41. Topic: Infant with Severe Dyspnea and Apnea after Feeding

Correct Answer: C. Bilateral choanal atresia

Explanation: In a healthy infant presenting with severe dyspnea and apnea immediately after feeding, bilateral choanal atresia (C) is the most likely diagnosis. Choanal atresia refers to a congenital condition where the back of the nasal passage (choanae) is blocked, usually by bony or soft tissue. This obstruction can severely impair the infant’s ability to breathe through the nose, particularly noticeable during feeding when nasal airflow increase

42. Topic: Diagnosis for Newborn

Correct Answer: B. Hirschsprung’s disease

Explanation: In a newborn presenting with severe constipation, abdominal distension, and occasional bile-stained vomiting, the most likely diagnosis is Hirschsprung’s disease. This congenital condition results from the absence of ganglion cells in the distal colon, causing obstruction and constipation.

43. Topic: Diagnosis of Hirschsprung’s Disease

Correct Answer: D. A rectal biopsy

Explanation: The diagnosis of Hirschsprung’s disease is best confirmed by performing a rectal biopsy. This procedure helps identify the absence of ganglion cells in the rectum and confirms the diagnosis of this congenital disorder, which leads to severe constipation and bowel obstruction in newborns.

44. Topic: Turner Syndrome

Correct Answer: C. Turner

Explanation: Turner syndrome is characterized by a variety of features including a webbed neck, short stature, and coarctation (narrowing) of the aorta. This condition is caused by the complete or partial absence of one X chromosome in females. The physical traits associated with Turner syndrome can vary, but the combination of a webbed neck, short stature, and aortic coarctation are among the notable clinical features.

45. Topic: Pediatric Respiratory Conditions

Correct Answer: C. Bronchiolitis

Explanation: Bronchiolitis is a common respiratory infection in infants, typically caused by respiratory syncytial virus (RSV). It presents with symptoms such as coughing, sneezing, runny nose, and wheezing, often accompanied by respiratory distress. Hyper-distension on chest X-ray can be seen due to air trapping in the smaller airways (bronchioles). Bronchitis (option D) typically presents with cough and inflammation of the larger airways, while bronchiolitis specifically affects the smaller airways, as described in this case.

46.  Topic: Brachial Plexus Injury

Correct Answer: E. Diaphragmatic paralysis

Explanation: Brachial plexus injury during a difficult delivery can lead to trauma to the nerves supplying the arm, which are derived from cervical nerve roots C5-C8 and thoracic nerve root T1. Diaphragmatic paralysis (option E) can occur as a result of damage to the phrenic nerve, which originates from cervical nerve roots C3-C5. This nerve controls the movement of the diaphragm, and its injury can lead to impaired function of the diaphragm, resulting in respiratory difficulties.

47.  Topic: Dermatomyositis

Correct Answer: A. Sebaceous adenoma

Explanation: Dermatomyositis is an autoimmune disease characterized by inflammation of the muscles and skin. The signs typically include: Proximal muscle weakness (option B), which is a hallmark feature due to muscle inflammation.Gottron’s papules on the finger joints (option C), which are red or violaceous papules typically over the knuckles.Violaceous lesions on the upper part of the trunk (option D), which are a characteristic rash seen in dermatomyositis.Periorbital edema (option E), which is swelling around the eyes, often referred to as heliotrope rash.Sebaceous adenoma (option A) is not associated with dermatomyositis. It is a benign tumor of sebaceous glands and is not part of the typical clinical features seen in this condition. Therefore, option A is the correct answer.

48. Topic: Asthma Triggers

Correct Answer: B. Administration of beta-antagonists

Explanation: Asthma attacks can be triggered by various factors, including:Exercise (option A): Physical exertion can induce asthma symptoms in susceptible individuals.Exposure to pollutants (option C): Environmental pollutants such as smoke, dust, and chemicals can aggravate asthma.Emotions (option D): Stress and strong emotions can sometimes trigger asthma symptoms.Respiratory viral infection (option E): Infections like the common cold or flu can exacerbate asthma. However, administration of beta-antagonists (option B), which are actually beta-blockers, can exacerbate asthma symptoms and potentially trigger an asthma attack. Beta-antagonists are contraindicated in asthma because they can block the beta-2 receptors in the lungs, which are crucial for bronchodilation. Therefore, option B is the correct answer as it is not a trigger but rather a contrain

49. Topic: Fetal Hydrops

Correct Answer: E. None of the above

Explanation: Fetal hydrops refers to abnormal fluid accumulation in two or more fetal compartments, which can be caused by various underlying conditions.Chronic severe anemia due to Rh incompatibility (A): Severe hemolytic disease due to Rh or other blood group incompatibilities can lead to fetal hydrops.Hypo-proteinemia (B): This can cause hydrops due to reduced oncotic pressure, leading to fluid accumulation in fetal tissues.Intrauterine infection (C): Infections such as parvovirus B19 or cytomegalovirus can cause fetal hydrops.Idiopathic (D): Sometimes fetal hydrops occurs without a known cause, termed idiopathic.Therefore, the correct answer is E. “None of the above” because all the listed options are known causes or associated conditions of fetal hydrops.

50. Topic: Pediatric Neurology

Correct Answer: B. Hydrocephalus

Explanation: Hydrocephalus is characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to enlargement of the head circumference (macrocephaly) in infants. This condition can result from various causes, including congenital malformations, infections, or tumors obstructing the flow of CSF. Meningitis (A): While meningitis can cause head enlargement due to inflammation, it typically presents with other symptoms such as fever, irritability, and neck stiffness.Cerebral palsy (C): Cerebral palsy is a neurological disorder affecting muscle coordination and movement, not directly associated with head enlargement.Hyperthyroidism (D): Hyperthyroidism in infants can cause symptoms like poor weight gain and irritability but does not typically lead to head enlargement.Therefore, in the context of an infant with an enlarged head circumference and suture separation without other symptoms suggestive of meningitis, cerebral palsy, or hyperthyroidism, hydrocephalus is the most likely diagnosis. Thus, the correct answer is B.

51. Topic: Pediatric Gastroenterology

Correct Answer: C. Metabolic alkalosis

Explanation: Pyloric stenosis, a condition characterized by the thickening of the pyloric muscle, leads to obstruction of gastric outflow. This results in projectile vomiting, which causes the loss of gastric contents that are rich in hydrochloric acid.Hypokalemia (A): While hypokalemia can occur due to loss of potassium in the vomit, it is a secondary finding.Metabolic acidosis (B): This condition would result from the loss of bicarbonate through diarrhea, not vomiting.Respiratory acidosis (D) and Respiratory alkalosis (E): These are related to respiratory function and are not typical consequences of pyloric stenosis.The primary metabolic disturbance in pyloric stenosis is metabolic alkalosis (C) due to the significant loss of acid from the stomach. Therefore, the correct answer is C.

52. Topic: Neonatology

Correct Answer: D. Intercostal pulling

Explanation: The Apgar score assesses a newborn’s health based on five parameters: heart rate (A), skin coloration (B), breathing (C), and tone (E). Intercostal pulling (D) is not one of these parameters, making it the incorrect statement. The Apgar score focuses on quick, observable signs of a newborn’s condition immediately after birth.

53. Topic: Hyperbilirubinemia in Newborns

Correct Answer: B. Unconjugated bilirubin is strongly bound to albumin

Explanation: Unconjugated bilirubin is strongly bound to albumin (B), which prevents it from crossing the blood-brain barrier and causing bilirubin encephalopathy or kernicterus. Other mechanisms such as solubility (A), binding to hemoglobin (C), impermeability of the blood-brain barrier (D), and metabolism by cerebrospinal fluid (E) do not play a significant role in this prevention. Proper management of hyperbilirubinemia ensures that bilirubin remains safely bound to albumin.

54. Topic: Development of Hand Dominance

Correct Answer: C. 4-6 years

Explanation: The regular use of a dominant hand is typically established between the ages of 4 and 6 years (C). Before this age range, children may use both hands interchangeably. The establishment of hand dominance is an important developmental milestone and typically becomes evident during early childhood, not as early as 12 or 24 months (A and B) and not as late as 7 or 9 years (D and E).

55. Topic: Pediatric Nephrology

Correct Answer: B. Post-streptococcal glomerulonephritis

Explanation: The most likely cause of a 6-year-old boy presenting with brown urine, hypertension, dyspnea, periorbital edema, hepatomegaly, and a history of healing impetigo lesions is post-streptococcal glomerulonephritis (B). This condition often follows a streptococcal infection, such as impetigo, and is characterized by hematuria (brown urine), edema, and hypertension. Other options like IgA nephropathy (A), idiopathic hypercalciuria (C), pyelonephritis (D), and sexually transmitted diseases (E) do not typically present with this combination of symptoms and history.

56. Topic: Pediatric Neurology

Correct Answer: A. Duchenne muscular dystrophy

Explanation: Duchenne muscular dystrophy (DMD) is characterized by progressive muscle weakness, which often presents as an awkward gait and mild scoliosis in young boys. The use of hands to push on the legs to rise from the ground, known as Gower’s sign, is a hallmark of DMD (A). Conditions like Guillain Barré syndrome (B), Hunter syndrome (C), Motor Neuron Disease (D), and Polio (E) do not typically present with this specific combination of symptoms and the characteristic Gower’s sign.

57. Topic: Pediatric Infectious Diseases

Correct Answer: B. Measles

Explanation: The presentation of malaise, cough, coryza, conjunctivitis, and high fever, followed by Koplik spots (whitish-blue spots on a red background in the mouth) and an erythematous, nonpruritic, maculopapular rash starting at the hairline and spreading over the body, is classic for measles (B). These symptoms and signs are distinct for measles and not characteristic of hand-foot-and-mouth disease (A), rubella (C), mumps (D), or whooping cough (E).

58. Topic: Pediatric Cardiology

Correct Answer: A. Interventricular communication

Explanation: The presence of a systolic tremor at the left lower sternal border, a pan-systolic murmur, and an accentuated second heart sound strongly suggests an interventricular communication (ventricular septal defect). This defect causes turbulent blood flow between the ventricles during systole, producing the characteristic murmur and tremor. Other conditions like atrial septal defect (B), patent ductus arteriosus (C), tetralogy of Fallot (D), and congenital aortic stenosis (E) have different auscultatory findings and symptomatology.

59. Topic: Pediatric Infectious Diseases

Correct Answer: A. Measles

Explanation: The presentation of conjunctivitis and a maculopapular rash that starts on the head and spreads downward is characteristic of measles. This pattern of rash progression, along with conjunctivitis, is a hallmark of measles, distinguishing it from rubella (B), infant roseola (C), scarlet fever (D), and pityriasis versicolor (E), which have different clinical manifestations and rash patterns.

60. Topic: Pediatric Gastrointestinal Disorders

Correct Answer: E. Intussusception

Explanation: Intussusception is a condition where one segment of the intestine telescopes into another, causing obstruction and potentially compromising blood flow. The classic presentation includes sudden onset of severe abdominal pain, often with screaming in pain, followed by pallor, shock, and passage of blood and mucus per rectum (currant jelly stool). Examination may reveal a sausage-shaped mass in the abdomen due to the telescoped bowel. This clinical picture is typical for intussusception (E) and distinguishes it from Meckel’s diverticulum (A), Crohn’s disease (B), appendicitis (C), and simple constipation (D), which present with different symptoms and signs.

61. Topic: Muscular Dystrophy

Correct Answer: B. Serum creatine phosphokinase assay

Explanation: Muscular dystrophy is a group of genetic disorders characterized by progressive muscle weakness and degeneration. Diagnosis is typically confirmed by assessing serum creatine phosphokinase (CPK) levels, which are often elevated due to ongoing muscle damage and breakdown. Elevated CPK levels indicate muscle pathology, supporting the diagnosis of muscular dystrophy. Muscle biopsy (A) can also provide definitive diagnosis by examining muscle tissue for specific genetic abnormalities or dystrophic changes. Electromyogram (EMG) (C) evaluates electrical activity in muscles but is not specific to muscular dystrophy alone. Cholinesterase enzyme assay (D) and serum aldolase assay (E) are not specific tests for muscular dystrophy. Therefore, the correct and most appropriate initial test for diagnosing muscular dystrophy is the serum creatine phosphokinase assay (B).

62. Topic: Sturge-Weber Syndrome

Correct Answer: E. Ipsilateral hemiparesis develops in one of cases

Explanation: Sturge-Weber Syndrome is a neurocutaneous disorder characterized by the following cardinal manifestations:Ipsilateral leptomeningeal angiomatosis (A): This refers to abnormal growth of blood vessels in the leptomeninges on one side of the brain.Intracranial calcification (B): Calcifications can occur in the brain due to abnormal blood vessel development.Mental retardation (C): Cognitive impairment is often associated with this syndrome.Port wine stain of the ophthalmic division of the fifth trigeminal nerve (D): This is a characteristic facial birthmark seen in Sturge-Weber Syndrome.The incorrect statement among these options is:Ipsilateral hemiparesis develops in one of cases (E): Hemiparesis (weakness on one side of the body) is not a cardinal manifestation of Sturge-Weber Syndrome. Instead, the syndrome primarily involves neurological and dermatological features related to abnormal blood vessel development and calcification in the brain.

63. Topic: Juvenile Polyps

Correct Answer: A. The colon

Explanation: Juvenile polyps are benign growths that are most commonly found in the colon. They typically occur in children and adolescents, hence the term “juvenile” polyps. These polyps are characterized by their smooth surface and are usually solitary, though they can sometimes be multiple.Option A (The colon): This is the correct answer as juvenile polyps are predominantly found in the colon, particularly in the rectosigmoid region.Option B (The transverse colon): While polyps can occur throughout the colon, juvenile polyps are more frequently found in the rectosigmoid area rather than specifically in the transverse colon.Option C (The ileo-caecal junction): Although polyps can occur here, juvenile polyps are more commonly found in the distal colon.Option D (The rectum): Juvenile polyps can indeed occur in the rectum, but they are not limited to this location alone.Option E (None of the above): This is incorrect because juvenile polyps are typically found in the colon.

64. Topic: Upper GI Bleeding in a Child

Correct Answer: E. Upper GI endoscopy

Explanation: In a 10-year-old girl presenting with epigastric pain and vomiting coffee-brown substance (which suggests upper gastrointestinal bleeding), the best investigation to perform would be an upper GI endoscopy. Here’s why:Option A (X-ray of the abdomen without preparation): X-rays may show signs of perforation or air under the diaphragm in cases of acute abdomen but are not specific for upper GI bleeding.Option B (Complete blood count and blood chemistry): These tests can provide information about the extent of bleeding and the patient’s overall condition but do not identify the source of bleeding directly.Option C (Arteriography): Arteriography may be used in cases of severe bleeding if endoscopy is inconclusive or unavailable, but it is invasive and less commonly used as the initial diagnostic test.Option D (Lavage of the peritoneum): Peritoneal lavage is not indicated in this scenario and is typically used in trauma or suspected peritonitis.Option E (Upper GI endoscopy): This is the correct answer because upper GI endoscopy allows direct visualization of the upper gastrointestinal tract, including the esophagus, stomach, and duodenum. It can identify the source of bleeding, such as esophageal varices, peptic ulcers, or Mallory-Weiss tears, which could present with coffee-ground vomitus.Therefore, in the case of a 10-year-old girl presenting with vomiting of coffee-brown substance (indicating upper GI bleeding), the most appropriate initial investigation to perform is E. Upper GI endoscopy.

65. Topic: Diagnosis of Apnea in a Newborn

Correct Answer: A. Cerebral angiography

Explanation: Apnea in a newborn can be investigated using various diagnostic tools. Here’s an explanation of why cerebral angiography is not a useful investigation in this context:Option A (Cerebral angiography): Cerebral angiography is not typically used to diagnose apnea in newborns. It is an invasive procedure involving the injection of contrast dye into the blood vessels of the brain to visualize the blood flow. This procedure is more suited for diagnosing vascular abnormalities, aneurysms, or vascular malformations in older children or adults and is not indicated for the evaluation of apnea.Option B (EEG study): EEG (Electroencephalogram) is useful in evaluating brain activity and can detect abnormal patterns associated with seizures or neurological conditions that may cause apnea.Option C (Esophagogastroduodenal transit): This is not typically used to diagnose apnea. It involves imaging the passage of a contrast material through the esophagus, stomach, and duodenum to assess for structural abnormalities or motility disorders.Option D (Electrocardiogram): An ECG is useful to assess cardiac function, which can be affected by apnea and associated conditions.Option E (Ultrasound of the head): Ultrasound of the head can evaluate for structural abnormalities, intracranial hemorrhage, or hydrocephalus, which could be relevant in the evaluation of apnea. Therefore, the correct answer is A. Cerebral angiography, as it is not a useful investigation for diagnosing apnea in a newborn.

66. Topic: Acute Reaction to Insecticides

Correct Answer: A. Exposure to insecticides

Explanation: The symptoms described in the scenario are indicative of an acute systemic reaction to insecticides, commonly known as organophosphate or carbamate poisoning. Here’s an explanation of why this is the correct diagnosis:Option A (Exposure to insecticides): Organophosphate and carbamate insecticides can cause a cholinergic crisis characterized by wheezing (due to bronchoconstriction), bradycardia (from excessive parasympathetic stimulation), profuse salivation, and constricted pupils (miosis). These symptoms reflect the overstimulation of cholinergic receptors due to inhibition of acetylcholinesterase.Option B (Pollen allergy): Pollen allergy typically presents with respiratory symptoms such as sneezing, nasal congestion, and itchy/watery eyes, but does not cause bradycardia, salivation, or constricted pupils.Option C (Bee sting): A bee sting can cause anaphylaxis, which presents with symptoms such as hives, swelling, difficulty breathing, and potentially anaphylactic shock. However, it does not typically cause bradycardia or profuse salivation.Option D (Exposure to dust): Dust exposure can exacerbate asthma or cause allergic rhinitis symptoms like sneezing and nasal congestion, but does not cause bradycardia, salivation, or constricted pupils.Option E (None of the above): Given the symptoms described, exposure to insecticides (specifically organophosphates or carbamates) is the most likely cause, making option E incorrect. Therefore, the correct answer is A. Exposure to insecticides, which explains the constellation of symptoms including wheezing, bradycardia, profuse salivation, and constricted pupils seen in the child after the picnic.

67. Topic: Treatment for Organophosphate/Carbamate Poisoning

Correct Answer: B. Atropine and pralidoxime

Explanation: In the context of organophosphate or carbamate poisoning, which was suggested by the symptoms in the previous question, the appropriate treatment involves specific antidotes and supportive care. Here’s why option B is the correct choice:Option A (Naloxone): Naloxone is used to reverse opioid overdose by competitively inhibiting opioid receptors. It is not effective in treating organophosphate or carbamate poisoning.Option B (Atropine and pralidoxime): This is the correct answer. Atropine is an anticholinergic medication that helps counteract the excessive parasympathetic effects (such as bradycardia and excessive secretions) caused by organophosphates or carbamates. Pralidoxime (also known as 2-PAM) reactivates acetylcholinesterase, which helps to restore normal neuromuscular function. These two medications are essential in managing cholinergic crisis. Option C (Diazepam): Diazepam is a benzodiazepine used for its sedative, anxiolytic, muscle relaxant, and anticonvulsant properties. It is not indicated as a primary treatment for organophosphate or carbamate poisoning.Option D (Activated charcoal): Activated charcoal is used to absorb toxins in the gastrointestinal tract and is typically administered to prevent absorption after ingestion of certain poisons. It is not effective for organophosphate or carbamate poisoning.Option E (Intravenous theophylline): Theophylline is a bronchodilator used in conditions like asthma or chronic obstructive pulmonary disease (COPD) and is not indicated for organophosphate or carbamate poisoning. Therefore, the correct and best treatment option for the child presenting with symptoms of organophosphate or carbamate poisoning (wheezing, bradycardia, profuse salivation, constricted pupils) is B. Atropine and pralidoxime. These medications act to counteract the effects of excessive acetylcholine due to poisoning and restore normal physiological function.

68. Topic: Wilson’s Disease

Correct Answer: D. Decrease in urinary copper flow

Explanation: Wilson’s disease is an inherited disorder of copper metabolism characterized by the following features:Option A (Autosomal recessive inheritance): Wilson’s disease is inherited in an autosomal recessive manner, meaning an affected individual must inherit two copies of the defective gene (one from each parent).Option B (Low level of ceruloplasmin): Ceruloplasmin is a copper-binding protein in the blood. In Wilson’s disease, there is a deficiency of ceruloplasmin due to impaired copper transport, leading to low levels of this protein.Option C (Kayser-Fleischer ring): This is a distinctive ring of copper deposits that forms around the cornea of the eye. It is a characteristic feature of Wilson’s disease due to copper accumulation in the eye tissues.Option D (Decrease in urinary copper flow): This statement is incorrect. In Wilson’s disease, there is actually an increase in urinary copper excretion due to impaired copper transport and metabolism, leading to copper accumulation in tissues like the liver and brain.Option E (Can be treated with D-penicillamine): D-penicillamine is a chelating agent that helps remove excess copper from the body. It is a key treatment for Wilson’s disease to reduce copper levels and prevent further tissue damage.Therefore, the correct answer is D. Wilson’s disease is not characterized by a decrease in urinary copper flow; instead, it is characterized by increased urinary copper excretion due to impaired copper metabolism.

69. Topic: Toxoplasmosis in Newborns

Correct Answer: E. All of the above

Explanation: Toxoplasmosis in newborns can present with various manifestations due to congenital infection. Key features include:Option A (Chorioretinitis): Toxoplasmosis can cause inflammation of the retina and choroid, leading to chorioretinitis, which can result in visual impairment or blindness.Option B (Hydrocephalus): Congenital toxoplasmosis can lead to hydrocephalus, characterized by an abnormal accumulation of cerebrospinal fluid in the brain’s ventricles.Option C (Cerebral calcifications): Calcifications in the brain are a common finding in congenital toxoplasmosis, indicating areas of past infection and inflammation.Option D (Encephalitis): Newborns with toxoplasmosis can develop encephalitis, which is inflammation of the brain tissue, leading to neurological symptoms. Therefore, the correct answer is E. Toxoplasmosis in newborns can manifest with chorioretinitis, hydrocephalus, cerebral calcifications, and encephalitis, reflecting the diverse neurological and ophthalmological complications associated with congenital infection.

70. Topic: Childhood Illness with Rash

Correct Answer: D. Sudden exanthem

Explanation: Sudden exanthem refers to a sudden onset rash that appears following a period of fever. It typically resolves quickly after the fever subsides. Here’s why it fits the scenario described:Clinical Presentation: The child had a high fever for several days, followed by the sudden appearance of a discrete pink macular rash once the fever resolved.Characteristics of Sudden Exanthem: This condition is characterized by a rapid onset of rash post-fever, often appearing as pink macules (flat lesions) on the skin.Absence of Other Symptoms: Unlike other conditions listed:Sudden exanthem fits the scenario described where the fever resolves, and a rash suddenly appears without other significant symptoms or systemic involvement. Therefore, option D is the correct answer.

71. Topic: Macrocytic Anemia

Correct Answer: A. Folic acid deficiency

Explanation: Folic acid deficiency causes macrocytic anemia due to its role in DNA synthesis and cell division. This deficiency leads to larger red blood cells (macrocytes) and ineffective erythropoiesis. Symptoms include fatigue, weakness, and pallor. Lab findings show macrocytic RBCs and hypersegmented neutrophils. Therefore, folic acid deficiency (Option A) is correct for macrocytic anemia due to its impact on erythropoiesis and RBC size.

72. Topic: Vaccination in a Child with a History of Seizure

Correct Answer: C. Continue as planned

Explanation: Children with a history of seizures can generally receive routine vaccinations as scheduled. The decision to delay or modify vaccinations would depend on the specific circumstances of the seizure and any underlying conditions, which should be assessed by a healthcare provider. Routine vaccinations, including DPT (diphtheria, pertussis, tetanus) and Haemophilus influenzae type b (Hib) vaccines, are crucial for protecting against infectious diseases unless otherwise contraindicated. Therefore, continuing vaccinations as planned (Option C) is the correct approach unless there are specific medical reasons to delay or modify them.

73. Topic: Evaluation of Decreased Hearing in a 2-Year-Old Boy

Correct Answer: D. Refer to ENT

Explanation: In a 2-year-old boy with a new onset of decreased hearing, it is important to promptly refer him to an Ear, Nose, and Throat (ENT) specialist. Hearing loss in children can have various causes, including congenital issues, acquired infections, or structural abnormalities. An ENT evaluation is crucial to assess the specific cause of hearing loss and determine appropriate management, which may include hearing tests, imaging studies, or further diagnostic evaluations. Therefore, referring the child to an ENT specialist (Option D) is the correct course of action to determine the cause of decreased hearing and initiate appropriate management.

74. Topic: Persistent Hoarse Voice in a 3-Year-Old

Correct Answer: E. Adenoidectomy

Explanation: Persistent hoarse voice in a 3-year-old child may indicate adenoid hypertrophy, which can affect vocal cord function and lead to hoarseness. Adenoidectomy, the surgical removal of the adenoids, is often indicated in such cases to relieve symptoms and improve vocal quality. Adenoidectomy helps in cases where enlarged adenoids obstruct the airway or affect vocal cord function, contributing to hoarseness.Therefore, adenoidectomy (Option E) is the correct answer as it addresses the potential cause of persistent hoarseness due to adenoid hypertrophy in a 3-year-old child.

75. Topic: Parotitis in a 2-Year-Old Boy

Correct Answer: C. Mumps virus

Explanation: A 2-year-old boy presenting with fever, severe sialorrhea (excessive drooling), and a swelling or mass on the left side of the neck suggests parotitis, which is commonly caused by the mumps virus. Mumps is characterized by inflammation of the parotid glands, leading to swelling and pain in the affected area. The classic triad of symptoms includes fever, parotid gland swelling, and sialorrhea. Therefore, based on the presentation of fever, sialorrhea, and parotid swelling, the most likely cause in this case is mumps virus infection (Option C).

76. Topic: Pediatric Gastroenteritis

Correct Answer: E. Rotavirus

Explanation: Pediatric gastroenteritis presenting with diarrhea, nausea, and vomiting shortly after a school trip is most likely caused by rotavirus infection. Rotavirus is a common viral cause of gastroenteritis in young children, characterized by sudden onset of symptoms and typically resolving within a few days. It is transmitted via the fecal-oral route, often associated with outbreaks in settings like schools and daycare centers. Rotavirus vaccination has significantly reduced the incidence and severity of rotavirus gastroenteritis globally.

77. Topic: Pediatric Gastrointestinal Disorders

Correct Answer: A. Celiac disease

Explanation: The symptoms of large, pale, frothy, and foul-smelling stools developing gradually after adding wheat to the diet suggest malabsorption, which is characteristic of celiac disease. Celiac disease is an autoimmune disorder triggered by gluten ingestion (found in wheat and other grains), leading to damage to the small intestine’s lining and impaired absorption of nutrients. This condition often presents with diarrhea, bloating, abdominal distension, and failure to thrive in children. Avoidance of gluten-containing foods is the mainstay of treatment for celiac disease.

78. Topic: Management of Celiac Disease

Correct Answer: B. The gluten-free diet

Explanation: The best approach to manage celiac disease is with a gluten-free diet. This involves avoiding foods that contain gluten, such as wheat, barley, and rye, as these trigger autoimmune reactions and damage the small intestine in individuals with celiac disease. Avoidance of high-fat diets (A) is not specifically indicated unless there are additional concerns, and leaving the child hungry until diarrhea stops (C) is not recommended as it does not address the underlying cause of celiac disease. Therefore, option B, the gluten-free diet, is the correct and most effective treatment strategy for managing celiac disease.

79. Topic: Enterobiasis (Pinworm Infection)

Correct Answer: C. Enterobiasis

Explanation: Enterobiasis, or pinworm infection, is characterized by symptoms such as difficulty sleeping due to itching in the anal and vulvar areas, which are exacerbated at night. This itching can lead to a short attention span and irritability during the day. The diagnosis is typically made by identifying pinworm eggs or adult worms in the perianal area using a tape test. Abuse of a minor (A), dermatitis (B), and anal fissures (D) do not typically present with the specific symptoms described. Therefore, option C, enterobiasis, is the most likely diagnosis based on the symptoms presented.

80. Topic: Ascariasis

Correct Answer: D. It is usually associated with diarrhea

Explanation: Ascariasis, caused by the roundworm Ascaris lumbricoides, typically presents with symptoms such as abdominal discomfort, intestinal obstruction (especially in heavy infections), and complications like migration into the bile duct or appendix, potentially causing appendicitis (C). While ascariasis can lead to respiratory symptoms like pneumonia with eosinophilia (E), it is not typically associated with diarrhea (D). Instead, it often presents with symptoms related to gastrointestinal obstruction or complications from the migration of worms. Therefore, option D is incorrect as it does not align with the typical clinical presentation of ascariasis.