VVK17-001

a. What procedure has this patient undergone?
b. Enlist the 2 indication for the procedure.
c. Mention 3 common complications post procedure.
d. What care does the patient need following procedure?

Answer

VVK17-002
Select the answers.

a. Can lead to substantial elevations of serum bilirubin
b. Most likely to induce acute hypovolemic shock
c. Drainage is contraindicated
d. Generally resolves by 48 hours of age
i. Cephalhematoma
v. Cephalhematoma, caput succedaneum, and subgaleal hematoma

Answer

VVK17-003

a. What test is being performed in the baby?
b. What is the finding in this baby?
c. What does the finding suggest?
d. What is the treatment?
e. Where else can this test be performed?
f. What can be another use of the equipment?

Answer

VVK17-004

a. What is the diagnosis?
b. What is the incidence?
c. What is the cause?
d. What is the commonest inheritance pattern?
e. What are immediate and long-term complications?
f. What is the treatment?

Answer

VVK17-005
1.2 kg, 7 day old, 28 week newborn is receiving protein at 3 g/kg/day, lipid at 2 g/kg/day and GIR of 6 mg/kg/min. Baby is nil by mouth.

Calculate.

a. NPC/N
b. Fluid rate of below to achieve above goals
i. 10% protein
c. i. Total calorie intake.
d. What is the adequate calorie intake in such baby?

Answer

VVK17-006
Match the Following:

Teratogens/Maternal Diseases Potential Effects/Disorder

• 1. Alcohol A. Arthrogryposis
• 2. Sodium valproate B. Long philtrum
• 3. Diabetics mellitus C. Neural tube defects
• 4. Lithium D. Caudal regression syndrome
• 5. Myasthenia gravis E. Ebstein's anomaly

Answer

VVK17-007
Study the photograph and answer the questions.

This female neonate was born with a large mass in relation to the umbilical cord:

a. Identify the condition.
b. Give three important aspects that you will take care of in the transport of such a neonate.
c. List 3 anomalies associated with this condition.
d. What is the definitive treatment for this condition?

Answer

VVK17-008
A term male baby weighing 3.6 kg presents on day 2 of life with seizures. Mother is gravida 4 with history of 2 neonatal deaths with one live child aged 3 years. He was born at home and mother had a history of greenish vaginal discharge just prior to delivery.

a. Enlist 3 most likely causes of seizures in this baby.
b. Write first 5 steps of management of the current episode of seizure in sequential order.

Answer

VVK17-009
You are attending pediatrician of a 31 week preterm whose birth weight was 1400 g. He had an uneventful NICU stay except for 1 day of phototherapy for jaundice.

a. List 3 criteria for discharge?
b. Is this neonate a candidate for:
i. ROP screening

Answer

VVK17-010
A HBsAg +ve woman is 20 weeks pregnant.

a. What are the other relevant investigations you would request?
b. The risk of perinatal transmission is maximum if mother is HBe Ag + and
c. What is the advice to be given to the partner/husband?
d. What is the ideal management of a preterm newborn after birth?

Answer

VVK17-011
A term baby is born to a mother via elective cesarian section. The mother is diagnosed to have HIV infection. The baby's test for HIV DNA PCR is positive within 48 hours.

a. What does this positive PCR imply?
b. How would you confirm the diagnosis?
c. What are the drugs used to control? ( Name 3 subgroups with 1 example in each group).

Answer

VVK17-012
A 5-day-old girl who was delivered at home has presented in emergency for bruising and gastrointestinal bleeding. There is no history of maternal drug or alcohol abuse during pregnancy. There is no family history of similar problems. Laboratory findings are given below.
Haemoglobin : 15.2 g/dL Platelet count : 290,000/mm3
INR : >2
APTT : >100 seconds Serum bilirubin : 3.5 mg/dL SGPT : 41 mg/dL SGOT : 28 mg/dL

a. What is the most likely diagnosis of this bleeding neonate?
b. Enlist 2 risk factors in a neonate admitted to NICU which can potentially lead into this problem.
c. How can you prevent the same?
d. How would you treat once the diagnosis is confirmed?

Answer

VVK17-013
A term male infant is born via normal vaginal delivery. He is found to have choanal atresia, bilateral colobomas, ear anomalies, and cryptorchidism.

a. What is the most likely diagnosis?
b. What are the 2 problems which are likely to exist in this neonate on further evaluation or later on in the childhood?
c. What is the most appropriate initial test to exclude any associated abnormalities?
d. What is the treatment of choanal atresia in an otherwise stable child?

Answer

VVK17-014
A term male newborn delivered at home is seen in the pediatric OPD on day 2 of life.

a. What are abnormalities detected in the left arm of this baby?
b. What is the likely diagnosis?
c. What is the etiology?
d. What is the most common associated complication?

Answer

VVK17-015
Match the following.
In monozygotic twins what is the relationship between chronicity, amnionicity and timing of division of egg:
Type of chorion and amnion Timing of division of egg

a. Monochorionic, monoamniotic (i) 0–3 days
b. Monochorionic, diamniotic (ii) 3–7 days
c. Dichorionic, diamniotic (iii) 7–14 days
d. Conjoint twins (iv) >14 days.

Answer

VVK17-016
Given below is CT of an 1800 g term male neonate born to an unbooked primigravida mother.

a. List 2 positive findings on the CT.
b. What is the most likely etiological diagnosis?
c. List 2 possible clinical findings in the neonatal period which may accompany the likely diagnosis.

Answer

VVK17-017
A 26 week male infant is born via emergency LSCS in view of absent end diastolic flow on umbilical arterial Doppler. The baby is now 3 hours old and has been intubated and ventilated. He has received 1 dose of surfactant. His ventilator settings are:

a. What are the blood gas findings?
b. What change will you make in the ventilator settings to improve the blood gas?
c. What is the optimal size of ETT for this neonate?
b. What changes will you make in the ventilator settings to improve the blood gas?
c. List 2 most important risks/complications which can occur if you leave this baby on current ventilator settings?
a. What is the formula for calculating volume of partial exchange transfusion?
b. What is the volume required for this neonate?
c. List 3 complications of polycythemia
a. What is the blood gas finding?
b. What changes will you make in the ventilator settings to improve the blood
c. What is alternate mode of ventilation you can use for this baby?
a. What is the likely diagnosis?
b. What is the etiology?
c. What is the most common associated complication?
b. What is the diagnosis?
a. Enlist the 2 most important drugs you could use in treating hypotension in this patient.
b. What precaution will you take whilst measuring CVP of a baby on ventilator?
c. What is the normal range of CVP?
d. Where should be the tip of UVC to measure CVP?
e. What is the relationship of CVP and volume replacement in managing hypotension?

Answer

VVK17-018
A 32-weeks-old male infant is born via normal vaginal delivery. He soon started having moderate respiratory distress with increasing oxygen requirement. A decision is made to start him on nasal CPAP.

a. What is the ideal pressure to start CPAP in this neonate?
b. Enlist three complications associated with nasal CPAP.
c. Enlist two absolute contraindications of nasal CPAP.

Answer

VVK17-019
A Sick term male infant is admitted in NICU. He is born to a primigravida mother with no significant antenatal concerns and no risk factors for sepsis. He was born via normal vaginal delivery and did not require any resuscitation. He developed significant respiratory distress soon after birth. He was intubated and ventilated at 2 hours age. He is persistently cyanosed at 4 hours of age. His blood report (including CBC, CRP), chest X-ray have been reported normal. He is currently on high frequency ventilator. His saturation in right lower limb is 76% and right upper limb is 92%. His mean BP is 42 mm Hg and HR is 180/min.
An ECHO has been performed and does not show any structural cardiac abnormality or cyanotic heart disease.

a. What is the most likely diagnosis?
b. What is the drug of choice?
c. What is the best treatment modality if medical management fails?
d. List 4 drugs which can be used in treating this condition.

Answer

VVK17-020
A 34 week male infant is born via normal vaginal delivery. He is noted to be jittery and lethargic at 24 hours age. On examination, he is noted to be plethoric.

a. What is the most likely diagnosis?
b. How do you confirm the diagnosis? Give the age related values to confirm the diagnosis at 2 hours and thereafter.
c. What is the treatment if the diagnosis is confirmed in this neonate?

Answer

VVK17-021
Given below is the picture of a 2 day old term newborn.

a. What is the diagnosis?
b. List any 2 common risk factors for this problem.
c. List 3 components of this abnormality.
d. What are the treatment options?

Answer

VVK17-022
A term male infant was born via elective LSCS to a primigravida mother. He was shifted to NICU in view of hypoglycemia on day 1 of life. His examination revealed a microphallus. On further investigation his free T4 and TSH level were found to be 0.5 µg/dL (normal = 6.5–16.3µg/ dL) and 1.6 mU/L (normal = 1.7-9.1 mU/mL) respectively.

a. What is the most likely diagnosis?
b. List 2 investigations you would perform on this baby.

Answer

VVK17-023
A term neonate is diagnosed to have hypothyroidism based on initial routine neonatal screening. He is investigated further and his BERA reveals bilateral sensorineural hearing loss.

a. What is the most likely diagnosis?
b. What is the mode of inheritance?
c. What is the cause of hypothyroidism associated with this diagnosis?
d. What is the finding on thyroid scan and thyroid ultrasound?

Answer

VVK17-024
A term neonate was born in poor condition needing prolonged resuscitation. He was born via emergency LSCS for a non reactive NST. At birth he was cyanosed, limp, with HR< 60/min. His condition improved with IPPV. At 1 hour age he is lethargic with diminished spontaneous movements. On examination, he is noted to have mild hypotonia with a weak suck.

a. What is the most likely diagnosis?
b. What is the staging of the disease in this neonate?
c. After what gestation can you use this staging?
d. What is the likely outcome?
e. In neonatal resuscitation—what is the order of recovery in the heart rate, color and tone in most neonates after the initial depression of vital signs?

Answer

VVK17-025
Disorder of sexual development (DSD)
Match the following signs occurring in association with DSD with the diagnosis.
Signs and symptoms Diagnosis

b. Anosmia ii. Cornelia De lange
d. Synophrys iv. Bardet-Biedl

Answer

VVK17-026
Newborn rash Parents are anxious about this generalized rash on a 2-day-old neonate.

a. What is the most likely diagnosis?
b. What is the treatment and prognosis?
c. What does the microscopic examination from the lesion reveal?

Answer

VVK17-027
Given below is the X-ray of a 5-day-old male neonate who presented with abdominal distension.

a. What is the diagnosis?
b. What are the predisposing factors?
c. What is the diagnostic triad of this condition?
d. Give details of classification used in accordance with severity of this disease.

Answer

VVK17-028
Umbilical arterial line
After putting in a UA line, the right lower limb appears bluish-black.

a. What is the next step in management?
b. What is the level of the renal artery and celiac plexus in terms of vertebral levels?
c. How do you maintain a UA line?

Answer

VVK17-029
A full term, male child develops jaundice on day 3 of life, (serum bilirubin 34 mg/dL) and is planned to undergo an exchange transfusion. Answer the following questions.

a. What is the complication likely to occur if left untreated?
b. Where is the anatomical location of the feared complication?
c. What are the long-term complications in this patient?
d. List 2 investigations you would perform prior to or soon after discharge.

Answer

VVK17-030
A 15-days-old male newborn is noticed to have sweating and poor feeding of sudden onset. On examination, his HR is >240/min with signs of poor perfusion. There is no history maternal drug or alcohol abuse during pregnancy. There is no family history of similar problems.

a. What is the most likely diagnosis?
b. What is the immediate management?
c. Is DC shock the treatment of choice?

Answer

VVK17-031
Given below is the photograph of scalp of a well term neonate.

a. What is the most likely diagnosis?
b. What is the most common differential diagnosis of this condition?
c. List 3 conditions which can be associated with this condition

Answer

VVK17-032
Given below is the image of a 30-week-old male neonate. He is diagnosed to have sepsis. He also has bleeding from the base of umbilical stump.

a. What is most likely diagnosis? He has had frequent episode of apnea and desaturation in past 2 hours.
b. List 2 most important investigations you will request in this neonate.
c. What is the most likely cause of his deterioration?

Answer

VVK17-033
A 29-week-old neonate has had sudden increase in ventilatory requirement.

a. What is the test being performed?
b. What are the findings in a positive test performed above?
c. What is the diagnosis if the test is positive?

Answer

VVK17-034
Given below is a picture of a 2-day-old term neonate.

a. What is the diagnosis?
b. What is the definitive treatment?
c. What can be the long-term problem after the treatment?
d. List 4 associated malformations.

Answer

VVK17-035
This is a term female infant was born via normal vaginal delivery.

a. Describe the rash seen in picture above.
b. What is the most likely diagnosis?
c. What is the most common etiology/causative organism?
d. What is the treatment in this infant?

Answer

VVK17-036
Given below is a term male neonate born via elective LSCS. Baby was born in poor condition and did not respond to any resuscitation.

a. What is the most likely diagnosis?
b. List 1 pulmonary and 1 abdominal complication associated with this condition.
c. List 5 causes of the diagnosis including 2 where anemia is not an associated finding.

Answer

VVK17-037
Given below is a photograph of a term male infant.

a. What is the most likely diagnosis?
b. What is the definitive treatment?
c. What is the most common complication seen later in childhood?

Answer

VVK17-038
This term neonate is noted to have premature closure of sutures.

a. What is the most likely diagnosis?
b. List 2 clinical findings seen in this diagnosis.
c. What is the long-term problem?

Answer

VVK17-039
This is photograph of a 1-month-old term infant.

a. What is the equipment used on this infant?
b. What is the most likely problem with this infant?
c. What is the ideal age of the infant when this procedure is most successful?
d. What is the ideal duration of the total procedure?

Answer

VVK17-040
This term neonate was born via normal vaginal delivery. He was initially covered with a tight glistening membrane.

a. What is the most likely diagnosis?
b. List 2 possible immediate complications.
c. What is the immediate treatment?

Answer

VVK17-041
Given below is the picture of a term female neonate.

a. What is the diagnosis?
b. List 2 condition associated with this diagnosis.
c. List 2 neonatal complication of this diagnosis.

Answer

VVK17-042
A term newborn was noted to have audible cranial bruit. Given below is the MRA of this neonate.

a. What is the most likely diagnosis?
b. List 2 most common complication associated with this condition.
c. Name 1 treatment option.

Answer

VVK17-043
Given below is a picture of a 20-day-old term neonate.

a. What is the sign seen in this photo?
b. What is the pathophysiology of this sign?
c. What is the most likely cause of this sign?

Answer

VVK17-044
An 8-month-old infant presented in paediatric OPD with severe seborrheic dermatitis and bilateral otitis media. There is history of recurrent fever and weight loss over past 2 months. On examination, he is noted to have axillary lymphadenopathy and hepatosplenomegaly. Given below is the X-ray of this infant.

a. What is the finding seen on the chest X-ray?
b. What is the most likely diagnosis?
c. What is the treatment in this patient?

Answer

VVK17-045
Given below is the X-ray of term neonate who was born via elective LSCS.

a. List 3 findings seen on X-ray.
b. What is the most likely diagnosis?
c. What are the clinical findings likely to be seen in this neonate?

Answer

VVK17-046
A male newborn was born at 28 week gestation. He is now 4 weeks old and has needed 4 packed red cell transfusions. His current Hb is 6.8 mg/dL with low reticulocyte count. He is on full enteral feeds and iron (4 mg/kg/day) for past 10 days.

a. What is the most likely diagnosis?
b. What medication could have decreased the need for frequent blood transfusions in this neonate?
c. Give one non-hematological advantage of this medication.

Answer

VVK17-047
A term neonate is noted to have petechiae and purpura all over the body on day 2 of life. His platelet counts are noted to be 60,000/mm3 . Mother is a primigravida and known case of SLE. Her platelet counts are 70,000/mm3 .

a. What is the most likely diagnosis in this newborn?
b. Enlist 2 generally accepted criteria for platelet transfusion in case of neonatal thrombocytopenia.
c. How do you define neonatal thrombocytopenia?
d. What is the treatment?

Answer

VVK17-048
A 3 kg term ventilated neonate is nil by mouth. He is on 10% dextrose at rate of 9 mL/hr.

a. What is formula for calculating glucose infusion rate (GIR)?
b. Calculate the GIR for this baby.
c. What is the minimum GIR requirement of a neonate?

Answer

VVK17-049
A 30-week female infant is about to be delivered via emergency LSCS in view of severe oilgohydramnios. The serial scans since 20 weeks have shown oligohydramnios.

a. Enlist 2 most common causes of oilgohydramnios.
b. Give 1 serious complication which might be seen on delivery of this neonate.
a. Colostomy
b. Anorectal malformation
a. 5
b. 4
c. 5
d. 2
a. Transillumination
b. Positive-transillumination, free gas in the abdomen
c. Suggestive of intestinal perforation
d. NBM, Surgical intervention
e. Chest- to rule out pneumothorax
f. Identification of veins.
a. Colloidan baby
b. Incidence 1 in 600,000
c. Congenital ichthyosiform erythrodema
d. Autosomal recessive
e. Immediate complications
a. Exomphalos major/omphalocele.
b. i. Transport supine with the hernia suspended by a string
v. Place an orogastric tube.
c. Beckwith Weidemann syndrome, cardiac anomalies e.g. TOF and ASD, chromosomal abnormalities e.g. various trisomies, genitourinary anomalies, diaphragmatic hernia.
d. Surgical correction (usually non-urgent, staged closure).
a. HIE/perinatal asphyxia:
b. i. Management of the airway, breathing and circulation.
v. Repeat IV Phenobarbitone in a dose of 5–10 mg/kg up to maximum total dose of 40 mg/kg.
a. i. Ability to maintain temperature in an open crib.
b. i. Yes
a. HBeAg and anti HBe Ag.
b. Anti HBs Ag +ve.
c. Husband to get his HBs Ag status checked and to use barrier contraception during sexual intercourse.
d. Give first dose of hepatitis B vaccine and HBIG concurrently at different sites within 12 hours of birth followed by hepatitis B vaccine at 1 and 6 months.
a. It implies in utero infection and possibly a rapidly progressive disease.
b. By repeating the sample. A diagnosis of HIV infection can be made with 2 positive virologic test results obtained from different blood samples.
c. i. Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIS). Zidovudine, didanosine, tenofovir, stavudine, abacavir.
a. Vitamin K deficiency (classical).
b. Administration of total parentral alimentation.
c. Parentral administration of vitamin K to all newborns at the time of birth.
d. 1 mg IV or IM vitamin K.
c. ECHO
d. Transnasal repair.
a. Arm is held in adduction, elbow extended, internally rotated, forearm pronated and wrist flexed (Waiters tip position).
b. Erb palsy.
c. Injury to upper nerve roots of brachial plexus $C5+C6\pm C7$ .
d. Phrenic nerve involvement—Ipsilateral diaphragmatic paralysis.
b. Congenital CMV infection.
c. Hepatosplenomegaly.
a. Uncompensated respiratory acidosis.
b. Increase the rate.
c. Size 2.5.
a. Partially compensated respiratory alkalosis with hyperoxia.
b. Decrease PIP.
c. Periventricular leucomalacia/intraventricular hemorrhage.
a. Hypoxemia.
b. Increase PEEP.
c. HFOV.
a. Klumpke palsy.
b. Injury to lower nerve roots of brachial plexus C7 + C8 + T1.
c. Horner syndrome.
a. Uncompensated metabolic acidosis.
b. Shock.
c. IV Bolus of normal saline 10 mL/kg over 20–30 minutes.
b. Disconnect from ventilator transiently at the time of measurement.
c. 5 to 8 mm Hg.
d. Intrathoracic inferior vena cava.
e. Maintaining CVP at 5 to 8 mm Hg with volume infusions is associated with improved cardiac output. If CVP exceeds 5 to 8 mm Hg, additional volume will usually not be helpful.
a. 4-6 cm H2 O.
b. Pneumothorax.
a. Persistent pulmonary hypertension of newborn.
b. Nitric oxide.
c. ECMO.
d. Sildenafil, adenosine, magnesium sulfate, calcium channel blockers, inhaled prostacyclin, inhaled ethyl nitrite, and inhaled or intravenous tolazoline.
a. Polycythemia.
b. Venous hematocrit of over 65%
a. Congenital clubfoot or talipes equinocavovarus with metatarsal adduction.
b. First-degree relative suffering from the same condition:
c. Components:
d. Physical therapy and splinting. Manipulation and application of tapes, plaster or fiberglass casts.
a. Pan-hypopituitarism.
b. • Cortisol and growth hormone
a. Pendred syndrome.
b. Autosomal recessive.
c. Thyroid hormone synthetic defects.
d. Normal thyroid seen.
a. Hypoxic-ischemic encephalopathy.
b. Stage 2 (moderate)—Sarnat and sarnat staging.
c. 36 weeks.
d. 80% normal; abnormal if symptoms more than 5 to 7 days.
e. Improvement in heart rate followed by improvement in color followed by improvement in tone.
a. Erythema toxicum neonatorum.
b. Self limiting—no treatment required.
c. Inflammatory cells with >90% eosinophils.
a. The diagnosis is NEC.
b. Sepsis, prematurity, hypoxic or hemodynamic insult, etc.
c. Acidosis, hyponatremia, thrombocytopenia.
b. Moderately ill with systemic toxicity.
a. Impending intestinal perforation
b. Proven intestinal perforation.
a. Remove the UAC.
b. L1 and T12.
c. Continuous heparinised saline infusion.
a. Kernicterus/bilirubin encephalopathy.
b. Globus pallidus, dentate nucleus, cerebellar vermis, cochlear nuclei.
c. Choreoathetoid cerebral palsy, dystonic/dyskinetic CP, sensorineural deafness.
d. Audiometry testing. MRI
a. Supraventricular tachycardia.
b. Vagal stimulation followed by IV adenosine.
c. No.
a. Aplasia cutis congenita
b. Traumatic skin injury from monitoring devices, e.g. scalp electrodes.
c. Opitz syndrome:
a. DIC.
b. Clotting profile, cranial ultrasound.
a. Transillumination.
b. Hyperlucency in the affected area.
c. Pneumothorax.
a. Imperforate anus.
b. Low—Surgical dilatation.
c. Rectal inertia/constipation.
d. Genitourinary: Vesicoureteric reflux, renal agenesis, renal dysplasia, ureteral duplication, cryptorchidism, hypospadias, bicornuate uterus, vaginal septums.
a. Widespread honey colored bullae.
b. Impetigo.
c. Staph. aureus.
d. Cloxacillin (antistaphylococcal antibiotics).
a. Hydrops fetalis.
b. Pleural effusion and ascites.
c. Associated with anemia:
i. Haemolytic disease of newborn
i. Cardiac failure, e.g. in SVT
a. Gastroschisis.
b. Surgery: Staged or primary closure.
c. Short bowel syndrome.
a. Apert syndrome.
b. Asymmetry of head shape—Premature fusion of multiple sutures. Syndactyly of the 2nd, 3rd, and 4th fingers. Congenital cataract.
c. Progressive calcification and fusion of the bones of the hands, feet, and cervical spine.
a. Pavlik harness.
b. Developmental dysplasia of the hip.
c. 1–6 months—success rate >95%.
d. 6 weeks.
a. Collodion baby.
b. Skin infection/sepsis
a. Natal teeth.
b. Cleft palate
a. Vein of Galen malformation.
b. Hydrocephalous
a. Sun setting sign—the eyes deviate downward.
b. Impingement of the dilated suprapineal recess on the tectum.
c. Hydrocephalous.
a. Multiple osteolytic bone lesions.
b. Langerhans cell histiocytosis type 1.
c. Chemotherapy in view of multisystem involvement.
b. Osteogenesis imperfecta.
c. Blue sclera
a. Late anemia of prematurity.
b. Erythropoietin.
c. Decrease incidence of bronchopulmonary dysplasia.
a. Autoimmune thrombocytopenia (automaternal ITP).
b. Platelet count <20,000 Bleeding neonate.
c. Platelet count <150,000.
d. Platelet transfusion
a. Amniotic fluid leak, e.g. ROM Renal dysgenesis or agenesis.
b. Pulmonary hypoplasia Arthrogryposis/joint deformity.

Answer