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IAP pediatrics quiz questions MCQ neonatology growth nutrition vaccines neurology cardiology 2024

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🩺 IAP Pediatric Quiz — Mixed Difficulty | 3 Questions per Topic

📌 TOPIC 1: Neonatology

Q1. (Easy) A term neonate is born and is not crying. You dry, stimulate, and reposition the airway. Heart rate is 90/min at 30 seconds. What is the next step?

A) Begin chest compressions
B) Administer epinephrine
C) Start positive pressure ventilation (PPV)
D) Intubate immediately

✅ Answer: C - Start PPV Rationale: Per NRP guidelines, HR <100/min despite initial steps is an indication to begin PPV with 21% O₂ in term neonates. Chest compressions begin only if HR <60/min after 30 seconds of effective PPV.

Q2. (Medium) A preterm neonate at 28 weeks develops apnea, bradycardia, and hypoxia on Day 2. CXR shows bilateral ground-glass opacities with air bronchograms. What is the most likely diagnosis and definitive treatment?

A) Transient tachypnea of newborn — diuretics
B) Meconium aspiration syndrome — surfactant
C) Hyaline membrane disease (RDS) — exogenous surfactant
D) Congenital pneumonia — antibiotics

✅ Answer: C - Hyaline membrane disease / RDS — exogenous surfactant Rationale: RDS is caused by surfactant deficiency in preterm neonates. Classic CXR = ground-glass + air bronchograms. Treatment = exogenous surfactant (beractant/poractant alfa) + respiratory support.

Q3. (Hard) A neonate at 34 weeks develops abdominal distension, bloody stools, and pneumatosis intestinalis on X-ray at Day 5. Bell's staging is IIB. What is the treatment?

A) Continue feeds with antibiotics
B) NPO + IV antibiotics + surgical exploration immediately
C) NPO + NG decompression + IV antibiotics for 14 days
D) Total parenteral nutrition only

✅ Answer: C - NPO + NG decompression + IV antibiotics for 14 days Rationale: Bell Stage IIB (severe NEC, pneumatosis + systemic signs) = medical management: NPO, nasogastric decompression, broad-spectrum IV antibiotics for 10-14 days. Surgery (laparotomy) is reserved for Stage III (perforation, peritonitis).

📌 TOPIC 2: Growth & Development

Q1. (Easy) At what age does a normal infant double their birth weight?

A) 3 months
B) 5 months
C) 6 months
D) 9 months

✅ Answer: B - 5 months Rationale: Birth weight doubles by 5 months, triples by 1 year, and quadruples by 2 years. These are standard IAP growth milestones.

Q2. (Medium) A 9-month-old baby can sit without support, transfer objects hand-to-hand, babble "mama/dada" non-specifically, and waves bye-bye. Which milestone is DELAYED for this age?

A) Sitting without support
B) Transfer of objects
C) Pincer grasp
D) Waving bye-bye

✅ Answer: C - Pincer grasp Rationale: Pincer grasp (thumb + index finger) is expected at 9-10 months. Its absence at 9 months is a mild delay. All other listed milestones are appropriate for 9 months.

Q3. (Hard) A 3-year-old boy has height 85 cm (expected ~96 cm), weight 12 kg, bone age of 2 years, and low IGF-1. His mother's height is 150 cm and father's is 162 cm. Calculated mid-parental height is 150 cm. What is the most likely diagnosis?

A) Constitutional delay of growth and puberty
B) Familial short stature
C) Growth hormone deficiency
D) Hypothyroidism

✅ Answer: C - Growth hormone deficiency Rationale: Low IGF-1 + delayed bone age + height well below mid-parental target height + abnormal growth velocity = GH deficiency. Constitutional delay has delayed bone age but normal GH axis. Familial short stature has normal bone age.

📌 TOPIC 3: Nutrition

Q1. (Easy) WHO recommends exclusive breastfeeding for how long?

A) 3 months
B) 4 months
C) 6 months
D) 12 months

✅ Answer: C - 6 months Rationale: WHO and IAP recommend exclusive breastfeeding for the first 6 months of life, followed by complementary feeds with continued breastfeeding up to 2 years or beyond.

Q2. (Medium) A 2-year-old child has bilateral pitting pedal edema, moon face, desquamating skin rash (flaky paint dermatosis), and irritability. Weight-for-height is <-3 SD. Appetite is poor. What is the diagnosis?

A) Marasmus
B) Kwashiorkor
C) Marasmic-kwashiorkor
D) Vitamin A deficiency

✅ Answer: B - Kwashiorkor Rationale: Kwashiorkor = protein-energy malnutrition with predominant protein deficiency. Cardinal features: bilateral pitting edema, skin changes (flaky paint), moon face, irritability, poor appetite. Weight may appear falsely normal due to edema.

Q3. (Hard) A 6-month-old exclusively breastfed infant presents with seizures. Serum calcium is 6.5 mg/dL, phosphorus is 8 mg/dL, alkaline phosphatase is markedly elevated. Wrist X-ray shows fraying and cupping of metaphyses. What is the cause?

A) Primary hypoparathyroidism
B) Vitamin D-deficient rickets
C) Pseudohypoparathyroidism
D) Hypomagnesemia

✅ Answer: B - Vitamin D-deficient rickets Rationale: Classic nutritional rickets = hypocalcemia + hyperphosphatemia (or low-normal PO₄) + raised ALP + radiographic changes (cupping, fraying, widening of metaphyses). Exclusively breastfed infants without vitamin D supplementation are at high risk.

📌 TOPIC 4: Vaccines / Immunization

Q1. (Easy) Which of the following vaccines is given at birth as per the IAP immunization schedule?

A) OPV + Hep B + BCG
B) OPV + BCG only
C) Hep B + IPV + BCG
D) BCG + OPV + Rotavirus

✅ Answer: A - OPV + Hep B + BCG Rationale: IAP schedule at birth includes BCG (for TB), OPV-0 (oral polio vaccine), and Hep B-1 (preferably within 24 hours). This protects against the most critical early-life infections.

Q2. (Medium) A 15-month-old child has a contraindication to live vaccines due to primary immunodeficiency. Which of the following can be safely given?

A) MMR
B) Varicella
C) Yellow fever
D) Hepatitis B vaccine

✅ Answer: D - Hepatitis B vaccine Rationale: Hep B is an inactivated/recombinant subunit vaccine and is safe in immunocompromised patients. MMR, varicella, and yellow fever are live attenuated vaccines - absolutely contraindicated in primary immunodeficiency.

Q3. (Hard) A child receives MMR vaccine. 7 days later, develops fever and a maculopapular rash. The most likely cause is:

A) Wild-type measles infection
B) Hypersensitivity to gelatin in vaccine
C) Modified measles-like reaction from the vaccine virus
D) Bacterial superinfection

✅ Answer: C - Modified measles-like reaction from vaccine virus Rationale: 5-12 days post-MMR, ~5% of children develop a mild fever + faint rash — a modified measles-like response due to viral replication of attenuated measles component. This is expected and self-limiting. Gelatin allergy causes immediate hypersensitivity (urticaria, anaphylaxis), not a delayed rash.

📌 TOPIC 5: Infectious Diseases

Q1. (Easy) Koplik's spots are pathognomonic of which disease?

A) Rubella
B) Roseola infantum
C) Measles (Rubeola)
D) Chickenpox

✅ Answer: C - Measles (Rubeola) Rationale: Koplik's spots (white spots on buccal mucosa opposite lower molars) appear 1-2 days before the measles rash and are pathognomonic for measles.

Q2. (Medium) A 4-year-old with fever, drooling, muffled voice, stridor, and sitting in tripod position (leaning forward). What is the most likely diagnosis and immediate step?

A) Croup — give nebulized epinephrine
B) Retropharyngeal abscess — lateral neck X-ray
C) Epiglottitis — secure airway immediately, do NOT examine throat
D) Bacterial tracheitis — give IV antibiotics

✅ Answer: C - Epiglottitis — secure airway immediately Rationale: Classic presentation: school-age child, sudden onset high fever, dysphagia, drooling, muffled voice, tripod sitting. Causative organism: Hib (Haemophilus influenzae type b). Immediate airway securing in OR setting is priority. Examining the throat can precipitate complete obstruction.

Q3. (Hard) A neonate born to a HBsAg-positive mother should receive which prophylaxis within 12 hours of birth?

A) Hep B vaccine only
B) HBIG only
C) Hep B vaccine + HBIG at separate sites
D) Hep B vaccine + HBIG at same site

✅ Answer: C - Hep B vaccine + HBIG at separate sites Rationale: Perinatal Hep B prophylaxis requires both active (Hep B vaccine) and passive (HBIG 0.5 mL IM) immunization within 12 hours of birth, given at separate injection sites. This reduces perinatal transmission by >90%.

📌 TOPIC 6: Pediatric Cardiology

Q1. (Easy) The most common congenital heart defect is:

A) Atrial Septal Defect (ASD)
B) Ventricular Septal Defect (VSD)
C) Patent Ductus Arteriosus (PDA)
D) Tetralogy of Fallot

✅ Answer: B - Ventricular Septal Defect (VSD) Rationale: VSD accounts for ~30-35% of all congenital heart defects, making it the most common. Small VSDs frequently close spontaneously. Large VSDs cause left-to-right shunt, pulmonary hypertension.

Q2. (Medium) A cyanotic 3-month-old infant has a harsh ejection systolic murmur, right ventricular hypertrophy on ECG, and boot-shaped heart on CXR. Which is the most likely diagnosis?

A) Complete AVSD
B) Transposition of Great Arteries
C) Tetralogy of Fallot
D) Truncus arteriosus

✅ Answer: C - Tetralogy of Fallot Rationale: ToF has 4 components: VSD + RVOTO + overriding aorta + RVH. Classic findings: boot-shaped heart ("coeur en sabot"), RVH on ECG, harsh ESM at left upper sternal border, cyanosis worsening with crying (tet spells). Most common cyanotic CHD after 1 year.

Q3. (Hard) A newborn develops severe cyanosis at birth that does not improve with oxygen. Echo shows parallel great arteries with the aorta arising from the right ventricle. PGE1 is started. What does PGE1 achieve in this situation?

A) Closes the PDA to reduce pulmonary congestion
B) Maintains ductal patency to allow mixing of blood
C) Dilates pulmonary vasculature to improve oxygenation
D) Converts to normal sinus rhythm

✅ Answer: B - Maintains ductal patency to allow mixing of blood Rationale: In d-TGA, PDA is the only mixing point. PGE1 (prostaglandin E1) keeps the ductus arteriosus patent, allowing systemic and pulmonary circulations to mix, maintaining oxygenation until surgical correction (Jatene arterial switch operation).

📌 TOPIC 7: Pediatric Neurology

Q1. (Easy) The most common cause of bacterial meningitis in neonates (0-3 months) is:

A) Neisseria meningitidis
B) Streptococcus pneumoniae
C) Group B Streptococcus (GBS) + E. coli
D) Listeria monocytogenes

✅ Answer: C - Group B Streptococcus + E. coli Rationale: Neonatal bacterial meningitis is most commonly caused by GBS (Group B Strep) and Gram-negative enteric organisms (E. coli, Klebsiella). These are acquired from the birth canal (vertical transmission).

Q2. (Medium) A 5-year-old boy has his first seizure. It lasts 12 minutes, is generalized tonic-clonic, and occurs with fever of 38.8°C. He has no neurological deficit after. Which statement is TRUE?

A) This is a complex febrile seizure — start prophylactic anticonvulsants
B) This is a simple febrile seizure — risk of epilepsy is >30%
C) This is a simple febrile seizure — anticonvulsant therapy is NOT recommended
D) LP is mandatory to rule out meningitis in all cases

✅ Answer: C - Simple febrile seizure — anticonvulsant therapy not recommended Rationale: Simple febrile seizure = generalized, <15 min, single episode in 24 hours, age 6 months - 6 years. Risk of epilepsy is only ~2-3% (same as general population). No routine anticonvulsant prophylaxis is recommended. LP is indicated if meningitis signs are present or child <12-18 months.

Q3. (Hard) A 2-year-old has acute onset flaccid paralysis of the right leg, absent deep tendon reflexes, no sensory loss, CSF shows elevated protein and lymphocytic pleocytosis. Which is most likely?

A) Guillain-Barré syndrome
B) Transverse myelitis
C) Acute flaccid paralysis due to poliovirus or enterovirus
D) Spinal muscular atrophy type I

✅ Answer: C - Acute flaccid paralysis (poliovirus/enterovirus) Rationale: Acute asymmetric flaccid paralysis + absent DTRs + no sensory loss + CSF lymphocytosis = classic AFP due to anterior horn cell involvement (poliovirus / non-polio enteroviruses like EV-D68). GBS shows ascending symmetric paralysis + albuminocytologic dissociation in CSF.

📌 TOPIC 8: Pediatric Nephrology

Q1. (Easy) The most common cause of nephrotic syndrome in children aged 1-8 years is:

A) Focal segmental glomerulosclerosis (FSGS)
B) Minimal change disease (MCD)
C) Membranous nephropathy
D) IgA nephropathy

✅ Answer: B - Minimal change disease (MCD) Rationale: MCD accounts for ~80% of childhood nephrotic syndrome (ages 1-8). It is steroid-responsive, has a good prognosis, and shows no change on light microscopy (effacement of foot processes on EM).

Q2. (Medium) A 5-year-old with periorbital edema, frothy urine, and hypoalbuminemia is diagnosed with nephrotic syndrome. He is started on prednisolone. After 4 weeks of full-dose steroids, there is no remission. What is this called?

A) Steroid-sensitive nephrotic syndrome
B) Steroid-resistant nephrotic syndrome
C) Steroid-dependent nephrotic syndrome
D) Frequently relapsing nephrotic syndrome

✅ Answer: B - Steroid-resistant nephrotic syndrome Rationale: SRNS = failure to achieve remission (urine protein negative or trace) after 4 weeks of daily prednisolone at full dose (2 mg/kg/day). These children need biopsy and second-line agents (tacrolimus, cyclosporine).

Q3. (Hard) A 3-year-old presents with gross hematuria, mild hypertension, and periorbital edema 2 weeks after a sore throat. Complement C3 is low, C4 is normal, ASO titer is elevated. What is the expected course?

A) Progressive renal failure in 70% of cases
B) Complete resolution in >95% of cases
C) Progresses to rapidly progressive GN
D) Requires cyclophosphamide therapy

✅ Answer: B - Complete resolution in >95% of cases Rationale: Post-streptococcal glomerulonephritis (PSGN) - classic presentation: hematuria 10-21 days post-strep throat, edema, hypertension, low C3 (normal C4), elevated ASO. Prognosis in children is excellent — >95% recover completely with supportive care.

📌 TOPIC 9: Pediatric Pulmonology / Respiratory

Q1. (Easy) The most common cause of acute lower respiratory tract infection in children under 2 years is:

A) Streptococcus pneumoniae
B) Respiratory syncytial virus (RSV)
C) Parainfluenza virus
D) Mycoplasma pneumoniae

✅ Answer: B - Respiratory syncytial virus (RSV) Rationale: RSV is the leading cause of bronchiolitis and viral pneumonia in infants <2 years globally. Clinical: wheeze, hyperinflation, subcostal recession. High-risk groups (premature, CHD) may receive palivizumab prophylaxis.

Q2. (Medium) A 6-year-old with recurrent wheeze, nighttime cough, and FEV1/FVC ratio of 72% (predicted 80%) that improves by >12% after salbutamol. Diagnosis and first-line treatment?

A) COPD — LABA + LAMA
B) Asthma — inhaled corticosteroids (ICS)
C) Allergic rhinitis — intranasal steroids
D) Cystic fibrosis — DNase

✅ Answer: B - Asthma — inhaled corticosteroids (ICS) Rationale: Reversible obstructive airway disease (>12% improvement in FEV1 post-bronchodilator) + classic symptoms = asthma. GINA/IAP guidelines: low-dose ICS is first-line controller therapy. Salbutamol (SABA) is reliever.

Q3. (Hard) A 3-year-old with recurrent respiratory infections, failure to thrive, steatorrhea, and sweat chloride of 85 mEq/L. Most common mutation in this condition in South Asian populations?

A) ΔF508 (F508del)
B) W1282X
C) G551D
D) R117H

✅ Answer: A - ΔF508 (F508del) Rationale: Cystic fibrosis (CF) - sweat chloride >60 mEq/L is diagnostic. ΔF508 (deletion of phenylalanine at position 508 of CFTR) is the most common mutation worldwide (~70% of CF alleles), and also the most prevalent in South Asian CF patients, though less frequent than in Caucasians.

📌 TOPIC 10: Hematology / Oncology

Q1. (Easy) The most common childhood malignancy is:

A) Neuroblastoma
B) Wilms tumor
C) Acute lymphoblastic leukemia (ALL)
D) Hodgkin's lymphoma

✅ Answer: C - Acute Lymphoblastic Leukemia (ALL) Rationale: ALL accounts for ~25-30% of all childhood cancers, making it the most common pediatric malignancy. Peak age: 2-5 years. Cure rate with treatment is >85%.

Q2. (Medium) A 4-year-old has pallor, hepatosplenomegaly, lymphadenopathy, bone pain, and CBC showing WBC 80,000/µL with 80% blasts. Bone marrow shows >25% blasts. TdT positive, CALLA (CD10) positive. Diagnosis?

A) AML (M3 subtype)
B) B-cell ALL (common ALL)
C) T-cell ALL
D) Burkitt's lymphoma/leukemia

✅ Answer: B - B-cell ALL (common ALL) Rationale: TdT+ + CD10 (CALLA)+ + age 2-5 years = common B-cell ALL (pre-B ALL). This is the most common subtype of childhood ALL and has the best prognosis. T-ALL typically presents in older boys with mediastinal mass.

Q3. (Hard) A 1-year-old presents with a large unilateral abdominal mass that does not cross the midline. Ultrasound shows intrarenal origin. IVP shows distortion of the calyceal system. The child has aniridia and hypospadias. Which syndrome is associated and what gene is implicated?

A) Beckwith-Wiedemann syndrome — IGF-2
B) WAGR syndrome — WT1 gene deletion
C) Denys-Drash syndrome — WT2 gene
D) Li-Fraumeni syndrome — TP53

✅ Answer: B - WAGR syndrome — WT1 gene deletion Rationale: Wilms tumor + Aniridia + Genitourinary anomalies + Range of intellectual disability = WAGR syndrome, caused by deletion of WT1 (and PAX6) on chromosome 11p13. Aniridia is the key clinical clue. Beckwith-Wiedemann (macroglossia, hemihypertrophy, omphalocele) is associated with WT2/IGF-2.

📌 TOPIC 11: Pediatric Endocrinology

Q1. (Easy) The most common cause of congenital hypothyroidism is:

A) TSH receptor antibodies from mother
B) Thyroid dysgenesis (aplasia/ectopia)
C) Iodine deficiency
D) Hashimoto's thyroiditis

✅ Answer: B - Thyroid dysgenesis Rationale: Thyroid dysgenesis (aplasia, hypoplasia, ectopic thyroid) accounts for ~85% of permanent congenital hypothyroidism. Early treatment with levothyroxine (<2 weeks of life) is critical to prevent cretinism. NBS (newborn screening) detects elevated TSH.

Q2. (Medium) A 10-year-old girl has Tanner stage 3 breast development, pubic hair stage 2, height velocity 8 cm/year, and bone age of 13 years. LH increases significantly after GnRH stimulation test. Diagnosis and treatment?

A) Premature adrenarche — no treatment
B) McCune-Albright syndrome — aromatase inhibitor
C) Central precocious puberty — GnRH agonist
D) Congenital adrenal hyperplasia — glucocorticoids

✅ Answer: C - Central (GnRH-dependent) precocious puberty — GnRH agonist Rationale: CPP = activation of HPG axis before age 8 in girls. GnRH stimulation test showing pubertal LH rise confirms central etiology. Treatment: GnRH agonist (leuprolide) to pause puberty and preserve final height.

Q3. (Hard) A 3-week-old neonate has ambiguous genitalia, hyponatremia (Na 122), hyperkalemia (K 6.8), hypoglycemia, and hypotension. 17-OHP level is extremely elevated. What is the enzyme deficiency?

A) 11-beta hydroxylase
B) 17-alpha hydroxylase
C) 21-hydroxylase
D) 3-beta hydroxysteroid dehydrogenase

✅ Answer: C - 21-hydroxylase deficiency Rationale: Classic salt-wasting CAH = deficiency of 21-hydroxylase (CYP21A2, chromosome 6p21.3). Results in cortisol + aldosterone deficiency + androgen excess. Clinical: female virilization (ambiguous genitalia), hyponatremia, hyperkalemia, hypoglycemia, shock. 17-OHP is the diagnostic marker. >90% of CAH cases.

📌 TOPIC 12: Pediatric Gastroenterology

Q1. (Easy) Bilious vomiting in a newborn on Day 1 of life, abdomen distended, no meconium passed in 48 hours. What is the most likely diagnosis?

A) Pyloric stenosis
B) Hirschsprung's disease
C) Malrotation with volvulus
D) Duodenal atresia

✅ Answer: D - Duodenal atresia (or C if bilious vomiting with collapse) Rationale: Bilious (green) vomiting Day 1 with "double bubble" sign on X-ray = duodenal atresia. Associated with Down syndrome (trisomy 21) in 30% of cases. Malrotation/volvulus also causes bilious vomiting but usually with abdominal rigidity and shock - a surgical emergency.

Q2. (Medium) A 5-week-old first-born male infant has projectile non-bilious vomiting immediately after every feed. On examination, a small olive-shaped mass is palpable in the epigastrium. What is the investigation of choice and treatment?

A) Barium meal — laparotomy
B) Ultrasound — Ramstedt pyloromyotomy
C) Upper GI endoscopy — proton pump inhibitor
D) X-ray abdomen — conservative management

✅ Answer: B - Ultrasound showing thick pylorus — Ramstedt pyloromyotomy Rationale: Hypertrophic pyloric stenosis: first-born male, 3-6 weeks, projectile NON-bilious vomiting, palpable "olive" (hypertrophied pylorus), metabolic alkalosis with hypokalemia. USG: pyloric muscle thickness >4 mm, pyloric channel length >17 mm. Treatment: correct electrolytes then Ramstedt pyloromyotomy.

Q3. (Hard) A 2-year-old has recurrent episodes of severe colicky abdominal pain, draws legs to abdomen, passes "redcurrant jelly" stools. Ultrasound shows "target sign." What is the definitive first-line treatment if child is hemodynamically stable?

A) Emergency laparotomy
B) Air enema (pneumatic reduction)
C) Manual reduction during colonoscopy
D) IV steroids and observation

✅ Answer: B - Air/pneumatic enema reduction Rationale: Intussusception (most common: ileocolic) presents with the classic triad of colicky pain + abdominal mass + redcurrant jelly stool. USG: "target sign" (concentric rings). First-line treatment: pneumatic (air) or hydrostatic (saline/barium) enema reduction under fluoroscopy or ultrasound guidance, success rate ~80-90%. Surgery if enema fails or peritonitis present.

Sources used: Red Book 2021 (Pediatric Infectious Diseases), Harriet Lane Handbook 23rd Ed, Tintinalli's Emergency Medicine, Park's Preventive & Social Medicine, and core IAP-level clinical knowledge.

Total: 36 questions across 12 topics — covering Neonatology, Growth & Development, Nutrition, Vaccines, Infectious Diseases, Cardiology, Neurology, Nephrology, Pulmonology, Hematology/Oncology, Endocrinology, and Gastroenterology, at easy / medium / hard difficulty levels.

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