome is", "exp": "Betamethasone is the antenatal coicosteroid of choice and the recommendation is to give 2 doses of 12mg intramuscularly 24 hrs apa to all pregnant women in preterm labour between 24 and 35 wks irrespective of whether the membranes are intact or not. This is to reduce the rate of respiratory distress syndrome and intraventricular hemorrhage. The other option is dexamethasone 6mg every 12hrs for 4 doses. Reference : page 194 Textbook of Obstetrics Sheila Balakrishnan 2nd edition", "cop": 2, "opa": "6 mg", "opb": "12 mg two doses 24 hours apa", "opc": "6 mg every 12 hours", "opd": "4 mg stat", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "b2d6c8f2-7f5d-47a6-80a2-22590dd29f32", "choice_type": "single"}
+{"question": "Neonatal sepsis is commonly caused by", "exp": "(E. coli) (161-G) (136-Ghai 7th)* Neonatal sepsis is the single most important cause of neonatal deaths in the community accounting for over half of them.* Most cases of neonatal sepsis in the community are caused by Escherichia-coli and staphylococcus aureus. In hospitals, Klebsiella pneumonia is also a common organism", "cop": 2, "opa": "b-haemolytic streptococci", "opb": "E. coli", "opc": "H. influenzae", "opd": "Listeria", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "26789ae1-170e-4155-9a0f-271735fb6c2b", "choice_type": "single"}
+{"question": "Severe Acute Malnutrition is defined as", "exp": "Severe acute malnutition in children of 6 months - 5 year is defined as \na) Weight / Height < - 3SD\nb) Mid - upper arm circumference < 11.5 cm\nc) Presence of bipedal edema", "cop": 3, "opa": "Weight / Height < - 2SD", "opb": "Mid - Upper arm circumference < 12.5 cm", "opc": "Presence of bipedal edema", "opd": "Weight / age < - 3SD", "subject_name": "Pediatrics", "topic_name": null, "id": "4c970812-44c7-4d12-a5b7-4d8816f93633", "choice_type": "single"}
+{"question": "Ω Omega shaped epiglottis is seen in", "exp": "On Laryngoscopy, Omega shaped epiglottis is seen in laryngomalacia.", "cop": 3, "opa": "Acute epiglottitis", "opb": "Croup", "opc": "Laryngomalacia", "opd": "Bronchiolitis", "subject_name": "Pediatrics", "topic_name": null, "id": "50b81105-2713-4fec-85b9-c149959b1601", "choice_type": "single"}
+{"question": "Auer rods are specific for", "exp": "-Auer rods are Needle-like azurophilic fusiform inclusions in cytoplasm of myeloblasts -Auer rods are most reliable morphological feature of AML -Myeloblasts Stain +ve with MPO and Sudan Black B", "cop": 1, "opa": "Acute myeloid leukemia", "opb": "Acute lymphocytic leukemia", "opc": "Chronic lymphocytic leukemia", "opd": "Hodgkin's lymphoma", "subject_name": "Pediatrics", "topic_name": "Neoplastic disorders of WBCs", "id": "d695d0d3-78db-4fba-b896-bb268da062a5", "choice_type": "single"}
+{"question": "EMG is least useful for diagnosis of", "exp": "EMG is leastly used in cerebral palsy since the cause is in the brain and not in the muscles", "cop": 1, "opa": "Cerebral palsy", "opb": "Spinal muscular atrophy", "opc": "Charot-Marie-Tooth disease", "opd": "Myasthenia gravis", "subject_name": "Pediatrics", "topic_name": "Musculoskeletal disorders", "id": "c84e4ac4-6ecb-4c9f-b69e-4427e9cc404d", "choice_type": "single"}
+{"question": "The most common cause of severe obstructive uropathy in children is", "exp": "Posterior Urethral ValvesThe most common cause of severe obstructive uropathy in children is posterior urethral valves, affecting 1 in 8,000 boys. The urethral valves are tissue leaflets fanning distally from the prostatic urethra to the external urinary sphincter.Valves are of unclear embryologic origin and cause varying degrees of obstruction. Ref: Nelson Textbook of Pediatrics; 20th edition; Page no: 2574", "cop": 1, "opa": "Posterior urethral valves", "opb": "Phimosis", "opc": "Urethral atresia", "opd": "Bladder neck obstruction", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "36fd3187-0ae3-47e8-80e8-f0836db3fe90", "choice_type": "single"}
+{"question": "Preventable causes of Mental Retardation are", "exp": "Cretinism is congenital iron deficiency syndrome which can be preventable by intake in required amounts. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Downs", "opb": "Phenylketonuria", "opc": "Cretinism", "opd": "Cerebral palsy", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "ef15f52d-dc57-45ca-8c4a-6b53211213a8", "choice_type": "single"}
+{"question": "NOT a feature of Atrial Septal defect among the\nfollowing", "exp": "Left Atrial hypertrophy is never seen in ASD.", "cop": 1, "opa": "Complications include Left Atrial hypertrophy", "opb": "Complications due to ASD are of late onset", "opc": "Most Common Congenital heart disease presenting in Adult age", "opd": "Wide fixed Split in 2nd heart sound", "subject_name": "Pediatrics", "topic_name": null, "id": "2684e3a2-908b-4611-8d66-f83b02aefb7a", "choice_type": "single"}
+{"question": "Treatment of multiple carboxylase deficiency", "exp": "Treatment of multiple carboxylase or biotinidase deficiency is biotin.Oral dose is 10-40 mg/kg/day Reference:Essential pediatrics-Ghai,8th edition,page no:650", "cop": 1, "opa": "Biotin", "opb": "Pyridoxine", "opc": "Thiamine", "opd": "Folic acid", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "048df25c-98b5-41a1-9c6d-3e714ce4ef73", "choice_type": "single"}
+{"question": "The best indicator of acute malnutrition is", "exp": "Severe acute malnutrition is defined by a very low weight for height (below-3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional edema.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 301)", "cop": 1, "opa": "Weight for height", "opb": "Weight for age", "opc": "Height for age", "opd": "BMI <2SD", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "a72d3868-e530-413a-b2db-561d92980c76", "choice_type": "single"}
+{"question": "Skin change in newborn that disappear spontaneously", "exp": ".Harlequin color change is a cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body&;s midline. This transient change occurs in approximately 10% of healthy newborns. It is seen usually between two and five days of bih. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Harlequins skin change", "opb": "Mangolian spots", "opc": "Erytherma toxicum", "opd": "Lymphoma", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "ea9ffee5-8a0e-49d1-8b97-df9863fd8ed8", "choice_type": "single"}
+{"question": "Hutchisons traid is seen", "exp": "* Hutchinson&;s triad is seen in congenital syphilis. *it includes interstitial keratitis, deafness and Hutchinson&;s teeth ( central incissors with peg shaped, notched appearance ). Reference : IADVL&;s concise textbook of dermatology, first edition, pg no: 126", "cop": 2, "opa": "Primary syphilis", "opb": "Congenital syphilis", "opc": "Secondary syphilis", "opd": "Teiary syphilis", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "f351aa69-dbc3-4fca-a98a-1be920e89b24", "choice_type": "single"}
+{"question": "Enzyme deficient is Von Gierke disease is", "exp": "Enzyme deficient in Von Gierke disease is Glucose 6 - phosphatase.", "cop": 4, "opa": "Acid maltase", "opb": "Alpha 1, 4 glucosidase", "opc": "Glucose phosphorylase", "opd": "Glucose 6 - phosphatase", "subject_name": "Pediatrics", "topic_name": null, "id": "79cf0a8f-0acd-4925-adbb-bafebb7d9525", "choice_type": "single"}
+{"question": "Recent marker for Downs syndrome is", "exp": "Inhibin A is a protein secreted by the ovary, and is designed to inhibit the production of the hormone FSH by the pituitary gland. The level of inhibin A is increased in the blood of mothers of fetuses with Down syndrome. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "HCG", "opb": "Alpha fetoprotein", "opc": "Inhibin", "opd": "Estriol", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "1c9503ba-14d8-459f-8509-d468f171815a", "choice_type": "single"}
+{"question": "Between 3 to 4months of age, Infant weight increases approximately around", "exp": "Between 3 and 4 months of age, the rate of growth slows to approximately 20 g/day.By age 4 months, bih weight is doubled.(Refer: Nelson; Chapter 10; pg no. 69)", "cop": 1, "opa": "20 g/d", "opb": "40 g/d", "opc": "50 g/d", "opd": "60 g/d", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "d0243de2-7811-4783-86c3-304b50405a16", "choice_type": "single"}
+{"question": "Most common cardiac anomoly associated with Turner's syndrome among the following is", "exp": "Most common cardiac anomoly associated with Turner's syndrome is Bicuspid Aortic valve > Coarctation of Aorta.", "cop": 3, "opa": "Aortic stenosis", "opb": "Ventricular septal defect", "opc": "Coarctation of Aorta", "opd": "Pulmonary stenosis", "subject_name": "Pediatrics", "topic_name": null, "id": "f77d5a89-9fc9-459c-a584-a38fe00d59b6", "choice_type": "single"}
+{"question": "A most common cause of Neonatal Hypothyroidism is", "exp": "Iodine deficiency is the commonest cause of congenital hypothyroidism in certain parts of India, while thyroid dysgenesis is the most common aetiology in non-endemic areas (75% of all cases).", "cop": 1, "opa": "Throid dysgenesis", "opb": "Transplacental maternal thyroid antibodies", "opc": "Inherited genetic disorders", "opd": "Decreased thyroglubin", "subject_name": "Pediatrics", "topic_name": null, "id": "cf7d1a56-96da-42ef-947e-b9a220e4fd24", "choice_type": "single"}
+{"question": "Select the most common clinical sign or symptom for diagnosis Tuberous sclerosis", "exp": "Tuberous sclerosis, an autosomal dominant condition, can result in severe mental retardation and seizures. Infantile spasms, a hypsarrhythmic EEG pattern, hypopigmented lesions (ash-leaf spots), cardiac tumors, sebaceous adenomas, a shagreen patch (a roughened, raised lesion over the sacrum), and calcifications on the CT scan are all features of this condition. No specific treatment is available.", "cop": 2, "opa": "A 6-month-old child with blindness on the same side as a large facial lesion", "opb": "An infant with infantile spasms, a hypsarrhythmic EEG pattern, and ash-leaf depigmentation on her back", "opc": "An 18-year-old patient with a history of fractures and optic gliomas, who now has developed a malignant schwannoma", "opd": "A 2-year-old child with multiple episodes of skin infection and failure to thrive", "subject_name": "Pediatrics", "topic_name": "Musculo Skeletal Disorders", "id": "922878af-0601-45df-ab41-109f33437220", "choice_type": "single"}
+{"question": "Amount of Protein present in 100ml of breast milk is", "exp": "Amount of Protein present in 100ml of breast milk is: 1.1 g/dl", "cop": 2, "opa": "2.2 g", "opb": "1.1 g", "opc": "0.55g", "opd": "3.3g", "subject_name": "Pediatrics", "topic_name": "JIPMER 2019", "id": "83a46f0a-6314-48e8-b6a9-846317eef4cd", "choice_type": "single"}
+{"question": "A five year old child presents to the emergency depament with burns. The burn area corresponding to the size of his palm is equal to", "exp": "Ans is 'a' i.e., 1% BSA Estimation of body surface area (BSA) of burn o Rough estimate of body surface area of burn can be estimated by following rules. Rule of Palm (Palmar method) o It can be used in Children as well as in adults. o It is used for small burns ( o The palm of patients hand represents I% of BSA. Palm is the area of hand from wrist crease to the finger crease. o Entire burned hand represents 2.5% of BSA: 1 /% for palm; 1% for dors um of the hand (excluding fingers);0. 5% for the fingers. Rule of 9 o It can be used in adults and children older than 14 years. o It is used for larger surface area burns. o Estimates the body surface area of an adult in multiples of 9. o An adult who has been burned, the percent of the body involved can be calculated as follows: Head and Neck = 9% Anterior chest = 9% Anterior abdomen =9% Upper back = 9% Lower back = 9% Right upper extremity (Anterior + Posterior) = 9% Left upper extremity (Anterior + Posterior) = 9% Right lower extermity, Anterior = 9% Right lower extremity, Posterior = 9% Left lower extremity, anterior = 9% Left lower extremity, Posterior = 9% Perenium = 1% o Percent of the burn in a child can be calculated as follows: Head and neck = 9% Anterior trunk = 18% Posterior trunk = 18% Upper extremity (Right) = 9% Upper extremity (Left) = 9% Lower extremity (Right) = 18% Lower extremity (Left) = 18% Perenium = 1%", "cop": 1, "opa": "1% BSA", "opb": "5% BSA", "opc": "10% BSA", "opd": "20% BSA", "subject_name": "Pediatrics", "topic_name": null, "id": "d284e1a0-686c-4742-bc38-17e9798a39b1", "choice_type": "single"}
+{"question": "3 months old child with typical mewing cry and congenital hea disease, chromosome abnormality", "exp": "Ans. is 'b' i.e., 5p Cri-du-chat syndrome. A high-pitched cry like a cat, giving the syndrome its name. Genetic studies have confirmed that this characteristic cry results from the deletion at 5p15 The main features are hypotonia, sho stature, characteristic cry, microcephaly with protruding metopic suture, moonlike face, hypeelorism, bilateral epicanthic folds, high arched palate, wide and flat nasal bridge, and mental retardation. Cardiac abnormalities including ventricular septal defect, atrial septal defect, patent ductus aeriosus and Fallot's tetralogy.", "cop": 2, "opa": "5g", "opb": "5p", "opc": "4p", "opd": "9p", "subject_name": "Pediatrics", "topic_name": null, "id": "33cf1750-eded-4842-98a4-36969615e126", "choice_type": "single"}
+{"question": "Most common cause of lower respiratory tract infection in 3 year old child is", "exp": "Ans. is 'c' i.e., Streptococcal pneumonia", "cop": 3, "opa": "Klebsella", "opb": "H-influenza", "opc": "Streptococcal pneumonia", "opd": "Staphe aureus", "subject_name": "Pediatrics", "topic_name": null, "id": "c5c85fb3-b838-4e07-b572-0fd85f5a0ebc", "choice_type": "single"}
+{"question": "A 5 year lod child is assessed to have developmental age of one year. His developmental patient would be", "exp": null, "cop": 3, "opa": "100", "opb": "80", "opc": "20", "opd": "60", "subject_name": "Pediatrics", "topic_name": null, "id": "b349b664-7fcb-44bb-a1ed-53c4d3f7a3a2", "choice_type": "single"}
+{"question": "Most common cause of ESRD in children", "exp": "This is why kidney failure is also called end-stage renal disease, or ESRD for sho. Diabetes is the most common cause of ESRD. Common causes of acute renal failure include: Hea attack. Illegal drug use and drug abuse. Not enough blood flowing to the kidneys. Urinary tract problems Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "ADPKD", "opb": "Nephronopthisis", "opc": "Medullary cystic disease", "opd": "ARPKD", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "cc707bf8-c1a7-43a6-be17-648375645e38", "choice_type": "single"}
+{"question": "Most common organism causing meningitis in a 1 year old child", "exp": "Streptococcus pneumonia is the most common organism causes meningitis even in the 1 year old child. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Streptococcus pneumoniae", "opb": "H. influenza", "opc": "Listeria", "opd": "Neisseria meningitidIs", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "3b289823-9143-40e7-818d-93d16fcdc323", "choice_type": "single"}
+{"question": "Most common cause of hea failure in infancy is", "exp": "Most common cause of hea failure in infancy is CHD. Ref : Ghai essential of pediatrics, eighth edition, p.no:397", "cop": 4, "opa": "Myocarditis", "opb": "Rheumatic fever", "opc": "Cardiomyopathy", "opd": "Congenital hea disease", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "589ef2d9-916b-48d3-831b-21565c49c717", "choice_type": "single"}
+{"question": "The karyotype of a patient with androgen insensitivity Syndrome is", "exp": "Karyotype-46 ,XY. Normal genitK appearance -SRY deletion ,SF1 defect,Gonadal dysgenesis ,Severe StAR defect ,Complete androgen insensitivity syndrome. Genital ambiguity -Testicular dysgenesis ,Steroidogenic defects,Paial androgen insensitivity syndrome ,Aromatase deficiency. * Chromosomal study: Karyotype is 46, XY. * In infants and children, stimulation by hCG before measurement of hormones needed. * Serum testosterone is normal (or higher) * Serum E2 level is high normal for males * Serum LH level is normal or slightly elevated * FSH is normal. * USG: --Ovaries, uterus, upper 2/3rd of vagina and tubes are absent Reference: OP Ghai ,essential.paediatrics ,8 th edition, page no- 538,table 17.32 .", "cop": 2, "opa": "46XX", "opb": "46XY", "opc": "47XXY", "opd": "45X0", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "ff5eb061-ca6a-4082-a70f-0b467b06a0c1", "choice_type": "single"}
+{"question": "Automatism is seen in", "exp": "A complex paial seizure is a type of seizure that arises in one lobe of the brain, rather than the whole brain. The seizure affects people&;s awareness and may cause them to lose consciousness . A complex paial seizure stas focally within the brain and causes impairment of consciousness. This definition is based on both clinical and electroencephalographic (EEG) data. A complex paial seizure is most commonly a manifestation of temporal lobe epilepsy, but the term is so broadly defined (le, as any focal seizure with Impairment of consciousness) that it is very nonspecific. For this reason, many clinicians make a point of distinguishing between temporal and extratemporal complex paial seizures. Complex paial seizures are paial seizures that are associated with an alteration of consciousness ( Complex-Paial Seizures with Automatisms). The term psychomotor describes a paicular semiology characterized by automatisms and impairment of consciousness, usually of temporal lobe origin. Automatisms: Automatisms are nonpurposeful, stereotyped, and repetitive behaviors that commonly accompany complex paial seizures (In the sem lologic classification, they define automotor seizures). The behavior Is Inappropriate for the situation. Verbal automatisms range from simple vocalizations, such as moaning, to more complex, comprehensible, stereotyped speech. The most common automatisms, at least In temporal lobe epilepsy, are oral (eg, lip smacking, chewing, swallowing) and manual (eg, picking. fumbling, patting). Unilateral manual automatisms accompanied by contralateral arm dystonia usually Indicates seizure onset from the cerebral hemisphere !psilateral to the manual automatisms. Automatisms can also be more elaborate, coordinated movements Involving bilateral extremities. Bizarre automatisms, such as alternating limb movements, right-to-left head rolling, or sexual automatisms, may occur with frontal lobe seizures. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Paial seizures", "opb": "complex paial seizures", "opc": "Infantile spasms", "opd": "Absence seizures", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "5a675843-7d4a-4933-8c72-5f74e6a1b297", "choice_type": "single"}
+{"question": "3 months old baby with fever and respiratory rate 60, irritable, and well feed, no stridor, no chest indrawing, no convulsions. Diagnosis", "exp": "The above given history is suggestive of pneumonia as there is increased respiratory rate. New ARI classification (2014) by WHO: Diagnosis Clinical features Pneumonia Fast breathing and/or chest indrawing Severe pneumonia or Very severe disease General danger signs present If the child Is: Fast breathing Is: 2 months up to 12 months 50 breaths per minute or more 12 months up to 5 years 40 breaths per minute or more", "cop": 1, "opa": "Pneumonia", "opb": "Severe pneumonia", "opc": "Very sever pneumonia", "opd": "No Pneumonia", "subject_name": "Pediatrics", "topic_name": "FMGE 2019", "id": "626164b8-6137-4061-843b-04314e24e821", "choice_type": "single"}
+{"question": "A child is brought by mother with HO massive hemetemesis with HO drug intake previously with NSAIDS and on Rx.Associated with moderate splenomegaly diagnosis is", "exp": "Massive hematemesis,moderate splenomegaly are features of oesophageal varices Ref : ESSENTIAL PEDIATRICS,O.P.GHAI.,PG NO:290, 7th edition", "cop": 1, "opa": "Oesophageal varices", "opb": "Duodenal ulcer", "opc": "Drug induced gastritis", "opd": "Peptic ulcer", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "496d8590-38f5-486c-bd9e-07c91707a2bb", "choice_type": "single"}
+{"question": "Flag hair sign is seen in", "exp": "Ans. (a) KwashiorkorRef: Nelson's Pedia, 19th ed. Ch 670# kwashiorkorDisease due to decreased protein and caloric intake.Clinical Features are:# Hypoalbuminemia which leads to pedal edema# Hepatomegaly- Hallmark feature of kwashiorkor# Skin: Sun-exposed skin is relatively spared, as are the feet and dorsal aspects of the hands; Hypo pigmentation# Hair and Nail: Nails are thin and soft, and hair is sparse, thin, and depigmented, sometimes displaying a flag sign of alternating light and dark bands that reflect alternating periods of adequate and inadequate nutrition.# Apathy# Lack of appetite* PELLAGRA:This presents with edema, erythema, and burning of sun-exposed skin on the face, neck, and dorsal aspects of the hands, forearms, and feet* SCURVY (VITAMIN C OR ASCORBIC ACID DEFICIENCY): This presents initially with follicular hyperkeratosis and coiling of hair on the upper arms, back, buttocks, and lower extremities. Perifollicular erythema and hemorrhage, swollen, erythematous gums; stomatitis; and subperiosteal hematomas are also seen.", "cop": 1, "opa": "Kwashiorkor", "opb": "Marasmus", "opc": "Scurvy", "opd": "Pellagra", "subject_name": "Pediatrics", "topic_name": "Nutrition, Food Security, and Health", "id": "3b76dd11-d921-4dbb-a85f-01ca8d802e44", "choice_type": "single"}
+{"question": "Most common benign tumours during infancy is", "exp": "An infantile hemangioma is one of the most common benign tumors of infancy and occurs in approximately 5-10% of infants.They occur more frequently in females,premature and low bih weight infants. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Lymphangioma", "opb": "Hemangioma", "opc": "Cystic hygroma", "opd": "Lipoma", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "508ea8fb-9159-4a66-bc01-4d8f533bf40a", "choice_type": "single"}
+{"question": "A new bom presented with Jaundice. Most diagnostic investigation of choice is", "exp": "(Total and Direct bilirubin) (171 - Ghair 6th)* Unconjugated Hyperbilirubinemia1. Clinical Jaundice appearing in the first 24 hours2. Increase in level of total bilirubin by more than 0.5 mg/dL /hour or 5mg/dL /24 hours3. Total bilirubin >15mg/dL (hyper bilirubinemia)4. Direct bilirubin >2.0mg /dL* Conjugated hyperbilirubinemia - is rare in newborn, conjugated hyper bilirubinemia is defined as a direct reacting fraction of >2mg/dL or >15% of the total bilirubin", "cop": 1, "opa": "Total and Direct bilirubin", "opb": "Conjugated bilirubin", "opc": "Serum. Bilirubin", "opd": "Uroporphyrin levels", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "b0165b96-bae0-4564-ae48-18d8c04899f4", "choice_type": "single"}
+{"question": "Brain abscess in Cyanotic hea disease is commonly located in", "exp": "Brain abscess in CHD is located mainly in frontal lobe. Ghai essential of pediatrics, eighth edition, p.no:411", "cop": 2, "opa": "Carebellar hemisphere", "opb": "Frontal lobe", "opc": "Temporal lobe", "opd": "Parietal lobe", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "cffb0908-602b-48cc-afaf-11f8fc2a2b15", "choice_type": "single"}
+{"question": "Commonest cause of short stature in children", "exp": null, "cop": 4, "opa": "Under nutrition", "opb": "Hypothyroidism", "opc": "Familial short stature", "opd": "Constitutional delay", "subject_name": "Pediatrics", "topic_name": null, "id": "b2f4acdb-d947-4007-b8f7-43fbc2f53b79", "choice_type": "single"}
+{"question": "Minimal interval between two live vaccines administered by the oral route is", "exp": "Live vaccines administered by the oral route (Oral Polio vaccine-OPV; oral typhoid and Rota virus) are not believed to interfere with each other if not given simultaneously. These vaccines may be given at any time before or after each other. Live parenteral (injected) vaccines and live intranasal influenza vaccine should either be administered at the same visit or they should be seperated by atleast 4 weeks. Ref: Ghai essentials 9th edition Pgno: 190", "cop": 1, "opa": "Any time", "opb": "2 weeks", "opc": "4 weeks", "opd": "3 months", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "99be6250-8f74-4521-b450-3b4cade34103", "choice_type": "single"}
+{"question": "Investigation of choice in VUR", "exp": "c. Voiding cystourethrogram(Ref: Nelson's 20/e p 2562-2567, Ghai 8/e p 485-486)The most useful process for conclusive diagnosis of VUR is micturating cystourethrogram (MCU)MCU demonstrates the grade of reflux as well as urethral anatomy.Radionuclide imaging is sensitive at detecting reflux but does not demonstrate anatomic details", "cop": 3, "opa": "Ultrasound", "opb": "MRI", "opc": "Voiding cystourethrogram", "opd": "Cystoscopy", "subject_name": "Pediatrics", "topic_name": "Kidney", "id": "1d468343-c892-4f36-a8e4-e3f20347ad69", "choice_type": "single"}
+{"question": "Chromosomal anomalies more than 20% is associated with aEUR'", "exp": "Omphalocele \"Chromosomal abnormalities have been repoed in as many as 43% fetuses with omphalocele. The most common being 13, 18, 21 and Turner's syndrome\". Omphalocele Omphalocele is a midline defect of the anterior abdominal wall characterized by herniation of the abdominal visceral in to the base of the umbilical cord. Omphalocele is a defect of the umbilical ring which results from a failure of the two lateral abdominal wall folds to migrate and. fuse normally in the midline around the 3rd or 4th week of intrauterine life. The defect is characteristically located at the base of the umbilical cord and may contain abdominal and thoracic structures. The herniated visceral are included in a sac which is .formed internally by the peritoneum and externally by Whaon's jelly and the amnion. Omphalocele is associated with number of congenital anomalies Anomalies Gastroschisis Gastroschisis is a herniation of the abdominal viscera through a paraumibilical defect of the anterior abdominal wall. The defect is usually located at the right side of the cord inseion and comprises full thickness of the abdominal wall. The herniated organ is usually bowel and very rarely other structures are involved. In contrast to omphalocele - \"Gastrochisis is rarely associated with other congenital anomalies\". The most frequent associated anomalies are gastrointestinal in origin and are related to the same vascular embryologic problem that originates the gastrochisis. - Intestinal atresia or stenosis (7-30%) cardiac malformation seen in 8% cases. It is also associated with I.U.G.R.", "cop": 2, "opa": "Gastroschisis", "opb": "Omphalocele", "opc": "Spina Bifida", "opd": "Cleft Palate", "subject_name": "Pediatrics", "topic_name": null, "id": "8a64dfd6-6cbb-4b89-9e5f-12dd88a535cd", "choice_type": "single"}
+{"question": "Low bih weight is defined as", "exp": "Low bih weight (LBW) neonate- A neonate weighing less than 2500g at bih irrespective of the gestational age. Very low bihweight (VLBW) neonate- A neonate weighing leas than 1500g at bih irrespective of the gestational age. Extremely low bih weight (ELBW) neonate- A neonate weighing leas than 1000g at bih irrespective of the gestational age. Reference : page 125 Ghai Essential Pediatrics 8th edition", "cop": 1, "opa": "Weight < 2.5 kg", "opb": "Weight < 2.0 kg", "opc": "Weight < 1.5 kg", "opd": "Weight < 10 percentile for their gastational age", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "f8ab00a6-ca59-4865-ad15-3f61dac2ccca", "choice_type": "single"}
+{"question": "Umbilical cord becomes black in", "exp": "The cord becomes brownish black within 2 or 3 days after bihIt falls off in about 10-14 days(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 811)", "cop": 1, "opa": "2-3 days", "opb": "5-7 days", "opc": "7-10 days", "opd": "10-14 days", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "8ccccc44-01d8-4569-a737-dae7bfabf16d", "choice_type": "single"}
+{"question": "As per as latest resuscitation guidelines Umbilical cord clamping must be delayed for atleast ( in preterm )", "exp": "Umbilical cord clamping must be delayed for atleast 30 seconds (in term + preterm babies) Benefits of delayed cord clamping | Total body iron stores Expand blood volume | Incidence of anemia in neonates Note - If case of Bih asphyxia, cord should be clamped immediately NELSON states 30-60 seconds so, better response is 30 seconds as the value is common to our 2 references and the question mentions ''ATLEAST''.", "cop": 2, "opa": "20 seconds", "opb": "30 seconds", "opc": "40 seconds", "opd": "60 seconds", "subject_name": "Pediatrics", "topic_name": "Neonatal Resuscitation", "id": "cb422d25-1b68-44cc-8783-3fb86dbfcbbf", "choice_type": "single"}
+{"question": "Most common Enzyme Deficiency leading to childhood hypeension is", "exp": "Most common enzyme deficiency causing hypeension in pediatric child group is APPARENTMINERALOCOICOID EXCESS. Apparent mineralocoicoid excess (AME) is an autosomal recessive disorder caused by deficiency of 11 beta hydroxysteroid dehydrogenase 2 (11-beta HSD 2) enzyme which is encoded by a gene in chromosome 16q22. Congenital adrenal hyperplasia due to 11b-hydroxylase deficiency is a form of congenital adrenal hyperplasia (CAH) which produces a higher than normal amount of androgen,resulting from a defect in the gene encoding the enzyme steroid 11b-hydroxylase (11b-OH) which mediates the final step of coisol synthesis in the adrenal. 11b-OH CAH results in hypeension due to excessive mineralocoicoid effects. It also causes excessive androgen production both before and after bih and can virilize a genetically female fetus or a child of either sex. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "17- Alpha hydroxylase", "opb": "21- Beta hydroxylase", "opc": "11- Beta hydroxylase", "opd": "3- Beta hydroxy steroid dehydrogenase", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "11a63442-080e-4952-9dbd-7c17f9b04ab7", "choice_type": "single"}
+{"question": "One month old baby is referred for failure to thrive. On examination there are features of congestive cardiac failure. Femoral pulses are feeble compared to brachial pulses. The likely diagnosis is", "exp": "In coarctation of aoa there will be radiofemoral delay. Ghai essential of pediatrics, eighth edition, p.no:432", "cop": 1, "opa": "Coarctation of aoa", "opb": "Patent ductus aeriosus", "opc": "Congenital aoic stenosis", "opd": "Congenital aoa-iliac disease", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "de199236-369f-4bf9-a78f-1fc0236c4a46", "choice_type": "single"}
+{"question": "ASD patient with murmur similar to MR and left axis detion of 40 degrees is having", "exp": "Floppy mitral valve REF: Pediatrics: A Concise Text - Text - SK Kabra, RN Srivastava Page 135 Repeat in December 2011 The murmur is the clinching point here as the patient is having ostium primum type of ASD with MR and Ostium primum defect alone cannot produce such murmur and in question it is already mentioned that the patient is having ASD, Floppy mitral valve should be the answer. \"Presence of pansystolic murmur of mitral regurgitation (MR) in a patient with ASD suggests the presence of ostium primum defect with cleft mitral laeflet or floppy mitral valve with mitral valve prolapsed\" \"ECG shows right axis detion in ostium secundum ASD and extreme left axis detion in ostium primum ASD\" \"Clinical presentation of ostium primum is similar to ostium secundum except that there may be a mitral systolic murmur due to MR and ECG shows left axis detion\"", "cop": 4, "opa": "TGA", "opb": "Ostium secondum", "opc": "Ostium primum", "opd": "Floppy mitral valve", "subject_name": "Pediatrics", "topic_name": null, "id": "a00d5ec0-a315-4ef5-a4ad-9e79c40fcb37", "choice_type": "single"}
+{"question": "Drug of choice for Prophylaxis of Bronchialitis in a child with heart disease", "exp": "Treatment for Bronchiolitis in a child with co-morbidities is inhaled Ribavirin.\nDrug of choice for prophylaxis of Bronchialitis in a child with co-morbidities is Palivizumab.", "cop": 3, "opa": "Ribavirin", "opb": "Doxycycline", "opc": "Palivizumab", "opd": "Penicillin V", "subject_name": "Pediatrics", "topic_name": null, "id": "2b523b65-91cd-4e21-9e91-ebfc05fce3a1", "choice_type": "single"}
+{"question": "Earliest sign of Rickets is", "exp": "A. i.e. (Craniotabes) (82- Ghai 7th) (128 - Ghai 6th)RICKETSSCURVY* Craniotabes* is the earliest manifestations (felt like a ping pong ball)* Anterior fontanel is large and its closure is delayed beyond 18 months* Bossing of frontal and parietal bones* Rachitic rosaiy (costochondral junction become prominent dome shaped and semicircular)* Pigeon breast - sternum projects forward* Harrison's groove (Horizontal depression)* Eruption of primary teeth delayed* Moderate degree of scoliosis kyphosis or lordosis* Epiphysis of long bones are widened and broadening of wrists* Long bones of legs get deformed when the child starts bearing weight* Anterior bowing of legs, knock knee and coxa vera*** Pot- belly (Abdomen become protuberant)* Visceroptosis and lumber lordosis* Child is listless, anorexic, fretful and cries onbeing handled* Bones are tender* Hemorrhages occur under the periosteum of long bones* Gum bleeds are common* Petechiae may be seen over the skin* Costochondral junction is prominent and appears sharp and angular* Scorbutic rosary is attributed to separation of epiphysis of ribs and backward displacement of sternum* Wound healing is delayed* Anemia may co- exist* Metaphyseal flaring of the anterior ends of the ribs is characteristically seen in rickets*** **First change to appear is \"loss of normal zone ofprovisional calcification\" adjacent to metaphysis", "cop": 1, "opa": "Craniotabes", "opb": "Harrison's groove", "opc": "Rachitic rosary", "opd": "Pigeon breast", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "e0a5cb7f-2b28-4417-a52c-4a27b949427c", "choice_type": "single"}
+{"question": "Most common cause of Congenital hypothyroidism is", "exp": "Most common cause of congenital hypothyroidism is thyroid dygenesis > thyroid dysharmonogenesis.", "cop": 3, "opa": "Thyroid agenesis", "opb": "Thyroid dysharmonogenesis", "opc": "Thyroid dysgensis", "opd": "Iodine deficiency", "subject_name": "Pediatrics", "topic_name": null, "id": "fa7f6990-3cc2-4793-be8a-afda9fa5dc0b", "choice_type": "single"}
+{"question": "Cause of \"bloody\" vomitus in a neonate", "exp": "Meckel&;s dieiculum may cause severe hemorrhage due to peptic ulceration. The blood is usually passed per rectum and is maroon in colour. it may cause bloody vomitus. Ref : BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,24 TH EDITION PG NO:1159", "cop": 1, "opa": "Meckel's diveiculum", "opb": "Intussusception", "opc": "Malrotation", "opd": "Cholecystitis", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "6e9ea73b-13c6-4306-9945-0dbfcdfa071f", "choice_type": "single"}
+{"question": "Surfactant deficiency occurs in", "exp": "Fetal lung maturation in diabetic pregnancy. The increased incidence of the idiopathic respiratory distress syndrome (IRDS) in infants of diabetic mothers may be explained by preterm delivery and asphyxia but the metabolic derangement per se may also be responsible for the inadequate production of surfactant Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Infant of diabetic mother", "opb": "Meconeum aspiration syndrome", "opc": "Transient tachypnea of newborn", "opd": "Bronchopulmonary dysplasia", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "aae67ca1-0bed-42ea-89a4-fbe7f8f8251c", "choice_type": "single"}
+{"question": "After 3 days of bih, the base of the umbilical cord is red and swollen. It indicates", "exp": "Redness or edema at the base of umbilical cord indicate inflammatory changes and infectionIt is called as omphalitis(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 890, 811)", "cop": 3, "opa": "Normal phenomenon", "opb": "CHF", "opc": "Infection", "opd": "Clotting factor deficiency", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "6620e14c-88bc-4f88-a928-195e1119cf62", "choice_type": "single"}
+{"question": "Diagnostic Criteria of JRA", "exp": "It is defined as ahritis of one or more joints with onset below 16 yr age and persisting for atleast 6 weeks Ref Ghai pediatrics eighth edition pg no 625", "cop": 1, "opa": "Disease persisting 6 weeks or longer", "opb": "Onset before age 16 years", "opc": "Ahritis involving >5 joints", "opd": "Polyaicular JRA ANA is +ve", "subject_name": "Pediatrics", "topic_name": "Musculoskeletal disorders", "id": "dd43d72c-1a78-4d51-b8c5-d376182cc99a", "choice_type": "single"}
+{"question": "OATP 1B1/2 gene mutation is seen in", "exp": "OATP 1B1/2 gene mutation - Rotor syndrome\nABCCA gene mutation - Dubin johnson syndrome", "cop": 2, "opa": "Gilbert syndrome", "opb": "Rotor syndrome", "opc": "Crigler Najjar syndrome", "opd": "Dubin Johnson syndrome", "subject_name": "Pediatrics", "topic_name": null, "id": "5a9d0548-367f-4baa-b501-a55ed3bcd2cd", "choice_type": "single"}
+{"question": "Persistence of Moro's reflex is abnormal beyond the age of", "exp": "3rd month According to Ghai 6th/e p. 146 \"Moro's reflex disappear at three month of age and persistence of this reflex beyond three months is abnormal.\" According to Ghai 7m/e p. 114 \"Moro's reflex disappear by six months in normal infant\" We have done an extensive search for this one. We are sure of one point. Persistence of Moro's reflex beyond 6 months of age indicates neurological abnormality \"In the normal infant the 17101-0' s reflex begins to fade at three months of age and gradually disappear at 4-6 months of age. When it persist beyond 6 months of age it indicates delay in CNS development such as cerebral palsy.\" (Tachdjian clinical paediatric ohopaedic p. 371) But still we are not sure what would be the answer for Moro's reflex disappear at ??", "cop": 1, "opa": "3rd month", "opb": "4th month", "opc": "5th month", "opd": "6th month", "subject_name": "Pediatrics", "topic_name": null, "id": "ea67a628-a54c-4ea3-8bf1-1d57bbe47e53", "choice_type": "single"}
+{"question": "Neonatal hepatitis, cholestasis, triangle shaped face, pulmonary stenosis is seen in", "exp": "The above clinical features seen in Alagille syndrome.", "cop": 3, "opa": "Apert syndrome", "opb": "Noonan syndrome", "opc": "Alagille syndrome", "opd": "William syndrome", "subject_name": "Pediatrics", "topic_name": null, "id": "0017cf50-1635-45f8-843a-7edce8448317", "choice_type": "single"}
+{"question": "In a neonate, Jaundice appears for the first time in the 2nd week. The following is not a cause", "exp": "In case of rh incompatibility the baby may have jaundice within 24 hrs and not late. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Galactosemia", "opb": "Rh Incompatibility", "opc": "Hypothyroidism", "opd": "Breast milk jaundice", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "d86bc87d-9db1-4950-b57a-206e93df3aba", "choice_type": "single"}
+{"question": "After premature delivery, mother's milk is low in", "exp": "Ans. a (Lactose) (Ref OP Ghai 6th/ p. 158; 7th/p. 131, 134)After premature delivery, mother's milk is low in:# Calcium # Phosphates # LactoseADVANTAGES OF BREAST MILK# Docosahexanoic acid (DHA, W3, 2:3) present in breast milk helps in brain development.# Maximum synthesis of breast milk occurs at 12 months.# Has better calcium than cow milk for baby to absorb.# Iron in breast has 70% availablity. # Prevents against infections by:- Human milk contains bacterial and viral antibodies, including secretory IgA. They probably account for the lower incidence of diarrhea, otitis media, pneumonia, bacteremia, and meningitis during the 1st yr of life.e- Macrophages in human milk may synthesize complement, lysozyme, and lactoferrin.- Lactoferrin has an inhibitory effect on the growth of Escherichia coli in the intestine.- The lower pH of the stool of breast-fed infants is thought to contribute to the favorable intestinal flora of infants fed human milk vs. formula (i.e., more bifidobacteria and lactobacilli; fewer E. coli), which also helps protect against infections caused by some species of E. coli.- Human milk also contains bile salt-stimulated lipase, which kills Giardia lamblia and Entamoeba histolytica.DISADVANTAGES OF BREAST MILK# Breast milk is balanced, will supply all the necessary nutrients except, perhaps, fluoride and, after several months, vitamin D.# The iron content of human milk is somewhat low. However, most normal infants have sufficient iron stores for the first 6 mo of life. Moreover, human milk iron is well absorbed.# The vitamin K content of human milk also is low and may contribute to hemorrhagic disease of the newborn. Parenteral administration of 1 mg of vitamin K, at birth is recommended for all infants, edpecially for those who will be breast- fed.# Cytomegalovirus (CMV), human T-cell lymphotropic virus type 1, rubella virus, hepatitis B virus, and herpes simplex virus also have been demonstrated in breast milk. Of these, the presence of CMV is the most troublesome.Nutritive value of milk compared BuffaloCowGoatHuman1Fat (g)6.54.14.53.42Protein (g)4.33.23.31.13Lactose (g)5.14.44.67.1Q4Calcium (mg)210120170285Iron (mg)0.20.20.3--6Vitamin C (mg)12137Minerals (g)0.80.80.80.18Water (g)81.08786.888", "cop": 1, "opa": "Lactose", "opb": "Fat", "opc": "Protein", "opd": "Sodium", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "2ec73e7d-7ab4-4724-8bc5-fb2213dd5217", "choice_type": "single"}
+{"question": "Myelodysplasia in fetus can be best diagnosed by", "exp": "Ans. a (AFP); (Ref. Robbins, Pathologic Basis of Disease, 6th/pg.325)Maternal serum AFP (MSAFP)# It is a oncofoetal protein# Highest level of which in foetal serum and amniotic fluid, it reaches around 13 weeks and decreases thereafter.# It reaches a peak around 32 weeks.# It decreases in Down's syndrome.# Its increased levels are seen in (Mnemonic = WORMIAN)- Wrong gestational age,- Open neural tube defects,- Renal anomalies,- Multiple pregnancy,- IUD,- Anterior abdominal wall defects,- Nephrotic syndrome (Congenital).# Ach esterase has better diagnostic value than AFP in open neural tube defects. (AI 2005)# Normal levels of AFP in liquor at 16th week = 20 mg/dL.# AFP is tumor marker for HCC, Non-seminomatous GCTs and ovarian sexcord tumors like Sertoli-Leydig tumors.", "cop": 1, "opa": "AFP", "opb": "Lumbar puncture", "opc": "HCG", "opd": "Unconjugated estriol", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "bca22e0b-6e5f-4a8a-bac1-4203bf2a3dd5", "choice_type": "single"}
+{"question": "A Full Term Baby, exclusively breast fed, at the end of 1 week was passing Golden yellow stools and was found to have adequate hydration with normal systemic examination. The weight of the baby was just same as it was at bih. The pediatrician should now advice", "exp": "Sometimes the physiological changes may vary from different children,proper reassurance to mother is very impoant. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Give oral solution with breast feeding", "opb": "Sta tap feeding", "opc": "Investigate for lactic acidosis", "opd": "Reassure the mother that nothing is abnormal", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "ca9a20d1-3db3-4570-a94e-66392e0fc2ff", "choice_type": "single"}
+{"question": "Central bronchiectasis is seen with", "exp": "The distribution . bronchiectasis mar be impoant diagnostically A central - Perihilar allergic bronchopulmonary aspergillosis. Predominant upper lobe o Middle and lower lobe - Cystic fibrosis or one of its variants. Distribution is consistent with PCD Lower lobe involvement is - Middle lobe and lingular segment of the LUL involvement is characteristic of non tuberculous mycobacteria (NTM). Idiopathic bronchiectasis REF : OP-GHAI 9th edition", "cop": 2, "opa": "Cystic Adenomatoid Malformation", "opb": "Cystic fibrosis", "opc": "Broncho carcinoma", "opd": "Tuberculosis", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "562e5228-d165-442b-b03a-0a78d9c30130", "choice_type": "single"}
+{"question": "ECG new born child with Down syndrome", "exp": "Ans. is 'a' i.e., Normal Neonatal ECG screening for congenital hea disease in Down syndrome. Narchi HI He studied the value of routine neonatal electrocardiography (ECG) in the 1st 48 hours of life to diagnose congenital hea disease in 37 neonates with Down syndrome. 60% infants had no clinical evidence of congenital hea disease, had normal ECGs and normal cardiac anatomy on echocardiography. About 40% children with down syndrome have congenital hea disease. Endocardial cushion defect (ASD with ostium primum) account for 40-60% of cases.", "cop": 1, "opa": "Normal", "opb": "ASD", "opc": "VSD", "opd": "TOF", "subject_name": "Pediatrics", "topic_name": null, "id": "9cb655fe-6b01-40a6-a518-97b9b9fd074d", "choice_type": "single"}
+{"question": "The cardiac silhouette can have an \"egg on side\" appearance in", "exp": "Transposition of great vessels (TGA) is defined as aoa arising from the right ventricle and pulmonary aery from the left ventricle. In patients with TGA, the oxygenated pulmonary venous blood recirculates in the lungs whereas the systemic venous blood recirculates in the systemic circulation. The pulmonary aery saturation is thus always higher than the aoic saturation. Survival depends on the mixing available between the two circulations. Patients of complete TGA with intact ventricular septum are cyanotic at bih. Since the interatrial communication results in poor mixing, the neonates present with rapid breathing and congestive failure secondary to hypoxemia within the first week of life. Physical examination shows severe cyanosis, congestive failure, normal first sound, single second sound and an insignificant grade one to two ejection systolic murmur. The electrocardiogram shows right axis detion and right ventricular hyperophy. The thoracic roentgenogram shows cardiomegaly with a narrow base and plethoric lung fields. The cardiac silhouette can have an \"egg on side\" appearance: The right upper lung fields appear more plethoric than other areas. The thymic shadow is often absent. Patients of TGA with VSD have increased pulmonary blood flow; mixing at the ventricular level determines the severity of cyanosis. They develop congestive failure around 4-10 weeks of age. Physical findings consist of cyanosis, cardiomegaly, congestive failure, normal first sound, single or normally split second sound and grade II-IV ejection systolic murmur. Apical third sound gallop or a mid-diastolic rumble may be present. Electrocardiogram shows right axis detion with biventricular, right ventricular or left ventricular hyperophy. Chest X-ray shows cardiomegaly, plethoric lung fields and features of pulmonary venous hypeension. The aerial switch operation is now established as the treatment of choice for TGA, Prostaglandin El can help reduce cyanosis in selected cases by keeping the PDA open. Interim palliation can be accomplished through a balloon atrial septostomy. Reference: Essential Paediatrics; O.P. Ghai; Page no: 425", "cop": 4, "opa": "VSD", "opb": "PDA", "opc": "TOF", "opd": "Transposition of Great Vessels", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "160f1ef7-451b-4362-bd71-97c72fcc8140", "choice_type": "single"}
+{"question": "Confirmatory test for cushing's disease is", "exp": null, "cop": 4, "opa": "High dose dexamethasone suppression test", "opb": "24 hr urine free cortisol", "opc": "Overnight dexamethasone suppression test", "opd": "Bilateral inferior petrous sinus sampling", "subject_name": "Pediatrics", "topic_name": null, "id": "6f88efd9-6b88-464e-afde-30a089058fb9", "choice_type": "single"}
+{"question": "Chromosome associated with autosomal dominant PCKD", "exp": "PKD1 gene → Chromosome 16.\nPKD2 gene → Chromosome 4.", "cop": 3, "opa": "6 and 14", "opb": "12 and 14", "opc": "4 and 16", "opd": "12 and 16", "subject_name": "Pediatrics", "topic_name": null, "id": "bdce8547-481d-4aa4-8ac1-1fbf732162ac", "choice_type": "single"}
+{"question": "Hyperbilirubinemia in a child can be due to", "exp": "Breast milk jaundice - bilirubin in excess of 10mg/dl. Seen beyond 3rd-4th weeks of life. A diagnosis of breast milk jaundice should be considered if this is unconjugated (not staining nappies) and other causes for prolongation such as inadequate feeding, continuing hemolysis, extravasated blood, G6PD deficiency and hypothyroidism have been ruled out. Cystic fibrosis is an autosomal recessive disorder caused by mutation in the gene encoding the chloride conductance channel, CF transmembrane conductance regulator(CFTR). The failure of chloride conductance by epithelial cells leads to dehydration of secretions that are too viscid and difficult to clear. Fanconi syndrome is characterised by tubular proteinuria and aminoaciduria and variable degrees of bicarbonaturia, phosphaturia, electrolyte wasting and glucosuria. Alpha1-antitrypsin deficiency (AATD) is a genetic inherited autosomal-codominant condition. People with AATD are predisposed to obstructive pulmonary disease and liver disease (eg, cirrhosis and hepatocellular carcinoma in children and adults). Reference : page 172,499, 393 Ghai Essential Pediatrics 8th edition", "cop": 1, "opa": "Breast milk jaundice", "opb": "Cystic fibrosis", "opc": "Fanconi's syndrome", "opd": "Alpha - 1 antitrypsin deficiency", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "0c09b283-a185-4b89-825b-04c0079c3343", "choice_type": "single"}
+{"question": "Profuse watery diarrhoea in an immune compromised child is due to", "exp": "Giardiasis caused by Giardia lamblia is a major cause of diarrhoea in children and travellers. Individuals with malnutrition,humoral immunodefeciencies,and cystic fibrosis are particularly susceptible.\nFeatures: acute diarrhoea with sudden onset of explosive, watery foul smelling stools, along with nausea and anorexia,abdominal distension,flatulence,epigastric camps and mild fever.", "cop": 3, "opa": "Cryptococcus", "opb": "Amoeba", "opc": "Giardia", "opd": "Lactose intolerance", "subject_name": "Pediatrics", "topic_name": null, "id": "c088fbf4-f74b-405c-9f75-06120a90ff1a", "choice_type": "single"}
+{"question": "Early eiphyseal closure is seen with", "exp": "(Estrogens): Ref: 1859-Nelson 17thEstrogen has direct result of the known on promoting epiphyseal fusion and therapy must begin before the bone age has reached 12 years (Marfan's syndrome)* Recent studies have demonstrated that is estrogen that mediates epiphyseal fusion in both girls and boys* Androgens also accelerates skeletal maturation, presumably via aromatization to estrogens, but at the price of rapid virilization.", "cop": 3, "opa": "LH", "opb": "FSH", "opc": "Estrogens", "opd": "Progesterone", "subject_name": "Pediatrics", "topic_name": "Growth, Development, and Behavior", "id": "ffb7b407-1ace-4ccc-8726-b0b69929defc", "choice_type": "single"}
+{"question": "Trisomy 13 is seen in", "exp": "Trisomy 13 is seen in Patau syndrome Edward syndrome is trisomy 18 Down syndrome trisomy 21 and turner syndrome is due to 45 XO . Reference : Nelson TB of pediatrics 19th edition.", "cop": 2, "opa": "Edward Syndrome", "opb": "Patau Syndrome", "opc": "Down Syndrome", "opd": "Turnur Syndrome", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "1e8a8adb-1e71-42e9-8815-85aa752e139b", "choice_type": "single"}
+{"question": "A 9 months old girl is presented with PR bleed, vomiting, mass & colicky pain in Rt lumbar region with masked liver dullness. She is in shocklike condition. Management should includes", "exp": ".Intussusception Mostly between 6-11 months of age Features:intermittent colicky abdominal pain,vomiting,bloody mucous stools(current jelly) History of recent change of milk formula,upper respiratory tract infection,vaccination may be present. Sausage shaped mass maybe palpable on right quadrant of abdomen...iliac fossa may appear empty it is a surgical emergency but aim is reduction of the obstructed bowel.in intussusception of sho duration hydrostatic pressure of the barium enema or saline enema usually relieve it. ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:259,7 th edition", "cop": 1, "opa": "Barium enema", "opb": "Saline reduction", "opc": "Give O2", "opd": "Nasogastric tube", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "73829694-f73d-4a87-a101-7b7a29a87c18", "choice_type": "single"}
+{"question": "Expressed breast milk can be stored at room temperature for", "exp": "Expressed Breast Milk (EBM) If a mother is not in a position to feed her baby (e.g. ill mother, preterm baby, working mother, etc.), she should express her milk in a clean wide-mouthed container and this milk should be fed to her baby. EBM can be stored at room temperature for 6-8 hr, in a refrigerator for 24 hr and a freezer at -20degC for 3 months. Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 155", "cop": 2, "opa": "1-4 hours", "opb": "6-8 hours", "opc": "12-24 hours", "opd": "> 24 hours", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "31c356ad-31a8-473e-8168-844172c8ef8f", "choice_type": "single"}
+{"question": "Wilson disease is caused by defect in", "exp": "ATP 7B gene on chromosome 13 is mutated in Wilson disease.", "cop": 4, "opa": "ATP 7A mutation", "opb": "ATP 6A mutation", "opc": "ATP 6B mutation", "opd": "ATP 7B mutation", "subject_name": "Pediatrics", "topic_name": null, "id": "ace998ba-39cf-4efc-8f43-a53bc1576b3f", "choice_type": "single"}
+{"question": "A 3 year old child comes with complaint of limp diagnosis is", "exp": ".Septic ahritis, also known as jointinfection or infectious ahritis, is the invasion of a joint by an infectious agent resulting in joint inflammation. Symptoms typically include redness, heat and pain in a single jointassociated with a decreased ability to move the joint.", "cop": 1, "opa": "Septic Arhritis", "opb": "Slipped capital femoral epiphysis", "opc": "Pehe's disease", "opd": "DDH", "subject_name": "Pediatrics", "topic_name": "Musculoskeletal disorders", "id": "41da97d2-ffff-4e11-8667-0898943e2635", "choice_type": "single"}
+{"question": "Mousy odor of urine is seen in", "exp": "Children with classic phenyl ketonuria have an unpleasant odour of urine due to presence of phenylacetic acid,which is often described as musty or mousey. Phenylketonuria is due to deficiency of enzyme phenylalanine hydroxylase or of its cofactor tetra hydro biopterin. Reference: Nelson TB of pediatrics pg 418 edit", "cop": 2, "opa": "Isovaleric acidemia", "opb": "Phenyl ketonuria", "opc": "MSUD", "opd": "Tyrosinemia", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "52941748-3e30-4e06-8873-d1e7ce639f4b", "choice_type": "single"}
+{"question": "Most common GI malignancy of childhood", "exp": "Ans. is 'b' i.e., Lymphoma Over all hemangioma is most common Tumor in infant. Hemangioma is usually benign in Nature. Leukemia is most common malignancy in pediatric age gyp. 2\"' most common is CNS Tumor = Lymphoma is the most common malignancy of the gastrointestinal tract in children. About 30% of children with non-Hodgkin lymphoma present with abdominal tumors.", "cop": 2, "opa": "Adenocarcinoma", "opb": "Lymphoma", "opc": "Sarcoma", "opd": "carcinoid", "subject_name": "Pediatrics", "topic_name": null, "id": "3c6fba5c-2380-4e7c-8590-af1ada0a39ed", "choice_type": "single"}
+{"question": "The test is done to diagnose syphilis in a newborn if the mother is syphilitic is", "exp": "Diagnosis of congenital syphilisIt involves Dark ground Microscopy and VDRL.As IgM does not cross the placenta, its presence in neonatal serum confirms congenital syphilis and helps to differentiate it from seropositivity due to passively transferred maternal antibodies. The tests to detect IgM are-FTA-ABS (19S IgM FTA-ABS)Syphilis Capita M test(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1475-1477)", "cop": 1, "opa": "Syphilis Capita M test", "opb": "Detection of IgG", "opc": "ZN staining", "opd": "Fluorescent antigen test", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "21bd180c-94a3-4a44-b512-36ab1fe09ef9", "choice_type": "single"}
+{"question": "A newborn baby presented with profuse bleeding from umbilical stump after birth. Probable diagnosis is", "exp": "Ans. is 'a' i.e. Factor XIII deficiency Bleeding from umbilical stump suggests Factor XIII deficiency.Neonates with a positive bleeding history, particularly with features such as delayed bleeding, umbilical stump bleeding or miscarriages and in whom the initial panel of screening test is negative should be tested for factor XIII deficiency.The normal screening tests such as PT and PTT are normal in factor XIII deficiency because factor XIII is needed to stabilize the clot after a fibrin clot has formed, so tests used for evaluating the extrinsic or intrinsic pathways are not affected. (Note, that factor XIII is used, once the clot has formed.)Test used for evaluation of factor XIIITest used in qualitative evaluation of factor XIII is evaluation of clot stability in 5M urea.Clots formed from normal individuals remain stable in 5M urea, while clots from factor XIII deficient patient dissolve in urea.This assay detects only the most severely affected patients with 1% to 2% factor XIII deficiency or tests.A quantitative chromogenic assay has been developed but is not yet readily available.In addition to hemorrhages these patients may have poor wound healing a high incidence of infertility among males and abortion among affected females and a high incidence of intracerebral hemorrhage.About other options:Von Willebrand diseasePatients with Von-Willebrand disease rarely presents in the neonatal period because plasma concentration of Von Willebrand factor is high in neonatal period.Platelet function disordersGenetic disorders that result in deficient platelet function are rare causes of bleeding in infants.Most patients with these platelet disorders do not present in neonatal period but rather later in life. They are not recognized as a problem during the neonatal period.Glanzman's thromboastheniaThis is an extremely rare disorder of the blood in which the platelets lack the glycoprotein IIb/HIa.Hence platelet aggregation cannot occur and bleeding time is significantly prolonged and there is increased bleeding.Bernard Soulier syndromeIt is an autosomal recessive disorder characterized by thrombocytopenia and large platelets (giant platelets)There is absence of the platelet membrane GpIb/IX complex.Symptoms are consistent with low or dysfunctional platelets and include easy bruising, nosebleeds, mucosal bleeding, menorrhagia and occasionally G.I. bleedingFactor XII deficiency * It is not associated with clinical bleeding.", "cop": 1, "opa": "Factor XIII deficiency", "opb": "VWF deficiency", "opc": "Factor XII deficiency", "opd": "Glanzmann thrombosthenia", "subject_name": "Pediatrics", "topic_name": "The Umbilicus", "id": "f0383f5b-0334-4e96-81d9-9471ecc5bfa4", "choice_type": "single"}
+{"question": "Best indicator of growth monitoring in children aEUR'", "exp": "Rate of increase in height & weight Midarm circumference, Body weight and chest circumference are one time point estimates therefore they are not adequate to provide information about long term nutritional stats of the child. A measurement which shows the time trends like rate of increase in height or weight with passage of time would be more useful. - The growth chas demonstrate progressive change in the height and weight of child as age advances therefore they are the best indicator of long term nutritional status. \"The growth cha has been described as passpo to child health care. It has won international recognition and is now a standard method of monitoring children's health and nutritional status\". Uses of growth cha - For growth monitoring - Diagnostic tool for identifying \"high risk\" children - Planning and policy making - Education tool - Tool.for action - Evaluation - Tool for teaching", "cop": 3, "opa": "Weight", "opb": "Mid-arm circumference", "opc": "Rate of increase in height & weight", "opd": "Head circumference", "subject_name": "Pediatrics", "topic_name": null, "id": "4822dcf8-790c-4b4d-8841-1d551543d50e", "choice_type": "single"}
+{"question": "Expressed Breast milk can be stored in refrigerator up to", "exp": "(24 hours) (151-Ghai 6th) (127-Ghai 7th)Expressed breast milk can be stored at room temperature for 6-8 hours* In refrigerator - 24 hours* In freezer at - 20deg for 3 months", "cop": 3, "opa": "4 hours", "opb": "10 hours", "opc": "24 hours", "opd": "3 months", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "23aa558d-99c2-4667-8286-18762c27e6cd", "choice_type": "single"}
+{"question": "Acquired megacolon can be due to", "exp": "Acquired megacolon may occur at any age as a result of Chagas disease (Trypanosoma cruzi), obstruction by a neoplasm or inflammatory stricture, toxic megacolon complicating ulcerative colitis, visceral myopathy, or in association with functional psychosomatic disorders (poor toilet training during infancy). Ref : Bailey and Love 26e pg: 1177", "cop": 3, "opa": "Leishmaniasis", "opb": "Typhoid", "opc": "Chagas disease", "opd": "Amoebiasis", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "8e9cc0a8-4ad4-4537-925e-aa7e0200ede4", "choice_type": "single"}
+{"question": "A3 year old girl has problems with writing and spelling. Other intelligence is normal", "exp": "Dyslexia\n\nDyslexia - problem in reading, spelling and written expression\nIntelligence is normal\nDyslexia is the most common type of learning disability.\nChildren with dyslexia have problem in reading, spelling and written expression.\nThe important clues to dyslexia in school age children include delayed language, trouble rhymic words, mispronunciation, hesitation,\nwork-finding difficulties and poor spellings with presence of letter reversal. Reading is slow, inaccurated and labored.", "cop": 3, "opa": "Specific writing disorder", "opb": "Mental retardation", "opc": "Dyslexia", "opd": "Dysphonia", "subject_name": "Pediatrics", "topic_name": null, "id": "15385aaa-b0a5-4e7f-8d56-d48ac3d00de0", "choice_type": "single"}
+{"question": "A 3 day child vomits everything he feeds, has a distended abdomen & diarrhoea. The urine is positive for benedicts test for reducing substance. The substance in urine is aEUR'", "exp": "Galactose Characteristic symptom i.e., vomiting, distended abdomen and diarrhea along with the presence of reducing substance in the urine suggests the diagnosis of galactosemia Benedict's Test Benedict's test is a biochemical test to detect reducing sugars. -Benedicts test detects the presence of aldehydes except (aromatic ones) and alpha hydroxyketones in a compound. All monosaccharides are reducing sugars i.e., they all have a free reactive aldehyde group and are positive on Benedicts. Some disaccharides such as fructose have alpha hydroxyl ketones and can reduce sugars. All other disaccharides are non reducing sugars and will not react with Benedict's solution Galactosemia Galactosemia is a group of inherited metabotic disorders in which an enzyme deficiency affects the normal metabolism of the sugar galactose Galactose is a monosaccharide Most of the galactose originates from the dairy products that contain lactose or milk sugar Lactose is a disaccharide that is catalyzed by the enzyme lactase into two monosaccharides i.e. lactose and glucose From the intestine the galactose is transpoed to liver where it is conveed to glucose phosphate, which can be used in several metabolic pathway. Conversion of Galactose to Gulose I phosphate occurs in several successive steps. A specific enzyme is required at each step Galactosemia occurs because of the deficiency of any of the enzymes involved in the metabolism of Galactose. The most common enzyme associated with galactosemia is the deficiency of the enzyme galactose -1- phosphate uridyl trans-ferase. The deficiency of the enzyme or the defect in the metabolism results in an accumulation of galactose -1- PO4 and galacticol that are thought to have direct toxic effect on the liver and other organs. Clinical features Infants with galactosemia appear normal at bih, however symptomsusually appear a few days to weeks after initiating galactose containing .feeds The early clinical features of severe galactosemia include liver dysfunction, manifested by jaundice and hypoglycemia, The accompanying gastrointestinal.findings are poor feeding, vomiting and diarrhoea. Due to the effect of galacticol toxicity on brain it may cause C.N.S symptoms to predominate which are irritability and seizures Diagnosis If galactosemia is suspected, urine should be tested simultaneously with Benedicts reagent and with Glucose oxidase method. - The Glucose oxidase method is specific for glucose, whereas - Benedict's reagent can detect any reducing substance -A negative glucose oxidase test with positive benedicts test suggests that a non glucose reducing substance is present. - With appropriate clinical findings this is most likely to be galactose Confirmatory diagnosis The confirmatory diagnosis is made by the enzyme assay.", "cop": 3, "opa": "Sucrose", "opb": "Glucose", "opc": "Galactose", "opd": "Fructose", "subject_name": "Pediatrics", "topic_name": null, "id": "23416b6c-93d0-4a24-8f04-b11ceb75ea3d", "choice_type": "single"}
+{"question": "Commonest cause of hypothyroidism is", "exp": "(Thyroid dysgenesis) (1872-73-Nelson 17th) (481-Ghai 7th)HYPOTHYROIDISM results from deficient production of thyroid hormone or a defect in thyroid hormone or a defect in thyroid hormonal receptor activity* Someform of thyroid dysgenesis (aplasia, hypoplasia or an ectopic gland) is the most common cause of congenital hypothyroidism, accounting for 85% of cases, 10% are caused by an in bom error of thyroxine synthjesis and 5% are the result of transplacental maternal thyrotropin receptor blocking antibody.* Pendred syndrome - congenital hypothyroidism with sensorineural deafness and goiter, also have a positive perchlorate discharge.* ** Sodium L-thyroxine given orally is the treatment of choices (side effects are - craniosynostosis and temperature problems pseudotumour cerebri)* Acquired hypothyroidism - is most commonly caused by auto immune destruction of thyroid as a part of Chronic lymphocytic thyroidits (Hashimoto's thyroiditis", "cop": 4, "opa": "Defective synthesis of thyroxine", "opb": "Defect of iodide transport", "opc": "Defect of the thyroglobulin synthesis", "opd": "Thyroid dysgenesis", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "ee998901-aeb1-4859-a627-b2475c045118", "choice_type": "single"}
+{"question": "Investigation of choice for confirming Henoch Schonlein Purpura is", "exp": "Biopsy of the kidney may be performed both to establish the diagnosis or to assess the severity of already suspected kidney disease. The main findings on kidney biopsy are increased cells and IgA deposition in the mesangium (pa of the glomerulus, where blood is filtered), white blood cells, and the development of crescents.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1217 - 1218)", "cop": 3, "opa": "Serum IgA levels", "opb": "CRP levels", "opc": "Renal Biopsy", "opd": "DTPA", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "9b731916-576e-492b-8e33-50d968002657", "choice_type": "single"}
+{"question": "The poor indicator of response during treatment of malnutrition includes", "exp": "Primary failure to respond may be characterized by:1. Failure to regain appetite by day 42. Failure to sta losing edema by day 43. Failure of the disappearance of edema by day 104. Failure to gain weight at least by 5g/kg/day by day 10 of therapyRef: Nelson Paediatrics; 20th edition", "cop": 2, "opa": "Failure to gain appetite by day 10", "opb": "Presence of edema on day 10", "opc": "Failure to gain at least 5 g/kg/day by day 4", "opd": "Failure to gain at least 2 g/kg/day by day 10", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "fcbe1cdb-e265-4297-b43f-645404a411b8", "choice_type": "single"}
+{"question": "Endemic cardiomyopathy in children is linked to the deficiency of", "exp": "Deficiency of selenium has resulted in Keshan disease, a form of cardiomyopathy endemic in China. Other dietary factors such as low intake of vitamin E, protein, and methionine are also considered relevant to the causation of the disease. Selenium deficiency is usually associated with vitamin E deficiency. Ref: Page 131; Ghai essential pediatrics; 6th edition", "cop": 3, "opa": "Zinc", "opb": "Cobalt", "opc": "Selenium", "opd": "Chromium", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "52fa6fb4-089c-44ef-af85-f51091d1a255", "choice_type": "single"}
+{"question": "In pediatric advanced life suppo intraosseous access for drug/fluid administration is recommended for", "exp": "Intraosseous infusion (IO) is the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system. This technique is used in emergency situations to provide fluids and medication when intravenous access is not available or not feasible. A comparison of intravenous (IV), intramuscular (IM), and intraosseous (IO) routes of administration concluded that the intraosseous route is demonstrably superior to intramuscular and comparable to intravenous administration (in delivering paediatric anesthetic drugs). Due to the rapid advance and adoption of superior intraosseous access technology, IO access has now become the preferred method of establishing vascular access for patients in whom traditional access is difficult or impossible. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "<1 year", "opb": "<6 years", "opc": "<12 years", "opd": "Any age", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "6f5a90c7-ae27-444a-bc3f-7ce2a336728d", "choice_type": "single"}
+{"question": "The gene for Wilson&;s disease is on", "exp": "In Wilson&;s disease,the underlying defect lies in the long arm of chromosome 13 where there is a mutation in ATP7B gene,the normal hepatic copper- excreting gene.Eventually,capacity of hepatocytes to store copper is exceeded and copper is released into circulation which then gets deposited in extrahepatic tissues such as the brain eyes, and others. Reference:Textbook of pathology-Harsh Mohan,6th edition,page no:628", "cop": 1, "opa": "Long arm of Chromosome 13", "opb": "Long arm of Chromosome 6", "opc": "Sho arm of Chromosome 13", "opd": "Sho arm of Chromosome 6", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "3646cd16-a20e-4196-8e4e-7e2f749a53b2", "choice_type": "single"}
+{"question": "Hematopoisis in first month of life is", "exp": "After bih, and during early childhood, hematopoiesis occurs in the red marrow of the bone. With age, hematopoiesis becomes restricted to the skull, sternum, ribs, veebrae, and pelvis. Yellow marrow, comprised of fat cells, replaces the red marrow and limits its potential for hematopoiesis. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Medullary", "opb": "Hepatic", "opc": "Lymphatic", "opd": "Mesoblastic", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "31dfdc88-2f02-4512-9d31-99964bb411f5", "choice_type": "single"}
+{"question": "Moderate Hypothermia in a neonate is defined as an axillary temperature", "exp": "Classification of Neonatal hypothermia: Cold stress: 36.0 - 36.4oC Moderate hypothermia: 32 - 35.9oC Severe hypothermia: < 32oC.", "cop": 4, "opa": "< 34 degree C", "opb": "31-34 degree C", "opc": "< 32 degree C", "opd": "32-35.9 degree C", "subject_name": "Pediatrics", "topic_name": "Neonatal hypothermia", "id": "8b92fb45-9e7f-45c3-9dec-737f7511e45e", "choice_type": "single"}
+{"question": "Enzyme replacement therapy is most commonly used for", "exp": "Gaucher disease is a multisystemuc lipidosis characterized by hematological abnormalities,organomegaly and,skeletal involvement.It has 3 clinical subtypes . It occurs due to the deficient activity of acid beta glucosidase . Thus glucosylceramide accumulate in reticule end I the loam cells. Treatment is mainly enzyme replacement therapy with recombinant acid beta glucosidase.Most extra skeletal symptoms are reversed by 60 IU/kg enzyme iv infusion every other week. Monthly maintenance improves skeletal manifestations. Reference: Nelsons TB of pediatrics 19th edit,pg 487", "cop": 1, "opa": "Gaucher's disease", "opb": "Fabry's disease", "opc": "Niemenn pick's disease", "opd": "Pompe disease", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "82a59bbf-ca52-45a6-a50e-aede05ee61bf", "choice_type": "single"}
+{"question": "The Blood sugar in a neonate sholy after bih reaches the lowest level of 30 mg/dl at the age of", "exp": "Hypoglycemia is a condition in which the level of glucose in the blood is lower than normal. A baby is at risk if he or she has a mother with diabetes, is preterm, or is large. If your baby has signs of hypoglycemia, give him or her formula or glucose and water mixture. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "1 hour", "opb": "3 hours", "opc": "6 hours", "opd": "8 hours", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "e7c06173-0ca9-4e83-a2f4-77e5b22644de", "choice_type": "single"}
+{"question": "Best method of estimation of amount of proteinuria in a 2 year child with nephrotic syndrome is", "exp": "c. Spot urine sample for protein/creatinine ratio(Ref: Nelson 20/e 2518)Though 24 hr urine for protein and creatinine, is more accurate, but due to difficulty in collecting 24 hour urinary sample in children, Spot urine sample for protein/creatinine ratio is preferred.", "cop": 3, "opa": "Dipstick testing", "opb": "24 hr urine protein", "opc": "Spot urine sample for protein/creatinine ratio", "opd": "Microalbuminuria", "subject_name": "Pediatrics", "topic_name": "Kidney", "id": "cee9fc3f-1d28-4832-ad61-f36d55fe76f8", "choice_type": "single"}
+{"question": "Most common cause of acquired hea disease in children", "exp": "Ans. is 'a' i.e., Acute Rheumatic fever Acute rheumatic fever Most common cause of acquired hea disease in children. Caused by group A f3 hemolytic streptococci Usually seen in school going children Jones criteria = very impotrant Mitral valve most common followed by aoic valve In acute phase - MR seen In RI-ID MS seen", "cop": 1, "opa": "Acute rheuamatic fever", "opb": "Kawasaki", "opc": "Takayasu", "opd": "Diabetes", "subject_name": "Pediatrics", "topic_name": null, "id": "4d7e730c-3810-4263-aed2-8442c3445770", "choice_type": "single"}
+{"question": "In Sickel cell disease, aplastic crisis is due to", "exp": "In Sickel cell disease, due to infection of red cell progenitors by ParvoVirus B19 infection aplastic crisis occurs.", "cop": 3, "opa": "Herpes infection", "opb": "Measles infection", "opc": "Parvo Virus B19 infection", "opd": "Rubella infection", "subject_name": "Pediatrics", "topic_name": null, "id": "46f9f6da-5c43-4fce-870e-0ae2b35bf70d", "choice_type": "single"}
+{"question": "In child, foreign body in lung", "exp": "The children are treated by removal of foreign body through a rigid bronchoscope.Bronchoscopy should be undeaken if the clinical and radiological picture suggests the diagnosis even when the history of foreign body aspiration is not fohcoming. Ref : Essential Paediatrics,O.P.Ghai,7th edition,Pg No:368", "cop": 1, "opa": "Rigid bronchoscopy", "opb": "Chest x-ray", "opc": "Flexible endoscopy", "opd": "Direct laryngoscopy", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "5da30f8c-ad44-4f29-ae5a-9f4c58911b3d", "choice_type": "single"}
+{"question": "A 4 year baby is having large face, large jaw, large ear and macro orchidism is", "exp": "A child with large face large ears large jaw and macro orchidism has fragile X syndrome It is due to a fragile site in one of the distal long arm of chromosome Xq27.3 Reference: Nelson TB of pediatrics pg 411 edition 19.", "cop": 4, "opa": "Mc Cuneal bright syndrome", "opb": "Down's syndrome", "opc": "Cri-du chat syndrome", "opd": "Fragile X syndrome", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "944bd626-f3f8-4e4d-938e-692b21279406", "choice_type": "single"}
+{"question": "Calculate the silverman score for a neonate with paradoxical breathing, mild lower chest retraction, marked xiphoid retraction, minimal nasal flare and expiratory grunt audible without stethoscope", "exp": "Score for Paradoxical breathing\n2\n\n\nMild lower chest retraction\n1\n\n\nMarked xiphoid retraction\n2\n\n\nMinimal nasal flare\n1\n\n\nExpiratory grunt audible without stethoscope\n2\n\n\nTotal score\n8", "cop": 3, "opa": "6", "opb": "7", "opc": "8", "opd": "9", "subject_name": "Pediatrics", "topic_name": null, "id": "591ef9e0-76ff-470f-8219-eac8cfdd33a9", "choice_type": "single"}
+{"question": "Macrosomia is a", "exp": "Macrosomia:- A condition where a baby is large before bihFactors causing macrosomia:Mother having diabetesMother having gestational diabetesObese mother(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 777, 897 - 899)", "cop": 1, "opa": "Large size baby", "opb": "Big mouth", "opc": "Large head", "opd": "Large tongue", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "e828463d-f844-4e66-acb8-7b75e9733df4", "choice_type": "single"}
+{"question": "Characteristic feature of Systemic Juvenile Idiopathic Arthritis is", "exp": "Systemic Juvenile Idiopathic Arthritis\n\nIt begins at below 16 years of age\nNSAIDs are given \nRa factor is negative\nUveitus is seen in oligoarticular JIA", "cop": 4, "opa": "Uveitis is a feature", "opb": "It occurs after 16 years of age", "opc": "NSAIDs are contraindicated", "opd": "RA factor is negative", "subject_name": "Pediatrics", "topic_name": null, "id": "aee54667-ff80-4a7a-a196-550c4646a259", "choice_type": "single"}
+{"question": "Initial drug of choice in a child with status epilepticus", "exp": "Prompt treatment with benzodiazepines is the first-line treatment of status epilepticus, but many patients will need additional treatment with additional medications including phenytoin, valproic acid, phenobarbital, or levetiracetam. The Neurocritical Care Society's guideline states that benzodiazepines remain the \"emergent initial therapy\" of choice based both on available evidence and expe consensus. When possible, intravenous benzodiazepine administration is preferred. However, formulations exist for buccal, intranasal, intramuscular, and rectal administration, and these should be administered if intravenous access cannot be rapidly established. The American Epilepsy Society's guideline concludes that intravenous lorazepam and diazepam are efficacious at stopping seizures lasting at least five min and that rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective at terminating seizures lasting at least five minutes . Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Lorazepam", "opb": "Phenobarbitone", "opc": "Valproate", "opd": "Phenytoin", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "915f4dec-f6e4-412d-89aa-7efa5c092fe4", "choice_type": "single"}
+{"question": "Exclusive breast feeding means", "exp": "(D) Breast feeding only > Exclusive Breastfeeding. Only breastmilk is given. No other food or drink, not even water, is given. Medicines, vitamins or mineral drops are permitted if indicated. An infant should be exclusively breastfed for first 6 months of life.", "cop": 4, "opa": "Breast feeding on demand only + solid foods at other times", "opb": "Breast feeding + solid foods + water", "opc": "Breast feeding + water", "opd": "Breast feeding only", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "f514e5ec-8006-4ca3-8740-e05702e90bce", "choice_type": "single"}
+{"question": "Vision is tested in the newborn by", "exp": "Methods of assessing vision in infants:Papillary light reflexRed reflexOptokinetic nystagmus (using nystagmus drum)Visual evoked potentialsAbility to follow a target(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2802)", "cop": 3, "opa": "Electrooculogram", "opb": "Electroretinogram", "opc": "Visual Evoked potentials", "opd": "Brainstem Response assessment", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "6246b106-68c8-45f7-8c84-3950a04bc779", "choice_type": "single"}
+{"question": "2 year old baby having testicular lump. Increased AFP diagnosis", "exp": "Yolk sac tumor is the most common characteristic testicular tumor of infants and young children up to the age of 4 years.Alphafetoprotein levels are elevated in 100% cases of yolk sac tumors. Germ cell tumours unrelated to germ cell neoplasia in situ (non-GCNIS) Spermatocytic tumour Yolk sac tumour, prepubeal type Teratoma, prepubeal type - Dermoid cyst - Epidermoid cyst - Differentiated neuroendocrine tumours Mixed teratoma and yolk sac tumour, prepubeal type Germ cell tumours derived from germ cell neoplasia in situ (GCNIS) Seminoma Embryonal carcinoma Yolk sac tumour, postpuberal type Choriocarcinoma Teratoma, postpuberal type Mixed germ cell tumours Regressed germ cell tumours Sex cord-stromal tumours Leydig cell tumour Seoli cell tumour Granulosa cell tumour Tumour containing both germ cell and sex cord-stromal elements Gonadoblastoma Haematolymphoid tumours Tumours of collecting duct and rete testis Miscellaneous Reference:Textbook of pathology-Harsh Mohan,6th edition,page no:711.", "cop": 1, "opa": "Yolk sac tumor", "opb": "Seminoma", "opc": "Choriocarcinoma", "opd": "Teratoma", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "01857b92-077c-4821-b652-9fc959e430a1", "choice_type": "single"}
+{"question": "Drugs that can be used in Kernicterus", "exp": "Barbiturates can be used in Kernicterus . Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Barbiturates", "opb": "Benzodiazepines", "opc": "Phenytoin", "opd": "Chlorpromazine", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "186e43a8-1100-4716-991e-81748838606c", "choice_type": "single"}
+{"question": "The most common manifestation of congenital toxoplasmosis", "exp": "*Congenital toxoplasmosis is caused by toxoplasma gondi .The transmissibility increases but the risk of feral disease decreases with advancing pregnancy * The classical triad of toxoplasmosis includes intracranial calcification, hydrocephalus and chorioretinitis. Diagnosis is confirmed by demonstrating IgM in serum of the baby Image : Severe, active retinochoroiditis. Reference : Ghai essential pediatrics, 9 th edition, pgno :264", "cop": 2, "opa": "Deafness", "opb": "Chorioretinitis", "opc": "Hepatosplenomegaly", "opd": "Thrombocytopenia", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "75f686b2-0de1-4692-b43e-e4369a67efec", "choice_type": "single"}
+{"question": "A 5 year old boy comes with overnight petechial spots 2 weeks back he had history of abdominal pain and no hepatosplenomegaly. Diagnosis is", "exp": "most probable diagnosis here is ITP. in ALL there will be hepatosplenomegaly of a plastic anemia infection Symptoms Immune thrombocytopenia may have no signs and symptoms. When they do occur, they may include: Easy or excessive bruising Superficial bleeding into the skin that appears as pinpoint-sized reddish-purple spots (petechiae) that look like a rash, usually on the lower legs Bleeding from the gums or nose Blood in urine or stools Unusually heavy menstrual flow Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Aute lymphatic leukemia", "opb": "Aplastic anemia", "opc": "Idiopathic thrombocytopenis purpura", "opd": "Acute viral infection", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "6c31cc63-c5c4-4fa9-8bc2-ab56aadce29d", "choice_type": "single"}
+{"question": "The most common congenital cardiac abnormality associated with the maternal rubella infection during pregnancy is", "exp": "Congenital rubella syndrome characterized by PDA,PS,VSD. Ref : Ghai essential of pediatrics, eighth edition ,p.no:401", "cop": 2, "opa": "Atrial septal defect", "opb": "Patent ductus aeriosus", "opc": "Ventricular septal defect", "opd": "Coarctation of aoa", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "751422fa-c4c2-48b6-b1db-44c7a8f07234", "choice_type": "single"}
+{"question": "A Child with increased Ca++ & hyperphosphatemia is seen in", "exp": "Ans. c (Renal osteodystrophy). (Ref. Harrison Medicine, 18th/Ch.44, 279, Nelson, Paediatrics, 17th/223)# The principal clinical consequences of hyperphosphatemia are hypocalcemia and systemic calcification.# Ectopic calcification occurs in untreated, chronic renal failure with severe hypercalcemia and in vitamin D intoxication.# Tumor calcinosis is rare inherited disorder in which hyperphosphatemia is associated with ectopic calcification.# Vitamin D intoxication causes excessive gastrointestinal absorption of both Ca++ and Ph++ and suppression of PTH by hypercalcemia causes decrease in renal phosphorous excretion.# Hyperphosphatemia in hyperthyroidism or acromegaly is also associated with hypercalcemia.", "cop": 3, "opa": "Vitamin D dependent rickets", "opb": "Vitamin D resistant rickets", "opc": "Renal osteodystrophy", "opd": "Hypophosphatasia", "subject_name": "Pediatrics", "topic_name": "Metabolic Disorders", "id": "8506038d-f039-4c3a-9faf-1c0f0565e91e", "choice_type": "single"}
+{"question": "The risk of intraventricular hemorrhage (IVH) can be reduced by using", "exp": "Ans. a (Vitamin K) (Ref. Williams Obstetrics 22nd/Ch. 29)INTRAVENTRICULAR HEMORRHAGEThere are four major categories of neonatal intracranial hemorrhage: subdural hemorrhage is usually the result of trauma. Subarachnoid hemorrhage and intracerebellar hemorrhage usually result from trauma in term infants but in preterm infants are commonly due to hypoxia. Periventricular-intraventricular hemorrhage results from either trauma or asphyxia in half of term infants but has no discernible cause in 25 percent of cases. In preterm neonates, the pathogenesis of periventricular hemorrhage is multifactorial and includes hypoxic-ischemic events, anatomical factors, coagulopathy, and many others.The severity of intraventricular hemorrhage can be assessed by ultrasound and computed tomography. Papile and colleagues (1978) devised the most widely used grading scheme to quantify the extent of the lesion and estimate prognosis.# Grade I--hemorrhage limited to the germinal matrix.# Grade II--intraventricular hemorrhage.# Grade III--hemorrhage with ventricular dilatation.# Grade IV--parenchymal extension of hemorrhage.Prevention and Treatment# Administration of corticosteroids at least 24 hours before delivery appears to prevent or reduce the incidence and severity of intraventricular hemorrhage.# The type of corticosteroid administered may be important. Although both betamethasone and dexamethasone cross the placenta in their active form, betamethasone has a longer half-life. This is because it has a larger volume of distribution and is cleared more slowly than dexamethasone# The efficacy of phenobarbital, vitamin K, vitamin E, or indomethacin in diminishing the frequency and severity of intracranial hemorrhage, when administered either to the neonate or to the mother during labor, remains controversial.# Magnesium sulfate may prevent the sequelae of periventricular hemorrhage.# It is generally agreed that avoiding significant hypoxia both before and after preterm delivery is of paramount importance. There is presently no convincing evidence, however, that routine cesarean delivery for the preterm fetus presenting cephalic will decrease the incidence of periventricular hemorrhage.", "cop": 1, "opa": "Vitamin K", "opb": "Vitamin C", "opc": "Vitamin E", "opd": "Vitamin A", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "037f2c36-e4f2-44e3-aa53-6ee015628094", "choice_type": "single"}
+{"question": "This clinical condition is seen in", "exp": null, "cop": 4, "opa": "Marasmus", "opb": "Scurvy", "opc": "Rickets", "opd": "kwashiorkor", "subject_name": "Pediatrics", "topic_name": null, "id": "e0a28062-a404-4b62-8005-125957a37c2f", "choice_type": "single"}
+{"question": "Treatment of choice for stage 4S neuroblastoma is", "exp": "The usual treatment for children with low-risk neuroblastoma is surgery for stages 1 and 2 Observation for stage 4S with cure rates generally >90% without fuher therapy. Treatment with chemotherapy or radiation for the rare child with local recurrence can still be curative. Reference: Nelson; Neuroblastoma; Page no: 2463", "cop": 1, "opa": "Observation", "opb": "Surgery", "opc": "Chemotherapy", "opd": "Radiotherapy", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "c5e7de33-4a25-42bd-924b-5fb2bc6b3587", "choice_type": "single"}
+{"question": "NOT a feature of Turner's syndrome", "exp": "Cubitus valgus is seen in Turner's syndrome.", "cop": 3, "opa": "Short stature", "opb": "Normal IQ", "opc": "Cubitus varus", "opd": "Streak ovaries", "subject_name": "Pediatrics", "topic_name": null, "id": "c18beb2d-9046-4f72-8ada-9119f87bde52", "choice_type": "single"}
+{"question": "Most common cause of persistent hypeension in child with Intrinsic Renal disease is", "exp": "ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Bedtime dosing of at least one antihypeensive medication improves BP control in patients with CKD. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "CGN", "opb": "Chronic pyelonephritis", "opc": "Obstructive uropathy", "opd": "Renal tumor", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "e45f585c-9c04-4deb-a1b7-8e3216307267", "choice_type": "single"}
+{"question": "Sign of pubey in girl is needed to change", "exp": "In girls, the first visible sign of pubey is the appearance of breast buds (Thelarche), between 8-12 years of ageIn boys the first visible sign of pubey is testicular enlargement, beginning as early as 9 1/2yr(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 926)", "cop": 2, "opa": "Puberche", "opb": "Thelarche", "opc": "Menarche", "opd": "Growth spu", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "70e18c36-1b4f-455b-bf15-ce03a471bd6c", "choice_type": "single"}
+{"question": "The most potent form of vitamin D is", "exp": "1,25 dihydroxy cholecalciferol is the metabolically active form of vitamin D. It helps in the absorption of calcium and phosphorus in the gut, and promotes bone dissolution and mineralization, thereby increasing serum calcium and alkaline phosphatase activity. Ref: Page 127; Ghai essential pediatrics; 6th edition", "cop": 4, "opa": "Ergocalciferol (Vit. D2)", "opb": "7 dihydroxy cholecalciferol", "opc": "25 dihydroxy cholecalciferol", "opd": "1,25 dihydroxy cholecalciferol", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "1ae77d0c-2a3b-46af-ac7e-c57a3593c6d3", "choice_type": "single"}
+{"question": "The best indicator of nutritional status for a child is", "exp": "The best indicator of nutritional status of a child is the rate of increase in height & weight. Rest of them are age independent indices. Ref: Page 64, Ghai Essential Pediatrics; 7th edition", "cop": 3, "opa": "Mid arm circumference", "opb": "Head circumference", "opc": "Rate of increase in height and weight", "opd": "Chest circumference", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "6ee9228b-4565-4f05-bd2e-54ae36d428c3", "choice_type": "single"}
+{"question": "Most common complication of mumps in children is", "exp": "(B) Aseptic meningitis > In adult males, mumps can cause bilateral orchitis and sterility, Meningitis usually follow parotitis and acute pancreatitis occurs in 2nd week, may result in diabetes mellitus.> Meningo encephalitis results 3-10 days after onset of glandular swelling.> Incubation period of mumps is 12-21 days (Mean 17 days)> COMPLICATIONS OF MUMPS: Epididymo-orchitis is a complication seen in about a third of postpubertal male patients. The testis becomes swollen and acutely painful, with accompanying fever and chills. Orchitis is usually unilateral but when it is bilateral and followed by testicular atrophy, sterility or low sperm counts may result. The central nervous system is involved in about 60 per cent of cases, as indicated by pleocytosis in the CSF but only about 10 per cent show symptoms of meningitis.> Mumps has been reported to cause about 10-15 per cent of cases of aseptic meningitis'. Mumps meningitis and meningoencephalitis usually resolve without sequelae but deafness may sometimes result. Munps meningitis may occasionally occur in the absence of parotitis, when diagnosis rests solely on laboratory evidence. The virus can be grown readily from the CSF in the early phase of meningitis.> Other less common complications are arthritis, oophoritis, nephritis, pancreatitis, thyroiditis and myocarditis. Most common complication of mumps in children is aseptic meningitis.", "cop": 2, "opa": "Orchitis", "opb": "Aseptic meningitis", "opc": "Pancreatitis", "opd": "Myocarditis", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "4a46db71-d836-4482-ab14-69f49b41a2ec", "choice_type": "single"}
+{"question": "Most common hea lesion in down syndrome", "exp": "Ans. is 'a' i.e., ASD with ostium primum About 40% children with down syndrome have congenital hea disease. Endocardial cushion defect (ASD with ostium primum) account for 40-60% of cases.", "cop": 1, "opa": "ASD with ostium primum", "opb": "ASD with ostium secundum", "opc": "VSD", "opd": "Coaection of aoa", "subject_name": "Pediatrics", "topic_name": null, "id": "f3a6f442-442f-4365-8736-41cf3c1c1e80", "choice_type": "single"}
+{"question": "Felty syndrome is characterised by A/E", "exp": "Ans. is 'd' i.e., Thrombocytopenia Felty's syndrome is characterized by the combination of rheumatoid ahritis, splenomegaly and neutropenia. The condition is more common in those aged 50-70 years, and is more prevalent in females than males", "cop": 4, "opa": "Rheumatoid ahritis", "opb": "Splenomegaly", "opc": "Neutropeni", "opd": "Thrombocytopenia", "subject_name": "Pediatrics", "topic_name": null, "id": "f14ddf6b-2f16-435a-9904-ad144bb3f411", "choice_type": "single"}
+{"question": "Straining and Dribbling of urine in a male infant with recurrent urinary infection should lead to the suspicious of", "exp": "Posterior urethral valves are a problem with the urethra in a boy. The urethra is the tube that drains urine from the bladder to the outside of the body. These valves are small leaflets of tissue in the urethra. They paly block urine flow because not enough urine can get through them to leave the body. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Vesico-ureteric reflux", "opb": "Posterior urethral valve", "opc": "Pelvic ureteric junction obstruction", "opd": "Phimosis", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "e193341f-97d2-4656-85a1-118f4abc210a", "choice_type": "single"}
+{"question": "Darkening of urine on standing is associated with", "exp": "Alkaptonuria is caused by defect of the enzyme homogentisate 1,2-dioxygenase(homogentisic acid oxidase).The disorder comes to attention due to change in colour of urine to brownish black/ staining of diapers.The urine becomes dark on standing,especially if the pH of urine is alkaline,due to the presence of homogentisic acid.Excessive urine homogentisate results in positive reducing substances. Reference:Essential pediatrics-Ghai,8th edition,page no:653.", "cop": 1, "opa": "Alkaptonuria", "opb": "Cystinuria", "opc": "Fabry's disease", "opd": "Tyrosinemia", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "4e9b8c2c-3599-4b04-9655-cb891a61d598", "choice_type": "single"}
+{"question": "One year old male child with sparse blond hair, developmental delay and tremors, diagnosis", "exp": "Phenylketonuria is due to deficiency of enzyme phenylalanine hydroxylase or of its cofactor tetrahydrobiopterin ;leads to accumulation of phenylalanine in body fluids and brain. It is mainly characterized by profound mental retardation ,lighter complexion and neurologic symptoms like tremors,hyperreflexia and spasticity. Reference: Nelson TB of pediatrics 19th edition, pg 418", "cop": 2, "opa": "Albinism", "opb": "Phenylketonuria", "opc": "Cerebral palsy", "opd": "Infantile tremor syndrome", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "dc14a38c-26c6-42e4-b3dc-d628a7781c84", "choice_type": "single"}
+{"question": "Most common cause of infectious croup is", "exp": "Ans. is 'b' i.e., Parainfluenza type I Infectious croup (Laryngitis & laryngotracheobronchitis)o Nearly always caused by viral infectiono Usually by parainfluenza type I.o Other-RSVParainfluenza 2,3InfluenzaAdenoviruso TreatmentHumidified oxygenIntravenous fluid for adequate hydrationAntibiotic (ampicillin ceftriaxone) if suspecting epiglottitis.", "cop": 2, "opa": "Adenovirus", "opb": "Parainfluenza type I", "opc": "RSV", "opd": "Influenza", "subject_name": "Pediatrics", "topic_name": "Disorders of the Respiratory Tract", "id": "0714e71a-d116-47b9-974e-503c6428d92e", "choice_type": "single"}
+{"question": "Most common cardiac anamoly associated with Noonan 's syndrome is", "exp": "Most common cardiac anamoly associated with Noonan's syndrome is pulmonary stenosis.", "cop": 3, "opa": "Aortic stenosis", "opb": "Ventricular septal defect", "opc": "Pulmonary stenosis", "opd": "Atrial septal defect", "subject_name": "Pediatrics", "topic_name": null, "id": "2467534e-db69-4826-9ebe-3f03adaad3ee", "choice_type": "single"}
+{"question": "Most common cause of neonatal meningitis is", "exp": "The most common bacterial causes of neonatal meningitis are GBS(S.agalactiae), E.coli, and L.monocytogenes Most common cause of neonatal sepsis in hospitals in India is - KLEBSIELLAMost common cause of neonatal sepsis in hospitals across the world is - E.COLI", "cop": 1, "opa": "S. agalactiae", "opb": "Streptococcus", "opc": "Pneumococcus", "opd": "E. coli", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "91867458-abb5-4691-8e00-da10488bb48b", "choice_type": "single"}
+{"question": "A 6 months old baby was brought do difficulty in feeding. '' The child was found to be hypotonic with a weak gag. The child is on breast milk and mother also gives honey to the child during periods of excessive crying. The causative agent is", "exp": "Infant botulism is associated with intake of honey, breastmilk etc. The child presents with generalized weakness and hypotonia in addition to bulbar palsies with symptoms like poor feeding, feeble cry,weak suck,drooling and obstructive apnea. Reference: Nelson textbook of pediatrics 19th edition Page 988", "cop": 3, "opa": "Gram positive aerobic COCCUS", "opb": "Gram positive anaerobic spre-suffering bacillus", "opc": "Toxin produced by gram positive anaerobic bacillus", "opd": "Echovirus", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "d116d4b1-ae26-4479-b577-995a16d891d9", "choice_type": "single"}
+{"question": "Attention deficit hyperactivity disorder is seen in", "exp": "ADHD:\n\nAttention Deficit Hyperactivity Disorder.\nDifficulty in paying attention, difficulty in controlling behavior and hyperactivity.\nEtiology- both genetic and environmental factors. Abnormality in dopamine transporter and thyroid receptor beta genes in some patients.\n\nThree subtypes are known:\n\nPredominantly hyperactive-impulsive\nPredominantly inattentive\nCombined hyperactive-impulsive and inattentive.\n\nDiagnosis is primarily clinical, using thorough clinical interview of parents and use of behavior rating scales. Physical examination includes direct observation of the child and ruling out chronic systemic illnesses that affect child's attention span.", "cop": 4, "opa": "Insulin resistance", "opb": "Thyroid hormone resistance", "opc": "Testosterone deficiency", "opd": "Calmodulin Deficiency", "subject_name": "Pediatrics", "topic_name": null, "id": "e235d36d-80c6-4d5e-b314-8b2675ebf537", "choice_type": "single"}
+{"question": "Sodium content in normal saline and Ringer lactate respectively are", "exp": "Sodium Content in\na) Normal saline = 154 meq / L\nb) Ringer lactate = 130 meq / L", "cop": 1, "opa": "154 meq / L; 130 meq / L", "opb": "140 meq / L; 109 meq / L", "opc": "150 meq / L; 136 meq / L", "opd": "134 meq / L; 150 meq / L", "subject_name": "Pediatrics", "topic_name": null, "id": "d75ad01e-2289-40df-84bf-7e4cfdbc984c", "choice_type": "single"}
+{"question": "The commonest cause of intestinal obstruction in children between 3 months to 6 years of age", "exp": "Ans. a (Intussusception) (Ref. Nelson paediatrics, p. 1569)INTUSSUSCEPTION# Intussusception occurs when a portion of the alimentary tract is telescoped into an adjacent segment. It is the most common cause of intestinal obstruction between 3 mo and 5 yr of age.# Sixty percent of patients are younger than 1 yr, and 80% of the cases occur before 24 mo: it is rare in neonates.# The incidence varies from 1 to 4/1,000 live births.# The male:female ratio is 4:1. A few intussusceptions reduce spontaneously, but if left untreated, most will lead to intestinal infarction, perforation, peritonitis, and death.Etiology and Epidemiology# The cause of most intussusceptions is unknown.# The seasonal incidence has peaks in spring and autumn.# Correlation with prior or concurrent respiratory adenovirus (type C) infection has been noted, and the condition may complicate otitis media, gastroenteritis, Henoch-Schonlein purpura.# The risk of intussusceptions in infants <1 yr of age after receiving a no longer available tetravalent rhesus-human reassortant rotavirus vaccine within 2 wk of immunization was increased.# Lymphoid nodular hyperplasia is another related risk factor. Prominent mounds of lymph tissue lead to mucosal prolapse of the ileum into the colon, thus causing an intussusception.# In 2-8% of patients, recognizable lead points for the intussusception are found, such as a Meckel diverticulum, intestinal polyp, neurofibroma, intestinal duplication, hemangioma, or malignant conditions such as lymphoma. Intussusception can complicate mucosal hemorrhage, as in Henoch-Schonlein purpura or hemophilia.# Cystic fibrosis is another risk factor.# Postoperative intussusception is ileoileal and usually occurs within 5 days of an abdominal operation.# Lead points are more common in children >2 yr of age.Pathology# Intussusceptions are most often ileocolic, less commonly cecocolic, and rarely exclusively ileal.Clinical manifestations# Spasmodic intermittent abdominal pain;# \"Red currant\" jelly stools# Palpable lump.# Dance sign, n \"Empty RIF\" signDiagnosis# Ultrasound is investigation of choice.# Ba enema is now 2nd line investigation# USG signs:- \"Doughnut or target\" appearance in transverse images.- \"Sandwich or hamburger\" sign in longitudinal images- Pseudokidney sign# Ba emema signs:- \"Claw\"sign- \"Coiled-spring\" signRx# Hydrostatic reduction# Air reduction is associated with fewer complications and lower radiation exposure than traditional contrast hydrostatic techniques.# The success rate of radiologic hydrostatic reduction under fluoroscopic or ultrasonic guidance is =50% if symptoms are present longer than 48 hr and 70-90% if reduction is done in the 1st 48 hr.# If manual operative reduction is impossible or the bowel is not viable, resection of the intussusceptions is necessary with end-to-end anastomosis.# Corticosteroids may reduce the frequency of recurrent intussusception.", "cop": 1, "opa": "Intussusception", "opb": "Meckel's diverticulum", "opc": "Intestinal polyp", "opd": "Nonspecific cause", "subject_name": "Pediatrics", "topic_name": "Gastro Intestinal System", "id": "2f396d6f-a448-41a5-9104-8ea6d148830e", "choice_type": "single"}
+{"question": "Baby is not at risk for hypoglycemia", "exp": "newborns are at risk for hypoglycemia : Babies born to mothers with diabetes. Babies who are small for gestational age or growth-restricted. Preterm babies, especially those with low bih weights. Babies born under significant stress. Babies with mothers treated with ceain medicines such as terbutaline. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Post dated pregnancy", "opb": "Mother on beta blocker", "opc": "Mother with diabetes mellitus", "opd": "IUGR", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "4dc6995c-18e8-4abe-b37c-a00bb2d5d2a2", "choice_type": "single"}
+{"question": "Child begins to sit with suppo, able to transfer objects from one hand to another hand and speak monosyllabic babbles at the age of", "exp": " . Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand).transfer object from one hand to other. 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}", "cop": 2, "opa": "3 months", "opb": "6 months", "opc": "9 months", "opd": "12 months", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "d4152b4b-88e0-456b-ae4b-ba03c0cbd641", "choice_type": "single"}
+{"question": "The likely diagnosis in a child with limb pain and pancytopenia is", "exp": "Child with acute lymphocytic leukemia presents with pallor, petechiae, infection(pancytopenia),. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Aplastic anemia", "opb": "Acute lymphocytic leukemia", "opc": "Rheumatic fever", "opd": "Rheumatoid ahritis", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "d392d7ff-0c3a-469e-906e-0934414184c6", "choice_type": "single"}
+{"question": "Ponds fracture is most common in", "exp": ".The Ping-Pong skull fracture or a pond skullfracture refers to a depressed skull fracture of the infant skull caused by inner buckling of the calvarium.", "cop": 1, "opa": "Children", "opb": "Adult", "opc": "Old age", "opd": "No relation with age", "subject_name": "Pediatrics", "topic_name": "Musculoskeletal disorders", "id": "fbfb8841-758d-41c2-a143-963fb20f7439", "choice_type": "single"}
+{"question": "DPT is contraindicated in", "exp": "C. i.e. (Progressive neurological illness) (191 - Ghai 6th) (168- 69- Ghai 7th)Following are NOT contraindication for administration of vaccine1. Mild acute illness2. Low grade fever3. Mild diarrheal4. Current antibiotic therapy5. Prematurity6. Recent exposure to an infectious disease7. History of allergies8. Allergy to penicillin9. Malnutrition* Children suffering from progressive neurological disorders or with history of convulsions to a previous dose are at a higher risk of adverse reactions following whole cell pertuessis vaccine* The vaccine is relatively contraindicated in children with progressive neurological disease, but children with stable neurological disease like developmental delay cerebral palsy and idiopathic epilepsy may be vaccinated (169 - Ghai 7th)", "cop": 3, "opa": "Family history of convulsions", "opb": "Acute respiratory tract infections", "opc": "Progressive neurological illness", "opd": "Mild diarrhea", "subject_name": "Pediatrics", "topic_name": "Immunization", "id": "150cfec7-4092-49b4-b4e2-664156528382", "choice_type": "single"}
+{"question": "Membraneous gap seen between fetal skull bone is known as", "exp": "Ans) a (Fontanelle) Ref D.C. Dutta p84,Nehon 18th ed p 677Flat bones of the vault are united together by nonossified membranes attached to the margin of the bone.These are called sutures and fontanelles.Wide gap in the suture line is called fontanelleCraniosynostosis is defined as premature closure of the cranial suturesDisorders Associated with a Large Anterior FontanelAchondroplisinIntrauterine growth retardationApert syndromeKenny syndromeAthyrotic hypothyroidismOsteogenesis imperfectnCleidocrininl dysostosisPrematurityCongenital rubella syndromePylenodysctslosisHallermantl-Sucill syndromeRussell-Silver syndromeHydrocephaly13-, 18-, 21-trisoniesHypophospnatasiaVitamin D deficiency ricketsPersistently small fontanels suggest microcephaly, craniosynostosis, con-genital hyperthyroidism, or wormian bones. A 3rd fontanel suggests trisomy 21 but is seen in preterm infants. Soft areas in the occipital region suggest the irregular calcification and wonnian bone formation.Important causes of wonnian bones Hypothyroidism/ cretinismHypophosphatasia RcketsCliedocraniodysostosis / pyknodysostosis Osteogenesis imperfecta", "cop": 1, "opa": "Fontanelle", "opb": "Suture", "opc": "Wormian bone", "opd": "Craniosynostosis", "subject_name": "Pediatrics", "topic_name": "Growth, Development, and Behavior", "id": "0397caba-5f9c-4cba-81ec-225677849e6c", "choice_type": "single"}
+{"question": "Non immune hydrops fetalis is caused by", "exp": "Primary fetal infection is associated with nonimmune fetal hydrops and intrauterine fetal demise,with the risk for fetal loss after infection estimated at <5%. The mechanism of fetal disease appears to be a viral-induced RBC aplasia at a time when the fetal erythroid fraction is rapidly expanding ,leading to profound anemia, high-output cardiac failure, and fetal hydrops. Nonimmune type * Three major causes -- parvovirus B 19 -- alfa-thalassemia -- cardiovascular defects, chromosomal anomalies, and fetal anemia Reference: Nelson textbook of pediatrics 19th edition, Page 1096", "cop": 4, "opa": "HIV", "opb": "CMV", "opc": "HSV", "opd": "Parvovirus B 19", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "8b16fec6-04a4-4359-ba9e-12c0f00ef2c1", "choice_type": "single"}
+{"question": "A 4 year child presents with a history of hoarseness, croupy cough and aphonia, the child has dyspnoea with wheezing. The most probable diagnosis is", "exp": "The given symptoms points to laryngeal foreign body. the course of illness depends on the nature of foreign body,its size,extent,and site of lodgement. Ref : Essential pediatrics,O.P.Ghai,7 th edition,pg no:367", "cop": 2, "opa": "Asthmatic bronchitis", "opb": "Laryngeal Foreign body", "opc": "Bronchopneumonia", "opd": "Retropharyngeal abscess", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "4388fa31-59ab-4c8e-862d-ac77f2090e0a", "choice_type": "single"}
+{"question": "A neonate is suspected to be suffering from necrotizing entercolitis (NEC). On fuhur examination and investigation, he is diagnosed to be Bell&;s stage INEC. The management of choice would be", "exp": ".Abdomen radiographs may show pneumatosis intestinalis,or free intraperitoneal air. management consists of agressive resuscitation and intravenous feeding.The optimal time for surgery is not in the acute phase as the baby can withstand the pressure of necrosis better than an adult,but not in the stress laprotomy. BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,PG NO:1200, 24th edition", "cop": 3, "opa": "Laporotomy and proceed", "opb": "Inseion of bilateral pelvic drains", "opc": "Conservative management with IV fluids and antibiotics", "opd": "Initial conservative management and laparotomy after 24 hours", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "b33aca63-309d-4307-85d4-23c53154b6c6", "choice_type": "single"}
+{"question": "Apnea of prematurity is defined as sudden stoppage of breathing that lasts for", "exp": "Apnea of prematurity defined as sudden stoppage of breathing that lasts for 20 sec or is associated with bradycardia or cyanosisApnea of prematurity should be different from periodic breathing which is normal phenomenon is preterm neonate.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 832, 849 - 850)", "cop": 3, "opa": "10 sec", "opb": "15 sec", "opc": "20 sec", "opd": "30 sec", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "81589859-4353-42ac-87c9-bcfee4837f5a", "choice_type": "single"}
+{"question": "Sodium content of ReSoMal is", "exp": "Fish are naturally low in sodium and even those species with the highest sodium levels contain less than 100 milligrams per 3 ounce cooked poion. Most shellfish generally have more sodium, ranging from 100 to 500 milligrams per 3 ounce cooked serving. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "90 mmol/lit", "opb": "60 mmol/lit", "opc": "45 mmol/lit", "opd": "30 mmol/lit", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "27aa38b1-1332-416a-9b83-27d6b78c6183", "choice_type": "single"}
+{"question": "A five year old child presents to the emergency department with burns. The burn area corresponding to the size of his palm is equal to", "exp": "Estimation of body surface area (BSA) of burn\nRough estimate of body surface area of bum can be estimated by following rules.\nRule of Palm (Palmar method)\n\nIt can be used in Children as well as in adults.\nIt is used for small burns (<10% of BSA)\nThe palm of patients hand represents I% of BSA. Palm is the area of hand from wrist crease to the finger crease.\nEntire burned hand represents 2.5% of BSA: 1/% for palm; 1% for dorsum of the hand (excluding fingers);0. 5% for the fingers\n\nRule of 9\n\nIt can be used in adults and children older than 14 years.\nIt is used for larger surface area burns.\nEstimates the body surface area of an adult in multiples of 9.\nAn adult who has been burned, the percent of the body involved can be calculated as follows:\nHead and Neck = 9%\nAnterior chest = 9%\nAnterior abdomen =9%\nUpper back = 9%\nLower back = 9%\nRight upper extremity (Anterior + Posterior) = 9%\nLeft upper extremity (Anterior + Posterior) = 9%\nRight lower extensity, Anterior = 9%\nRight lower extremity, Posterior = 9%\nLeft lower extremity, anterior = 9%\nLeft lower extremity, Posterior = 9%\nPerenium= 1%\nPercent of the burn in a child can be calculated as follows:\nHead and neck = 9%\nAnterior trunk =18%\nPosterior trunk =18%\nUpper extremity (Right) = 9%\nUpper extremity (Left) = 9%\nLower extremity (Right) = 18%\nLower extremity (Left) =18%\nPerenium = 1%", "cop": 1, "opa": "1% BSA", "opb": "5% BSA", "opc": "10% BSA", "opd": "20% BSA", "subject_name": "Pediatrics", "topic_name": null, "id": "dc57dbe3-e608-4714-aeeb-22298466e711", "choice_type": "single"}
+{"question": "The most common symptom of AIDS in an infant is", "exp": "Clinical features in an HIV infected infant is:Recurrent GI infection and oral thrush is commonly foundClinical features in older children:Growth failureFeverDiarrheaSecondary infection(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 202)", "cop": 1, "opa": "Gastrointestinal infection", "opb": "Persistent cough", "opc": "Failure to thrive", "opd": "Lymphadenopathy", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "d06a9b48-4fa9-44cd-8c56-12e46b1f5d2a", "choice_type": "single"}
+{"question": "A child presented with fever for 2 days, altered sensorium and purpuric rashes. His blood pressure is 90/60 mmHg. Treatment of choice is>", "exp": "Ans. is 'c' i.e. Penicillin .The clinical presentation of fever, altered sensorium and purpuric rashes, is highly suggestive of meningococcal meningitis.Purpuric rash in quite characteristic of meningococcemia.I. V. Penicillin is the treatment of choice for meningoccal inf. among the given options.The DOC for meningococcal infection is -IIIrd generation cephalosporin e.g. Cefotaxime, Ceftriaxone.Also RememberWaterhouse Friderichsen syndromeSeen in fulminant meningococcemiaadrenal insufficiency occurs* due Haemorrhage and necrosis in the adrenal glandsClinical presentation isprostrationhypotensionshock andUltimately coma and death.", "cop": 3, "opa": "IV Quinine", "opb": "IV Artesunate", "opc": "IV Penicillin", "opd": "Chloroquine", "subject_name": "Pediatrics", "topic_name": "CNS Infections", "id": "774b74b7-8fd5-4841-94a7-eddf0d7a94d0", "choice_type": "single"}
+{"question": "Pneumatoceles on chest radiograms in a child with pneumonia are seen in infection", "exp": "staphylococcal pneumonia : pneumonic process is diffuse but soon lesions suppurate and cause bronchoalveolar destruction multiple microabscesses erode the bronchial wall and discharge their contents in bronchi. several pneumatocoeles form and they fluctuate in size over time ultimately resolving and disappearing in few weeks to months in Xray pneumatocoeles persist as thin walled cysts.they are also seen in klebsiella pneumonia Ref : ESSENTIAL PEDIATRICS,O.P.GHAI, PG NO:353,7thedition", "cop": 1, "opa": "Staphylococcus", "opb": "Pneumococcus", "opc": "Streptococcus", "opd": "Haemophilus influenzae", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "74b2c563-d65e-4ddb-bc17-f487f8f97170", "choice_type": "single"}
+{"question": "The ratio of ICF volume to Extracellular fluid volume reaches adult values at the age of", "exp": "Total body water is divided between 2 main compaments: intracellular fluid (ICF) and extracellular fluid (ECF). In the fetus and newborn, the ECF volume is larger than the ICF volume. The normal postnatal diuresis causes an immediate decrease in the ECF volume. This is followed by continued expansion of the ICF volume, which results from cellular growth. By 1year of age, the ratio of the ICF volume to the ECF volume approaches adult levels.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 55; Electrolyte and Acid-Base Disorders", "cop": 1, "opa": "1 year", "opb": "2 years", "opc": "3 years", "opd": "4 years", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "664f1688-1068-480d-992b-441e8ad0ce8f", "choice_type": "single"}
+{"question": "The pediatric disease that most closely resembles amyotrophic lateral sclerosis (ALS) is", "exp": "Werdnig-Hoffmann disease most closely resembles amyotrophic lateral sclerosis (ALS). Both of these diseases involve the degeneration of motor neurons. Presentation Symptoms symmetric flaccid paralysis most affected infants are hypotonic at bih proximal muscle involvement lower extremity greater than upper extremity sparing of upper cranial nerves e.g., normal eye movements Physical exam absent or decreased deep tendon reflexes tongue and finger fasciculatons infants have flaccid \"frog-like\" posture restrictive respiratory insufficiency ALS appears to be increasing in incidence. In 5% to 10% of cases, there is an autosomal dominant pattern with strong age-dependent penetrance. Proposed etiologies include oxidative stress, viral infection, immunologic disease, or some unknown environmental factor. Currently, the oxidative stress theory is ored because a defect in the zinc-copper binding superoxide dismutase (5001) coded on chromosome 21 was discovered. Because SO 01 is an antioxidant that conves the superoxide free radical into peroxide and oxygen, reduced activity causes apoptosis (individual cell necrosis) of spinal motor neurons. Inhibition of glutamate transpo potentiates the toxicity associated with the reduced SODllevels. ALS most commonly presents with both upper motor neuron signs (e.g., spastic paralysis) and, eventually, lower motor neuron signs (e.g., muscle atrophy, fasciculations). Atrophy of the intrinsic muscles of the hand and forearms with hand weakness and spastic changes in the lower legs are early signs. Antioxidant cocktails have now been developed, which offer some symptomatic improvement. Werdnig- Hoffmann disease is a progressive muscular atrophy noted in infants. It often presents as the floppy child syndrome. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Schilder disease (adrenoleukodystrophy)", "opb": "Tabes dorsalis", "opc": "Werdnig-Hoffmann disease", "opd": "Gauches disease", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "7bc0db96-c370-40ce-be17-9fb4e1e110f7", "choice_type": "single"}
+{"question": "Most common type of Atrial septal defect is", "exp": "The atrial septal defect can occur in any poion of the atrial septum(secundum, primum or sinus venosus)OSTIUM SECUNDUM:Most common type of ASD accounts for 7% of al congenital hea disease.Defect situated at fossa ovalis.Associated with structurally normal atrioventricular (AV)valves.OSTIUM PRIMUM/ ENDOCARDIAL CUSHION DEFECT:Defect situated inferior to fossa ovalis.Associated with the cleft in AV valves.Most common cardiac lesion in Down&;s syndrome is endocardial cushion defect.", "cop": 2, "opa": "Ostium primum", "opb": "Ostium secundum", "opc": "Cushion defect", "opd": "Endocardial hyperophy", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "7ef128e6-8f19-486f-870e-d38aa437c2d4", "choice_type": "single"}
+{"question": "Bart's hydrops fetalis is lethal because", "exp": "Bart hydrops fetalis is a lethal complication of alpha thalassemia trait where oxygen can't release from hemoglobin", "cop": 2, "opa": "Hb Bart's cannot bind oxygen", "opb": "Hb Bart's cannot release oxygen to fetal tissues", "opc": "Microcytic red cells become trapped in the placental", "opd": "The excess a - globin form insoluble precipitates", "subject_name": "Pediatrics", "topic_name": null, "id": "a8c3cb3f-6d36-44ef-b8a2-0ce731cc975b", "choice_type": "single"}
+{"question": "The development of septal defects in the fetal hea occurs at", "exp": "Fetal hea septal defect develop by 6-8 weeks. Ref : Ghai essential of pediatrics, eighth edition, p.no: 402", "cop": 2, "opa": "3-5 weeks", "opb": "6-8 weeks", "opc": "9-12 weeks", "opd": "13-15 weeks", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "266c645d-9f93-4cb5-9619-33b8113750cd", "choice_type": "single"}
+{"question": "NOT an indication for surgery in Ventricular septal\ndefect", "exp": "Eisenmenger's Syndrome is an absolute contraindication for Surgery in Ventricular septal defect.", "cop": 4, "opa": "Hepatomegaly", "opb": "Suck- Rest-Suck cycle while feeding", "opc": "Pulmonary: Systemic blood flow > 2:1", "opd": "Eisenmenger's Syndrome", "subject_name": "Pediatrics", "topic_name": null, "id": "ceddf62b-479e-4baf-a5d5-e5493782909a", "choice_type": "single"}
+{"question": "Most common lobe involved in congenital lobar emphysema", "exp": "Congenital lobar emphysema present with respiratory distress. Most common lobe involved is Left upper lobe. X-ray shows shift of mediastinum to Right side.", "cop": 3, "opa": "Right upper lobe", "opb": "Right middle lobe", "opc": "Left upper lobe", "opd": "Left lower lobe", "subject_name": "Pediatrics", "topic_name": null, "id": "9b138448-df41-43a3-8ef5-f6aca1dee3c1", "choice_type": "single"}
+{"question": "Most common cause of Acute epiglottis is", "exp": "Most common cause of Acute epiglottis is Hemophilius influenza B", "cop": 4, "opa": "Respiratory Syncytial Virus", "opb": "Parainfluenza virus", "opc": "Hemophilius influenza A", "opd": "Hemophilius influenza B", "subject_name": "Pediatrics", "topic_name": null, "id": "b86f609b-a355-48ca-a4e1-4d35ab33eb27", "choice_type": "single"}
+{"question": "Sign of pubey in boys is", "exp": "In girls, the first visible sign of pubey is the appearance of breast buds (Thelarche), between 8-12 years of ageIn boys the first visible sign of pubey is testicular enlargement, beginning as early as 9 1/2 yr.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 926)", "cop": 2, "opa": "Enlargement of penis", "opb": "Enlargement of testes", "opc": "Appearance of pubic hair", "opd": "Appearance of axillary hair", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "e1f7fcc6-da4f-46ba-8367-9f8f66420766", "choice_type": "single"}
+{"question": "Most common delivery room emergency in newborns", "exp": "Ans. d (Failure to initiate efficient respiration) (Ref. Nelson textbook of paediatrics, p. 723)The most common delivery room emergency for neonates is secondary to failure to initiate and maintain effective respirations. Less frequently, but of major importance are shock, severe anemia, plethora, convulsions and management of life-threatening congenital malformation.Educational Points:# NEC is the most common life-threatening emergency of the gastrointestinal tract in the newborn period.# ABO incompatibility is the most common cause of hemolytic disease of the newborn.", "cop": 4, "opa": "Shock", "opb": "Life threatening congenital malformations", "opc": "Convulsions", "opd": "Failure to initiate efficient respiration", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "6ac2f17f-566b-419f-9f0f-62bb70ce6a54", "choice_type": "single"}
+{"question": "Para amino benzoic acid in breast milk prevents the infection of", "exp": "Para-amino-benzoic acid(PABA) of breast milk provides protection against malaria.Ref: Page 97; Ghai essential pediatrics; 6th edition", "cop": 1, "opa": "Plasmodium vivax", "opb": "Kleibsella-pneumonia", "opc": "Giardia", "opd": "E.coli", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "44a325aa-8b46-49ba-9fd5-4d79cad6bb5d", "choice_type": "single"}
+{"question": "In neonatal cholestasis, if the serum gammaglutamyl transpeptidase is more than 600IU/L the most likely diagnosis is.", "exp": "Ans. is 'd' i.e., Biliary atresia Most of the books are of the opinion that alkaline phosphatase and gamma glutamyl transpeptidase are two enzymes that are associated with biliary tract disease.Serum levels of these enzymes are usually increased in cholestasis or bile duct obstruction.But the problem in that, all of these books also add that they may also be increased in parenchymal disease or infiltrative or mass lesions of the liverIn the question only the value of Gamma glutamyl transpeptidase is given. Nothing is mentioned about the value of other enzymes.We cannot come to a conclusive diagnosis only by the level of Gamma glutamyl transpeptidaseBut still such a considerable elevation in the serum level of Gamma glutamyl transpeptidase i.e., 10 to 12 times its normal value points towards the diagnosis of biliary tract diseaseNote:- Normal value of serum Gamma glutamyl transpeptidase is - 10-40IU/L", "cop": 4, "opa": "Neonatal Hepatitis", "opb": "Choledochal cyst", "opc": "Hypothyroidism", "opd": "Biliary atrisia", "subject_name": "Pediatrics", "topic_name": "Liver and Biliary System", "id": "1c4b55eb-fa82-41db-a2be-49d7c47557a8", "choice_type": "single"}
+{"question": "A single umbilical aery in newborn increases the risk of", "exp": "The umbilical cord should have 2 aeries and 1 vein. A single umbilical aery is associated with an increased risk for an occult renal anomaly.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 94; The Newborn Infant", "cop": 2, "opa": "Meningomyelocoele", "opb": "Occult Renal anomaly", "opc": "Omphalocoele", "opd": "Gastrochisis", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "d8caff68-4d20-454f-9321-a3ced7c5ccee", "choice_type": "single"}
+{"question": "Hetch Giant cell pneumonia is caused by", "exp": "Hetch Giant cell pneumonia is caused by Rubeola or Measles virus.", "cop": 3, "opa": "Mumps virus", "opb": "Rubella", "opc": "Rubeola", "opd": "Varicella", "subject_name": "Pediatrics", "topic_name": null, "id": "8650b947-a5cc-4384-aaa3-4d1c88f6ff15", "choice_type": "single"}
+{"question": "Thrombocytopenia, macerated skin lesions, rash and periostitis in a new born are seen in", "exp": "In Syphilis, thrombocytopenia is often associated with platelet trapping in an enlarged spleen. Characteristic osteochondritis and periostitis and a mucocutaneous rash manifesting with erythematous maculopapular or vesiculobullous lesions followed by desquamation involving hands and feet are common. Reference : Nelson textbook of pediatrics 19th edition Page 1017 & 1018", "cop": 3, "opa": "Erythroblastosis fetalis", "opb": "Cytomegalovirils infection", "opc": "Syphilis", "opd": "HIV infection", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "77087998-31ef-40cd-a18f-a1c8f301c0e0", "choice_type": "single"}
+{"question": "Most common enzyme deficiency in congenital adrenal hyperplasia is", "exp": "congenital adrenal hyperplasia is a group of autosomal recessive defects in steroid synthesis characterised by deficiency of adrenocoical hormones The commonest form of congenital adrenal hyperplasia accounting for about 90% of cases is due to deficiency of 21-alpha hydroxylase It is associated with diminished synthesis of coisol and aldosterone Reference: Ghai TB of pediatrics 8th edition pg 526", "cop": 4, "opa": "3 beta hydroxylase", "opb": "11 beta hydroxylase", "opc": "17 hydroxylase", "opd": "21 alfa hydroxylase", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "1681be1d-be68-465a-b2b1-41d89239b04f", "choice_type": "single"}
+{"question": "The most common etiological agent for acute bronchiolitis in infancy is", "exp": "Most cases of bronchiolitis are caused by the respiratory syncytial virus (RSV). RSV is a common virus that infects just about every child by the age of 2. Outbreaks of the RSV infection occur every winter. Bronchiolitis can also be caused by other viruses, including those thatcause the flu or the common cold. Bronchiolitis Lower respiratory tract (bronchioles) Microbiology : * Respiratory syncytial virus (RSV) * Rhinovirus. Parainfluenza virus, Human metapneumovirus * Influenza virus Clinical * Occurs primarily in children s 2-years-old * Often preceded by a 1 to 3 day URI prodrome * Fever. Cough * Respiratory distress (tachypnea, retractions, wheezing, crackles) Complications * Dehydration * Apnea (premature and < 2 months old) * Aspiration pneumonia, Respiratory failure Management Nonsevere bronchiolitis * Anticipatory guidance, nasal suctioning, hydration Severe bronchiolitis * Trial of inhaled bronchodilator (controversial) * Heated humidified high-flow nasal cannula * Continuous positive airway pressure * Endotracheal intubation Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Influenza virus", "opb": "Parainfluenza virus", "opc": "Rhinovirus", "opd": "Respiratory syncytial virus", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "21dffd5e-d956-4a23-a5fb-922e415cb3bd", "choice_type": "single"}
+{"question": "Macrosomia is", "exp": "The term \"macrosomia\" is used to describe a newborn who&;s significantly larger than average ( large size baby ). A baby diagnosed with fetal macrosomia has a bih weight of more than 4,000 grams (8 pounds 13 ounces), regardless of his or her gestational age. Another definition of macrosomia is a bih weight above the 90th percentile, corrected for gestational age and sex. Factors associated with fetal macrosomia include high blood sugar levels from gestational diabetes or diabetes mellitus, ethnicity (Hispanic women are more at risk), obesity, gaining extra weight during the pregnancy, carrying baby past term, gender of fetus (males are more prone to macrosomia), history of a previous large baby. Reference : page 137 Ghai Essential Pediatrics 8th edition", "cop": 1, "opa": "Large size baby", "opb": "Big mouth", "opc": "Large head", "opd": "Large tongue", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "a7392e62-b5c1-4383-8e3f-6c09107ba633", "choice_type": "single"}
+{"question": "Definition of low birth weight", "exp": "Some important definitions in Neonatology Low birth weight: Birth weight of less than 2.5 kg irrespective of gestational age Very low birth weight: Birth weight of less than 1.5 kg irrespective of gestational age.\nExtremely low birth weight: Birth weight of less than 1.0 kg irrespective of gestational age Neonatal: First 28 days of postnatal life. Preterm:\nLess than 37 completed weeks of gestations Term: After 37 completed weeks of gestations Post term: After 42 completed weeks of gestations Past Dates:\nAfter 40 completed weeks of gestations Stillbirth: Delivering dead fetus after 28 weeks of gestation. (Defn changes with the country) Abortion:\nExpulsion of products of conception before 28 weeks of gestation. Small for Gestational Age (SGA):\nWeight below the I Oth percentile for the gestational age Large for Gestational Age (LGA):\nWeight above the 90th percentile for the gestational age Appropriate for Gestational Age (AGA): Weight between 10 lh & 90th percentile for the gestational age", "cop": 3, "opa": "Wt <2kg", "opb": "Wt < 1.5kg", "opc": "Wt <2.5kg", "opd": "Wt <1 k", "subject_name": "Pediatrics", "topic_name": null, "id": "5f3119bb-7c40-4a16-a295-4cbc6d14934f", "choice_type": "single"}
+{"question": "A 5 year old boy is suffering from mimimal change nephrotic syndrome. For bringing about a remission induction, the drug of choice is", "exp": "Because of the high prevalence of minimal-change disease (MCD) in children with nephrotic syndrome, an empiric trial of coicosteroids commonly is the first step in therapy. Coicosteroids are the treatment of choice, leading to complete remission of proteinuria in most cases. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Furosemide", "opb": "Levamisole", "opc": "Cyclophosphamide", "opd": "Prednisolone", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "29ed0cae-689a-430f-8227-50ec7ed7bdd3", "choice_type": "single"}
+{"question": "In &;Down&;s syndrome, the shape of the head is", "exp": "Down syndrome is due to trisomy 21. A child with down syndrome presents with brachycephaly with flat occiput. Other features include flat face,upward slanted palpebral fissure ,epicanthal folds,speckled irises and delayed fontanel closure . Image : characteristics of Down syndrome (DS) skull and brain. A: lateral views of euploid and DS skulls. Left: the face of an euploid young adult presents downward growth of the maxillae; therefore, the distance between the inferior orbital ridge, the nasal spine, and the alveolar crest is considerably increased. The mandible is angled. Right: although the DS skull grows to nearly the same size as the normal adult, it presents brachycephaly, which means \"sho headed,\" and occurs when the right and left coronal sutures close prematurely. Brachycephaly results in an abnormally broad head with a high forehead. It is often associated with other craniofacial abnormalities. In DS, the face is small, with underdeveloped maxillae, and the mandible is still relatively straight. Reference: Nelson TB of pediatrics 19th edit pg 402.", "cop": 3, "opa": "Oxycephalic", "opb": "Scaphocephalic", "opc": "Brachicephalic", "opd": "Plagiocephalic", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "5a87deb5-bba7-424f-9431-e072c2282082", "choice_type": "single"}
+{"question": "Flaky paint appearance of skin is seen in", "exp": "There are skin lesions in kwashiorkor which consist of increased pigmentation, desquamation, and dyspigmentation. Pigmentation, when gets confluent, is known as flaky paint dermatitis. Ref: Page 100; Ghai Essential Pediatrics; 8th edition.", "cop": 4, "opa": "Dermatitis", "opb": "Pellagra", "opc": "Marasmus", "opd": "Kwashiorkor", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "30089d3e-2a3c-4328-b3f4-6a800a5daeb0", "choice_type": "single"}
+{"question": "Most common organism causing neonatal meningitis is", "exp": "The most common causes of neonatal meningitis is bacterial infection of the blood, known as bacteremia (specifically group B streptococci (Streptococcus agalactiae), Escherichia coli, and Listeria monocytogenes . Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "E. coli", "opb": "Listeria", "opc": "Pseudomonas", "opd": "Staph aureus", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "e0550b1a-21d3-452e-94ce-36b5910bfab2", "choice_type": "single"}
+{"question": "Most common cause of Extradual/Subdural Hemorrhage in children is", "exp": "(B) Skull fracture", "cop": 2, "opa": "A-V malformation", "opb": "Skull fracture", "opc": "Aneurysms", "opd": "Atherosclerosis", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "aaa6c545-f413-457c-a0da-41ec956893b3", "choice_type": "single"}
+{"question": "Hemorrhagic disease of the newborn is attributed to the deficiency of", "exp": "• Vitamin K is produced by our gut flora. The gut of a New-born baby is sterile and hence no vitamin K is being produced.\nMoreover vitamin k is negligible in breast milk. In lieu of these factors all babies are susceptible to development of Hemorrhagic disease of New-born.\n• To prevent this from happening therefore, as standard operating procedure in all hospitals injection vitamin K 1 :\n1 mg intramuscular is given to prevent hemorrhagic disease of new born referred to as H.D.N.\n• In our country where a large number of children are born via home deliveries,\nno vitamin K would be given to the child and therefore the child may be brought to the hospital on day 5 with umbilical stump bleeding.\n• For management: the child should be given injection vitamin K lmg intravenously.\nIf bleeding is still present then FFP needs to be administered. Previous Year Questions on Topic: Bleeding Disorders in Children\n• Type of vitamin K used for treatment of H.D.N= vitamin K1\n• Umbilical stump bleeding in child on day 1 of life= factor 13 deficiency\n• Umbilical stump bleeding in child on day 5 of life= H.D.N\n• Male baby with excessive circumcision bleeding= hemophilia A\n• Vaginal bleeding in a girl child on day 5 of life= No intervention required", "cop": 1, "opa": "Vitamin K", "opb": "Vitamin A", "opc": "Vitamin E", "opd": "Vitamin C", "subject_name": "Pediatrics", "topic_name": null, "id": "b0965a2c-e952-46a7-a43a-ed340f810a00", "choice_type": "single"}
+{"question": "Wilm's tumour commonly presents as", "exp": "(Abdominal mass): Ref: 574-G (592-Ghai 7th)WILM'S TUMOR or nephroblastoma is the most common malignant tumour of the kidney* 80% of children under the 5 years (mean age 3years/* Congenital anomalies particularly -- Aniridia- Hemihypertrophy- Beckweith - Wiedmann syndrome- Mental retardation* Deletion in the region of 11 p 13Clinical Presentation* Most of the patients presents with a asymptomatic abdominal mass* Hematuria (10- 25%) Hypertension (about 25%)* Other frequent symptoms - abdominal pain (30%) fever (20%) anorexia and vomiting* Ultrasound scanning is the most important investigation", "cop": 2, "opa": "Pain in the abdomen", "opb": "Abdominal mass", "opc": "Fever", "opd": "Hematuria", "subject_name": "Pediatrics", "topic_name": "Kidney", "id": "776d8c50-c7e4-4ace-80c3-eda5e16aea3d", "choice_type": "single"}
+{"question": "Absolute C/I of Bag & Mask ventilation", "exp": "Absolute C/I of Bag and Mask ventilation is - CDH Also know Q The resuscitation bag should have capacity of 240 to 750 mL Reservoir +O2 attached - Fio2 delivered >90% Only reservoir attached - [?] 21% Only oxygen & no reservoir - [?] 40 Q Indications of PPV - 1. Apnea 2. Gasping 3. HR <100/min inspite of 100 percent oxygen Q Most successful indicator of successful resuscitation - Improvement in hea rate.", "cop": 2, "opa": "Tracheoesophageal fistula", "opb": "Congenital diaphragmatic hernia", "opc": "Choanal atresia", "opd": "Cleft palate", "subject_name": "Pediatrics", "topic_name": "Paediatrics", "id": "c5f1b094-b9cd-4496-afc9-5db1b074ea2b", "choice_type": "single"}
+{"question": "The natural probiotic activity in breast milk is due to", "exp": "The natural probiotic activity in the breast milk is due to lactobacillus it is the good bacteria of intestine . Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Lactobacillus", "opb": "Sacchromyces boullardi", "opc": "Bifido bacterium", "opd": "Bacillus cereus", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "d081bd6b-0e67-4b92-9c5e-44ecf54e4e0c", "choice_type": "single"}
+{"question": "Most Common type of Roger's anomaly is", "exp": "Roger's anomaly is another name for ventricular septal defeat. \nMost common type is perimembranous type.", "cop": 4, "opa": "Muscular type", "opb": "Inlet type", "opc": "Outlet type", "opd": "Perimembranous type", "subject_name": "Pediatrics", "topic_name": null, "id": "98db56d0-adde-4132-b222-68aae11ee0fd", "choice_type": "single"}
+{"question": "A baby presents with diarrhea and perianal diaper area redness. Diagnosis is", "exp": "In Lactose intolerance, there is a deficiency of the enzyme lactaseSo there is no natural breakdown of lactose - a carbohydrate present in milkThis causes diarrheaThe stool contains reducing sugar which causes perianal excoriation(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1876)", "cop": 1, "opa": "Lactose intolerance", "opb": "Shigella diarrhea", "opc": "Salmonella", "opd": "Fungal", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "594cf101-f3c9-445d-8704-725ea6f4aa27", "choice_type": "single"}
+{"question": "Localised Langerhans cells histiocytosis affecting head and neck is", "exp": "d. Eosinophilic granuloma(Ref: Nelson's 20/e p 2484-2489, Ghai 8/e p 620-623)Eosinophilic granuloma: Bone lesions, with no visceral involvement; Localised; affects head and neck", "cop": 4, "opa": "Letterer-Siwe disease", "opb": "Pulmonary Langerhans cell histiocytosis", "opc": "Hand-Schuller-Christian disease", "opd": "Eosinophilic granuloma", "subject_name": "Pediatrics", "topic_name": "C.V.S.", "id": "bdd33734-c747-431c-b865-4571fe94cd8e", "choice_type": "single"}
+{"question": "A 2 old boy with fever and rhinorrhea developed a maculopapular rash, to the face, the neck, chest, arms in that order. Diagnosis includes", "exp": "The disease is most common in preschool children; infants are protected by transplacental antibodies, which generally decay by 9 months The prodromal phase is characterized by fever, rhinorrhea, conjunctiva! congestion and a dry hacking cough. Koplik spots, considered as pathognomonic of measles, appear opposite the lower second molars on the buccal mucosa on the second or third day of the illness as grey or white lesions resembling grains of sand with surrounding erythema. The rash, usually appears on the fouh day with a rise in fever, appears as faint reddish macules behind the ears, along the hairline and on the posterior aspects of the cheeks. The rash rapidly becomes maculopapular and spreads to the face, the neck, chest, arms, trunk, thighs and legs in that order over the next 2-3 days. It then stas fading in the same order that it appeared and leaves behind branny desquamation and brownish discolouration, which fade over 10 days Refer : O.P Ghai 8e pg:213", "cop": 1, "opa": "Measles", "opb": "Meningococcal septicaemia", "opc": "Haemophilia", "opd": "Chicken pox", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "1b91c0f4-fe57-44e0-880b-b1f93fbe06a0", "choice_type": "single"}
+{"question": "A 8 year old boy presents with recurrent pneumonia since birth. The boy had a history of delayed passage of Meconium at birth. Probable diagnosis is", "exp": "Features of Cystic fibrosis\n\nDelayed passage of Meconium\nRecurrent pneumonia\nSteatorrhea\nLate onset Diabetes\nAzoospermia", "cop": 3, "opa": "Kartagener's syndrome", "opb": "Bronchiectasis", "opc": "Cystic fibrosis", "opd": "Hirnchiprung disease", "subject_name": "Pediatrics", "topic_name": null, "id": "dccc20a4-6f29-4123-b06a-034b801eda63", "choice_type": "single"}
+{"question": "Normal anion gap metabolic acidosis can occur in", "exp": "In renal failure, there is retention of unmeasured anions, including phosphate, urate, and sulfate. The increase in unmeasured anions in renal failure is usually less than the decrease in the bicarbonate concentration. Renal failure is thus a mix of an increased gap and a normal gap metabolic acidosis. The normal gap metabolic acidosis is especially prominent in children with renal failure as a result of tubular damage, as occurs with renal dysplasia or obstructive uropathy, because these patients have a concurrent A.Other distractors are causes of high anion gap metabolic acidosis. Ref:- Nelson&;s textbook of paediatrics; pg num:- 574", "cop": 1, "opa": "Renal failure", "opb": "Liver failure", "opc": "Severe anemia", "opd": "Malignancy", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "91bf0367-7b8b-43ed-82ea-a05e8f9bd46f", "choice_type": "single"}
+{"question": "Diagnosis of beta Thalassemia is established by", "exp": "Diagnostic test for thalassemia is Hb electrophoresis. NESTROFT Test - Naked Eye Single Tube Red Cell Osmotic Fragility Test - used for screening for Thalassemia HbA1c - Used to assess long term glycemic control in diabetics (blood sugar control over past 3 months) Target cells - A feature of thalassemia, but not diagnostic Reference : Ghai essential of pediatrics, eighth edition, p.no:342", "cop": 3, "opa": "NESTROFT Test", "opb": "Hb A1c estimation", "opc": "Hb electrophoresis", "opd": "Target cells in peripheral smear", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "9fa97b8c-d9d3-4693-895c-e9b6afeb31b7", "choice_type": "single"}
+{"question": "Mutation in Hartnup's disease is", "exp": "SLC6A19 gene encodes neutral amino acid transporter. Its mutation is seen in Hartnup's disease.", "cop": 3, "opa": "SLC6A18", "opb": "SLC6A17", "opc": "SLC6A19", "opd": "SLC6A20", "subject_name": "Pediatrics", "topic_name": null, "id": "85a89d7b-a846-474d-b7e8-a5821b886cd4", "choice_type": "single"}
+{"question": "6 weeks old female baby found unconscious suddenly in the crib. She was previously healthy. Normal blood pressure, hyperpigmentation of genitals, blood glucose 30 mg/dl. Diagnosis is aEUR'", "exp": "Familial glucocoicoid deficiency Familial glucocoicoid deficiency is a rare autosomal recessive condition. It is characterized by adrenal insufficiency. The pathological examination of the adrenal gland reveals that:- This causes low coisol concentration because the zona fasciculata is primarily responsible for glucocoicoid production. Because the zona glomerulosa is well preserved mineralocoicoid action is usually unaffected. Low circulating serum coisol results in lack of feedback inhibition to the hypothalamus which results in increased ACTH secretion from pituitary. Clinical features Patients with .familial glucocoicoid deficiency generally presents with signs and symptoms of adrenal insufficiency with the impoant distinction that mineralocoicoid production is always normal. The most common initial presenting sign is \"deep hyperm,ementation\" of the skin, mucous membrane or both as a result of the action of adrenocoicotrophic hormone (ACTH) on cutaneous melanocyte stimulating hormone (MSH) receptors. The symptoms are compatible with glucocoicoid deficiency. Many patients presents 4vith recurrent hypoglycemia or severe infections. - In the neonatal period, frequent presenting signs include - feeding problems, failure to thrive, regurgitation and hypoglycemia manifesting as seizures", "cop": 2, "opa": "CAH due to 21-alpha hydroxylase deficiency", "opb": "Familial glucocoicoid deficiency", "opc": "Cushing syndrome", "opd": "Insulinoma", "subject_name": "Pediatrics", "topic_name": null, "id": "caff8829-b67a-4b5f-999c-2d77cc2b654e", "choice_type": "single"}
+{"question": "Infantile myocarditis and pericarditis is due to", "exp": "Ans. is 'b' i.e., Coxsackie B o The commonest cause of myocarditis is coxsackie B infection, which occurs any where from the age of a few hours to 7 weeks, with a peak around two weeks.", "cop": 2, "opa": "Coxsackie A", "opb": "Coxsackie B", "opc": "Mumps", "opd": "Pox virus", "subject_name": "Pediatrics", "topic_name": null, "id": "a78ee142-0316-4956-b077-3306e8d0e9ca", "choice_type": "single"}
+{"question": "Hypoplasia of limbs & scarring is caused due to aEUR'", "exp": "Varicella virus Congenital Varicella syndrome is characteristically associated with limb reduction defects (if infection occurs prior to limb bud formation) and scarring of skin The association of Limb reduction defects with scarring of skin suggests the diagnosis of congenital varicella syndrome. Limb reduction defects (Limb hypoplasia) and congenital varicella. Limb reduction defects are seen if infection occurs prior to or during limb bud formation. The virus has a tendency to select tissues that are in a rapid development stage such as the limb buds Fetus infected at 6-12 weeks of gestation appears to have maximal interruption with limb development. This may result in 1 or more shoened and malformed extremities. The remaining of the torso may be entirely normal in appearance. Scarring of Skin (Cicatrical skin lesions) and Varicella Scarring of skin is a common feature of congenital varicella syndrome. The characteristic cutaneous lesion has been called a 'Cicatrix' 'Cicatrix' represents zigzag scarring in a dermatomal distribution (and is often associated with atrophy of the affected limb) This characteristic cicatrical scaring is believed to represent the cutaneous residua of WV infection of the sensory nerves analogous to herpes zoster.", "cop": 1, "opa": "Varicella", "opb": "Herpes simplex", "opc": "Rubella", "opd": "Toxoplasma", "subject_name": "Pediatrics", "topic_name": null, "id": "b64f95a2-ab0e-45c1-a9ca-aa50b5d610a9", "choice_type": "single"}
+{"question": "Early strict toilet training can result in", "exp": "A condition in which a child resists having bowel movements, causing impacted stool to collect in the colon and rectum and lead to leakage. Common causes of this symptom Encopresis can have causes that aren&;t due to underlying disease. Examples include sneezing, constipation, incontinence due to lack of potty training or incontinence due to misinterpretation of body signals. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "Nocturnal enuresis", "opb": "Encopresis", "opc": "Night terror", "opd": "Temper tantrauma", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "a3da19ac-1e6f-4c7a-9e90-2ed8b303c71a", "choice_type": "single"}
+{"question": "Most common cardiac anamoly associated with Congenital Rubella Syndrome among the following is", "exp": "Most common cardiac anamoly associated with Congenital Rubella Syndrome is in the order patent ductus arteriosus > pulmonary stenosis > Ventricular septal defect.", "cop": 2, "opa": "Ventricular septal defect", "opb": "Pulmonary stenosis", "opc": "Atrial septal defect", "opd": "Truncus arteriosus", "subject_name": "Pediatrics", "topic_name": null, "id": "7f1c834c-d383-4e5d-9871-6cfa3c6925ab", "choice_type": "single"}
+{"question": "A new born presented with Jaundice. Most common diagnostic Investigation of choice is", "exp": "Bilirubin test : If it&;s thought your baby has jaundice, the level of bilirubin in their blood will need to be tested. This can be done using: a blood test of a sample of blood taken by pricking your baby&;s heel with a needle (the level of bilirubin in the liquid pa of the blood called the serum is then measured). Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Total and Direct Bilirubin", "opb": "Conjugated Bilirubin", "opc": "Serum Bilirubin", "opd": "Uroporphyrin levels", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "c94be2c3-95cd-41a4-a8f5-2283ea35f562", "choice_type": "single"}
+{"question": "Embryonic hemoglobins among the following are", "exp": "Embryonic hemoglobins are Gower hemoglobin and Portland hemoglobin.", "cop": 4, "opa": "Fetal hemoglobin and Gower hemoglobin", "opb": "Fetal hemoglobin and Portland hemoglobin", "opc": "Portland hemoglobin and HbA2", "opd": "Gower hemoglobin and Portland hemoglobin", "subject_name": "Pediatrics", "topic_name": null, "id": "a33744dd-5e7f-4c17-8fd2-5a4f39b17f53", "choice_type": "single"}
+{"question": "Oral glucose tolerance test in children is done with", "exp": "Ideal weight of the glucose taken for glucose tolerance test for children are 1.75gm/kg glucose . Obtain a fasting blood sugar level, then administer an oral glucose load (2 g/kg for children aged < 3 y, 1.75 g/kg for children aged 3-10 y , or 75 g for children aged >10 y). Check the blood glucose concentration again after 2 hours. A fasting whole-blood glucose level higher than 120 mg/dL (6.7 mmol/L) or a 2-hour value higher than 200 mg/dL (11 mmol/L) indicates diabetes. However, mild elevations may not indicate diabetes when the patient has no symptoms and no diabetes-related antibodies. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "1.5 gm/kg glucose", "opb": "1.75 gm/kg glucose", "opc": "2 gm/kg glucose", "opd": "2.5 gm/kg glucose", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "aa3af173-4296-4a04-84f4-6b67814329be", "choice_type": "single"}
+{"question": "Most sensitive indicator of intravascular volume depletion in infant aEUR'", "exp": "Hea Rate \"A significant misconception is that shock occurs only with low B.P.(hypotension). Through various compensatory mechanisms hypotension is often a late .finding. Tachycardia, with or without tachyapnea may be the 1' or only sign of early compensated shock\". Shock is an acute dramatic syndrome characterized by inadequate circulatory supply of oxygen so that the metabolic demands of vital organs and tissues are not met. Shock has been categorized into series of recognizable stage: ? Compensated Uncompensated Irreversible An initial insult triggers shock, thus disrupting blood flow to end organs leading to inadequate tissue perfusion. The body's compensatory mechanism is initiated to maintain perfusion to vital organs. If treatment is not introduced during this period, decompensated shock develops causing tissue damage that leads to multisystem organ dysfunction and death. Compensatory shock In the early phases of shock, multiple compensatory physiologic mechanisms act to maintain blood pressure and preserve tissue perfusion. - Blood pressure remains normal, initially, because of peripheral vasoconstriction and increased systemic vascular resistance. - Thus hypotension occurs late and is more a characteristic of uncompensated stage of shock. - Patients in compensated shock have relatively normal cardiac output and normal blood pressures but they have alteration in microcirculation that increase flow to some organs and reduce flow to other. - In infants compensatory increases in cardiac output are achieved primarily by \"tachycardia\" rather than by increase in stroke volume. - Hea rates of 190-210/min are common in infants with compensated shock. - On the other hand in older patients cardiac contractility (stroke volume) and (hea rate) increase to improve cardiac output.", "cop": 2, "opa": "Stroke volume", "opb": "Hea rate", "opc": "Cardiac output", "opd": "lood pressure", "subject_name": "Pediatrics", "topic_name": null, "id": "2cc16881-adee-46ab-90cf-7b871ed54b89", "choice_type": "single"}
+{"question": "A malignant tumor of childhood, that metastsizes to bones most often, is", "exp": "In neuroblastoma,metastasis is present in 60-70% of children,usually to the skeleton(facial bones,skull),bone marrow,also to lymph nodes. Reference:Essential pediatrics-Ghai,8th edition,page no:617.", "cop": 2, "opa": "Wilm's tumor", "opb": "Neuroblastoma", "opc": "Adrenal gland tumors", "opd": "Granulosa cell tumor of ovary", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "8885f52e-c3ea-44f5-99fb-86a9f0dfec4e", "choice_type": "single"}
+{"question": "Precocious puberty in girls is defined by the onset of secondary sexual characteristic before the age of", "exp": "Precocious puberty :\nOnset of secondary sexual characteristic before the age of 8 years in girls and 9 years in boys.", "cop": 3, "opa": "5 years", "opb": "7 years", "opc": "8 years", "opd": "9 years", "subject_name": "Pediatrics", "topic_name": null, "id": "8e3b5309-7b30-4083-816b-c20bc268fd57", "choice_type": "single"}
+{"question": "The commonest cause of obstructive hydrocephalus in children is", "exp": "ETIOLOGY OF HYDROCEPHALUSCommunicating/non-obstructiveNon-communicating/obstructivePostmeningiticAqueductal stenosisposthemorrhagicDandy-walker/Chiari malformationChoroid plexus papillomaTuberculosisObstructive /non-communicating hydrocephalus develops most commonly in children due to aqueductal stenosis.Non-obstructive hydrocephalus most commonly occurs due to subarachnoid hemorrhage which is usually a result of intraventricular hemorrhage in a preterm infant.", "cop": 1, "opa": "Aqueductal stenosis", "opb": "Dandy walker syndrome", "opc": "Subarachnoid hemorrhage", "opd": "Tubercular meningitis", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "cdf23a79-cfd1-4ee8-9755-e1156f105dbb", "choice_type": "single"}
+{"question": "Most common organ involved by congenital TB is", "exp": "Congenital tuberculosis is rare. The fetus may be infected hematogenously through umbilical vessels. The primary focus in this case is liver. In children with congenital TB, the liver is usually affected first, which adds to the hepatoxicity of the therapeutic regimens currently available Reference : Ghai essential pediatrics, eighth edition, page no:257", "cop": 1, "opa": "Liver", "opb": "Pancreas", "opc": "Kidney", "opd": "Lung", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "163d1937-1e93-4caf-a8db-5372f075bbae", "choice_type": "single"}
+{"question": "The Most common cause of perinatal mortality is", "exp": "(B) Prematurity # Direct causes of death: About 80% of the perinatal deaths are related to perinatal hypoxia, low birth weight, infection & intracranial haemorrhage.> The undetermined group is reduced to 15%.> Thus autopsy study is essential in any perinatal; mortality study when the real causes of death can only be ascertained so that preventive measures can be taken to prevent its occurrence.> The WHO's definition \"Deaths occurring during late pregnancy (at 22 completed weeks gestation and over), during childbirh and up to seven completed days of life\" is not universally accepted. The perinatal mortality is the sum of the fetal mortality and the neonatal mortality.> Collectively, the two types of deaths are referred to as perinatal deaths. Maternal and prenatal foetal conditions leading to slow foetal growth, foetal malnutrition and immaturity are the major contributing factors.> Hypoxia, birth asphyxia and congenital anomalies are some of the major causes of perinatal deaths", "cop": 2, "opa": "Anoxia", "opb": "Prematurity", "opc": "Congenital anomalies", "opd": "Toxaemia", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "9f44a29a-e1e8-4f05-89a2-e778dba5b633", "choice_type": "single"}
+{"question": "A 3 year old male baby presents to Casualty with complaints of sudden onset of stridor. A foreign body is visualised in the upper airway. Next line of management", "exp": "In case of a foreign body in upper airway,\nif visualised - Foreign body removal using Magill's forceps\nIf not visualised - Heimlich's maneuver.", "cop": 2, "opa": "Heimlich's maneuver", "opb": "Foreign body removal using Magill's forceps", "opc": "Foreign body removal using Rigid Bronchoscope", "opd": "Foreign body removal using Fibreoptic Bronchoscope", "subject_name": "Pediatrics", "topic_name": null, "id": "89649a10-680a-4c38-9eb0-2fa15f3757b4", "choice_type": "single"}
+{"question": "A new bom child presented with CHD has cyanosis, become prominanat on breathing and improved in crying. The Diagnosis is", "exp": "i.e. (Bilateral choanal atresia) : (336-Ghai 7th) (178-458-Dhingra 5th)* Affected baby cycles between spells of cyanosis and crying. Attempts at suckling immediately precipitates cyanosis in CHOANAL ATRESIACHOANAL ATRESIA* More often unilateral. More common in female (2:1), more often on the right side and more often bony than membranous (9:1)* Due to persistance of bucconasal membrane* Bilateral choanal atresia usually presents immediately after birth with respiratory distress which is due to the fact that neonates are obligate nose-breathersSometimes babies bom with choanal atresia also have other abnormalities:ColobomaHeart defectsMental retardationGrowth impairmentOthers (see also CHARGE syndrome)Also any condition that causes significant depression of the nasal bridge or midface retraction can be associated with choanal atresia. Examples include the craniosynostosis syndrome such as Crouzon syndrome, and Antley- Bixler syndrome.* Diagnosis(i) Presence of mucoid discharge in the nose(ii) Absence of air bubbles in the nasal discharge(iii) Failure to pass a catheter from nose to pharynx(iv) Putting a few drops of a dye (methylene blue) in to the nose and seeing its passage into the pharynx(v) Installing - radio - opaque dye into the nose and taking a lateral film* Bilateral choanal atresia requires - Urgent management by inserting a finger in the baby's mouth: this can be replaced by with a plastic oropharyngeal airway or a Me Govern nipple - Failure - Endotrachial tube or tracheostomy* Bilateral atresia can be associated with other syndrome head and neck abnormalities eg CHARGE association (Coloboma, hearing impairment, choanal atresia, mental retardation, genital abnormality, endocardial cushion defects) meningo-myelocoeles, craniosynostosis etc.* Most patient with CHARGE syndrome have mutation in CHD7 gene. Mitomycin C has been used to present the development of granulation tissue & stenosis (1743-Nelson 18th)Diaphragmatic hernia - occurs because offailure of closure of the pleuroperitoneal membrane - at birth presented with respiratory distress and a scaphoid abdomen and mediastinal shift", "cop": 1, "opa": "Bilateral choanal atresia", "opb": "Diaphragmatic hernia", "opc": "Genitourinary defects", "opd": "Coloboma", "subject_name": "Pediatrics", "topic_name": "C.V.S.", "id": "05838ddf-d656-4a9f-90ec-48f750977495", "choice_type": "single"}
+{"question": "Conjugated hyperbilirubinemia in neonates is a feature of", "exp": "The predominant causes of conjugated hyperbilirubinemia are intrahepatic cholestasis and extrahepatic obstruction of the biliary tract, with the latter preventing bilirubin from moving into the intestines. Viruses, alcohol, and autoimmune disorders are the most common causes of hepatitis. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Breast milk jaundice", "opb": "Gilbe syndrome", "opc": "Hypothyroidism", "opd": "Rotor syndrome", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "8613a7e8-5628-4700-b2de-10944e2f8608", "choice_type": "single"}
+{"question": "Size of tracheal tube in a newborn weighing 2.5kg is", "exp": "Guidelines for Tracheal Tube Size and Depth of InseionTUBE SIZE (MM INTERNAL DIAMETER)DEPTH OF INSEION FROM UPPER LIP (cm)WEIGHT (g)GESTATION (wk)2.56.5-7<1,000<2837-81,000-2,00028-343/3.58-92,000-3,00034-383.5/4.0>=9>3,000>38Ref: Nelson; 20th edition; Page no: 846", "cop": 2, "opa": "2", "opb": "3", "opc": "4", "opd": "5", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "b8aa83d6-44db-499d-bd17-1f65fdddbeb1", "choice_type": "single"}
+{"question": "A ten year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity measured as 200/140 mm Hg. Femaral pulses were not palpable. The most likely diagnosis amongst the flollowing is", "exp": "In coarctation of aoa there will be radiofemoral delay. Ref : Ghai essential of pediatrics, eighth edition,p.no:432", "cop": 4, "opa": "Takayasu aooaeritis", "opb": "Renal parenchymal disease", "opc": "Grandmal seiures", "opd": "Coarcctation of aoa", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "57e65e72-c86f-42cc-b218-3ff77213e0ff", "choice_type": "single"}
+{"question": "Child changes a rattle from one hand to another at the age of", "exp": " . Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand).transfer objects from hand to hand. 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}", "cop": 2, "opa": "3 months", "opb": "6 months", "opc": "9 months", "opd": "1 year", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "20660ee9-47bf-4771-b4d4-82accb290120", "choice_type": "single"}
+{"question": "The commonest valvular manifestation of acute as well as previous rheumatic carditis is", "exp": "Mitral regurgitation (MR) is the commonest manifestation of acute as well as previous rheumatic carditis. Reference: Essential Paediatrics; O.P. Ghai; Page no: 438", "cop": 2, "opa": "Mitral stenosis", "opb": "Mitral regurgitation", "opc": "Aoic stenosis", "opd": "Aoic regurgitation", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "f7ccc9f7-59da-4f7d-910c-01f5d2bfce70", "choice_type": "single"}
+{"question": "Best parameter to monitor the response to injection of a bolus dose of fluids in a dehydrated child is", "exp": "Signs of mild or moderate dehydration include: Thirst ,Dry or sticky mouth. Signs of severe dehydration include: Not peeing or having very dark yellow pee. Very dry skin. Feeling dizzy. Rapid heabeat. Rapid breathing. Sunken eyes. Sleepiness, lack of energy, confusion or irritability. Fainting. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Skin condition", "opb": "Difference between core and surface temperature", "opc": "Capillary refilling time", "opd": "Radial pulse", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "fb71ea73-e6f9-4ebd-985b-b29a6a1a3d2b", "choice_type": "single"}
+{"question": "Testes are not palpable in", "exp": "WT-1 and SF-1 genes stimulate genital ridge to form primitive (bipotential) gonad which then differentiates either into ovary or testis.SRY genes involved in the development of male gonads (testes) from primitive (bipotential gonads)DAX-1, WNT-4, and RSPO1 genes are involved in the development of female gonads (ovary)(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2730)", "cop": 1, "opa": "SRY deletion", "opb": "DAX 1 deletion", "opc": "WNT4 gene mutation", "opd": "RSPO1 gene mutation", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "9884a244-07e6-41e4-915a-26c51efa601d", "choice_type": "single"}
+{"question": "Drug of choice in Absence Seizure", "exp": "Ethosuximide is the drug of choice in Absence seizures. Ethosuximide: Ethosuximide (Zarontin), a succinimide, has been considered an effective agent for the treatment of absence seizures since the mid-20th century.Although ethosuximide's mechanism of action is not fully understood, the blockade of a specific voltage-gated calcium channel (the T channel) in thalamic neurons appears integral to its antiepileptic activity. This blockade suppresses thalamic excitability, which is thought to be necessary for sustaining the characteristic spike-wave discharge of absence seizures. Serious adverse events linked to ethosuximide include agranulocytosis, aplastic anemia, pancytopenia, Stevens-Johnson syndrome (SJS), and systemic lupus erythematosus; however, these occur rarely and the medication is generally well tolerated. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Carbamazepine", "opb": "Phenytoin", "opc": "ACTH", "opd": "Ethosuximide", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "1a4ec9f2-a71d-4e25-b01a-40ac1c978b94", "choice_type": "single"}
+{"question": "Blood specimen for Neonatal thyroid screening is obtained on", "exp": "GUIDELINES FOR NEONATAL THYROID SCREENING - AMERICAN ACADEMY OF PEDIATRICS When to screen: Normal hospital delivery at term - Filter paper collection ideally at 2-4 days of age or at time of discharge NICU / preterm home bih - Within 7 days of bih Maternal history of thyroid medication / family history of congenital hypothyroidism - cord blood for screening Cord blood is to be used only if there is family history of hypothyroidism. In normal delivery, blood is taken at 2-4 days of age. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Cord blood", "opb": "24 hours after bih", "opc": "48 hours after bih", "opd": "72 hours after bih", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "33eb2af0-2e65-43d6-8c6a-df604de19363", "choice_type": "single"}
+{"question": "In children the most commonly recognized form of Familial Hyperlipidemia is", "exp": "Familial combined hyperlipidemia is a disorder that is passed down through families. It causes high cholesterol and and early coronary aery disease. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Hyperiglyceridemia", "opb": "Hypercholesterolemia", "opc": "Hyperchlyomicronemia", "opd": "Combined hyperlipidemia", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "c33d91a3-5a09-4201-aa1a-5010276ab4a4", "choice_type": "single"}
+{"question": "Chesrry red epiglottis is seen in", "exp": "On laryngoscopy, cherry red epiglottis is seen in Acute epiglottitis.", "cop": 4, "opa": "Larryngomalacia", "opb": "Croup", "opc": "Bronchiolitis", "opd": "Acute epiglottitis", "subject_name": "Pediatrics", "topic_name": null, "id": "c35df83a-c3c8-4520-9819-5ad370bfb26b", "choice_type": "single"}
+{"question": "Apnea in infant is", "exp": "Apnea may be defined as cessation of respiraton for 20s with or without bradycardia and cyanosis or for shoer periods if it is associated with bradycardia and cyanosis.Apnea is a central problem in preterm neonates.It could be central ,obstructive, or mixed. In preterm neonates it occurs in 2-5 th day of life and is because of the immaturity of the developing brain.Central apnea can also occur due to pathological causes like sepsis,metabolic problems,temperature instability,respiratory distress, anemia ,polycytemia. Treatment:suppoive,underlying cause corrected.Drugs used include aminophylline and caffeine. Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:146,7th edition", "cop": 2, "opa": "> 10 sec", "opb": "> 20 sec", "opc": "> 30 sec", "opd": "> 40 sec", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "4a16a9a7-226e-4c9c-936c-9f2b774ade8a", "choice_type": "single"}
+{"question": "Drug of choice for Steroid Resistant Nephrotic Syndrome is", "exp": "Drug of choice for Steroid Resistant Nephrotic Syndrome is Calcineurin Inhibitors like Cyclosporine A or Tacrolimus.", "cop": 4, "opa": "Cyclophosphamide", "opb": "Mycophenolate mofetil", "opc": "Prednisolone", "opd": "Tacrolimus", "subject_name": "Pediatrics", "topic_name": null, "id": "76c74d9c-43e7-479f-a325-7b0dcc3eb831", "choice_type": "single"}
+{"question": "First change of improvement noted after iron therapy is initiated", "exp": "First change of improvement noted after iron therapy is decreased irritability followed by increased reticulocyte count. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Decreased irritability", "opb": "Reticulcytosis", "opc": "Increase in serum iron levels", "opd": "Replenishment of iron stores", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "a937600a-0f2d-47a7-a689-e2792d77b580", "choice_type": "single"}
+{"question": "In infancy, atopic dermatitis spares", "exp": "Atopic dermatitis (AD), or eczema, is the most common chronic relapsing skin disease seen in infancy and childhood. Infants with the AD are predisposed to the development of allergic rhinitis and/or asthma later in childhood, a process called \"the atopic march.Major features:Pruritus Facial and extensor eczema in infants and childrenFlexural eczema in adolescentsChronic or relapsing dermatitisPersonal or family history of atopic diseaseMost patients with AD have dry, lackluster skin irrespective of their stage of illness. The AD is generally acuter in infancy and involves the face, scalp, and extensor surfaces of the extremities. The diaper area is usually spared. Older children and children with chronic AD have lichenification and localization of the rash to the flexural folds of the extremities.Reference: Nelson Textbook of Paediatrics; 20th edition; Chapter 145; Atopic Dermatitis (Atopic Eczema)", "cop": 4, "opa": "Extensor surfaces", "opb": "Forehead", "opc": "Scalp", "opd": "Diaper area", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "d6d564b0-ae07-4892-b755-74ebc065231d", "choice_type": "single"}
+{"question": "Lactose content of breast milk per 100 ml is", "exp": "Lactose content of breast milk per 100 ml is 7.0 g. Ref: Table 5.4, Page 97; Ghai essential pediatrics; 6th edition", "cop": 4, "opa": "3.5 gm", "opb": "4.5 gm", "opc": "6 gm", "opd": "7 gm", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "3afae527-ed37-4073-acf3-24d896cdb3ff", "choice_type": "single"}
+{"question": "6 year old drowsy child came in emergency with history of vomiting, loose motion for 3 days. On examination he had sunken eye, hypothermia, skin on pinching taken time to reve diagnosis", "exp": "Sunken eyes, mouth and tongue very dry , condition lethargy ,skin pinch goes back very slowly The patient has 2 / more signs there is severe dehydration Ref: Ghai pediatrics eighth edition pg no 293", "cop": 4, "opa": "No dehydration", "opb": "Mild dehydration", "opc": "Some dehydration", "opd": "Severe dehydration", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "af6a0acd-5f08-4a8d-b034-01706f801d62", "choice_type": "single"}
+{"question": "In a mother with active tuberculosis, treatment for infant is", "exp": "Prevention of perinatal TB If the mother has active disease, ATT should be staed for motherNeonate should be given INH prophylaxis till mother is sputum negative or at least 6 monthsRoutine BCG vaccinationSeparation of mother and neonate is not required and breastfeeding should be continued.(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1454)", "cop": 1, "opa": "Isoniazid prophylaxis", "opb": "No treatment", "opc": "Full treatment with HRE", "opd": "Treatment with Isoniazid and rifampicin", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "c8095764-57d1-42ee-b747-a626978a633e", "choice_type": "single"}
+{"question": "In a newborn, Harlequins skin change is due to", "exp": "HARLEQUIN COLOR CHANGEA rare but dramatic vascular event, harlequin color change occurs in the immediate newborn period and is most common in low bihweight infants. It probably reflects an imbalance in the autonomic vascular regulatory mechanism. When the infant is placed on 1 side, the body is bisected longitudinally into a pale upper half and a deep red dependent half. The color change lasts only for a few minutes and occasionally affects only a poion of the trunk or face. Changing the infant's position may reverse the pattern. Muscular activity causes generalized flushing and obliterates the color differential. Repeated episodes may occur but do not indicate a permanent autonomic imbalance.Ref: Nelson textbook of Paediatrics; 20th edition; Chapter 647; Diseases of the Neonate", "cop": 3, "opa": "Polycythemia", "opb": "Septicemia", "opc": "Autonomic dysfunction", "opd": "Ichthyosis", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "b155f144-cf2b-4e62-bace-b8afe2b2c504", "choice_type": "single"}
+{"question": "Mousy odour urine is seen in", "exp": "Mousy order urine is seen in phenylketonuria due to the presence of excessive phenylalanine and its metabolites.Mousy body odour is also present due to the excretion of phenyl lactic acid,its metabolite through sweat. Reference:Essential pediatrics-Ghai,8th edition,page no:652.", "cop": 2, "opa": "Maple syrup urine", "opb": "Phenylketonuria", "opc": "Isovalericacidria", "opd": "Cystinuria", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "fab32640-c89a-430c-927e-46ab763e9678", "choice_type": "single"}
+{"question": "Widely split S1 is heard in", "exp": "In ASD there Will be widely fixed split S2. Ref : Ghai essential of pediatrics, eighth edition, p.no:413", "cop": 3, "opa": "Right bundle branch block (RBBB)", "opb": "Mitral regurgitation (MR)", "opc": "Atrial septal defect (ASD)", "opd": "Ventricular septal defect (VSD)", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "e64bc315-a3b2-43aa-a4d6-41fec3098dbe", "choice_type": "single"}
+{"question": "Subependymal calcified nodules are seen in", "exp": "Definite Tuberous Sclerosis Complex is diagnosed when at least 2 major or one major plus 2 minor features are presentMajor featuresMinor featuresCoical tuberSubependymal noduleSubependymal giant cell astrocytomaFacial angiofibroma or forehead plaqueUngual or periungual fibroma (non-traumatic)Hypomelanotic macules (>3)Shagreen patchMultiple retinal hamaomasCardiac rhabdomyomaRenal angiomyolipomaPulmonary lymphangioleiomyomatosisCerebral white matter migration linesMultiple dental pitsGingival fibromasBone CystsRetinal achromatic patchConfetti skin lesionsNonrenal hamaomasMultiple renal cystsHamaomatous rectal polypsSubependymal nodules are lesions found along the wall of the lateral ventricles where they undergo calcification and project into the ventricular cavity, producing a candle-dripping appearance. These lesions do not cause any problems; however, in 5-10% of cases, these benign lesions can grow into subependymal giant cell astrocytomas (SEGAs).(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2877 - 2878)", "cop": 2, "opa": "Sturge Weber syndrome", "opb": "Tuberous sclerosis", "opc": "Neurofibromatosis type 2", "opd": "Von Hippel Lindau syndrome", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "3085bf7f-b8de-42b1-8911-84963f2eadbd", "choice_type": "single"}
+{"question": "Children born to mothers with SLE are likely to have one of the following anomalies", "exp": "Systemic lupus erythematosus (SLE) is one of the most common autoimmune disorders that affect women during their childbearing years. SLE increases the risk of spontaneous aboion, intrauterine fetal death, preeclampsia, intrauterine growth retardation, and preterm bih. HEA INVOLVEMENT IN NEONATAL LUPUS Complete hea block (CHB) is the most serious manifestation of the neonatal lupus syndrome (NLS), a congenital syndrome in which maternal IgG anti-Ro/SS-A autoantibodies cross the placenta and injure an otherwise normally developing hea. CHB is often regarded as a model of passively acquired autoimmunity in which antibodies are necessary but insufficient to cause CHB, and fetal factors are likely contributory . Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "ASD", "opb": "TOF", "opc": "TGA", "opd": "Complete hea block", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "5a8f6841-f3a6-4051-a6b8-8a0adb20d3fc", "choice_type": "single"}
+{"question": "Bater syndrome is mutation in", "exp": "Bater syndrome is a group of similar rare conditions that affect the kidneys. It&;s genetic, which means it&;s caused by a problem with a gene. If you have it, too much salt and calcium leave your body when you pee. It also may cause low levels of potassium and high levels of acid in the blood. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Na-k-cl co transpoer", "opb": "Na-Cl channel", "opc": "Renin", "opd": "ENaC protein", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "2ca4e357-e473-4648-8a5a-6a8014920ae0", "choice_type": "single"}
+{"question": "Fluid administration in an infant of 10 kg is", "exp": "For infants 3.5 to 10 kg the daily fluid requirement is 100 mL/kg. For children 11-20 kg the daily fluid requirement is 1000 mL + 50 mL/kg for every kg over 10. A guide for maintenance fluid therapy for children is as follows: 0-10 kg - 100 mL/kg/day (4 mL/kg/hr) 10-20 kg - 1000 mL/day + 50 mL/kg/day (40 mL/hr + 2 mL/kg/hr) >20 kg - 1500 mL/day + 25 mL/kg/day (60 mL/hr + 1 mL/kg/hr) Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "1 ml/kg/hr", "opb": "2 ml/kg/hr", "opc": "3 ml/kg/hr", "opd": "4 ml/kg/hr", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "9b1f2635-17fe-4405-b7a2-860f234b1d8f", "choice_type": "single"}
+{"question": "Orchidopex is done in cases of undescended testes at the age of", "exp": "Treatment is always surgical. Surgery is done between two and four years of age. The ideal timing for surgical correction of undescended testes (orchidopexy) has been considered in a number of fora, which have resulted in a range of consensus statements/guidelines stating that orchidopexy should ideally be performed between 6 and 12 months of age, or 18 at the very latest Reference: SRB&;S manual of surgery,5 th edition. page no 1080", "cop": 2, "opa": "Neonate", "opb": "1-2 yrs", "opc": "5 yrs", "opd": "Pubey", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "b320fddb-bec8-44a2-8563-da0e52a80e01", "choice_type": "single"}
+{"question": "Picket fence temperature seen in", "exp": "(Lateral sinus thrombosis): (95-Dhingra E.N.T. 5th edition)Picket-Fence type of fever - is a feature of the Lateral sinus thrombosis, due to septicaemia often coinciding with release of septic emboli into blood stream. Fever is irregular having one or more peaks a day. It is usually accompanied by chills and rigors. Profuse sweating follows fall of temperature* Clinical picture resembles malaria but lakes regularity* In between the bouts of fever, patient is alert with a sense of well being. Patient receiving antibiotics may not show the picture* Griesinger's sign - is due to thrombosis of mastoid emissary vein. Oedema appears over the posterior part of mastoid is another important sign of lateral sinus thrombosis", "cop": 2, "opa": "Otic hydrocephalus", "opb": "Lateral sinus thrombosis", "opc": "Extradural abscess", "opd": "Meningitis", "subject_name": "Pediatrics", "topic_name": "Central Nervous System", "id": "bd6ab896-9b71-40c3-b24a-b9293c72a84c", "choice_type": "single"}
+{"question": "\"Microsomia\" is defined as", "exp": "A neonate whose weight falls between the 10th and <90th percentile for gestational age is considered as Appropriate for gestational age (AGA). If the weight falls below the 10th percentile, the neonate is classified as Small for gestational age (SGA) or microsomic. If the weight falls at or above the 90th percentile, then the neonate is classified as Large for gestational age (LGA) or macrosomic. Reference : page 137 Ghai Essential Pediatrics 8th edition", "cop": 2, "opa": "Bih weight below 90th percentile", "opb": "Bih weight below 10th percentile", "opc": "Bih weight below 20th percentile", "opd": "Bih weight below 50th percentile", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "eaaeca46-414c-4a5c-95c6-6e1ea3208aa2", "choice_type": "single"}
+{"question": "NOT a feature of TAR syndrome", "exp": "TAR syndrome is characteristically associated with Atrial septal defect.", "cop": 3, "opa": "Thrombocytopenia", "opb": "Multiple skeletal anomalies", "opc": "Ventricular septal defect", "opd": "Autosomal recessive type of inheritance", "subject_name": "Pediatrics", "topic_name": null, "id": "9e5dceda-0419-4b8a-a514-78379ead77ad", "choice_type": "single"}
+{"question": "Most common secondary tumor with Retinoblastoma is", "exp": "Most common secondary tumor with Retinoblastoma Osteosarcoma, Soft tissue sarcoma and malignant melanoma.", "cop": 4, "opa": "Neuroblastoma", "opb": "Pineoblastoma", "opc": "Osteochondroma", "opd": "Osteosarcoma", "subject_name": "Pediatrics", "topic_name": null, "id": "8a4fa741-4898-40bb-bd11-8cedb1b2dd09", "choice_type": "single"}
+{"question": "Breast feeding contraindication", "exp": "Ans. is 'd' i.e., Active untreated tuberculosis Contraindication of Breast feeding Galactosemia Active untreated tuberculosis - only in initial period HIV positive mother - especially in developed country. Some medication Not contraindication of breast feeding Hbs Ag positive mother Hepatitis C infection CMV Febrile Tobacco smoking Alcohol", "cop": 4, "opa": "Hep A", "opb": "Hep B", "opc": "CMV", "opd": "Active untreated T.B", "subject_name": "Pediatrics", "topic_name": null, "id": "3fa2b578-85ab-44d0-aff7-850de20b9737", "choice_type": "single"}
+{"question": "A child presents with massive hepatomegaly and hypoglycemia. There is no improvement in blood glucose on administration of glucagon. The probable diagnosis is", "exp": "Clinical manifestations result, directly or indirectly, from inability to maintain an adequate blood glucose level during the post-absorptive hours of each day organ changes due to glycogen accumulation excessive lactic acid generation damage to tissue from hyperuricemia in GSD Ib, bleeding and infection risk from blood cell effects. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Von-Gierke disease", "opb": "McArdle disease", "opc": "Cori 's disease", "opd": "Forbe's disease", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "b8ef2939-6495-47aa-be6c-c5d45643b863", "choice_type": "single"}
+{"question": "A normal child will acquire complete neck control by", "exp": "GROSS MOTOR DEVELOPMENT:\n2 months: Holds head in the plane of rest of the body when held in ventral suspension. In the prone position in bed, the chin lifts momentarily.\n3 months: lift head above the plane of the body. Head control starts by 3 months and fully developed by 5 months.\n4 months: Remain on forearm support if put in prone position, lifting the upper part of the body off the bed.\n5 months: Rolls over.\n6 months: sit in a tripod fashion.\n8 months: sits without support., crawling\n9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. \n10 months: creeps\n12 months: creeps well, walk but falls, stand without support.\n15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs.\n18 months: Runs, walks upstairs with one hand held. Explores drawers\n2 years: walk up and downstairs, jumps.\n3 years: rides tricycle, alternate feet going upstairs.\n4 years: hops on one foot, alternate feet going downstairs.\n5 years: skips", "cop": 2, "opa": "8 weeks", "opb": "16 weeks", "opc": "28 weeks", "opd": "24 weeks", "subject_name": "Pediatrics", "topic_name": null, "id": "8370f8aa-c1d6-4a55-98a0-a27e90ca1144", "choice_type": "single"}
+{"question": "NOT a feature of Classical triad of Congenital Rubella Syndrome is", "exp": "Classical triad of Congenital Rubella Syndrome is\n\nCongenital Cataract\nCongenital heart disease (most common- Patent Ductus Arteriosus)\nDeafness", "cop": 3, "opa": "Cataract", "opb": "Patent Ductus Arteriosus", "opc": "Microcephaly", "opd": "Deafness", "subject_name": "Pediatrics", "topic_name": null, "id": "632479c6-e92e-4e1c-b477-0af995715f3f", "choice_type": "single"}
+{"question": "Nagayama spots is seen in", "exp": "Ulcer at Uvulopalatoglossal junction is called Nagayama spots caused by Roseola infantum.", "cop": 4, "opa": "Measles", "opb": "Mumps", "opc": "Rubella", "opd": "Roseola infantum", "subject_name": "Pediatrics", "topic_name": null, "id": "a8d42114-bf9d-46e7-bf2b-15c6ae11af19", "choice_type": "single"}
+{"question": "An infant with failure to thrive, hypertension, metabolic alkalosis and hyperkalemia presents to a clinician. Most probable cause is", "exp": "d. Gordon syndrome(Ref: Nelson 20/e p 2535)Out of the given causes, hyperkalemia is seen only in Gordon syndromeGordon syndrome or familial hyperkalemic hypertension, is due to gain-of-function mutations in WNK1 & ioss-of-funotion mutations in WNK4 in distal convoluted tubule, leading to excessive NCCT-mediated salt reabsorption with the clinical picture of pseudohypoaldosteronism type 2Liddle syndrome is due to gain-of-function mutations of the gene that encodes the epithelial sodium channel in the collecting duct, leading to hypertension, hypokalemia & suppressed aldosterone", "cop": 4, "opa": "Liddle's syndrome", "opb": "Bartter's syndrome", "opc": "Gittelman's syndrome", "opd": "Gordon syndrome", "subject_name": "Pediatrics", "topic_name": "Kidney", "id": "690f8f8e-3dda-4f40-a25a-74cc9482f71b", "choice_type": "single"}
+{"question": "Lowest recurrence in nocturnal enuresis is seen with", "exp": "Enuresis Defined as normal, complete evacuation of the bladder at a wrong place and time at least twice a month after 5 year of age. More than 85% children attain complete diurnal and nocturnal control by 5 years of age. Enuresis is primary when the child has never been dry and secondary when bed wetting stas after a minimum period of six months of dryness at night. It is said to be monosymptomatic if not accompanied by any lower urinary tract infection and nocturnal if it occurs during sleep. It has to be differentiated from continuous or intermittent incontinence or dribbling.The bed is usually soaking wet in enuresis, compared to incontinence in which there is loss of urine without normal emptying of bladder. ETIOLOGY:- 1. Maturation delay is most likely cause. 2. Anxiety producing episodes during the 2 nd to 5 th years, the time for development of nocturnal bladder control, are associated with increased risk of enuresis. 3. Lack of circadian rhythm of ADH or impaired response of kidneys to ADH. 4. Secondary enuresis can be precipitated by acute stressful condition or traumatic experience. Bladder irritability due to urinary tract infection or severe constipation with the full rectum impinging on the bladder can cause enuresis. 5. Conditions causing polyuria, spina bifida, ectopic ureter and giggle and stress incontinence are other causes. Treatment:- General advice given to all enurectic children but active treatment need not begin before 6 years of age. Caffeinated drinks like tea , coffee, sodas should be avoided in evening. Adequate fluid intake during day as 40% in morning, 40% in afternoon and 20% in evening is recommended. First line of treatment is usually non pharmacological, comprising motivational therapy and use of alarm devices. Motivational therapy:- Successful in curing enuresis upto 25%. The child is reassured and provided emotional suppo.Every attempt is made to remove any feeling of guilt. The child is encouraged to assume active responsibility, including keeping a dry night diary, voiding urine before going to bed, and changing wet clothes and bedding. Dry nights should be credited with praise.punishments and angry parenteral response should be avoided. Child is encouraged both to void frequently enough to avoid urgency and daytime incontinence and to have daily bowel movement. Alarm therapy: Involves the use of device to elicit a conditioned response of awakening to the sensation of full bladder. Best used afteemr seven years if age. Successful in two third cases without much recurrence. The alarm device consists of a small sensor attached to child&;s underwear or a mat under the bed sheet and an alarm attached to the childs collar or at bedside. When the child stas wetting, sensors are activated thus causing the alarm to ring. Pharmacotherapy:- Used if enuresis persists despite alarm therapy, regular voiding habits, exclusion or treatment of constipation, exclusion of post voidal residual urine. Imipramine works by aleing the arousal sleep mechanism. It gives satisfactory initial response at dise of 1-2.5 mg/ kg/ day. Relapse rate after discontinuation of therapy seen. Cardiac arrythmia is a serious adverse effect. Anticholinergic drugs reduce uninhibited bladder contractions and are useful in children who have significant daytime urge incontinence besides nocturnal enuresis. Usual dose is 5 mg for oxybutynin, 2 mg for tolterodine. Desmopressin works by reducing volume of urine. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Bed alarms", "opb": "Desmopressin", "opc": "Imipramine", "opd": "Oxybutynin", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "7cee35ef-a87f-442a-a8d4-60e751dbc975", "choice_type": "single"}
+{"question": "Cardiomyopathy is not a feature of", "exp": "Lowe&;s syndrome is not associated with cardiomyopathy. Cardiomyopathy is are associated with genetic disorder like duchenne dystrophy,Friedrich ataxia ,pompe disease. Ref : Harrison&;s principles of internal medicine, 19th edition, p.no:1555", "cop": 4, "opa": "Duchenne's Muscular Dystrophy", "opb": "Friedriech's ataxia", "opc": "Pompe disease", "opd": "Lowe's syndrome", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "90113e3a-ac77-4caf-9248-6b7ca7063c58", "choice_type": "single"}
+{"question": "Iron stores are best indicated by", "exp": "Serum ferritin reflects the storage of iron which is decreased in Iron deficiency anaemia.\nIt is the most sensitive marker.", "cop": 1, "opa": "Serum ferritin", "opb": "Serum iron", "opc": "Serum transferrin", "opd": "TIBC", "subject_name": "Pediatrics", "topic_name": null, "id": "0b76a025-187b-400d-8e2c-e1686a984b6b", "choice_type": "single"}
+{"question": "HbE is common in", "exp": "Ans. is 'c' i.e., Bengal o Besides hemoglobin S, there are other hemoglobinopathies due to point mutation in beta globin chain of hemoglobin. o These are ? 1) Hemoglobin C --> Seen in italians and black. 2) Hemoglobin E --> Prevalent in Bengal, Assam and in East India. 3) Hemoglobin D Prevalent in Punjabis and Gujaratis.", "cop": 3, "opa": "Punjab", "opb": "Kerala", "opc": "Bengal", "opd": "Maharstra", "subject_name": "Pediatrics", "topic_name": null, "id": "2c45ac50-f014-43e5-91a0-48a56d8f2fe5", "choice_type": "single"}
+{"question": "A child can ride a tricycle, copy a circle and knows age sex by the age of", "exp": " . Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning.copies circle 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}", "cop": 3, "opa": "30 months", "opb": "42 months", "opc": "36 months", "opd": "48 months", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "0d6f42e8-3711-4a19-b4bb-7f8690defe22", "choice_type": "single"}
+{"question": "Delayed puberty is seen in", "exp": "Delayed puberty may be related to chronic, reversible causes like systemic disease, malnutrition,eating disorders,hyperprolactinemia,and hypothyroidism.Irreversible defects include the destruction of the hypothalamic-pituitary axis by infection, surgery, tumour. All these are due to chronic disease.", "cop": 4, "opa": "Hypothyroidism", "opb": "Turnur's syndrome", "opc": "Malabsorbtion syndrome", "opd": "Chronic disease", "subject_name": "Pediatrics", "topic_name": null, "id": "b1f21f2d-5c9a-488d-9804-24ef0f4139d3", "choice_type": "single"}
+{"question": "Best diagnostic test in Thalassemia is", "exp": "(HbF) (310-11- Ghai 6th) (2035- Nelson 18th) (308-Ghai 7lh)Laboratory Investigations in Thalassemia* The infant is bom only with HbF or some cases HbF and HbE (heterozygosity for J3deg thalassemia)* Hb | (2-6 gm/dL), HbF T and HbA2 is nrmal* Reculocyte count is commonly <8% and is in appropriately low compared with the degree of anemia because of ineffective erythropoiesis* Unconjugated serum bilirubin level is usually elevated but the chemistry values may be normal at an early stages* Peripheral smears shows - hypochromia, anisocytosis and poikilocytosis, (Target and tear drop cell, Howell Jolly bodies & Heinz bodies) with marked basophilic stippling* Bone marrow - hypercellular with erythroid hyperplasia with erythroid hyperplasia with increased number of stippled erythroblasts and side roblasts* Osmotic fragility decreased* Serum iron, serum ferritin levels increased", "cop": 1, "opa": "HbF", "opb": "HbA2", "opc": "Serum iron levels", "opd": "Reticulocyte count", "subject_name": "Pediatrics", "topic_name": "Blood", "id": "c372e5bf-08fa-4716-8cf2-7708a0442a8d", "choice_type": "single"}
+{"question": "Dose of i.v adrenaline in term infant during neonatal resuscitation is", "exp": "When HR is <60/min even after 30sec of effective Positive Pressure Ventilation and chest compressions, adrenaline is given i.v through umbilical vein at a dose of 0.1 - 0.3 ml/kg in 1:10,000 concentration. Reference : page 132 Ghai Essential Pediatrics 8th edition", "cop": 3, "opa": "0.1 - 0.3 ml/kg in 1 : 1000", "opb": "0.3-0.5 ml/kg in 1:1000", "opc": "0.1-0.3 ml/kg in 1:10,000", "opd": "0.3-0.5 ml/kg in 1:10,000", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "ba6110d3-082c-43c0-b7c4-763050314afc", "choice_type": "single"}
+{"question": "Causes of status epilepticus in a child", "exp": "Approximately 25 % of childhood status epilepticus is idiopathic; 25% is associated with fever or meningoencephalitis; 50% of patients have a neurodevelopmental abnormality, head trauma, stroke, drug intoxication, subarachnoid bleed, pyridoxine deficiency, or metabolic abnormality ( hypoglycemia and hyponatremia ).Ref: Ghai, 8th edition; Pg no: 553", "cop": 2, "opa": "Hypernatremia", "opb": "Hyponatremia", "opc": "Hyperkalemia", "opd": "Hypokalemia", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "cb7f3858-d68c-4dc8-8393-893a070df944", "choice_type": "single"}
+{"question": "APGAR stands for", "exp": null, "cop": 3, "opa": "Appearance, Pulse rate, Growth, Activity, Respiratory rate", "opb": "Appearance, Pulse rate, Grimace, Activity, Respiratory rate", "opc": "Appearance, Pulse rate, Grimace, Activity, Respiratory effort.", "opd": "Activity, Pulse rate, Grimace, Activity, Respiratory effort.", "subject_name": "Pediatrics", "topic_name": null, "id": "8879927c-c6be-45e0-862e-afdaaf3849f7", "choice_type": "single"}
+{"question": ". Pondreal index of baby with weight of 2000gm and height of 50 cm. aEUR'", "exp": "1.6 [Re.f: O.P. Ghai 7/e p. t091 Ponderal index = X 100 = X 100 = 100X2/125 = 1.6 Ponderal index less than normal indicates that growth rates of adipose tissue and skeletal muscle the principle determinants of weight are less than normal. Ponderal index < 2 ----> Asymmetrical UGR Ponderal index > 2 Symmetrical UGR", "cop": 1, "opa": "1.6", "opb": "2.2", "opc": "2.6", "opd": "3.6", "subject_name": "Pediatrics", "topic_name": null, "id": "457e6877-1dac-4059-85cc-ff559e41cbcf", "choice_type": "single"}
+{"question": "A premature infant is born with a patent ductus aeriosus. Its closure can be stimulated by administration of", "exp": "Before 2 weeks of gestation indomethacin 0.2mg/kg dose orally every 12-24 hr for 3 doses. Ref : Ghai essential pediatrics,eighth edition P.no: 419", "cop": 4, "opa": "Prostaglandin analogue", "opb": "Estrogen", "opc": "Anti-estrogen compounds", "opd": "Prostaglandin inhibitors", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "c67832fc-0811-49d2-b49c-984e87ff6759", "choice_type": "single"}
+{"question": "Purposeful movement is staed at", "exp": "Palmer grasp goes at age of 4 monthTransfer object hand to hand 5.5 monthThe purposeful movement staed when there is an absence of Palmer group, so an above option best answer is 6 month(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 2798)", "cop": 1, "opa": "6 months", "opb": "8 months", "opc": "9 months", "opd": "12 months", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "592fea53-9a72-43d5-ba1b-9b3dcfdff066", "choice_type": "single"}
+{"question": "A one month old baby presents to the emergency room with history of vomiting, irritability and jaundice. The baby was previously healthy without any symptoms. One week ago cereals and fruit juices were introduced into the diet. USG revealed hepatomegaly and liver functions test were abnormal. The deficient enzyme is", "exp": "Answer: b) Aldolase-B (NELSON 20th ED, p-727)HEREDITARY FRUCTOSE INTOLERANCEDeficiency of fructose-1,6-bisphosphate aldolase (aldolase B)Patients are asymptomatic until fructose or sucrose (table sugar) is ingested (usually from fruit, fruit juice, or sweetened cereal)Symptoms may occur early in life, soon after birth if foods or formulas containing these sugars are introduced into the diet.Early clinical manifestations resemble galactosemia and include jaundice, hepatomegaly, vomiting, lethargy, irritability, and convulsionsLaboratory findings include prolonged clotting time, hypoalbuminuria, elevation of bilirubin and transaminase levels, and proximal tubular dysfunctionTreatment - complete elimination of all sources of sucrose, fructose, and sorbitol from the dietGalactose-1-phosphate uridyl transferase deficiency - Onset of symptoms typically by the second half of the 1st wk of lifeFructokinase deficiency - not associated with any clinical manifestations.Lysosomal acid alpha glucosidase (Pompe's disease) - affected infants present in the first few weeks to months of life with hypotonia, generalized muscle weakness with a \"floppy infant\" appearance, neuropathic bulbar weakness, feeding difficulties, macroglossia, hepatomegaly, and a hypertrophic cardiomyopathy followed by death from cardiorespiratory failure or respiratory infection usually by 1 yr of age", "cop": 2, "opa": "Fructokinase", "opb": "Aldolase-B", "opc": "Galactose-1 phosphate uridyl transferase", "opd": "Acid alpha glucosidase", "subject_name": "Pediatrics", "topic_name": "Inborn Errors of Metabolism", "id": "1ee9c404-7356-4e37-8ce2-075bee318828", "choice_type": "single"}
+{"question": "Hypoglycemia in neonates occurs in blood glucose less than", "exp": "B. i.e. (40%) (177 - Ghai 6th) (155. Ghai 7th)NEONATAL HYPOGLYCEMIA is defined as blood glucose of less than 40 mg/dL irrespective of the gestational age* Early transitional adaptive hypoglycemia occurs in LBW and babies of diabetic mothers* Classical transient neonatal hypoglycemia is observed in infants with small for gestational age infants* Recurrent severe hypoglycemia is caused by enzymatic or metabolic defectsClinical features* Sweating, tremors, Jitteriness and tachycardia, Diminished utilization of glucose in the cerebrum manifests as lethargy or irritability , restlessness, disturbance in sensorium and convulsions* Hypercalciuria is said to be present in children if daily calcium excretion in urine is more than 4 mg/ kg* Total body water of newborn is 80% of body weight**** Cardiac out put of a normal newborn is 350 ml/kg/ml", "cop": 2, "opa": "20 mg%", "opb": "40 mg%", "opc": "60 mg%", "opd": "10mg%", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "24603c3a-5c4a-41ad-877e-935aee072545", "choice_type": "single"}
+{"question": "Drug of choice of Strongyloides stercoralis", "exp": "Ans. c (Ivermectin) (Ref. Nelson paediatrics 18th, Table 276-1; Harrison's Internal Medicine 17th ed., Ch. el7)Nematodes (roundworms)TransmissionDiseaseRxStrongyloides stercoralisLarvae in soil penetrate the skinintestinal infection causing vomiting, diarrhea, epigastric pain (may be peptic ulcer- like)Ivermectin or albendazoleIVERMECTIN# Ivermectin is a derivative of the macrocyclic lactone avermectin produced by the soil-dwelling actinomycete Streptomyces avermitilis.# Recent data suggest that ivermectin acts by opening the neuromuscular membrane-associated, glutamate-dependent chloride channels. The influx of chloride ions results in hyperpolarization and muscle paralysis--particularly of the nematode pharynx, with consequent blockage of the oral ingestion of nutrients.# Ivermectin is available only as an oral formulation.# The drug is highly protein bound; it is almost completely excreted in feces.# The effect of food on bioavailability is unknown. Ivermectin is distributed widely throughout the body.# Ivermectin is generally administered as a single dose of 150-200 pg/kg.# Ivermectin is the drug of choice for the treatment of -- Strongyloidiasis,- Onchocerciasis,.....SOCS = Mneumonic- Cutaneous larva migrans,- Scabies.# Ivermectin is highly active against microfilariae of the lymphatic filariases but has no macrofllaricidal activity.# When ivermectin is used in combination with other agents such as DEC or albendazole for treatment of lymphatic filariasis, synergistic activity is seen.# While active against the intestinal helminths Ascaris lumbricoides and Enterobius vermicularis, ivermectin is only variably effective in trichuriasis and is ineffective against hookworms.# Adverse effects- In patients with filarial infections include fever, myalgia, malaise, lightheadednes,postural hypotension.- More severe complications of ivermectin therapy for onchocerciasis include encephalopathy in patients heavily infected with Loa loa. This reaction has led to the suspension of ivermectin distribution for this indication in regions where the two filarial infections are coendemic.- Ivermectin although is the first-line agent for the treatment of onchocerciasis, in areas of Africa co-endemic for O. volvulus and L. loa, however, ivermectin is contraindicated (as it is for pregnant or breast-feeding women) because of severe posttreatment encephalopathy.", "cop": 3, "opa": "Albendazole", "opb": "Mebendazole", "opc": "Ivermectin", "opd": "Pyrantel pamoate", "subject_name": "Pediatrics", "topic_name": "Infection", "id": "20451144-5d50-4777-ab57-f98e700c1c0a", "choice_type": "single"}
+{"question": "The first sign of pubey in female is", "exp": "Thelarche is the first sign of pubey in a girl around the age of 10 yearsDefinition:- beginning of secondary (Postnatal) breast development at the onset of pubey in girlsTanner stage 2 breast development.Because of rising level of estradiol.Breast development in a male is termed as gynecomastia, not thelarche(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 926)", "cop": 2, "opa": "Tanner stage I", "opb": "Tanner stage II", "opc": "Pubic hair", "opd": "Axillary hair", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "b1ff71eb-b907-4b72-b43c-79719fe2358c", "choice_type": "single"}
+{"question": "A preterm weight of 1600grams should not receive the following vaccine at bih", "exp": "Preterm infants generally can be vaccinated at the same chronologic age as full-term infants according to the recommended childhood immunization schedule. An exception is the bih dose of hepatitis B vaccine. Infants weighing >=2 kg and who are stable may receive a bih dose. However, hepatitis B vaccination should be deferred in infants weighing <2 kg at bih until 30 days of age, if born to an HBsAg negative mother. All preterm, low bihweight infants born to HBsAg positive mothers should receive hepatitis B immunoglobulin and hepatitis B vaccine within 12 hr of bih. However, such infants should receive an additional 3 doses of vaccine staing at 30 days of ageReference: Nelson Textbook of Paediatrics; 20th edition; Chapter 172; Immunization Practices", "cop": 2, "opa": "BCG", "opb": "Hepatitis", "opc": "Polio", "opd": "DPT", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "c427c4b6-23be-4c30-8d6c-213e2d379a4b", "choice_type": "single"}
+{"question": "For cardiopulmonary resuscitation in neonates ratio of chest compression to ventilation is", "exp": "Ans: b (3:1) Ref: Nelson, 18th ed,p. 389; 17th ed,p. 280Chest compression-ventilation relationship Neonate1-8 years> 8 yearsCompression rate120At least 100100Compression to ventilation ratio3:15:115:2Pulse checkUmbilical arteryBrachialcarotidQuestion is a direct pick from the above Table in Nelson.", "cop": 2, "opa": "2:01", "opb": "3:01", "opc": "4:01", "opd": "5:02", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "d333793c-8111-400f-8158-bb0389d55e14", "choice_type": "single"}
+{"question": "Daily water requirement in child weighing 30 kgs, height 123 m and BSA of 1 m2 is", "exp": "For calculating the minimum amount of fluid per day, a formula based on body weight is recommended: 1500 ml is the minimum water intake with 15ml fluid per kg to be added for the actual weight minus 20kg. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "1300 ml", "opb": "1700 ml", "opc": "2000 ml", "opd": "2500 ml", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "302d1538-f9f9-4e63-81e1-0b985e1609c3", "choice_type": "single"}
+{"question": "A one year old child presented with multiple fractures seen in various stages of healing. The most probable diagnosis in this case is", "exp": ".Battered child syndrome: A disease in which children are physically abused. The battered child syndromeis a form of child abuse. Not until the 19th century were children granted the same legal status as domesticated animals in regard to protection against cruelty and/or neglect.", "cop": 3, "opa": "Scurvy", "opb": "Rickets", "opc": "Battered baby syndrome", "opd": "Sickle cell disease", "subject_name": "Pediatrics", "topic_name": "Musculoskeletal disorders", "id": "d7643279-2bde-44cd-8147-fadb84f42c39", "choice_type": "single"}
+{"question": "Most common mutation in Hereditary Spherocytosis is", "exp": "Most common mutation in Hereditary Spherocytosis is Ankyrin > Band 3 > Spectrin and Band 2", "cop": 2, "opa": "Band 3", "opb": "Ankyrin", "opc": "Spectrin", "opd": "Band 4.2", "subject_name": "Pediatrics", "topic_name": null, "id": "95233bd9-9d82-41cf-98f9-d603ac556aed", "choice_type": "single"}
+{"question": "Most common cause of abdominal swelling in newborn", "exp": "It is dysplastic , non functional kidney replaced by cysts.\nIt is usually U/L : B/L is not compatible with life.", "cop": 1, "opa": "Multicystic dysplastic kidney", "opb": "Autosomal dominant PCKD", "opc": "Autosomal recessive PCKD", "opd": "Horseshoe Kidney", "subject_name": "Pediatrics", "topic_name": null, "id": "a185ecf0-2103-4ffb-87a7-a4a0ce3c2227", "choice_type": "single"}
+{"question": "NARP syndrome a disorder of", "exp": "NARP syndrome is seen associated with mitochondrial disorders.NARP syndrome refers to Neurogenic weakness,Ataxia and Retinitis Pigmentosa. Mitochondrial disorders refer to defect in oxidation phosphorylation pathway,thereby interfering with energy production. Tissues such as brain,liver and kidney have high energy requirement and are susceptible to injury. Reference: Ghai TB of pediatrics 8th edition pg 659", "cop": 2, "opa": "Lysosome", "opb": "Mitochondria", "opc": "Nucleus", "opd": "Cytosol", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "27e4a98f-e229-4be4-833d-d302992e6af1", "choice_type": "single"}
+{"question": "Duchnne's muscular dystrophy", "exp": "Duchene muscular dystrophy is a X linked recessive disorder. Usually become symptomatic before 5 yr and may have history of delayed walking", "cop": 2, "opa": "X-linked dominant", "opb": "X-linked recessive", "opc": "Autosomal dominant", "opd": "Autosomal recessive", "subject_name": "Pediatrics", "topic_name": "Musculoskeletal disorders", "id": "2e11771c-cdfb-47d0-8e20-52c762862017", "choice_type": "single"}
+{"question": "Most common Organism causing Bronchiolitis", "exp": "Most common Organism causing Bronchiolitis Respiratory Syncytial Virus.", "cop": 1, "opa": "Respiratory syncytial Virus", "opb": "Parainfluenza virus", "opc": "Hemophilius Influenza A", "opd": "Hemophilius Influenza B", "subject_name": "Pediatrics", "topic_name": null, "id": "9d9f1c38-2bc0-4ec5-91e3-c2af09bd88b7", "choice_type": "single"}
+{"question": "Zinc dose in 8 months infants", "exp": "Ans. is 'd' i.e., 20 mg/kg x 14 days", "cop": 4, "opa": "10 mg/kg x 10 days", "opb": "20 mg/kg x 10 days", "opc": "10 mg/kg x 14 days", "opd": "20 mg/kg x 14 days", "subject_name": "Pediatrics", "topic_name": null, "id": "2499af53-81c9-4589-b624-3c2b9961693d", "choice_type": "single"}
+{"question": "In pediatric advanced life suppo, intraosseous access for drug/fluid administration is recommended for", "exp": "** Intraosseous (IO) access was initially thought to be less applicable in patients older than 6 years, now there is growing suppo for consideration of IO techniques in patients of any age as rapid and equally effective alternatives to intravenous (IV) peripheral lines. Intraosseous infusion (IO) is the process of injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system.This technique is used in emergency situations to provide fluids and medication when intravenous access is not available or not feasible. A comparison of intravenous (IV), intramuscular (IM), and intraosseous (IO) routes of administration concluded that the intraosseous route is demonstrably superior to intramuscularand comparable to intravenous administration (in delivering paediatric anaesthetic drugs).Due to the rapid advance and adoption of superior intraosseous access technology, IO access has now become the preferred method of establishing vascular access for patients in whom traditional access is difficult or impossible.", "cop": 2, "opa": "<1yr", "opb": "<6 yrs", "opc": "<12yrs", "opd": "Any age", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "f6b3113f-11dc-42a7-8752-0359a722e9fc", "choice_type": "single"}
+{"question": "Encopresis is associated with", "exp": "(D) Severe emotional disturbances # Severe emotional disturbances> Encopresis (also known as paradoxical diarrhea) is involuntary fecal soiling in adults and children who have usually already been toilet trained. Persons with encopresis often leak stool into their undergarments.> Strong emotional reactions typically result from failed and repeated attempts to control this highly aversive bodily product.> These reactions then in turn may complicate conventional treatments using stool softeners, sitting demands, and behavioral strategies. The estimated prevalence of encopresis in four-year-olds is between one and three percent.> The disorder is thought to be more common in males than females, by a factor of 6 to 1.", "cop": 4, "opa": "Low socioeconomic class", "opb": "Less than 4 year old child", "opc": "Female sex", "opd": "Severe emotional disturbances", "subject_name": "Pediatrics", "topic_name": "Miscellaneous", "id": "edf5e447-a791-4c9c-b741-371f7a7ce295", "choice_type": "single"}
+{"question": "Increased ammonia level, normal pH, acidosis (High anion gap) is seen in", "exp": "C. i.e. (Organic acidemia) (610 - 13 - Ghai 6th) (632 - 33 - Ghai 7th)* Sodium benzoate usedfor hyperammonemic states in organic aciduriasAlkaptonuria* *Homogentisic acid oxidase deficiency* *Unne becomes dark on standing* *Ochronosis - Pigment deposition in the sclera, ear, nose* Renal stones and nephrosisTreatment - Ascorbic acid, Nitisirone**GalactosemiaDeficiency of Galactose 1. phosphate uridyl transferase deficiency or Galactokinase deficiency* Autosomal recessive, Physiolgical jaundice persisit longer, Hepatomegaly cataract *, mental retardation ** Vomiting, diarrhea and failure to thrive are early and common manifestationsTreatment - Galactose free diet **Urea cycle disordersDue to accumulation of ammonia, citrulline, arginosuccinic acid or arginine* Recurrent vomiting and irritability are observed early in life C.P - lethargy, coma, ataxia, and convulsion, mental retardation, muscle rigidity, opisthotonus and delayed development Blood urea levels are nearly normal * Organic Acidurias - develops a life threatening episodes of metabolic acidosis characterized by an increased anion gapCLINICAL APPROACH TO INFANTS WITH ORGANIC ACIDEMIA* Hyperammonia may suggest the presence of genetic defects in the urea cycle enzymes. Patients with defects in urea cycle enzymes are not acidotic (548 - Nelson 18th)* Calcification of intervertebral disc occurs in Alkaptonuria*** Positive urinary anion gap is seen in Renal tubular acidosis and Negative UAG seen in Diarrhea)", "cop": 3, "opa": "Urea cycle", "opb": "Galectosemia", "opc": "Organic - acidemia", "opd": "Alkaptonuria", "subject_name": "Pediatrics", "topic_name": "Metabolic Disorders", "id": "111ca9b9-3429-4ba1-99ac-22b2d0b8ae0e", "choice_type": "single"}
+{"question": "Subacute sclerosing panencephalitis is late neurological complication associated with infection due to", "exp": "Subacute sclerosing panencephalitis occurs 7 - 13 years after primary meastes infection. It has fatal outcome.", "cop": 2, "opa": "Mumps virus", "opb": "Measles virus", "opc": "Rubella virus", "opd": "Para influenza virus", "subject_name": "Pediatrics", "topic_name": null, "id": "95152540-8c14-42cc-8997-e233ba3df330", "choice_type": "single"}
+{"question": "Most common bacteria causing diarrhea in children", "exp": "- Enteropathogenic E.coli : these have been associated mainly with diarrhea in infants and infants. - It do not produce any toxin nor are they invasive. Reference : Anathanarayan & paniker&;s 9th edition, pg no:281", "cop": 4, "opa": "Enterotoxigenic E.coli", "opb": "Enteroinvasive E.coli", "opc": "Enterohemorrhagic E.coli", "opd": "Enteropathogenic E.coli", "subject_name": "Pediatrics", "topic_name": "Infectious disease", "id": "0603cfcf-1ae7-42b9-a6e2-475a236e7bb3", "choice_type": "single"}
+{"question": "Most common anomaly of upper urogenital tract is", "exp": "The most common obstructed lateral fusion defects is unilateral obstruction and is most commonly seen in women with complete duplication of the reproductive tract(double uterus, cervix and vagina) . Unilateral UPJ obstruction is the most common prenatally detected obstructive disease, often picked up on maternal ultrasounds during pregnancy. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Uretero pelvic junction stenosis", "opb": "Ectopic uretheral opening", "opc": "Ureterocele", "opd": "Ectopic ureter", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "b40cbd24-46f1-4117-8c7a-22dfde84ae8c", "choice_type": "single"}
+{"question": "Hemangioblastoma is most commonly associated with", "exp": "Von - Hippel lindau syndrome is associated with Cerebellar Hemangioblastoma, Spinal cord Hemangioblastoma, Retinal Hemangioblastoma.", "cop": 1, "opa": "Von - Hippel lindau syndrome", "opb": "Neurofibromatosis", "opc": "Tuberous Sclerosis", "opd": "Li - Fraumeni syndrome", "subject_name": "Pediatrics", "topic_name": null, "id": "77a6342d-053b-49d7-bee3-854aa3333542", "choice_type": "single"}
+{"question": "Oxygenated blood to the fetus is carried by", "exp": "Fetus receive oxygenated blood from placenta left and right umbilical vein. Ref : Ghai Essential pediatrics,eighth edition ,p.no:402", "cop": 2, "opa": "Umbilical aery", "opb": "Umbilical vein", "opc": "SVC", "opd": "Pulmonary aery", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "a537d12a-ef20-48b3-8fb5-9219cdb49a38", "choice_type": "single"}
+{"question": "Most common cause of nephrotic syndrome in paediatric age group is", "exp": "Ans. a (Minimal change disease). Refer to Q. No.49 of Pathology section of same paper.Minimal-Change Disease (Lipoid Nephrosis)# This relatively benign disorder is the most frequent cause of the nephrotic syndrome in children.# It is characterized by glomeruli that have a normal appearance by light microscopy but show diffuse effacement of podocyte foot processes when viewed with the electron microscope.# Although it may develop at any age, this condition is most common between ages 1 and 7 years.# When the changes in the podocytes reverse (e.g., in response to corticosteroids), the proteinuria remits.", "cop": 1, "opa": "Minimal change disease", "opb": "Membranous glomerulonephritis", "opc": "Malarial infection", "opd": "Mesangioproliferative glomerulonephritis", "subject_name": "Pediatrics", "topic_name": "Kidney", "id": "0d504d21-0926-4976-8ccc-1d77482128a2", "choice_type": "single"}
+{"question": "Diagnosis of the following karyotyping", "exp": "Cri du chat syndrome is due to deletion of short arm of 5th Chromosome.", "cop": 2, "opa": "Down's syndrome", "opb": "Cri du chat syndrome", "opc": "Turner's syndrome", "opd": "Patau Syndrome", "subject_name": "Pediatrics", "topic_name": null, "id": "138827c8-6087-4df0-9355-5489691ac369", "choice_type": "single"}
+{"question": "Commonest cause of Nephritic syndrome in children is", "exp": "There are many conditions that may cause nephritic syndrome, and it can occur in people of all ages. Common causes are infections, immune system disorders and inflammation of the blood vessels. The main symptoms are passing less urine than normal, leading to a fluid buildup in the body, and having blood in the urine. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Minimal change disease", "opb": "Membranous GN", "opc": "IgA nephropathy", "opd": "Mesangioproliferative GN", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "3a2ed35c-f438-4685-86d6-7c8033dd537a", "choice_type": "single"}
+{"question": "Bulging Anterior fontanel is are seen in", "exp": "Rickets - bowlegs, bulging anterior fontanelle are characteristic features of rickets Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "Rickets", "opb": "CMV infection", "opc": "Scurvy", "opd": "Hypothyroidism", "subject_name": "Pediatrics", "topic_name": "Central Nervous system", "id": "8aa01de4-8480-4683-bd52-b2485e53d631", "choice_type": "single"}
+{"question": "Poal venous pressure in a child is", "exp": "Poal venous pressure is the blood pressure in the hepatic poal vein, and is normally between 7 mmHg. Raised poal venous pressure is termed poal hypeension,and has numerous sequelae such as ascites and hepatic encephalopathy. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "5 mm Hg", "opb": "6 mm Hg", "opc": "7 mm Hg", "opd": "8 mm Hg", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "31d39f06-d621-4899-8e4b-5eedf0e21cec", "choice_type": "single"}
+{"question": "Triphasic Cells seen in Wilm's tumour are", "exp": "Wilm's tumour is Triphasic tumour. It has Blastemal Cells, Stromal Cells, Epithelial Cells.", "cop": 4, "opa": "Blastemal Cells, Embryonal Cells, Epithelial Cells", "opb": "Stromal Cells, Epithelial Cells, Embryonal Cells", "opc": "Mesenchymal Cells, Stromal Cells, Embryonal Cells", "opd": "Stromal Cells , Blastemal Cells, Epithelial Cells", "subject_name": "Pediatrics", "topic_name": null, "id": "1c945ffb-3574-4313-9f26-076ad7488f3e", "choice_type": "single"}
+{"question": "Most common CVS lesions in Down&;s Syndrome is", "exp": "Down syndrome:- Trisomy 21 Patients with down syndrome have mental and physical retardation, flat facial profile, an upward slant of eyes and epicanthic folds. Oblique palpebrak fissure seen. Nose is small with flat nasal bridge. Mouth shows narrow sho palate with small teeth and furrowed protruding tongue. There is significant hypotonia. Skull appears small and brachycephalic with flat occiput . Ears are small and dysplastic. Characteristic facial grimace on crying. Hands are sho and broad. Clinodactyly( hypoplasia of middle phalanx of fifth finger) and simian crease are usual. There is wide gap between the first and second toe( Sandle gap). Associated anomalies:- 1. Congenital hea disease- ventricular septal defect. 2. Gastrointestinal - atresia, annular pancreas and Hirschsprung disease. 3. Ophthalmic- cararact, nystagmus, squint. 4. Thyroid dysfunction 5. Conductive hearing loss Best serological marker for down syndrome is Beta HCG. Reference: GHAI Essential pediatrics, eighth edition", "cop": 1, "opa": "VSD", "opb": "ASD", "opc": "TOF", "opd": "COA", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "ce786c22-08ab-4245-8dae-5ed29acd8347", "choice_type": "single"}
+{"question": "A two year child is classified as having pneumonia, if the respiratory rate is more than", "exp": "According to ARI control programme pneumonia must have Respiratory rate(RR)/min 60 or more in <2 months of age 50 or more in 2 -12 months of age 40 or more in 1-5 years of age Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,7 th edition PG NO:356", "cop": 2, "opa": "30/min", "opb": "40/min", "opc": "50/min", "opd": "60/min", "subject_name": "Pediatrics", "topic_name": "Respiratory system", "id": "c0954cd5-e00a-4bc0-8e23-c2ed530d17ce", "choice_type": "single"}
+{"question": "In Unconjugated hyperbilirubinemia, the risk of kernicterus increases with the use of", "exp": "Sulfonamides (also called sulfa drugs) are a group of antibiotics that kill bacteria. Sulfonamides may unbind bilirubin from albumin, which increases blood levels of bilirubin. The unbound bilirubin can cross into the brain and cause kernicterus. Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Ceftriaxone", "opb": "Phenobarbitone", "opc": "Ampicillin", "opd": "Sulphonamide", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "9e797df6-40cf-475e-804f-944bbe7cbb64", "choice_type": "single"}
+{"question": "Principle mode of heat exchange in an infant incubator is", "exp": "WORKING PRINCIPLE : light bulbs heat air in the bottom pa of the incubator,the air passes over a container with evaporating water, so that its humidity increases,the warm, humid air then flows upwards (chimney effect) into the baby compament Reference: GHAI Essential pediatrics, 8th edition.", "cop": 3, "opa": "Radiation", "opb": "Evaporation", "opc": "Convection", "opd": "Conduction", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "da1add73-2168-49f1-9db6-ebd0df3f6d11", "choice_type": "single"}
+{"question": "The vitamin A supplement administered in \"Prevention of nutritional Blindness in children programme\" contain", "exp": "Under the National Vitamin A Prophylaxis Programme, children between 1& 5 yrs of age were given oral dose of 2 lakh IU, every 6 months. But due to inadequate coverage, currently this vaccine is being given to children under 3 yrs under routine immunization to improve coverage i.e, (1lakh IU- 9months; 2lakh IU- 15 to 18 months) According to NPPNB, Vit A 2 lakh IU orally is given every 6 months to pre school children,(1-6yrs) And half the dose ( 1lakh IU orally) to children age between 6 months and 1 yr of age. Ref: Ghai , 9th edition chapter 8; PSM 25th edition.", "cop": 2, "opa": "25,000 IU/ml", "opb": "1 Lakh IU/ml", "opc": "3 Lakh IU/ml", "opd": "5 Lakh IU/ml", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "cd2c2544-961d-4279-a1e3-fd71d1189605", "choice_type": "single"}
+{"question": "Best serogical marker of Down&;s syndrome in first trimester is", "exp": "Down syndrome:- Trisomy 21 Patients with down syndrome have mental and physical retardation, flat facial profile, an upward slant of eyes and epicanthic folds. Oblique palpebrak fissure seen. Nose is small with flat nasal bridge. Mouth shows narrow sho palate with small teeth and furrowed protruding tongue. There is significant hypotonia. Skull appears small and brachycephalic with flat occiput . Ears are small and dysplastic. Characteristic facial grimace on crying. Hands are sho and broad. Clinodactyly( hypoplasia of middle phalanx of fifth finger) and simian crease are usual. There is wide gap between the first and second toe( Sandle gap). Associated anomalies:- 1. Congenital hea disease- ventricular septal defect. 2. Gastrointestinal - atresia, annular pancreas and Hirschsprung disease. 3. Ophthalmic- cararact, nystagmus, squint. 4. Thyroid dysfunction 5. Conductive hearing loss Best serological marker for down syndrome is Beta HCG. Reference: GHAI Essential pediatrics, eighth edition", "cop": 3, "opa": "Nuchal translucency", "opb": "Skeletal abnormalities", "opc": "b-SCG", "opd": "Serum estriol", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "d0dc31b0-b947-45f6-9fd0-55c7c16ce61a", "choice_type": "single"}
+{"question": "Moro's Reflex disappears at", "exp": "Moro's reflex disappears by 3 - 6 months in normal infants. Persistence of the reflex after 6 months and absence or diminution of the Moro reflex within 2 to 3 months of age can be regarded as abnormal. Asymmetry of the response is usually a sign of local injury.", "cop": 2, "opa": "3 months", "opb": "6 months", "opc": "5 months", "opd": "7 months", "subject_name": "Pediatrics", "topic_name": null, "id": "71317695-7403-4114-94d3-9cc8601dd99f", "choice_type": "single"}
+{"question": "Increased fetal hemoglobin is seen in", "exp": "Juvenile chronic myeloid leukemia is characterised by elevated fetal hemoglobin levels and low or normal leukocyte alkaline phosphatase score.Thrombocytopenia and anemia are common.Peripheral smear shows leukocytosis with the full spectrum of granulocytic precursors and increased normoblasts.Bone marrow aspirate shows an increased cellularity with predominance of granulocytic cells in all stages of maturation;megakaryocytes are normal or decreased.Philadelphia chromosome is negative,and monosomy 7 is found in 30% patients. Reference:Essential pediatrics-Ghai,8th edition,page no:608.", "cop": 1, "opa": "Juvenile CML", "opb": "Congenital red cell aplasia", "opc": "Hereditary shperocytosis", "opd": "AML", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "7fd0f0f4-e0a3-4cfe-885f-1e942a22f57d", "choice_type": "single"}
+{"question": "A child presented with cola coloured urine, proteinuria 2+ & h/o rash 2 week ago. Probable Diagnosis is", "exp": "Henoch schonlein purpura : It is one of the most common vasculitic disorder of childhood. Characterised by the presence of nonthrombocytopenic , palpable purpura, transient ahralgia and abdominal symptoms. The illness begins with a rash more prominent over the extensor aspects of lower extremities and buttocks. It may be macular, maculopapular or even uicarial to begin with . Glomerulonephritis seen in one third of cases. And ca coloured urine Gastrointestinal manifestations usually occur in first 7-10 days if illness. Abdominal pain is intermittent, colicky and periumbilical.vomitingseen , whereas melena and hemetemesis are less common. Rare manifestations include CNS vasculitis, coma, Guillain Barre syndrome, pulmonary hemorrhage, carditis and orchitis. Criteria for childhood HSP:- Palpable purpura in the presence of at least one of the following 4 features: 1. Diffuse abdominal pain. 2. Any deposit showing IgA deposition. 3. Ahritis/Ahralgia. 4. Renal involvement. Investigation: Nonspecific rise in total serum IgA levels. Skin biopsy shows leukocytoclastic vasculitis. On indirect immunofluorescence there are mesangial deposits of IgA andC3 in skin and renal biopsy. Reference: GHAI essential Paediatrics", "cop": 2, "opa": "IgA nephropathy", "opb": "HSP", "opc": "HUS", "opd": "Wegener Granulomatosis", "subject_name": "Pediatrics", "topic_name": "Urinary tract", "id": "422e52eb-d890-4c3e-b899-dbd78e619d67", "choice_type": "single"}
+{"question": "Cat eye syndrome is", "exp": "Cat eye syndrome:-Schmid Fraccaro syndrome Paial trisomy of chromosome 22. It is coined cat eye because of the paicular appearance of the veical colobomas in the eyes of some patients. Other features: 1. Anal atresia 2. Unilateral or bilateral iris coloboma 3. Downward slanting palpebral fissure. 4. Preauricular pits/ tags. 5. Cardiac defects 6. Kidney problems 7. Sho stature 8. Intellectual disabilityi 9. Micrognathia 10. Cleft palate Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Paial trisomy 18", "opb": "Paial trisomy 13", "opc": "Paial trisomy 21", "opd": "Paial trisomy 22", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "c1b1957b-7bfb-4d95-b21d-b1d7ba50b471", "choice_type": "single"}
+{"question": "The most common cardiac defects seen in congenital rubella syndrome is", "exp": "Common cardiac defects in congenital rubella syndrome is PDA and PS. Ghai essential of pediatrics, eighth edition, p.no:401", "cop": 4, "opa": "Pulmonary aery stenosis and coarctation of aoa", "opb": "Vantricular septal defect (VSD) and patent ductus aesian (PDA)", "opc": "VSD and pulmonary aery stenosis", "opd": "Pulmonary aery stenosis and PDA", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "9187ee54-9e08-4110-89b1-d504f6a036ec", "choice_type": "single"}
+{"question": "Boold volume in preterm neonate is", "exp": "At the moment of bih the newborn infant was estimated to have a blood volume of 78 ml/kg with a venous hematocrit of 48 %. The average blood volume at bih was found to be 109 ml. per kilogram, a value slightly higher than in fullterm infants. In the first 2 1/2 months of life there was a tendency for the plasma volume to increase as the erythrocyte volume decreased. This had the effect of maintaining the total blood volume at a relatively high level. Reference: GHAI Essential pediatrics, 8th edition", "cop": 1, "opa": "90 ml/kg", "opb": "80 ml/kg", "opc": "70 ml/kg", "opd": "60 ml/kg", "subject_name": "Pediatrics", "topic_name": "Fluid and electrolytes", "id": "5da06b95-7aed-42ed-8b07-21ee0373e4bd", "choice_type": "single"}
+{"question": "Useful in acute diarrhea is", "exp": "Most cases of diarrhea are acute, self-limited, and due to infections or medication. Fluid and electrolyte replacement is of central impoance to all forms of acute diarrhea. In moderately severe nonfebrile and non-bloody diarrhea, antimotility and antisecretory agents such as loperamide can be useful adjuncts to control symptoms. Judicious use of antibiotics is appropriate in selected instances of acute diarrhea and may reduce its severity and duration . Zinc (20 mg/d until recovery) may be an effective adjunctive therapeutic strategy for diarrheal disease and pneumonia in children >= 6 months of age. Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 96e; Vitamin and Trace Mineral Deficiency and Excess", "cop": 1, "opa": "Zinc", "opb": "Magnesium", "opc": "Calcium", "opd": "Potassium", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "fb94df6e-dfd8-42cd-b37e-86f30fd7324a", "choice_type": "single"}
+{"question": "Daily iron requirement of a lOyr old boy is", "exp": "Ans) c (8mg) Ref Nelson 18th edp210", "cop": 3, "opa": "2 mg", "opb": "4mg", "opc": "8 mg", "opd": "10 mg", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "b5152e73-1c7c-4976-aa1e-e1fbd2a151da", "choice_type": "single"}
+{"question": "A child comes with the complaints of bed wetting. First line of Treatment", "exp": "Nocturnal enuresis' refers to involuntary urination at night beyond the age of 5 years. Treatment- First line - Diet and lifestyle changes, Motivational therapy Second line- Bed alarm technique- gives excellent response Third line - Drugs Bed Alarm technique These are moisture sensing alarms As soon as the child passes the urine in bed, it would detect the moisture in undergarment of the child and will ring. Combination of drug and bed alarm technique has lowest relapse rates.", "cop": 3, "opa": "Desmopressin", "opb": "Oxybutynin", "opc": "Motivational therapy", "opd": "Bed alarm technique", "subject_name": "Pediatrics", "topic_name": "FMGE 2019", "id": "e0d0c241-bb21-447c-af16-be8fa66b0daf", "choice_type": "single"}
+{"question": "The neonatal feature of cystic fibrosis is", "exp": "Meconium is the first stool (bowel movement) that a newborn has. This stool is very thick and sticky. Meconium ileus is a bowel obstruction that occurs when the meconium in your child&;s intestine is even thicker and stickier than normal meconium, creating a blockage in a pa of the small intestine called the ileum. Most infants with meconium ileus have a disease called cystic fibrosis. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Bronchitis", "opb": "Bronchiolitis", "opc": "Meconeum ileus", "opd": "Bronchiectasis", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "e13d791e-96d8-455f-a84f-617e8c075684", "choice_type": "single"}
+{"question": "Abnormal mousy/mushy odour of urine is associated with", "exp": "Ans. a (Phenylketonuria) (Ref. Harrison's Internal Medicine 17th/Ch. 358)Inborn errors of amino acid metabolism associated with abnormal odourInborn error of metabolismUrine odorGlutaric acidemia (type II)Sweaty feet, acridHawkinsinuriaSwimming poolIsovaleric acidemiaSweaty feet, acridMaple syrup urine diseaseMaple syrup/Burnt sugarHypermethioninemiaBoiled cabbageMultiple carboxylase deficiencyTomcat urineOasthouse urine diseaseHops-likePhenylketonuriaMousy or mustyTrimethylaminuriaRotting fishTyrosinemiaBoiled cabbage, rancid butterTHE HYPERPHENYLALANINEMIAS# result from impaired conversion of phenylalanine to tyrosine.# The most common and clinically important is phenylketonuria (frequency 1:10,000), which is an autosomal recessive disorder characterized by an | concentration of phenylalanine and its by-products in body fluids and by severe mental retardation if untreated in infancy.# It results from | activity of phenylalanine hydroxylase (phenylketonuria type I).# The accumulation of phenylalanine inhibits the transport of other amino acids required for protein or neurotransmitter synthesis, reduces synthesis and increases degradation of myelin, and leads to inadequate formation of norepinephrine and serotonin.# Phenylalanine is a competitive inhibitor of tyrosinase, a key enzyme in the pathway of melanin synthesis, and ac- counts for the hypopigmentation of hair and skin.# Untreated children with classic phenylketonuria are normal at birth but fail to attain early developmental milestones, develop microcephaly, and demonstrate progressive impairment of cerebral function.# Hyperactivity, seizures, and severe mental retardation are major clinical problems later in life.# EEG abnormalities; \"mousy\" odor of skin, hair, and urine (due to phenylacetate accumulation); and a tendency to hypopigmentation and eczema are devastating clinical picture.# In contrast, affected children who are detected and treated at birth show none of these abnormalities.Treatment# To prevent mental retardation, diagnosis and initiation of dietary treatment of classic phenylketonuria must occur before the child is 3 weeks of age.# Dietary phenylalanine restriction is usually instituted if blood phenylalanine levels are >250 pmol/L (4 mg/dL).# Treatment consists of a special diet low in phenylalanine and supplemented with tyrosine, since tyrosine becomes an essential amino acid in phenylalanine hydroxylase deficiency.# With therapy, plasma phenylalanine cone should be maintained between 120 and 360 pmol/L (2 and 6 mg/dL).# Dietary restriction should be continued and monitored indefinitely..# Pregnancy risks can be minimized by continuing lifelong phenylalanine-restricted diets and assuring strict phenylalanine restriction 2 months prior to conception and throughout gestation.ConditionEnzyme DefectClinical FindingsInheritance1. Phenylketonuria type IPhenylalanine hydroxylaseMental retardation, microcephaly, hypopig- mented skin and hairs, eczema, \"mousy\" odorAR2. Phenylketonuria type IIDihydropteridine reductaseMental retardation, hypotonia, spasticity, myoclonusAR3. Phenylketonuria type III6-Pyruvoyl- tetrahydropterin synthaseDystonia, neurologic deterioration, seizures, mental retardationAR4. GTP cyclohydrolase I deficiencyGTP cyclohydrolase IMental retardation, seizures, dystonia, temperature instabilityAR5. Carbinolamine dehydratase deficiencyPterin-4-carbinolamine dehydrataseTransient hyperphenylalaninemia (benign)AR", "cop": 1, "opa": "Phenylketonuria", "opb": "Tyrosinemia", "opc": "Maple syrup urine disease", "opd": "Hawkinsuria", "subject_name": "Pediatrics", "topic_name": "Inborn Errors of Metabolism", "id": "64f80edc-9494-4b09-b361-0d50d21ff9cb", "choice_type": "single"}
+{"question": "Low birth weight is defined as", "exp": "Low birth weight (LBW) neonate- A neonate weighing less than 2500g at birth irrespective of the gestational age.\nVery low birthweight (VLBW) neonate- A neonate weighing leas than 1500g at birth irrespective of the gestational age.\nExtremely low birth weight (ELBW) neonate- A neonate weighing leas than 1000g at birth irrespective of the gestational age.", "cop": 4, "opa": "Weight < 10 percentile for their gastational age", "opb": "Weight < 2.0 kg", "opc": "Weight < 1.5 kg", "opd": "Weight < 2.5 kg", "subject_name": "Pediatrics", "topic_name": null, "id": "4ad97ad9-6716-4351-bfbe-f1b35c411f57", "choice_type": "single"}
+{"question": "Commonest cause of intestinal obstruction in children is", "exp": ".Intussusception Most common in children Primary or secondary to intestinal pthology eg:polyps,appendix Ileocolic is the most common variety Can lead to ischaemic segment peak incidence at 3-9 months BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,PG NO:1195, 24 th edition", "cop": 1, "opa": "Intussusception", "opb": "Volvulus", "opc": "Hernia", "opd": "Adhesions", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "2cb505fc-979a-4e34-9021-622d961cc409", "choice_type": "single"}
+{"question": "Vertibular Schwannoma, spinal cord astrocytoma, meningioma are seen in", "exp": "Neurofibromatosis - 2 :\nVertibular Schwannoma.\nMeningioma.\nSpinal cord ependymoma.\nSpinal cord astrocytoma.", "cop": 4, "opa": "Tuberous sclerosis", "opb": "Neurofibromatosis - 1", "opc": "Von Hippel - lindeu syndrome", "opd": "Neurofibromatosis - 2", "subject_name": "Pediatrics", "topic_name": null, "id": "08a7a3c0-35fa-4879-8457-6df463d1f6af", "choice_type": "single"}
+{"question": "Normal QRS duration at 1 year of age is", "exp": "Normal QRS duration at various age groups Age group QRS duration in seconds 0-6 months 0.03-0.07 (0.05) 1-5 yr 0.04-0.08 (0.06) 10-15 yr 0.04-0.09 (0.07) >15 yr 0.06-0.09 (0.08) Reference: Essential Paediatrics; O.P. Ghai; Page no: 459", "cop": 2, "opa": "0.03-0.07 seconds", "opb": "0.04-0.08 seconds", "opc": "0.04-0.09 seconds", "opd": "0.06-0.09 seconds", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "2d86bcd6-3996-4c84-bb94-4a81b69204c2", "choice_type": "single"}
+{"question": "Retinopathy of Prematurity (ROP) screening is done in the following babies", "exp": "Retinopathy of Prematurity (ROP) Screening is done in\n\nPreterm babies < 32 weeks of gestation\nBabies with birth weight < 1.5 kg\nPreterm babies of 32 - 34 weeks of gestation\n\tBabies with birth weight 1.5 - 2 kg\n\nPreterm babies of 32-34 weeks and babies with birth weight 1.5-2kg should have had bad neonatal course like:\na) Ventilatory support\nb) O2 supply for > 24 hours\nc) Ionotrope support for condition like shock\nd) Blood transfusion\ne) Culture positive sepris.", "cop": 2, "opa": "Preterm < 34 weeks of gestation", "opb": "Preterm of 33 weeks of gestation who required mechanical ventilation", "opc": "Babies with birth weight < 1.8 kg", "opd": "Babies with birth weight < 2 kg", "subject_name": "Pediatrics", "topic_name": null, "id": "10285f15-d722-4df7-bf62-39d8e05e7426", "choice_type": "single"}
+{"question": "Respiratory rate in a 2 month old, to label it tachypnea is", "exp": "Tachypnea ( WHO criteria ) 1 . Newborn to 2 months : 60 breaths per minute 2 . Infant 2 months to 1 year : 50 breaths per minute 3 . Preschool Child 1 to 5 years : 40 breaths per minute 4 . School age Child: 20 - 30 breaths per minute 5 . Adults : 20 breaths per minute Reference : page 381 Ghai Essential Pediatrics 8th edition.", "cop": 3, "opa": "40", "opb": "50", "opc": "60", "opd": "70", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "8326d162-6376-46d9-9a77-df84d123c3fb", "choice_type": "single"}
+{"question": "Nocturnal Enuresis is occurrence of involuntary voiding at night in a child more than", "exp": "Ans. (d) 5yrs* OP ghai states enuresis as urinary incontinence beyond the age of 4 years for daytime and 6 years for night-time enuresis.* It is said to be present if it occurs twice per week for 3 consecutive months.* Most of children attain complete bladder control by age of 5 years* The prevalence of enuresis is 7% in boys and 3% in girls at age of 5 years and keeps on decreasing for every subsequent year.* Treatment of choice for nocturnal enuresis is alarm devices with desmopressin nasal spray.", "cop": 4, "opa": "2 1/2 yrs", "opb": "3 1/2 yrs", "opc": "4 yrs", "opd": "5 yrs", "subject_name": "Pediatrics", "topic_name": "Developmental-Behavioral Screening and Surveillance", "id": "0f8ae024-14f2-48c4-9361-621b728215e5", "choice_type": "single"}
+{"question": "MC cause of cholestatic jaundice in newborn is", "exp": "MC cause of cholestatic jaundice in newborn is Neonatal hepatitis. MCC of jaundice in 1st 24 hrs of life - Hemolytic disease of newborn. MCC of jaundice in 24 hrs to 72 hrs of life - Physiological jaundice.", "cop": 2, "opa": "Hypoplasia of biliary tract", "opb": "Neonatal hepatitis", "opc": "Choledochal cyst", "opd": "Physiological", "subject_name": "Pediatrics", "topic_name": "FMGE 2018", "id": "6470f5ba-04cb-4b1f-ba67-7064f165cb76", "choice_type": "single"}
+{"question": "Only male are affected in", "exp": "Hunter's syndrome belongs to Type II mucopolysaccharidoses in which mucopolysaccharides accumulate in the lysosomes causing disorganization of the cell structure & function.This syndrome is characterised by mild mental retardation;marked skeletal changes like thickening of the skull,marked deformity of sella tursica,broad spatula like ribs,beak shaped veebrae(around L1 veebra) and proximal tapering of metacarpals-these abnormalities are referred to as dysostosis multiplex;coarse facies & hepatosplenomegaly. Reference:Essential pediatrics-Ghai,8th edition,page no: 660,661.", "cop": 2, "opa": "Scheie's syndrome", "opb": "Hunter's syndrome", "opc": "Hurler's syndrome", "opd": "Gaucher's disease", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "3cdcb8a3-7240-430c-96f7-3838086bcb59", "choice_type": "single"}
+{"question": "Commonest site of extramedullary relapse of", "exp": "Ans. is 'a' i.e., CNS", "cop": 1, "opa": "CNS", "opb": "Lung", "opc": "Liver", "opd": "Testis", "subject_name": "Pediatrics", "topic_name": null, "id": "42dd5362-a07e-48dc-9c1c-c2cafed2d363", "choice_type": "single"}
+{"question": "Most common cause of Rapid progressive glomerulonephritis in children is", "exp": "Pauci - immune glomerulonephritis like Churg Strauss, Wegener's glomerulonephritis have highest risk for RPGN.", "cop": 4, "opa": "Good Pasteur syndrome", "opb": "Membranous glomerulonephritis", "opc": "Ig A nephropathy", "opd": "Pauci - immune glomerulonephritis", "subject_name": "Pediatrics", "topic_name": null, "id": "a91dc181-2987-47d7-bca0-6378d96fbf2f", "choice_type": "single"}
+{"question": "Most common mutation in hereditary elliptocytosis", "exp": "- Most common mutation in hereditory elliptocytosis - Spectrin - Inherited as Autosomal Dominant manner - In Spectrin mutations, the most common RBC abnormality is Hereditary Elliptocytosis > spherocytosis.", "cop": 1, "opa": "Spectrin", "opb": "Ankyrin", "opc": "Glycophorin A", "opd": "Band 4.2", "subject_name": "Pediatrics", "topic_name": "Hemolytic anemia", "id": "12437f60-7564-4e7b-953f-981677810b78", "choice_type": "single"}
+{"question": "Most common manifestation of rheumatic fever", "exp": "Ans. is 'a' i.e., Ahritis Ahritis in RF It is the most frequent major manifestation (75% of cases). o It is migratory polyahritis, i.e., several joints are involved in quick succession and each for a brief period of time. o Any joint may be affected but involvement of large joints such as knee, ankle, elbow, and wrist is common. Small joints of hands and feet are not involved. o Inflammation of any one joint subside spontaneously within a week and the entire bout of polyahritis rarely last more than 4 weeks. Resolution is complete with no residual joint damage. o A striking feature is dramatic response to salicylates.", "cop": 1, "opa": "Ahritis", "opb": "Carditis", "opc": "Chorea", "opd": "Nodules", "subject_name": "Pediatrics", "topic_name": null, "id": "d6c4e3cf-b30a-49fa-a049-4d69acd92159", "choice_type": "single"}
+{"question": "A 12 year old boy presents with hemetemesis, malena and mild splenomegaly. There is no obvious jaundice or ascitis. The most likely diagnosis is", "exp": ".Extra Hepatic Poal Venous Obstruction 5-6 years of age hematemesis with or without melena splenomegaly depends on duration of blockage liver usually normal in size ascites is rare variable extent of growth retardation is seen ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:289,7th edition", "cop": 1, "opa": "EHPVO", "opb": "NCPF", "opc": "Cirrhosis", "opd": "Malaria with DIC", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "7ccc4cdd-dcc8-43ce-90cb-1f35bbb9c96b", "choice_type": "single"}
+{"question": "Hypertrophic pyloric stanosis causes", "exp": "In Hypertrophic pyloric stenosis dehydration causes hypokalemic, hypochloremic metabolic alkalosis with paradoxical aciduria.", "cop": 4, "opa": "Hyperkalemic metabolic alkosis", "opb": "Hyperkalemic metabloic acidosis", "opc": "Hyperkalemic metabolic alkalosis with paradoxical aciduria", "opd": "Hypokalemic metabolic alkalosis with paradoxical aciduria", "subject_name": "Pediatrics", "topic_name": null, "id": "f2ac5132-e9b4-4251-bb60-cb02a3ec7bbd", "choice_type": "single"}
+{"question": "The newborn cardiac output is", "exp": "AgeCardiac output (ml/kg/min)Fetus450 Newborn3501-2 months of life150Adult75", "cop": 4, "opa": "200ml/kg/min", "opb": "250 ml/kg/min", "opc": "300 ml/kg/min", "opd": "350 ml/kg/min", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "44688fa3-27a5-4c73-9697-2f98ae6f0492", "choice_type": "single"}
+{"question": "Kangaroo mother care can be initiated immediately in babies weighing", "exp": "Kangaroo mother care (KMC) refers to care of preterm or low bih weight infants by placing the infant in skin-to-skin contact with the mother or any other caregiver.KMC was first suggested in 1978 by Dr Edgar Rey in Bogota, Colombia. The term kangaroo care is derived from practical similarities to marsupial caregiving, i.e. the infant is kept warm in the maternal pouch and close to the breasts for unlimited feeding.ComponentsKangaroo position. The kangaroo position consists of skin-to-skin contact between the mother and the infant in a veical position, between the mother&;s breasts and under her clothes. The provider must keep herself in a semi-reclining position to avoid the gastric reflux in the infant. The kangaroo position is maintained until the infant no longer tolerates it, as indicated by sweating in the baby or baby refusing to stay in KMC position.Kangaroo nutrition: Kangaroo nutrition is exclusive breastfeeding.Kangaroo discharge and followup: Early home discharge in the kangaroo position from the neonatal unit is one of the original components of the KMC intervention.Physiological BenefitsKMC results in keeping neonates warm and cozy. Babies get protected against cold stress and hypothermia.Physiological parameters such as hea and respiratory rates, oxygenation, sleep patterns get stabilized.Clinical BenefitsKMC significantly increases milk production in mothers and exclusive breastfeeding rates.KMC improves weight gain in the infants and improves thermal protection. It reduces incidence of respiratory tract and nosocomial infections, improves emotional bonding between the infant and mothers and results in earlier discharge from the hospital.Bih Weight > 1800grams, KMC can be initiated immediately after bih1200 to 1800grams: May take a few days before KMC can be initiated< 1200grams: May take days to weeks before KMC can be initiatedRef: Paediatrics; O.P. Ghai; 8th edition; Page no: 150", "cop": 4, "opa": "500 - 1000 grams", "opb": "1000 - 1200 grams", "opc": "1200 - 1800 grams", "opd": "> 1800 grams", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "4b2499ae-bc17-4b19-b57d-357b61eb25ea", "choice_type": "single"}
+{"question": "The most common malignant neoplasm of infancy is", "exp": "Neuroblastoma is the most common extracranial and intra- abdominal solid malignant tumor of infancy.It is a disease of early childhood with approximately 90% of patients presenting before 5 years of age & almost 50% within the first 2 years of life. Reference:Essential pediatrics-Ghai,8th edition,page no:616.", "cop": 2, "opa": "Malignant teratoma", "opb": "Neuroblastoma", "opc": "Wilms' tumor", "opd": "Hepatoblastoma", "subject_name": "Pediatrics", "topic_name": "Childhood tumors", "id": "2f9bdd8b-9a46-412b-be94-900e348b7973", "choice_type": "single"}
+{"question": "The hea lesion not found in Congenital Rubella infection is", "exp": "Classical triad of congenital rubella syndrome is cataract,deafness,cardiac defects. Cardiac defects include pulmonary stenosis,patent ductus aeriosus,ventricular septal defect. Ref : Harrison&;s principles of essential medicine P.no:1299", "cop": 1, "opa": "ASD", "opb": "VSD", "opc": "PDA", "opd": "PS", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "84476f68-e01b-4c63-9072-f7485d9b0139", "choice_type": "single"}
+{"question": "Most common chromosomal anomoly in miscarriage", "exp": "Most common Chromosomal anomoly in miscarriage Trisomy 16.", "cop": 3, "opa": "Down's syndrome", "opb": "Turner's syndrome", "opc": "Trisomy 16", "opd": "Edward syndrome", "subject_name": "Pediatrics", "topic_name": null, "id": "07bf5838-1d38-4c56-ab76-4c8c2182fe49", "choice_type": "single"}
+{"question": "Characteristic lab findings of hemophilia A are", "exp": "In hemophilia there will be abnormal aPTT and normal PT. Symptoms People with hemophilia A often, bleed longer than other people. Bleeds can occur internally, into joints and muscles, or externally, from minor cuts, dental procedures or trauma. How frequently a person bleeds and the severity of those bleeds depends on how much FVIII is in the plasma, the straw-colored fluid poion of blood. Normal plasma levels of FVIII range from 50% to 150%. Levels below 50%, or half of what is needed to form a clot, determine a person's symptoms. Mild hemophilia A- 6% up to 49% of FVIII in the blood. People with mild hemophilia Agenerally experience bleeding only after serious injury, trauma or surgery. In many cases, mild hemophilia is not diagnosed until an injury, surgery or tooth extraction results in prolonged bleeding. The first episode may not occur until adulthood. Women with mild hemophilia often experience menorrhagia, heavy menstrual periods, and can hemorrhage after childbih. Moderate hemophilia A. 1% up to 5% of FVIII in the blood. People with moderate hemophilia A tend to have bleeding episodes after injuries. Bleeds that occur without obvious cause are called spontaneous bleeding episodes. Severe hemophilia A. <1% of FVIII in the blood. People with severe hemophilia A experience bleeding following an injury and may have frequent spontaneous bleeding episodes, often into their joints and muscles. Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "PT", "opb": "aPTT", "opc": "X-linked recessive", "opd": "Presence of 30% of factor level express the disease", "subject_name": "Pediatrics", "topic_name": "Hematology", "id": "b0238c09-abde-4a63-b686-f27941e7985b", "choice_type": "single"}
+{"question": "Commonest congenital lesion complicated by infective endocarditis is", "exp": "VSD is the commonest congenital lesion complicated by infective endocarditis. The incidence of infective endocarditis has been estimated as 2/100 patients in a follow up of ten years, that is 1/500 patient years. The incidence of infective endocarditis is small enough that it is not an indication for operation in small defects. However, it is impoant to emphasize good oral-dental hygiene in all patients with VSD. Reference: Essential Paediatrics; O.P. Ghai; Page no: 417", "cop": 2, "opa": "ASD", "opb": "VSD", "opc": "PDA", "opd": "TOF", "subject_name": "Pediatrics", "topic_name": "C.V.S", "id": "01bec318-bb07-45cd-89eb-e98998c67cf2", "choice_type": "single"}
+{"question": "Drop metastases is seen in", "exp": "Drop metastases - Dissemination through CSF giving rise to nodular masses at some distance from primary tumour. It is seen in Medulloblastoma", "cop": 1, "opa": "Medulloblastoma", "opb": "Ependymoma", "opc": "Cerebellar astrocytoma", "opd": "Neuroblastoma", "subject_name": "Pediatrics", "topic_name": null, "id": "40aeabaa-c021-4196-a644-a4134a6665c8", "choice_type": "single"}
+{"question": "Unilateral renal agenesis is associated with", "exp": "Ans. is 'c' Single Umbilical Artery Nelson says \"Incidence of unilateral Renal Agenesis is increased in Newborns with a single umbilical artery \"Other associated malformations with U/L renal agenesisAbsent ureterContralateral vesicoureteric refluxAbsent Ipsilateral vas deferensNow something about bilateral renal agenesisBilateral Renal agenesis is incompatible with extrauterine life, death occurs shortly after birth from pulmonary hypoplasia.Bilateral renal agenesis is also known as Potter syndrome*", "cop": 3, "opa": "Polycystic disease of pancreas", "opb": "Hiatus Hernia", "opc": "Single umbilical artery", "opd": "Hypogonadism", "subject_name": "Pediatrics", "topic_name": "Nephropathy", "id": "17c7a565-83ed-4fe8-bd71-5654012ee23f", "choice_type": "single"}
+{"question": "The different manifestations of hypothermia are", "exp": "Hypothermia causes peripheral vasoconstriction resulting in acrocyanosis, cool extremities and delayed peripheral capillary refill time(C). The baby becomes restless and then lethargic. Chronic or recurrent episodes cause poor weight gain. CVS manifestations include bradycardia, hypotension, raised pulmonary aery pressure with resultant hypoxemia, tachypnoea and distress. Presence of lethargy, poor reflexes, decreased oral acceptance and apnea denotes neurological depression. Abdomen distension, vomiting and feeding intolerance make enteral intake difficult. Acidosis, hypoglycemia, oliguria, azotemia and generalised bleeding can occur in severe cases. Reference : page 146 Ghai Essential Pediatrics 8th edition", "cop": 1, "opa": "Apnea", "opb": "Hypoglycemia", "opc": "Hyperglycemia", "opd": "Tachycardia", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "fce533c8-3c97-42d8-b23a-5e3f8d6d6328", "choice_type": "single"}
+{"question": "Very low bih weight babies are", "exp": "Low bih weight (LBW) neonate- A neonate weighing less than 2500g at bih irrespective of the gestational age. Very low bihweight (VLBW) neonate- A neonate weighing leas than 1500g at bih irrespective of the gestational age. Extremely low bih weight (ELBW) neonate- A neonate weighing leas than 1000g at bih irrespective of the gestational age. Reference : page 125 Ghai Essential Pediatrics 8th edition", "cop": 2, "opa": "< 2500 gm of bih weight", "opb": "< 1500 gm of bih weight", "opc": "<1000 gm of bih weight", "opd": "Between 2500-300 gm of bih weight", "subject_name": "Pediatrics", "topic_name": "New born infants", "id": "43019623-790f-4e23-a5c3-cef2d2181d2f", "choice_type": "single"}
+{"question": "Four years old child presents with mild fever, malaise, ahritis, abdominal pain and microscopic hematuria. Most probable diagnosis", "exp": "Henoch-Schonlein Purpura (HSP) : Henoch-Schonlein purpura (HSP) is a disease involving Although HSP can affect people at any age, most cases occur in children between the ages of 2 and 11. It is more common in boys than girls. Adults with HSP are more likely to have more severe disease compared to children. HSP usually ends after four to six weeks -- sometimes with recurrence of symptoms over this period, but with no long-term consequences (recurrences are fairly common). If organs such as the Causes and Risk Factors for Henoch-Schonlein Purpura The exact cause of HSP is not known. The body&;s immune system is believed to play a role in targeting the blood vessels involved. An abnormal immune response to an infection may be a factor in many cases. Approximately two-thirds of the cases of HSP occur days after symptoms of an upper respiratory tract infection develop. Some cases of HSP have been linked to , ; foods, drugs, chemicals, and , and/or related , including blood in urine. Before these symptoms begin, patients may have two to three weeks of fever, Reference: GHAI Essential pediatrics, 8th edition", "cop": 4, "opa": "Thrombasthenia", "opb": "Idiopathic thrombocytopenic purpura", "opc": "SLE", "opd": "Henoch-Schonlein purpura", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "9a62dbfd-0b28-4969-930f-615eda4036de", "choice_type": "single"}
+{"question": "A new born infant is diagnosed with phenylketonuria. The enzyme that is deficient is", "exp": "Phenylketonuria is a disorder of phenylalanine metabolism and occurs due to deficiency of phenylalanine hydroxylase.It is a recessive condition.Here,phenylalanine could not be conveed to tyrosine,so phenylalanine accumulates and alternate minor pathways are opened to produce and excrete phenylketone(phenyl pyruvate),phenyl lactate and phenyl acetate in urine. Phenylalanine hydroxylase is an enzyme your body uses to conve phenylalanine into tyrosine, which your body needs to create neurotransmitters such as epinephrine, norepinephrine, and dopamine. PKU is caused by a defect in the gene that helps create phenylalanine hydroxylase. When this enzyme is missing, your body can't break down phenylalanine. This causes a buildup of phenylalanine in your body. Reference:Essential pediatrics-Ghai,8th edition,page no:652;Textbook of biochemistry-DM Vasudevan,6th edition,page no:207", "cop": 3, "opa": "Phenylamine oxidase", "opb": "Tyrosine hydroxylase", "opc": "Phenylalanine hydroxylase", "opd": "Dihydropteridine reductase", "subject_name": "Pediatrics", "topic_name": "Metabolic disorders", "id": "fbebdaa8-8ba5-44dc-a07d-49e7b5189c46", "choice_type": "single"}
+{"question": "Association of sexual precocity, multiple cystic bone lesions and endocrinopathies are seen in", "exp": "mc cube Albright syndrome characterized by recurrent ovarian cyst, cutaneous, skeletal & endocrine abnormalities. Figure : Cafe-au-lait skin pigmentation. (a) Skin lesions in a newborn demonstrating the characteristic association with the midline of the body, and distribution reflecting patterns of embryonic cell migration (developmental lines of Blaschko). (b) A typical lesion on the chest, face, and arm demostrating the irregular \"coast of Maine\" borders, relationship with the midline of the body, and distribution following developmental lines of Blaschko. (c). Typical lesions frequently found on the nape of the neck and crease of the buttocks Reference: Ghai essential of pediatrics, eighth edition, p.no:532.", "cop": 1, "opa": "McCune-Albright's syndrome", "opb": "Granulosa cell tumor", "opc": "Androblastoma", "opd": "Hepatoblastoma", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "1961bb84-a353-4e26-b9c1-9a39e55adda3", "choice_type": "single"}
+{"question": "Down syndrome is most commonly associated with", "exp": "An ostium primum atrial septal defect (ASD) occurs when then atrial septum near the atrioventricular valves has a communication between the two atrium causing a left to right shunt. The image to the right shows the location of the different types of atrial septal defects while looking from the right atrium. 1 = Upper sinus venosus defect 2 = Lower sinus venosus defect 3 = Ostium secundum atrial septal defect 4 = Coronary sinus atrial septal defect 5 = Ostium Primum atrial septal defect Reference: GHAI Essential pediatrics, 8th edition", "cop": 2, "opa": "ASD with ostium secundum", "opb": "ASD with ostium primum", "opc": "VSD", "opd": "TOF", "subject_name": "Pediatrics", "topic_name": "Genetic and genetic disorders", "id": "c9b8011a-4e40-4826-804e-4988cc861fb9", "choice_type": "single"}
+{"question": "Microcephaly is defined as", "exp": "Macrocephaly : Head circumference > 2SD above the mean for age and sex", "cop": 1, "opa": "Head circumference < -3SD below the mean for age and sex", "opb": "Head circumference < -2SD below the mean for age and sex", "opc": "Head circumference below 10th percentile the mean for age and sex", "opd": "Head circumference below 15th percentile the mean for age and sex", "subject_name": "Pediatrics", "topic_name": null, "id": "9b01ee36-e217-4836-b015-22287b4a15c4", "choice_type": "single"}
+{"question": "Congenital Wilson's disease is characterized by", "exp": "Ans. is 'b' i.e., May present as acute hepatitis o KF ring develop after sometime due to deposition of copper in cornea. o It may present as acute or chronic liver disease. o Hepatic copper concentration and urinary excretion of copper are incerased.", "cop": 2, "opa": "KF ring is present at bih", "opb": "May present as acute hepatitis", "opc": "Decreased Urinary copper excretion", "opd": "Decreased hapatic copper concentration", "subject_name": "Pediatrics", "topic_name": null, "id": "9956ea86-9c7f-41a7-9654-4aa955822b33", "choice_type": "single"}
+{"question": "Bilirubin UDP glucuronyl transferase activity is absent in", "exp": "Syndrome\nBilirubin UDP glucuronyl transferase activity\n\n\n\n\nCrigler-Najjar type I\n\t\t\tCrigler-Najjar type II\n\t\t\tGilbert syndrome\nAbsent\n\t\t\tMarkedly reduced : 0-10% of Normal\n\t\t\tReduced : 10-30% of Normal", "cop": 1, "opa": "Crigler-Najjar type I", "opb": "Crigler-Najjar type II", "opc": "Rotor syndrome", "opd": "Gilbert syndrome", "subject_name": "Pediatrics", "topic_name": null, "id": "6d04cf58-0d4b-466c-8b63-c8feae372e13", "choice_type": "single"}
+{"question": "A child is brought by mother with HO massive hemetemesis with HO drug intake previously with NSAIDS and on Rx. Associated with moderate splenomegaly diagnosis is", "exp": "Causes of portal hypertension\n\nPre sinusoidal\nExtrahepatic (most commoon) :portal vein/splenic vein thrombosis,splenic AV fistula,massive splenomegaly.\nIntrahepatic: sarcoidosis, schistosomiasis, congenital hepatic fibrosis, myeloproliferative disorders, nodular degenerative hyperplasia, idiopathic portal fibrosis.\nSinusoidal\nCirrhosis due to any cause.\nPost sinusoidal\nBudd chiari syndrome,right heart failure,constrictive pericarditis,web in inferior venacava.", "cop": 1, "opa": "Oesophageal varices", "opb": "Duodenal ulcer", "opc": "Drug induced gastritis", "opd": "Peptic ulcer", "subject_name": "Pediatrics", "topic_name": null, "id": "7bae26db-c361-4346-b7b8-3fb0247601fb", "choice_type": "single"}
+{"question": "The commonest cause of vomiting in a one month old infant is", "exp": "Aerophagia (var. aerophagy) is a condition of excessive air swallowing, which goes to the stomach. Aerophagia may also refer to an unusual condition where the primary symptom is excessive flatus, belching is not present, and the actual mechanism by which air enters the gut is obscure.Aerophagia in psychiatry is sometimes attributed to nervousness or anxiety. Reference: GHAI Essential pediatrics, 8th edition", "cop": 3, "opa": "Pyloric stenosis", "opb": "Cardiac chalasia", "opc": "Aerophagy", "opd": "Gastro-esophageal reflux", "subject_name": "Pediatrics", "topic_name": "Gastrointestinal tract", "id": "46010421-742d-42ea-b7a0-8e14fe64695b", "choice_type": "single"}
+{"question": "The immediate treatment of 10 kg weight infants presented with tetany", "exp": "Calcium gluconate 10%, 9mg calcium per ml is the preperation of choice.care should be taken to administer the drug slowly to avoid cardiac effects and tissue necrosis. Reference: OP G hai,eseential paediatrics,8 th edition. page no 522", "cop": 2, "opa": "IV Diazepam", "opb": "IV calcium gluconate with cardiac monitoring", "opc": "IV slow phenobarbitone", "opd": "Wait and watch", "subject_name": "Pediatrics", "topic_name": "Endocrinology", "id": "0e71d41c-aba0-40a1-904d-96be242ed207", "choice_type": "single"}
+{"question": "A one month old baby presents with frequent vomiting and failure to thrive, There are features of moderate dehydration, Blood sodium is 122 m Eq/i and potassium is 6.1 in Eq/L The most likely diagnosis is", "exp": "21 Hydroxylase deficiency - (A) Salt losing form of CALL due to associated with aldosterone deficiency, these patients presents with severe vomiting, and vascular collapse. Hyponatreniia hypochloremia and hyperkalemia (B) A Cryptic form of CAH is asymptomatic - presents with menstrual irregularities, acne, hirsutism * Female pseudo hermaphroditism in female 11 b hydroxylase deficiency - presents with hypeension, and hypokalemia Bater's syndrome - - Presents during childhood, having growth retardation, normal to low BP, hypokalemia secondary to renal K+ wasting, metabolic alkalosis, nephrocalcinotic Gitelman's syndrome - (Variant of Bater's syndrome presents during adolescence/adult hood) * Hypokalemia, hypocalciuria, hypomagnesemia and normal prostaglandin production * Metabolic alkalosis", "cop": 3, "opa": "Gitelman syndrome", "opb": "Bater syndrome", "opc": "21 hydroxylase deficiency", "opd": "11 B-hydroxylase deficiency", "subject_name": "Pediatrics", "topic_name": null, "id": "a048fd18-4d51-4ce3-9080-b2fe2f8517f7", "choice_type": "single"}
+{"question": "In sickle cell trait, number of bands found in Hb", "exp": "Ans. is 'a' i.e., 2 In hemoglobin electrophoresis, various types of hemoglobin move at varying speed. In sickle cell trait (heterozygous state), there are two types of hemoglobin - HbS (40%) and HbA (60%). So, on electrophoresis two different bands are produced. In Homozygous state, almost all hemoglobin is HbS. So, single band is produced. Laboratory findings of sickle cell anemia Moderate to severe anaemia o Peripheral smear will show Sickle cells Howell - Jolly bodies because of autosplenectomy Target cells o A positive sickling test with a reducing substance like sodium metabisulfite.", "cop": 1, "opa": "2", "opb": "1", "opc": "4", "opd": "5", "subject_name": "Pediatrics", "topic_name": null, "id": "46854fd5-f700-4907-97c1-af31cda3534c", "choice_type": "single"}
+{"question": "Most common presentation of a child with Wilm's tumour is", "exp": "Most common initial clinical presentation for Wilm's tumour is incidental discovery of Asymptomatic abdominal mass by parents while bathing an affected child or by physician during routine physical examination.", "cop": 3, "opa": "Hematuria", "opb": "Hypertension", "opc": "Asymptomatic abdominal mass", "opd": "Abdominal pain", "subject_name": "Pediatrics", "topic_name": null, "id": "061671bd-fe8e-49b1-807a-7e071162ee1c", "choice_type": "single"}
+{"question": "In the neonate, an intramuscular injection is given on", "exp": "Anterolateral aspect of the thigh This is preferred site up to 12 months of age(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1258)", "cop": 3, "opa": "Deltoid", "opb": "Gluteal region", "opc": "Thigh", "opd": "Abdomen", "subject_name": "Pediatrics", "topic_name": "All India exam", "id": "7f864c8a-fee2-4b7b-8a28-57ca2eeb5f88", "choice_type": "single"}
+{"question": "1 day old m ale baby delivered by LSCS had swelling over back in midline.", "exp": "Ans. is 'b' i.e., Folic acid o Folic acid supplementation decreases the incidence and recurrence of neural tube defects (NTD). Because the neural tube closes within the 1st 28 days ofconception, periconceptional supplementation is needed for prevention. It is recommended that women without a prior history of a NTD, ingest 400 ?g/day throughout their reproductive years. Women with a history of a prior pregnancy complicated by a NTD or a Ist-degree relative with a NTD should have preconceptual counseling and they should ingest 4 mgfday of supplemental folic acid at least 1 mo before conception. Use of some antiepileptic drugs (valproatet carbamazepine) during pregnancy is associated with an increased risk of NTD. Women taking these medications should ingest 1-5 mg of folic acid/day in the preconception period.", "cop": 2, "opa": "Iron", "opb": "Folic acid", "opc": "Thiamine", "opd": "Vit A", "subject_name": "Pediatrics", "topic_name": "New Born Infants", "id": "87c6d7dd-7ce6-47c3-9daf-4e2ad02a1652", "choice_type": "single"}
+{"question": "Normal child has dysfluency of speech between", "exp": "Stuttering is a defect in speech characterized by hesitation or spasmodic repetition of some syllables with pauses. There is difficulty in pronouncing the initial consonants caused by spasm of lingual and palatal muscles. It can affect up to 5% of children between 2 and 5 years of age. In this age group, parents should be reassured as most of them show resolution. If it persists beyond or appears after 5 years of age, opinion of psychologist and speech therapist should be sought", "cop": 1, "opa": "2 and 4 years", "opb": "4 and 6 years", "opc": "6 and 8 years", "opd": "8 and 10 years", "subject_name": "Pediatrics", "topic_name": "Growth and development", "id": "5d717952-fa80-4f93-b44a-5e564229f343", "choice_type": "single"}
+{"question": "Exclusive breastfeeding should be practiced at least until", "exp": "An infant should be exclusively breastfed until 6 months of age. During this age, additional food or fluid is not required as breast milk is nutritionally complete for the child&;s growth & development & it protects from infections and strengthens immune systemRef: Page 60; Ghai Essential Pediatrics; 7th edition", "cop": 2, "opa": "4 month", "opb": "6 month", "opc": "8 month", "opd": "10 month", "subject_name": "Pediatrics", "topic_name": "Nutrition", "id": "29ff8d4a-b1a2-438b-9c37-5a763c520ad1", "choice_type": "single"}