IAP Pediatrics Fellowship Quiz - True / False (20 Questions)

NEONATOLOGY (Questions 1-6)

TRUE. Nirsevimab (brand: Beyfortus) is a long-acting monoclonal antibody targeting the RSV prefusion F protein, recommended for passive immunoprophylaxis in infants - replacing palivizumab in many guidelines.

FALSE. ESPGHAN 2022 recommends 800-1000 IU/kg/day for preterm neonates, which is weight-based (not a flat daily dose), reflecting their higher metabolic needs and lower fat stores compared to term infants.

FALSE. The PLaNeT-2 trial established that a platelet count of less than 25,000/cu mm was a safe restrictive threshold for platelet transfusion in neonates, and that transfusing at higher thresholds (50,000/cu mm) did not improve outcomes.

FALSE. Lewis antigens (Le^a and Le^b) are adsorbed onto red cells rather than being intrinsic membrane antigens, and they are present as soluble antigens in plasma. They are NOT associated with HDN because the antibodies are predominantly IgM and do not cross the placenta.

FALSE. "Square window" and "popliteal angle" carry the highest scores in the neuromuscular maturity section of the Ballard score. Posture is scored 0-4, while popliteal angle is also scored 0-5 (range -1 to 5), making it one of the highest-weighted parameters.

FALSE. Plastic wraps are recommended for neonates born below 32 weeks gestation. For neonates 32-34 weeks, standard thermal care (warm environment, drying, skin-to-skin) is generally adequate.

INFECTIOUS DISEASES (Questions 7-10)

FALSE. Live vaccines including MMR are contraindicated during high-dose systemic corticosteroid therapy (≥2 mg/kg/day of prednisone equivalent for ≥14 days). The vaccine should be deferred until at least 1 month after cessation of high-dose therapy. (Red Book 2021)

FALSE. Per the Red Book 2021 (Interchangeability of Vaccine Products), if brands requiring different dose numbers are mixed in a primary series, the higher number of doses is recommended for series completion, to ensure adequate protection.

TRUE. MALDI-TOF (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight) is a rapid microbial identification tool used to identify causative organisms from blood cultures in neonatal sepsis, significantly reducing time to identification compared to conventional biochemical methods.

TRUE. As updated in Red Book 2021, IGSC has established utility for immunomodulation in autoimmune neurological conditions, offering an alternative to IVIG with the advantage of home administration.

NUTRITION & GROWTH (Questions 11-13)

FALSE. The first-line treatment for suspected CMPA in a formula-fed infant is an extensively hydrolyzed formula (eHF). Partially hydrolyzed formulas are NOT recommended for CMPA treatment because they still contain residual allergenic peptides. In breastfed infants, the mother should eliminate all dairy products.

TRUE. WHO recommendations support delayed cord clamping (minimum 1 minute, preferably up to 3 minutes) in all neonates where immediate resuscitation is not required. Benefits include higher hemoglobin, better iron stores in term infants, and reduced need for blood transfusion and lower rates of IVH in preterm infants.

TRUE. OI = (Mean Airway Pressure x FiO2 x 100) / PaO2. An OI >25 on two consecutive measurements is a common threshold for considering ECMO. Note: a variant using SpO2 instead of PaO2 is called the oxygen saturation index (OSI).

DEVELOPMENTAL PEDIATRICS (Questions 14-16)

TRUE. Multiple RCTs and meta-analyses confirm that antenatal magnesium sulfate administered for neuroprotection reduces the risk of cerebral palsy (and gross motor dysfunction) in preterm neonates, particularly those born before 30-32 weeks. It does NOT consistently improve survival, cognitive outcomes, or reduce NICU stay.

FALSE. TEF is a developmental anomaly that originates during the embryonic phase (weeks 4-5) of lung development, when the trachea and esophagus fail to properly separate from the foregut. The canalicular phase (weeks 17-27) is when respiratory bronchioles and primitive alveoli begin to form.

TRUE. RBSK is India's national child health screening and early intervention initiative that screens for 30 conditions grouped under the 4 Ds across four age groups, with the goal of reducing morbidity and mortality and improving quality of life.

GENERAL PEDIATRICS (Questions 17-20)

FALSE. In PSV, the clinician controls pressure support above PEEP, PEEP, backup rate, and FiO2. Tidal volume and inspiratory time are NOT directly set - they are patient-determined based on the set pressure support and the patient's lung compliance and effort. This distinguishes PSV from volume-control modes.

TRUE. The C20/C ratio compares compliance in the top 20% of a breath to overall compliance. A ratio <1 indicates that the lung is becoming stiffer at high volumes, signifying overdistension. This is a clinically important warning sign to reduce tidal volume or peak pressure.

TRUE. DW-MRI is highly sensitive for detecting cytotoxic edema and early ischemic injury within the first 72 hours and is the preferred early modality. Conventional MRI sequences (T1/T2) become more informative after 4-7 days when signal changes fully evolve.

TRUE. The Bland-Altman plot is used to assess agreement between two methods of measurement (e.g., transcutaneous bilirubin vs. serum bilirubin). It is the correct choice here - not Kaplan-Meier (survival), Chi-square (categorical association), or ROC curve (diagnostic accuracy).

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