[PEDIA2] LE2 2026 Flashcards

Question

Q25: What virus most commonly causes croup in children? A. Respiratory Syncytial Virus (RSV) B. Influenza virus C. Parainfluenza virus D. Adenovirus

Answer 1

C. Parainfluenza virus Rationale: The Parainfluenza virus is the most common causative agent of croup, especially in infants and young children. It leads to inflammation and narrowing of the subglottic area, resulting in the characteristic barking cough and stridor.

Answer 2

B. Haemophilus influenzae type B (HiB) Rationale: HiB is the classic and most common pathogen historically responsible for acute epiglottitis, especially in unvaccinated children. Since widespread HiB vaccination, its incidence has significantly decreased.

Answer 3

D. Laryngomalacia Rationale: Laryngomalacia is the most common cause of congenital stridor. It presents with inspiratory stridor that worsens when supine or feeding, but infants usually gain weight normally. It is often self-limiting.

Answer 4

C. Barking cough Rationale: A barking (seal-like) cough is characteristic of croup and distinguishes it from epiglottitis, which presents with drooling, toxic appearance, and muffled voice. Both may have stridor, but the cough is the key differentiator.

Answer 5

C. Deep breathing exercises, percussion, and postural drainage Rationale: The child likely developed postoperative atelectasis or mucus plugging, a common cause of respiratory distress after surgery. Pulmonary hygiene (deep breathing, chest physiotherapy, and postural drainage) is the first-line intervention.

Answer 6

C. Congenital cystic adenomatoid malformation (CCAM) Rationale: Although the infant was diagnosed prenatally with CDH, the presence of multiple lucent areas in the thorax with normal blood gases suggests CCAM, a cystic lung lesion. CCAM can mimic CDH, but CDH typically leads to severe respiratory distress and abnormal ABGs due to lung compression and hypoplasia.

Answer 7

C. Pancreatic pseudocyst Rationale: A pancreatic pseudocyst is a known complication of pancreatitis, especially following trauma in children. It typically presents weeks after the initial episode with recurrent abdominal pain, vomiting, and sometimes a palpable mass or persistent elevated amylase.

Answer 8

C. Congenital pyloric stenosis Rationale: The olive-shaped mass and projectile non-bilious vomiting in a first-born male infant are classic signs of pyloric stenosis, a hypertrophy of the pyloric muscle leading to gastric outlet obstruction.

Answer 9

B. Hypochloremic hypokalemic metabolic alkalosis Rationale: Infants with pyloric stenosis lose hydrogen, chloride, and potassium from persistent vomiting, leading to hypochloremic hypokalemic metabolic alkalosis, a classic finding.

Answer 10

B. Meckel scan (Technetium-99m pertechnetate) Rationale: Painless lower GI bleeding in a young child is highly suggestive of Meckel’s diverticulum. The Meckel scan is the diagnostic test of choice as it detects ectopic gastric mucosa, which is often the source of bleeding.

Answer 11

B. Inflammatory bowel disease Rationale: Chronic abdominal pain, weight loss, and anemia in adolescents strongly suggest Inflammatory Bowel Disease (IBD), especially Crohn's disease or Ulcerative colitis, which also have extraintestinal manifestations and a relapsing-remitting course.

Answer 12

B. Autoimmune hepatitis (Chronic active hepatitis) Rationale: This is classic for autoimmune hepatitis, especially in adolescent girls, with elevated bilirubin, negative viral panel, and elevated IgG levels. Chronic active hepatitis is the older term for what is now referred to as autoimmune hepatitis.

Answer 13

B. Ulcerative colitis Rationale: Toxic megacolon is a feared complication of ulcerative colitis, more common than in Crohn's. The presence of bloody diarrhea, tenesmus, and systemic toxicity supports this diagnosis.

Answer 14

D. 24-hour esophageal pH monitoring Rationale: The gold standard for diagnosing GERD in children is 24-hour pH monitoring, which quantifies acid exposure in the esophagus. Other tests like endoscopy or barium swallow may help but are not definitive.

Answer 15

B. Intussusception Rationale: The triad of colicky abdominal pain, vomiting (which becomes bilious), and a sausage-shaped abdominal mass is classic for intussusception, a common cause of intestinal obstruction in infants.

Answer 16

C. Barium or air contrast enema Rationale: The first-line treatment for intussusception in a hemodynamically stable child is a contrast enema (barium or air enema), which is both diagnostic and therapeutic. Surgery is reserved for complications or failed enema reduction.

Answer 17

B. Functional abdominal pain Rationale: Functional abdominal pain is common in school-aged children. It is typically periumbilical, vague, and chronic in nature without alarming signs (weight loss, blood in stool, or growth failure), and physical exam is usually normal.

Answer 18

C. Start Oral Rehydration Solution (ORS) Rationale: This is a case of viral gastroenteritis with mild dehydration. The child is alert with good perfusion, so the most appropriate management is oral rehydration therapy (ORS). No need for IV fluids or antibiotics at this stage.

Answer 19

D. Intraoperative cholangiography Rationale: Intraoperative cholangiography is the gold standard for diagnosing biliary atresia. It directly visualizes bile duct patency. If biliary atresia is confirmed, early Kasai portoenterostomy (before 8 weeks) offers the best prognosis.

Answer 20

C. Serum amylase Rationale: Serum amylase is a widely used test for diagnosing acute pancreatitis, especially in the context of abdominal trauma. While lipase is more specific, amylase is still an acceptable and frequently used test in many settings.

Answer 21

D. Traumatic injury Rationale: In adolescents, blunt abdominal trauma (e.g., from a blow or injury during contact sports or hazing) is a common cause of acute pancreatitis, particularly when there’s no history of alcohol, gallstones, or systemic disease.

Answer 22

B. Due to extraintestinal manifestations Rationale: Both Crohn’s disease and ulcerative colitis can have extraintestinal manifestations, but they vary in frequency and severity between the two diseases. Crohn’s also has transmural and segmental involvement, while UC is continuous and limited to the mucosa.

Answer 23

C. Congenital diaphragmatic hernia Rationale: A scaphoid abdomen and respiratory distress at birth, along with a barrel chest, are classic findings of congenital diaphragmatic hernia (CDH). Abdominal contents herniate into the chest, impairing lung development and function.

Answer 24

C. Pulmonary hypoplasia Rationale: The most significant and life-threatening complication of CDH is pulmonary hypoplasia, due to the herniated abdominal organs compressing developing lungs in utero, leading to underdeveloped alveoli and poor gas exchange.

Answer 25

D. Advise reassurance and conservative management Rationale: These findings are more consistent with functional constipation rather than Hirschsprung’s disease (which would show a tight rectum with empty vault). Initial management includes reassurance, diet modification, and stool softeners before invasive testing.

Answer 26

C. Peptic ulcer disease Rationale: The classic presentation of peptic ulcer disease (PUD) is epigastric pain relieved by antacids or food (like milk). Risk factors include NSAID use, H. pylori infection, and stress. PUD can present in adolescents with chronic symptoms.

Answer 27

C. Plain abdominal X-ray Rationale: In a neonate with bilious vomiting and delayed meconium passage, intestinal obstruction (e.g., Hirschsprung's disease, malrotation, or atresia) must be ruled out. Plain abdominal X-ray is the first-line imaging to identify air-fluid levels, bowel gas pattern, or signs of perforation.

Answer 28

D. Abdominal ultrasound Rationale: In a child with RUQ pain and jaundice, the most likely causes are hepatobiliary (e.g., cholecystitis, hepatitis, biliary obstruction). Abdominal ultrasound (UTZ) is the best initial imaging to assess gallbladder, bile ducts, and liver parenchyma.

Answer 29

B. Hirschsprung’s disease Rationale: Hirschsprung’s disease is the most common cause of lower intestinal obstruction in neonates. It’s characterized by aganglionic segments of the colon, leading to delayed meconium passage, abdominal distension, and often a male predilection (4:1 ratio).

Answer 30

C. Esophagus ends in a blind pouch with fistula from trachea to lower esophagus Rationale: The most common type of TEF (over 85% of cases) involves a proximal esophageal atresia with a distal tracheoesophageal fistula, where the upper esophagus ends blindly and the lower segment communicates with the trachea.

Answer 31

B. A primary motor disorder with loss of lower esophageal sphincter (LES) relaxation and peristalsis Rationale: Esophageal achalasia is a primary esophageal motor disorder characterized by failure of LES to relax and absent peristalsis of the esophageal body. It leads to progressive dysphagia, regurgitation, and sometimes chest pain.

Answer 32

D. It is not an emergency and will resolve spontaneously Rationale: Malrotation with midgut volvulus is a surgical emergency due to the risk of intestinal ischemia and necrosis. Any suggestion that it will spontaneously resolve is incorrect. Prompt diagnosis and surgical intervention (Ladd procedure) is required.

Answer 33

C. Esophageal atresia Rationale: Esophageal atresia, especially with tracheoesophageal fistula, presents with drooling, difficulty feeding, and inability to pass an NGT (seen curling on X-ray). It is a neonatal emergency requiring surgical correction.

Answer 34

B. Anti-HAV IgM and anti-HAV IgG Rationale: Hepatitis A is confirmed with anti-HAV IgM (indicates recent infection). Anti-HAV IgG indicates past infection or immunity. These serologic tests are non-invasive and diagnostic in the clinical setting of Hepatitis A.

Answer 35

C. HBsAg (Hepatitis B surface antigen) Rationale: The presence of HBsAg is diagnostic of active Hepatitis B infection. It is the earliest marker to appear and indicates that the person is infected and potentially infectious.

Answer 36

C. Insert nasogastric tube to decompress the stomach Rationale: The double-bubble sign indicates duodenal atresia, which is common in infants with Down syndrome. The first step is to decompress the stomach with an NGT to prevent aspiration, followed by IV fluids and surgical correction.

Answer 37

D. Splenomegaly Rationale: Splenomegaly is a classic sign of portal hypertension, which can lead to esophageal varices in patients with chronic liver disease, such as those with biliary atresia post-Kasai. Variceal bleeding should be suspected in such cases with GI bleeding and splenomegaly.

Answer 38

C. Hepatitis C Rationale: Among viral hepatitides, Hepatitis C carries the highest risk for chronic liver disease, including cirrhosis and hepatocellular carcinoma. While Hep B also poses a risk, Hep C is particularly insidious due to its often asymptomatic progression to chronicity.

Answer 39

C. Acute appendicitis Rationale: Appendicitis typically presents with right lower quadrant (RLQ) pain, not RUQ. Although early appendicitis may have vague periumbilical pain, RUQ tenderness specifically favors hepatobiliary causes. Alvarado Score is specific for appendicitis but relies on RLQ findings.

Answer 40

C. Regurgitation Rationale: In infants, the most common symptom of GERD is regurgitation, due to immature lower esophageal sphincter tone. This is generally benign but may warrant evaluation if associated with poor weight gain or respiratory symptoms.

Answer 41

D. Liver abscess Rationale: Prolonged fever, RUQ pain, and hepatomegaly, especially with a history of prior GI illness, point to liver abscess. It may be amebic or bacterial. Ultrasound is the diagnostic imaging of choice for confirmation.

Answer 42

C. Paracentesis Rationale: In a child with ascites, fever, and cirrhosis, spontaneous bacterial peritonitis (SBP) must be ruled out. Paracentesis is the diagnostic procedure of choice. The most common causative organism in pediatric SBP is Streptococcus pneumoniae.

Answer 43

C. It is associated with VATER syndrome Rationale: Hirschsprung’s disease is a gastrointestinal motility disorder due to aganglionic segments of the colon. It is not typically associated with VATER syndrome, which includes vertebral, anal, tracheoesophageal, and renal anomalies. This makes option C false.

Answer 44

C. Starvation Rationale: Primary malnutrition is due to inadequate intake of nutrients, commonly seen in cases of poverty, famine, or neglect—in short, starvation. This is in contrast to secondary malnutrition, which results from underlying diseases or conditions.

Answer 45

B. Hypophosphatemia Rationale: Refeeding syndrome occurs when malnourished patients are reintroduced to nutrition too quickly, leading to a shift of electrolytes into cells. The hallmark abnormality is hypophosphatemia, not hyperphosphatemia.

Answer 46

B. Kwashiorkor Rationale: Kwashiorkor is a form of severe protein-energy malnutrition associated with edema, especially in the lower extremities, as well as irritability, fatty liver, and dermatoses. It differs from marasmus, which has severe wasting without edema.

Answer 47

C. 200,000 IU Rationale: The World Health Organization recommends 200,000 IU of vitamin A every 4–6 months for children aged 12–59 months (including 2-year-olds) in areas with high risk of deficiency.

Answer 48

C. Vitamin B12 Rationale: Vitamin B12 is not found in plant-based foods, so vegan mothers may have low B12 stores, leading to B12 deficiency in exclusively breastfed infants, which can result in neurological damage and anemia if untreated.

Answer 49

C. Growth chart Rationale: The growth chart is the best and most comprehensive tool to assess nutritional status in children, as it tracks weight, height, and head circumference over time, allowing for comparison against standardized percentiles.

Answer 50

D. Emphasize the need for weight reduction Rationale: The child’s presentation is consistent with obesity hypoventilation syndrome or obstructive sleep apnea related to obesity. Weight reduction is the most important and sustainable intervention to address both the apnea and long-term health risks.

Answer 51

B. Zinc Rationale: Zinc supplementation is recommended by the WHO for 10–14 days in the treatment of acute diarrhea. It helps reduce severity, duration, and recurrence of diarrheal episodes in children.

Answer 52

C. Exposure to a limited range of food Rationale: Limited dietary variety often leads to nutritional imbalance and preference for high-calorie, low-nutrient foods, contributing to childhood obesity. A balanced, diverse diet with healthy choices is key to prevention.

Answer 53

C. Specific deficiency Rationale: The most likely cause is iron deficiency anemia, a specific micronutrient deficiency. Exclusively breastfed infants beyond 4–6 months may need iron supplementation because breast milk is low in iron.

Answer 54

C. Growth failure Rationale: Caloric malnutrition leads to growth faltering, as energy intake is insufficient to support normal growth. It is often seen in undernutrition or wasting conditions like marasmus.

Answer 55

C. Severe acute malnutrition Rationale: WHO classifies severe acute malnutrition (SAM) based on weight-for-height Z-score < -3, MUAC < 11.5 cm, or presence of bilateral pitting edema. This child meets all three criteria, confirming SAM.

Answer 56

C. Weight-for-age Rationale: Weight-for-age is the most widely used and easiest-to-measure index in many clinical settings to assess overall nutritional status, though it cannot distinguish between acute and chronic malnutrition.

Answer 57

B. 3 days ⸻ High-Yield Rationale: In the management of severe acute malnutrition (SAM) such as Kwashiorkor Grade 2, treatment is divided into three phases: 1. Stabilization Phase – focus is on treating infections, correcting electrolyte imbalance, and preventing hypoglycemia/hypothermia. F-75 formula is used. 2. Transition Phase – a short period to prepare the child for higher energy intake. 3. Rehabilitation Phase – emphasis is on catch-up growth with F-100 or RUTF. The transition phase generally lasts around 3 days. This period allows for the body to adjust to increased protein and caloric intake before full rehabilitation.

Answer 58

C. Edema and hypopigmented hair/skin Rationale: Kwashiorkor is characterized by edema, hypopigmented hair, skin changes, and apathy, due to protein deficiency. It contrasts with marasmus, which presents with wasting without edema.

Answer 59

B. 3 months ⸻ High-Yield Rationale: Iron supplementation in iron deficiency anemia should be continued for 3 months after correction of anemia to: • Replenish iron stores in the bone marrow and liver • Prevent relapse due to depleted reserves

Answer 60

C. Administer vitamin E Rationale: Preterm infants are at risk for vitamin E deficiency, which can lead to hemolytic anemia. The presentation of anemia with elevated reticulocyte count and thrombocytosis is suggestive of this. Vitamin E helps stabilize red blood cell membranes and correct the deficiency.

Answer 61

C. Iron supplementation is immediately recommended ⸻ High-Yield Rationale: In severe acute malnutrition (SAM), iron supplementation is not started immediately during the stabilization phase. This is because: • Iron promotes bacterial growth, which can worsen infections in a child who is already severely immunocompromised. • The child may also have ongoing infections that need to be treated first. • Iron is delayed until the rehabilitation phase when the child is more stable and gaining weight. ⸻ Why not the other choices? • A. Feeding should be gradual and monitored • ✅ True. Overfeeding too early can lead to refeeding syndrome or metabolic overload. • B. Micronutrient supplementation should be started • ✅ True. Vitamins and minerals (except iron initially) like zinc, vitamin A, and folate are essential and started right away. • D. Electrolyte imbalances should be corrected • ✅ True. Hypokalemia, hypomagnesemia, and sodium overload are common and need correction.

Answer 62

B. Mercury poisoning Rationale: The classic triad for chronic mercury poisoning includes tremors, neuropsychiatric disturbances (like irritability or memory problems), and gingivostomatitis (inflammation of the gums and mouth).

Answer 63

C. Pyridoxine Rationale: INH toxicity causes seizures due to pyridoxine (vitamin B6) deficiency. The treatment of choice is pyridoxine, given in a dose equal to the amount of INH ingested (mg per mg). Benzodiazepines are ineffective in this scenario without B6 replacement.

Answer 64

B. Whole bowel irrigation Rationale: Iron tablets are not effectively bound by activated charcoal. In cases of iron overdose with visible pills on X-ray, whole bowel irrigation is the preferred method to flush out unabsorbed iron and reduce toxicity.

Answer 65

C. Administer large amounts of water or milk Rationale: In cases of corrosive ingestion, dilution with water or milk is the first-line management. Inducing vomiting or using charcoal is contraindicated due to the risk of re-exposing the esophagus to the corrosive substance.

Answer 66

C. Liver Rationale: Acetaminophen (paracetamol) overdose causes dose-dependent hepatotoxicity, which can lead to acute liver failure. Hepatic necrosis is the most serious complication, and N-acetylcysteine (NAC) is the antidote.

Answer 67

C. They have poor ability to judge distance and speed of traffic Rationale: Children between 5–9 years often lack the cognitive and perceptual skills to accurately judge the speed and distance of oncoming vehicles, making them vulnerable to pedestrian injuries, especially when crossing streets.

Answer 68

C. They have poor ability to judge traffic speed and distance Rationale: Like question 93, this highlights the developmental limitations of children in estimating the relative speed and distance of moving objects, making them more prone to traffic-related injuries.

Answer 69

D. Bicycle accidents Rationale: Bicycle accidents are more common in older children. In 2-year-olds, typical injuries include falls, burns, and accidental ingestion. They lack the coordination and size for independent bicycle riding, making this the exception.

Answer 70

D. Burns that are 10% or less of the BSA and superficial Rationale: Minor burns (<10% BSA, superficial) can usually be managed outpatient, unless located in critical areas (e.g., face, hands, perineum) or associated with complications. The rest are valid indications for hospital admission.

Answer 71

C. Reduce likelihood of injury by modifying energy transfer to the body Rationale: These protective devices work by absorbing or redirecting energy during impact, thereby reducing injury severity. They do not eliminate injury entirely but mitigate the effects of trauma during accidents.

[PEDIA2] LE2 2026 Flashcards

(95 cards)