Questions 1. The most unlikely cause for neonatal seizures on Day 2, in an infant is a. Metabolic b. Birth Asphyxia c.

Intraventricular Hemorrhage d. Neonatal tetanus 1. (d) Neonatal tetanus Neonatal tetanus is very rare nowadays. The clinical features usually start on Day 5 to Day 10 and NEVER IN FIRST TWO DAYS, rarely after 2 weeks. Common Metabolic causes are (1) hypoglycaemia (2) hypocalcaemia. Birth Asphyxia is the most common cause of Neonatal seizures. 2. A full term neonate is having episodes of cyanosis and apnea which worsen on feeding and seems better when he is crying. The next step to establish a quick immediate diagnosis is a. Echocardiogram b. Bronchoscopy c. Upper GI d. Nasal exploration with a catheter 2. (d) Nasal exploration with a catheter The Diagnosis is Bilateral choanal atresia : (1) Infants are mostly obligate Nasal breathers (2) Immediate diagnosis . bedside-passing a narrow 8 Fr. Catheter. (3) Confirmatory: Endoscopy and CT Scan (4) Oral airway Lifesaving (5) Treatment Surgical 3. All of the following are seen in infants with Laryngomalacia, except, a. Stridor beginning at (or) shortly after birth b. No evidence of significant Expiratory obstruction c. Stridor is typically loudest during feeding d. Usually increases during crying 3. (d) Usually increases during crying (1) Stridor due to laryngomalacia, usually diminishes during sleep (or) when the child is crying (.ed Muscle tone may hold the supraglottic structures out of airstream) (2) No treatment is needed usually 4. Which of the following childhood problems improves with increase in age a. Conduct disorder b. Emotional problems c. Temper tantrum d. Sleep disorder 4. (c) Temper tantrum (or) Oppositionalism (1) From the age of 18 months to 3 years child begins to develop autonomy and starts separating from primary caregivers. (2) They tend to do the opposite of what has been requested and get frustated when they cant express their autonomy.

(3) Some children show their frustration by physical aggression (Biting, kicking, hitting) (or) resistance. This physical aggression is known as Temper tantrum. (4) Reaches a peak . 2nd to 3rd year of life and subsides at 3 to 6 years. 5. An Infant exhibits stranger reaction by a. 4 months b. 6 months c. 10 months d. 1 year 5. (b) 6 Months (1) By 6-7 months, an infant can differentiate between strangers and primary caregivers. It develops fear of strangers and turns away or runs toward primary caregiver in sight of strangers. (2) It is a normal phenomenon, may last upto 13 months. 6. Vocabulary of a 3 year old child is a. 100 words b. 150 words c. 250 words d. 500 words 6. (c) 250 words 18 months 6 20 words 3 years 250 words 2 years uses Pronouns 1 year 2 words with meaning 7. Handedness is evident in a child by a. 2 years b. 3 years c. 4 years d. 5 years 7. (b) 3 years 8. The Hormone not essential for inutero fetal growth is a. Insulin b. Insulin like growth factor c. Somatotropic hormone d. Thyroxine 8. (c) Somatotropic Hormone Insulin and Insulin like growth factor are most essential for fetal growth. Thyroxine is also essential. Somatotropic Hormone (or) Growth hormone is not essential for fetal growth in utero. 9. A child can walk up and down stairs, alternating his feet by a. 3 years b. 2 years c. 4 years d. None of the above

9. (a) 3 years Climb upstairs 2 years Coordinated climbing 3 years 10. External Genitalia can be clearly differentiated in a fetus by a. 12 weeks b. 20 weeks c. 8 weeks d. 10 weeks 10. (d) 10 weeks 8 weeks Ovaries and Testis distinguishable 10 weeks External genitalia distinguishable 11. Child changes rattle from one hand to another at the age of a. 3 Months b. 6 Months c. 8 Months d. 1 Year 11. (b) 6 months 3 months Holds rattle 56 months Transfers any object from hand to hand. 12. Visual acuity reaches Adult level by a. 3 years b. 4 years c. 5 years d. 7 years 12. (d) 7 years Binocular vision develops by 3 6 months. Adult acuity and depth perception by 67 years. 13. Pincer grasp is seen at a. 3 months b. 9 months c. 5 months d. 7 months 13. (b) 9 months 3 months Grasp appears 5 months Bidextrous Grasp with Reaching 7 months Palmar grasp 9 months Pincer grasp 14. A child starts to take self decisions by the age of a. 7 years b. 3 years c. 10 years d. 12 years 14. (a) 7 years Ref : Page 51 A child starts to make self evaluations and decisions from 6 years and this continues upto 12 years during which refinement occurs.

Self esteem becomes a central issue. 15. Deciduous Dentition is completed by the age of a. 6 months b. 6 weeks c. 6 years d. None of the above 15. (d) None of the above Ref : Nelson Page 1204 (Table) Deciduous dentition appears by 67 months. Lower central incisor is usually the first tooth to erupt and completed by 20 30 months (second molars) last deciduous tooth to erupt. First permanent dentition 6 - 7 years (3 tooth) (1) Lower central incisor and first molar (2) Upper First molar 16. Fatty acids necessary during 0 to 6 months of age for brain are a. Arachidonic acid b. Linoleic acid c. Both of the above d. None of the above 16. (c) Both of the above Ref : Nelson page 154. 17. The triad of Autistic Spectrum Disorders (ASD) are all except. a. Impaired social interaction b. Impaired learning c. Impaired Communication d. Impaired imagination 17. (b) Impaired Learning Ref : O.P.G. Page 65 .(a), (c), (d) are the classic triad of ASD .Onset usually before 3 years .Impaired learning is associated finding. 18. Breast Milk at room temperature can be stored for a. 7 hours b. 24 hours c. 4 hours d. 10 hours 18. (d) 10 hours Ref : O.P.G. Page 151 Expressed Breast milk can be stored for 1) 10 hours at Room temperature 2) 24 hours in a Refrigerator 3) 3 months at 20 C in a freezer. 19. Nipple Confusion occurs when a. A Baby is allowed to suckle on one side most of the times b. A suckling baby is pulled half way and placed on the opposite side during feeding

c. When the baby is positioned incorrectly d. None of the above 19. (d) None of the above Ref : O.P.G. Page 149 NIPPLE CONFUSION occurs in a baby who has been fed with bottle feeds, when put on to suckle at the breast. It finds very difficult and confusing to feed at the breast. 20. Order of development of 2 sexual characteristics in a male is a. Testis development Axillary hair Pubic hair beard b. Testis development Pubic hair Axillary hair - beard c. Beard Axillary hair Pubic hair Testis development d. Axillary hair Pubic hair beard Testis development 20. (b) Testis development Pubic hair Axillary hair - Beard Ref : Nelson (55) 21. Order of development of 2 sexual characteristics in female is a. Thelarche Menarche Pubarche Adrenarche (Axillary Hair) b. Menarche Thelarche Pubarche Adrenarche (Axillary Hair) c. Adrenarche (Axillary hair) Thelarche Pubarche Menarche d. Menarche Pubarche Adrenarche Thelarche 21. (a) Thelarche Menarche Pubarche Adrenarche (Axillary Hair) Ref : Nelson (55) 22. An Infant sits with minimal support, rolls over from supine to prone position, reaches for a toy, does not have a pincer grasp the developmental age is a. 3 Months b. 4 Months c. 6 Months d. 8 Months 22. (b) 4 months Ref : Nelson (55) Pincer grasp 9 months Palmar grasp 3 months 4 months 23. Incorrect about Thumb sucking a. Can lead to malocclusion b. Is a source of pleasure c. Is a sign of insecurity d. Must be treated at 1 year to prevent stubborness 23. (d) Must be treated at 1 year to prevent stubborness. Ref : O.P.G. (55) Thumb sucking usually between 14 years. Intervention required only if it persists beyond 46 years. 24. Two Infants are born at 36 weeks. Infant A weighs 2.6 Kg, Infant B weighs 1.6 Kg. Infant B is more likely to have a. Congenital malformations b. Low Hematocrit c. Hyperglycemia

d. None of the above 24. (a) Congenital malformations Ref : Behrman 16/e. 475 477 Macmillan 3/e. PP 206209. . Small for Date babies have different complications than appropriate for date preterm infants. . Congenital malformations, Asphyxia and Meconuim aspiration Syndrome are common. Pneumothorax, Pulmonary hemorrhage are more common than Hyaline membrane disease in these infants. . Neonatal symptomatic hypoglycaemia and elevated (or) normal Hematocrit are common. 25. Which of the following drugs given during the last 2 weeks of pregnancy is most likely to have deleterious effects on the fetus a. Propranolol b. Penicillin c. Heparin d. Phenytoin 25. (a) Propranolol . Pencillin and Heparin have not been shown to cause ill effects on the fetus. . Phenytoin causes Fetal hydantoin Syndrome when given in first trimester. . Propranolol causes decrease in Heart rate, low cardiac output at times of . ed demand and may cause hypoglycaemia. 26. The most uncommon manifestation / sign in Neonatal meningitis is a. Lethargy b. Neck stiffness c. Vomiting d. Hypothermia 26. (b) Neck stiffness Ref : IAP Textbook 2nde / Page 299 Behrman 1b/e 544 546. (1) The signs and symptoms of Neonatal meningitis are subtle and nonspecific (2) Neck stiffness is usually seen in older children. (3) Temperature instability, Irritability, Vomiting, bulging AF, Lethargy are common. 27. The most common Intra cranial tumor in 2 12 years age group is a. Cerebellar Astrocytoma b. Medulloblastoma c. Ependymoma d. Choroid plexus papilloma 27. (a) Cerebellar Astrocytoma Ref : I A P text book 2nd edition Page 306, 307 (1) Commonest Intracranial tumors in 2-12 yrs . INFRA TENTORIAL IN LOCATION (2) Of the Infra tentorial tumors, cerebellar astrocytoma, medulloblastoma

and brain stem gliomas are in order most common. (3) Less than 2 years and adolescence, Infratentorial = Supratentorial tumors. (4) *Commonest Intra Cranial Tumor in general is secondary metastasis. 28. The Important Prognostic Anthropometric measurement in a newborn is a. Weight b. Head circumference c. Length d. None of the above 28. (a) Weight Ref : I A P : 76 page chapter (7.1) . In any Newborn, be it Term / Preterm weight is the most important measurement. Appropriate weight for date babies tend to do well (prognostic point) than small / low birth weight babies. . Among low birth weight babies, those with normal or near normal Head circumference have a good prognosis. 29. In a standard growth chart; Head circumference is included for the age upto a. 1 Year b. 3 Years c. 2 Years d. 5 Years 29. (b) 3 years Ref : I A P text book Page 79 30. The brain size of a one year old Infant in relation to an adult brain is a. 67% b. 75% c. 90% d. 60% 30. (c) 90% Ref : I A P Page (79), (1) At Birth : 67% Adult Brain Size (2) At One year : 90% . Brain Growth is most rapid in 20 36 weeks of Intrauterine life and then in the first year of life. 31. The average normal blood pressure of a 3 year old child is a. 75/50 mmHg b. 90/60 mmHg c. 65/45 mmHg d. None of the above 31. (b) 90/60 mm Hg Ref : I A P 2nd edition Page 31 The average normal BP in children . New born 65/45 mm Hg

. 1 Year 75/50 mm Hg . 3 Years 90/60 mm Hg . 10 years 100/70 mm Hg 32. All are early indications for Exchange blood transfusion in Infants with Rh-Hemolytic Disease except a. Cord Hb > 12g/dL b. Cord Bilirubin 5 mg/dL (or) more c. Unconjugated Bilirubin > 10 mg/dL 24 hrs d. Rise of Bilirubin more than 0.5 mg/dL/hour 32. (a) Cord Hb > 12 g/dl Ref : I A P Page 73 Cord Hb < 10 mg/dl is an early indication. 33. Two carpal bones are radiologically seen in the wrist X-ray by the end of a. 1 Year b. 2 years c. 4 years d. 12 years 33. (a) 1 year Ref : Nelson Page 37 Capitate and Hamate appear as early as 2 3 months 34. IQ between 50-70 indicates a. Moderate Mental Retardation b. Mild Mental Retardation c. Severe Mental retardation d. Profound MR 34. (b) Mild Mental Retardation Ref : O.P.G. 543 Intelligence Quotient = Mental age Chronological age 100 . Mild MR 51 70 . Moderate MR 36 50 Sub Normal Intelligence - 71 89 . Severe MR 21 35 Normal Intelligence - 90 100 . Profound MR 0 20 35. Weight gain during first 3 months of age a. 250 gm/month b. 500 gm/month c. 350 gm/month d. 750 gm/month 35. (d) 750gm / month Ref : O.P.G. 4th page First 4 months 30gm / day Next 4 months 20gm / day Wt. gain Last 4 months 10gm / day . Average Birth Wt. : 3 Kg (O.P.G 4)

. By 10th day : Birth Wt. is regained (3) Kg . 5 months : Doubles Birth weight (6) Kg . 12 months : Tribles Birth Wt. (9) Kg . 24 months : Quadruples Birth Wt. (12) Kg; ie (1/5) of adult weight Height at 2 yrs = (1/2) Adult Height; (i.e) (8590 cm) 36. Length of the babies is recorded upto a. 1 Year b. 2 Years c. 21/2 years d. 11/2 years 36. (b) 2 years Ref : O.P.G. 4 . Length of a Neonate is 50 cm 3 months 60 cm 9 months 70 cm 1 year 75 cm 2 years 90 cm 37. Head circumference at 12 years of age is a. 48 cm b. 50 cm c. 52 cm d. 49 cm 37. (c) 52 cm At Birth 35 cm 3 months 40 cm 12 months 45 cm 2 years 48 cm 12 years 52 cm Increase in Head circumference >1 cm/2 weeks . Hydrocephalous Head circumference equals chest circumference at 1 year. 38. Anthropometric measure that does not show much change in 1 4 years is a. Abdominal circumference b. Head circumference c. Skinfold thickness d. Mid arm circumference 38. (d) Mid arm circumference Ref : Nelson 2131 Between 1 4 years the subcutaneous fat gets gradually replaced by increase in muscle mass. Both occur equally.Hence the loss of fat equals increase in muscle. So there is little change in Midarm circumference between 1 4 years. 39. A 5 year old child is assessed to have developmental age of 1 year. His IQ is a. 20 b. 40 c. 80

d. 100 39. (a) 20 IQ = Mental age Chronological age 100 IQ = 20 1 5 100 = 40. Shakir tape is used to measure a. Height b. Length c. Midarm circumference d. Head circumference e. Chest circumference 40. (c) Midarm Circumference 41. Skeletal age of Infants of 8 months age is assesed by a. X ray of Pelvis b. X ray of Radius&ulna c. X ray of skull d. X ray of shoulder 41. (d) X ray of shoulder Ref : O.P.G 6 . 3 6 months X ray shoulder . 1 13 yrs Hands & wrist . 12 14 yrs Elbow and Hip 42. Capacity of stomach in a newborn is a. 20 ml b. 30 ml c. 50 ml d. 100 ml 42. (b) 30 ml Ref : Chaurasia Vol II 4/e Page 238 43. Vomiting on the first day in a newborn is due to a. Esophageal atresia b. Pyloric stenosis c. Amniotic fluid gastritis d. Congenital megacolon 43. (a) Esophageal atresia Ref : Nelson 588 (1) Vomiting from esophageal atresia occurs with the first feed. (2) The diagnosis is suspected when excess, unusual drooling of saliva is observed and resistance is encountered on attempting to pass a catheter into stomach. (3) Vomiting in pyloric obstruction can occur anytime but mostly occurs in 4th to 6th week.

44. Air in the jejunum in an X ray of an Infant can be seen in a. 23 Hrs b. 15 Min.60 Min. c. 3 Hrs to 6 Hrs d. 24 Hrs. 44. (b) 15 min. 60 min. Ref : Nelson 588 Air can be demonstrated in the X ray of an infant in (a) Jejunum 15 60 min. (b) Ileum 2 3 hrs. (c) Colon 3 hrs. Absence of rectal gas in 24 hr film . Abnormal. 45. Large doses of Vit K administered to a new born may result in a. Hyperammonemia b. Hypobilirubinaemia c. Prolonged Hyperbilirubinaemia d. Prolonged bleeding time 45. (c) Prolonged Hyperbilirubinaemia Ref : Nelson 190 . Hypoprothrombinaemia due to deficiency of Vit K. otherwise called Hemorrhagic Disease of new born. Prevented by prophylactic administration of Vit K. . Hyperbilirubinaemia is caused by administration of large doses of Synthetic Vit K analogues. It does not occur with Synthetic Vit K analogues. 46. Foetal scalp Blood pH; Less than is abnormal a. 7.25 b. 7.3 c. 7.35 d. 7.4 46. (a) 7.25 Ref : Nelson 538 Fetal scalp blood pH ; during normal labour, decreases from 7.33 to 7.25. Any value less than 7.25 indicates Fetal distress, and pH less than 7.2 requires active intervention. Acidosis is mainly due to hypoxia induced Lactic Acidosis and monitoring of fetal scalp blood lactate levels also shows the condition of the fetus. 47. Neonatal seizures cause of which carries the best prognosis; a. Birth asphyxia b. Hypoglycaemia c. Meningitis d. Late onset Hypocalcemia 47. (d) Late onset hypocalcaemia 48. The normal heart rate at Birth is a. 6080 bpm b. 80110 bpm c. 70120 bpm

d. 110150 bpm 48. (d) 110 150 bpm Ref : Nelson 280 Table 57.1 Age Heart Rate Resp. Rate Preterm 0 3 months 3 6 months 6 12 months 1 3 yrs. 3 6 yrs. 6 12 yrs. 12 yrs. 120 170 100 150 90 120 80 120 70 110 65 110 60 95 55 85 40 70 35 55 30 45 25 40 20 30 20 25 14 22 12 18 (near Adult values) 49. In Neonatal necrotising enterocolitis all of following are found except a. Blood in stools b. Delayed gastric emptying c. Temperature instability d. Increased Bowel sounds 49. (c) Temperature Instability Ref : Nelson 590. NEC Neonatal Necrotizing Enterocolitis . NEC is the most common life threatening emergency of GIT in neonates . Common in LBW and PreMature babies . Distal ileum and Proximal colon are the commonest sites to be involved. . Less common in Infants fed on Breast milk. . Rarely occurs before initiation of enteral feeds. . DIC, Shock, Acidosis are sequelae. 50. Umbilical cord usually falls after a. 510 days

b. 3 days c. 14 days d. None of the above 50. (a) 5 10 days Ref : Nelson 608 51. The bone most frequently fractured during delivery is the a. Radius b. Clavicle c. Ulna d. Femur 51. (b) Clavicle Ref : Nelson 572 52. The Characteristics of caput succedaeneum, are all except a. Crosses midline b. Crosses the suture line c. Does not disappear within 23 days d. None of the above 52. (c) Does not disappear within 23 days Ref : Nelson 562 Caput Succedaneum It is a diffuse edematous sometimes ecchymotic swelling of the layers of scalp in the presenting part of the baby during delivery. It is seen during birth . Usually disappears in 35 days . Large caput indicates prolonged labour. . Moulding of the head and overriding of parietal bones usually seen. . Crosses Midline and Sutural lines. 53. All are true about Cephalohematoma except a. Limited to sutural lines b. Subperiosteal hemorrhage c. Visible several hours after birth d. Requires I and D 53. (d) Requires I and D Ref : Nelson 562 Caphalohematoma is a subperiosteal hemorrhage limited to a cranial bone. It is viable several hours after birth. I & D contraindicated. May cause Hyperbilirubinaemia and prolongation of physiological jaundice. 54. A child following delivery, incomplete moros reflex, grasp preserved one UL; Abduction and supination difficulty. The lesion is at the level of a. C8 T1 b. C2 C3 c. C5 C6 d. C6 C7

54. (c) C5 C6 Ref : Nelson 565 Erbs paralysis due to pulling of the infant vigorously by the arm. C8 T1 Klumpkis paralysis 55. 25% of Infants void within a. 72 hrs b. 48 hrs c. 24 hrs d. 8 hrs 55. (c) 24 hrs. . Urine is passed usually during birth (or) immediately after birth. . 95% of all infants void within 24 hrs. Meconium : 99% . Pass within 48 hrs. 56. Most common cause of convulsions on the first day of life in a neonate is a. Anoxia b. Head injury c. Hypoglycaemia d. Meningitis 56. (a) Anoxia Ref : O.P.G. Page 511 Nelson P: 567 Hypoxic ischaemic encephalopathy is the most common cause of neonatal convlusions(50%). Sepsis, meningitis are the next common causes. Metabolic disturbances, like hypoglycaemia, hypocalcaemia and dyselectrolytemia account for 25%. 57. Most common cause of respiratory distress after birth in the first 24 hrs is a. Neonatal sepsis b. Meconium Aspiration c. Pneumonia d. Air embolism 57. (b) Meconium Aspiration Ref : O.P.G. 167 Table. Commonest cause of respiratory distress in a preterm neonate Hyaline Membrane disease. Post term and SFD babies, with H/o Meconium aspiration may develop respiratory distress in 15% of cases. Thin meconium causes, chemical pneumonitis, thick meconium causes airway obstruction causing areas of atelectasis and emphysema. 58. All of the following increase the risk of respiratory distress syndrome (RDS), except a. Maternal diabetes b. Alkalosis c. Caesarean section d. Maternal diabetes

58. (b) Alkalosis Ref : O.P.G : 166 RDS :- Respiratory Distress Syndrome almost always occurs in PRETERM (< 34 weeks) babies. Surfactant production starts after 34 weeks and optimum levels occur only after 36 37 weeks. Surfactant is a lipoprotein containing phosphotydyl choline and phosphotydyl glycerol. Secreted by Type II Alveolar cells. It helps to reduce surface tension (soap like effect) and thus prevents the collapse of alveoli during expiration. Respiratory distress is evident within SIX hours of life. Lecithin / Sphingomyelin ratio Prenatal diagnosis normal > 2 and indicates adequate lung maturity. Test shake test. A simple bed side test. Where the amniotic fluid is mixed with absolute alcohol in a test tube and shook for 15 minutes. Copious bubbles indicates adequate surfactant and thus lung maturity. Treatment . Intratracheal administration of surfactant is now recommended. . Ventilatory support - Intermittent Mandatory ventilation severe disease (IMV). Mild disease Continuous Positive Airway Pressure (CPAP). 59. All are true regarding use of prenatal corticosteroids in the prevention of HMD, in cases of preterm labour except; a. All mothers at risk of preterm delivery between 2434 wks need the therapy b. Maternal Hypertension is not a contraindication c. Maternal diabetes is not a contraindication d. The effect of one course lasts for 2 weeks 59. (d) The Effect of one course lasts for 2 weeks Ref : O.P.G: 168 Table The benefits of prenatal corticosteroids are (1) 50% reduction in reduction of RDS (2) 40% reduction in mortality in babies with RDS Chorioamnionitis is a contraindication for the therapy. Treatment schedule : (1) Inj. Betamethasone 12 mg Intramuscular every 24 hours ; 2 doses -(preferred drug) (2) Alternatively, Inj. dexamethasone 6mg i.m every 12 hours (4) doses. Optimal effect occurs after 24 hrs of initiating treatment. One course lasts for 7 days. Hence if labour prolongs / continues after the expected preterm date (i.e. example 34 36 weeks) the course should be repeated on the 7th day to have the desired effect. 60. True regarding Transient Tachypnoea of newborn is a. Benign self limiting disease b. Usually occurs in Preterm neonates c. Chest X ray shows absent vascular markings d. Significant respiratory distress is present 60. (a) Benign self limiting disease

Ref : O.P.G. 168 TTN : (1) Occurs in Term Neonates (2) Due to delay in clearance of lung fluids (3) No respiratory distress or very minimal (4) Oxygen treatment in adequate (5) X ray shows Prominent vascular markings and prominent interlobar fissure. (6) Prognosis good. 61. Low birth weight baby is defined as a. Birth weight <1500 gms b. Birth weight <15002000 gms c. Birth weight <2500 gms d. None of the above 61. (c) Birth wt < 2500 gms. Ref : Nelson 550 Low Birth weight : < 2500 gms Very low birth weight : < 1500 gms Normal Birth weight : < 3.5 Kg 62. All are seen during hypothermia in early neonate except; a. Bradycardia b. Excess shivering c. Fall in core temperature d. Metabolic acidosis 62. (b) Excess shivering Ref : Nelson 528 Shivering mechanism is not developed in a neonate. Non shivering thermogenesis occuring in Brown fat (nape of neck) accounts for the source of heat in an infant.