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Give me questions with answers related the given topics for Indian academy of pediatrics quiz competition use standard pediatrics textbook like op ghai nelson

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Here is the complete question bank for the 39th IAP Pediatric Quiz for Undergraduates - 2026, drafted per IAP guidelines (specific answers, no yes/no, no controversial, equally balanced difficulty). Each round contains 6 primary questions + 2 spare questions (8 total per round, as per IAP's requirement of 6 per round plus 2 extras).

39th IAP PEDIATRIC QUIZ FOR UNDERGRADUATES - 2026

Question Bank (All Rounds)

ROUND 1 - BASIC SCIENCES

(Physiology, Anatomy, Embryology, Biochemistry, Pathology, Immunology, Microbiology, Pharmacology)

Q1.1 Which enzyme is deficient in a child who presents with megaloblastic anemia, recurrent infections, and absent tonsils, with absent B cells but normal T cells on flow cytometry?

Answer: Purine nucleoside phosphorylase (PNP) - causes combined immunodeficiency. (For isolated B cell defect with agammaglobulinemia - Bruton's tyrosine kinase / BTK deficiency.) If asking for absent B cells specifically: BTK (Bruton's tyrosine kinase)

Q1.2 The ductus arteriosus connects the pulmonary trunk to which vessel, and is kept patent physiologically by which substance?

Answer: Descending thoracic aorta (just distal to origin of left subclavian artery); kept patent by Prostaglandin E2 (PGE2). (Source: Nelson Textbook of Pediatrics, Cardiovascular Development)

Q1.3 Which immunoglobulin is the first to be produced in a primary immune response and is also the only immunoglobulin that does NOT cross the placenta?

Answer: IgM (Nelson's Pediatrics - Immunology chapter)

Q1.4 The amino acid phenylalanine is converted to tyrosine by the enzyme phenylalanine hydroxylase, which requires a cofactor. Name this cofactor.

Answer: Tetrahydrobiopterin (BH4) (Harper's Biochemistry / Lippincott)

Q1.5 In renal histopathology, which glomerular change is pathognomonic of minimal change disease on light microscopy?

Answer: Normal / no change on light microscopy (effacement of foot processes is seen only on electron microscopy) (Robbins Pathology)

Q1.6 Name the Gram-negative diplococcus that is the most common cause of bacterial meningitis in children between 1 month and 5 years of age (pre-vaccine era).

Answer: Neisseria meningitidis (Meningococcus) (OP Ghai Essential Pediatrics - Infectious Diseases)

Q1.7 (Spare) Which chromosome carries the gene for Duchenne muscular dystrophy, and what is the mode of inheritance?

Answer: X chromosome (Xp21); X-linked recessive (Nelson's - Neuromuscular Diseases)

Q1.8 (Spare) The drug used to keep the ductus arteriosus open in cyanotic congenital heart disease with duct-dependent circulation is Prostaglandin E1 (alprostadil). Which drug is used to close a patent ductus arteriosus pharmacologically in a preterm neonate?

Answer: Indomethacin (a cyclooxygenase inhibitor) or Ibuprofen (Nelson's Pediatrics, OP Ghai)

ROUND 2 - GENERAL PEDIATRICS

(Nutrition, Growth & Development, Fluid & Electrolytes, Behavioral Sciences)

Q2.1 A 2-year-old child has bilateral pitting edema, moon face, skin changes (flag sign), and adequate weight for height. His hair shows depigmentation. Name this nutritional deficiency disorder.

Answer: Kwashiorkor (OP Ghai Essential Pediatrics - Nutrition)

Q2.2 At what age does a normal child achieve the developmental milestone of walking independently without support?

Answer: 12-15 months (median 13 months; acceptable range 9-18 months) (OP Ghai Developmental Pediatrics / Denver Developmental Screening)

Q2.3 In the WHO Oral Rehydration Solution (ORS) 2002 formulation, what is the osmolarity and the concentration of sodium (mmol/L)?

Answer: Osmolarity 245 mOsm/L; Sodium 75 mmol/L (WHO 2002 Low Osmolarity ORS; OP Ghai)

Q2.4 A 6-month-old exclusively breastfed infant presents with tetany and seizures. Serum calcium is 6.5 mg/dL. The mother is a strict vegetarian and was housebound throughout pregnancy. Which vitamin deficiency is responsible?

Answer: Vitamin D deficiency (causing hypocalcemic tetany / neonatal/infantile rickets) (OP Ghai, Nelson's - Nutritional Rickets)

Q2.5 Which reflex, present at birth and disappearing by 3-4 months, involves the infant turning the head and opening the mouth when the cheek is stroked?

Answer: Rooting reflex (OP Ghai Developmental Pediatrics)

Q2.6 The Weight-for-Height Z-score (WHZ) of less than -3 SD indicates which grade of acute malnutrition as per WHO classification?

Answer: Severe Acute Malnutrition (SAM) (WHO 2006 growth standards; OP Ghai Nutrition)

Q2.7 (Spare) The condition in which a child repeatedly eats non-food substances (soil, chalk, clay) for more than one month beyond a developmentally appropriate age is called?

Answer: Pica (Nelson's Behavioral and Psychiatric Disorders)

Q2.8 (Spare) Identify the electrolyte abnormality: A child presents with lethargy, muscle cramps, and ECG showing peaked T waves and prolonged PR interval. Serum potassium is 6.8 mEq/L. Name this condition and its most common cause in children.

Answer: Hyperkalemia; most common cause in children - renal failure (acute kidney injury) (Nelson's - Fluid & Electrolytes)

ROUND 3 - INFECTIOUS DISEASES, VACCINES, IMMUNIZATION & NEONATOLOGY

Q3.1 Which specific rash pattern - beginning on the face and spreading centrifugally downward, with Koplik's spots on the buccal mucosa - is characteristic of which viral exanthem?

Answer: Measles (Rubeola) - caused by Paramyxovirus (OP Ghai, Nelson's - Infectious Diseases)

Q3.2 The Sabin-Feldman dye test is used for the diagnosis of which parasitic infection?

Answer: Toxoplasmosis (Toxoplasma gondii) (Nelson's Infectious Diseases)

Q3.3 In the Indian National Immunization Schedule (NIS) 2023-2024, at what age is the Measles-Rubella (MR) second dose given?

Answer: 16-24 months (IAP/NIS Immunization Schedule 2023-24; OP Ghai)

Q3.4 A neonate born at 38 weeks gestation develops respiratory distress within 6 hours of birth. The mother had prolonged rupture of membranes (>18 hours). The most likely organism responsible is?

Answer: Group B Streptococcus (Streptococcus agalactiae) - early onset neonatal sepsis (OP Ghai Neonatology, Nelson's)

Q3.5 Koplik's spots are pathognomonic of measles. On which mucosal surface are they found and what do they look like?

Answer: Found on the buccal mucosa (opposite the lower molars); appear as white/bluish-white spots on an erythematous base (described as "grains of salt on red background") (Nelson's / OP Ghai)

Q3.6 The Exchange transfusion threshold for a term neonate at 72 hours of age with non-hemolytic jaundice as per AAP 2022 guidelines is serum bilirubin level of approximately?

Answer: ~25 mg/dL (at 72 hours for term infant, AAP 2022 phototherapy thresholds - exchange transfusion approximately 25 mg/dL for low/medium risk) (Nelson's Neonatology; AAP 2022 Hyperbilirubinemia Guidelines)

Q3.7 (Spare) Which vaccine is given at birth along with BCG and OPV-0 as per the Indian National Immunization Schedule?

Answer: Hepatitis B (HepB-0 / Birth dose) (NIS India; OP Ghai Preventive Pediatrics)

Q3.8 (Spare) The most common congenital infection worldwide causing sensorineural hearing loss and periventricular calcifications in a neonate is caused by which virus?

Answer: Cytomegalovirus (CMV) (Nelson's - Congenital Infections / TORCH)

ROUNDS 4 & 5 - SYSTEMS

(Neurology, Pulmonology, Cardiology, Hepatology, Hematology, Nephrology, Gastrointestinal)

Q4.1 [Cardiology] A 5-year-old child is found to have a loud pansystolic murmur best heard at the lower left sternal border, with no cyanosis. Echocardiography confirms the diagnosis. Name the most common congenital heart defect overall in children.

Answer: Ventricular Septal Defect (VSD) (OP Ghai Cardiology; Nelson's)

Q4.2 [Neurology] A 3-year-old child presents with sudden brief episodes of staring, eye fluttering, and unresponsiveness lasting 5-10 seconds, occurring 20-30 times per day. EEG shows 3 Hz spike-and-wave discharges. Name this seizure type and the drug of choice.

Answer: Childhood Absence Epilepsy (Petit Mal) - Drug of choice: Ethosuximide (or Valproate) (Nelson's Neurology, OP Ghai)

Q4.3 [Pulmonology] A 2-year-old presents in December with fever, cough, and high-pitched inspiratory stridor worsening at night with a barking cough. X-ray neck shows the "Steeple sign." The most common causative organism is?

Answer: Parainfluenza virus type 1 (cause of Croup / Laryngotracheobronchitis) (Nelson's Respiratory Diseases, OP Ghai)

Q4.4 [Hematology] A 10-month-old child presents with severe pallor, massive splenomegaly, and hemoglobin of 4.5 g/dL. Peripheral smear shows microcytic hypochromic anemia with target cells, nucleated RBCs, and poikilocytosis. Hb electrophoresis shows HbF 90%, HbA2 elevated. Name this condition.

Answer: Beta-thalassemia major (Cooley's anemia) (OP Ghai Hematology, Nelson's)

Q4.5 [Nephrology] The triad of hematuria, proteinuria, and hypertension following a streptococcal throat infection by 10-21 days is characteristic of which condition? Name the complement component that is typically low in serum.

Answer: Post-streptococcal (Acute Post-infectious) Glomerulonephritis (APSGN); serum C3 is typically low (OP Ghai Nephrology, Nelson's)

Q4.6 [Hepatology] A 4-year-old child presents with progressive jaundice, acholic stools, and dark urine since birth. Liver biopsy shows bile duct proliferation and fibrosis. Name this condition and the surgical procedure of choice.

Answer: Biliary Atresia - Surgical procedure: Kasai portoenterostomy (hepatoportoenterostomy) (Nelson's GI/Hepatology, OP Ghai)

Q4.7 [GI] (Spare) A 6-week-old male infant presents with non-bilious projectile vomiting after every feed, olive-shaped mass palpable in the epigastrium, and the infant appears hungry after vomiting. Name this condition and the diagnostic ultrasound finding.

Answer: Hypertrophic Pyloric Stenosis - Ultrasound: pyloric muscle thickness >4 mm and channel length >17 mm (Nelson's, OP Ghai Neonatology/GI)

Q4.8 [Neurology] (Spare) Which inherited neurodegenerative disorder presents with progressive ataxia, absent deep tendon reflexes, pes cavus, cardiomyopathy, and spinal cord degeneration? Name the mode of inheritance.

Answer: Friedreich's Ataxia - Mode of inheritance: Autosomal recessive (GAA triplet repeat expansion in frataxin gene on chromosome 9) (Nelson's Neurology, OP Ghai)

Q5.1 [Cardiology] A newborn develops cyanosis within the first 24 hours of life, worsens on crying, but improves with crying (opposite of most lung disease). Chest X-ray shows "egg on a string" appearance. Name this congenital heart defect.

Answer: Transposition of the Great Arteries (d-TGA) (Nelson's Cardiology, OP Ghai)

Q5.2 [Pulmonology] The criteria for diagnosis of Severe Pneumonia in a child aged 2-59 months as per IMNCI/WHO guidelines includes which specific clinical sign (other than cough/breathing difficulty)?

Answer: Chest indrawing (subcostal/lower chest wall indrawing) (WHO/IMNCI guidelines; OP Ghai Respiratory)

Q5.3 [Nephrology] A 5-year-old boy has periorbital edema, frothy urine, serum albumin 1.8 g/dL, proteinuria 3+ on dipstick, and no hematuria. Most likely diagnosis and the steroid regime used?

Answer: Nephrotic Syndrome (Minimal Change Disease most likely); steroids - Prednisolone 2 mg/kg/day (max 60 mg/day) for 4-6 weeks, then 1.5 mg/kg on alternate days (ISKDC protocol; OP Ghai, Nelson's)

Q5.4 [GI] A 3-month-old infant has painless, massive rectal bleeding with "currant jelly stools." On abdominal examination there is a sausage-shaped mass in the right abdomen. Name this condition and its treatment of choice.

Answer: Intussusception - Treatment of choice: Air enema reduction (pneumatic reduction) or hydrostatic (saline/barium) enema (OP Ghai Surgery/GI, Nelson's)

Q5.5 [Hematology] Hemophilia A is caused by deficiency of which clotting factor? Name the X-linked inheritance pattern and the specific coagulation test that is prolonged.

Answer: Factor VIII deficiency; X-linked recessive; prolonged aPTT (activated Partial Thromboplastin Time) with normal PT (Nelson's Hematology, OP Ghai)

Q5.6 [Hepatology] A 10-year-old child presents with Kayser-Fleischer rings on slit-lamp examination, liver disease, and neuropsychiatric symptoms. Serum ceruloplasmin is low. Name this condition and the gene involved.

Answer: Wilson's Disease (Hepatolenticular degeneration) - gene: ATP7B (on chromosome 13); autosomal recessive (Nelson's, OP Ghai)

Q5.7 [Neurology] (Spare) A 6-year-old presents with severe headache, vomiting, and papilledema. MRI shows a midline cerebellar mass in the fourth ventricle. The most common primary brain tumor in children is?

Answer: Medulloblastoma (most common malignant brain tumor in children; arises in cerebellum/posterior fossa) (Nelson's Oncology/Neurology)

Q5.8 [Pulmonology] (Spare) The sweat chloride test is diagnostic for which condition? What is the cutoff value for a positive test?

Answer: Cystic Fibrosis - sweat chloride >60 mmol/L is diagnostic (borderline 30-59 mmol/L) (Nelson's Pulmonology, OP Ghai)

ROUND 6 - SUBSPECIALTY & MISCELLANEOUS

(Endocrinology, Inborn Errors of Metabolism, PSM, Ophthalmology, ENT, Dermatology, Dentistry)

Q6.1 [Endocrinology] A 2-year-old child presents with tall stature, advanced bone age, pubic hair, and enlarged phallus (in boys) or clitoral enlargement (in girls), but small gonads. Serum 17-hydroxyprogesterone is markedly elevated. Name the enzyme deficiency.

Answer: 21-hydroxylase deficiency (most common cause of Congenital Adrenal Hyperplasia, accounting for ~95% of cases) (OP Ghai Endocrinology, Nelson's)

Q6.2 [Inborn Errors of Metabolism] A newborn detected on neonatal screening has elevated phenylalanine. If untreated, this leads to intellectual disability, seizures, fair skin, and musty odor of urine. Name the condition and the dietary treatment.

Answer: Phenylketonuria (PKU) - Treatment: Phenylalanine-restricted diet (low-phenylalanine formula) (Nelson's IEM, OP Ghai)

Q6.3 [PSM - Preventive & Social Medicine] Under the Indian National Immunization Schedule, which vaccine is given intradermally in the right deltoid region at birth?

Answer: BCG vaccine (Bacille Calmette-Guerin) (Park's Textbook of PSM; NIS India)

Q6.4 [Ophthalmology] A 2-year-old child has a white reflex (leukocoria) in the left eye. Ophthalmological examination reveals a retinal mass. Name the most common intraocular tumor of childhood and the gene implicated.

Answer: Retinoblastoma - gene: RB1 (tumor suppressor gene on chromosome 13q14) (Nelson's Ophthalmology/Oncology, OP Ghai)

Q6.5 [ENT] A 4-year-old child presents with recurrent episodes of unilateral blood-stained nasal discharge with a foul smell. The most likely diagnosis is?

Answer: Foreign body in the nose (OP Ghai ENT, Nelson's)

Q6.6 [Dermatology] A 6-week-old infant develops vesiculopustular lesions on the scalp, face, and trunk. Tzanck smear shows multinucleated giant cells. The causative virus is a member of which family, and name the condition.

Answer: Neonatal Herpes Simplex - caused by Herpes Simplex Virus (HSV) (family Herpesviridae); Tzanck smear shows multinucleated giant cells (Nelson's Neonatology/Dermatology, OP Ghai)

Q6.7 [Endocrinology] (Spare) The most common cause of hyperthyroidism in children and adolescents, characterized by diffuse goiter, exophthalmos, and pretibial myxedema, is which autoimmune disease? Name the autoantibody responsible.

Answer: Graves' disease - autoantibody: TSH receptor antibody (TRAb / thyroid-stimulating immunoglobulin, TSI) (Nelson's Endocrinology, OP Ghai)

Q6.8 [Dermatology] (Spare) A 10-year-old child has hypopigmented macules with reduced sensation and thickened peripheral nerves. The causative organism is?

Answer: Mycobacterium leprae (cause of Leprosy/Hansen's disease) (Park's PSM, OP Ghai Dermatology)

TIE BREAKER ROUND (4 Questions)

TB.1 The "triple test" for Down syndrome in the second trimester consists of three maternal serum markers. Name all three.

Answer: Alpha-fetoprotein (AFP) - low, Human chorionic gonadotropin (hCG) - high, and Unconjugated estriol (uE3) - low (Nelson's Genetics, OP Ghai)

TB.2 Which specific inclusion body is seen in neurons in Rabies encephalitis on histopathology?

Answer: Negri bodies (eosinophilic intracytoplasmic inclusions in hippocampal neurons / Purkinje cells) (Robbins Pathology, OP Ghai)

TB.3 Name the syndrome characterized by the combination of congenital cataracts, patent ductus arteriosus, and sensorineural deafness following maternal infection in the first trimester.

Answer: Congenital Rubella Syndrome (Gregg's triad) (Nelson's - Congenital Infections, OP Ghai)

TB.4 A 7-year-old child has episodic facial flushing, watery diarrhea, and wheezing. Urine 5-HIAA levels are elevated. Name this tumor and its most common site of origin in children.

Answer: Carcinoid tumor - most common site: appendix (in children) (Nelson's Oncology/GI)

Summary Table

Round	Topics	Questions
Round 1	Basic Sciences	6 + 2 spare = 8
Round 2	General Pediatrics	6 + 2 spare = 8
Round 3	Infections, Vaccines, Neonatology	6 + 2 spare = 8
Round 4	Systems Part 1	6 + 2 spare = 8
Round 5	Systems Part 2	6 + 2 spare = 8
Round 6	Subspecialty & Miscellaneous	6 + 2 spare = 8
Tie Breaker	Mixed	4
Total		52 questions

Key notes on question design:

All questions have specific, single answers - no yes/no, no controversial answers
Questions are sourced from OP Ghai Essential Pediatrics (9th Ed), Nelson's Textbook of Pediatrics (21st Ed), Harriet Lane Handbook (23rd Ed), Park's PSM, Robbins Pathology, and Harper's Biochemistry
Difficulty is balanced within each round - some straightforward factual, some application-based
Questions are designed so that if passed to another team, the answer cannot be easily guessed by elimination
Spare questions are clearly marked for use in case of audience interference or other reasons making original questions invalid

Take time and give me all possible questions and answers from op ghai nelson

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Here is the most comprehensive IAP-style question bank possible, drawn from OP Ghai Essential Pediatrics (9th Ed) and Nelson's Textbook of Pediatrics (21st Ed), strictly following IAP quiz guidelines.

39th IAP PEDIATRIC QUIZ FOR UNDERGRADUATES - 2026

COMPLETE QUESTION BANK

ROUND 1 - BASIC SCIENCES

Physiology | Anatomy & Embryology | Biochemistry | Pathology | Immunology | Microbiology | Pharmacology

PHYSIOLOGY

Q1. The normal fetal hemoglobin (HbF) has a higher oxygen affinity than adult HbA. Which specific subunit difference accounts for this property? A: HbF has gamma (γ) chains instead of beta (β) chains. Gamma chains bind 2,3-DPG less avidly, resulting in higher O₂ affinity. (Nelson's - Hematology; OP Ghai)

Q2. The total body water as a percentage of body weight is highest at which stage of life and what is the approximate percentage? A: Preterm neonates - approximately 80-85% of body weight (Nelson's - Fluid & Electrolytes; OP Ghai)

Q3. At birth, the normal newborn has a higher hematocrit than adults. What is the normal hemoglobin range in a term newborn at birth? A: 14-20 g/dL (mean ~17 g/dL) (OP Ghai Neonatology; Harriet Lane Handbook)

Q4. The functional residual capacity (FRC) of the lung is maintained by surfactant. What is the primary phospholipid component of surfactant? A: Dipalmitoylphosphatidylcholine (DPPC) - also called lecithin (Nelson's Respiratory; OP Ghai)

Q5. Which nerve supplies all the intrinsic muscles of the tongue except the palatoglossus? A: Hypoglossal nerve (CN XII) (Gray's Anatomy / OP Ghai Anatomy)

Q6. The renin-angiotensin-aldosterone axis (RAAS) plays a key role in sodium balance. Which cells of the kidney secrete renin? A: Juxtaglomerular (JG) cells of the afferent arteriole (Nelson's - Nephrology; Ganong Physiology)

Q7. What is the normal glomerular filtration rate (GFR) in a full-term newborn at birth (expressed per 1.73 m²)? A: Approximately 20-30 mL/min/1.73 m² (reaches adult values ~2 years of age) (OP Ghai Nephrology; Nelson's)

Q8. The sinoatrial (SA) node is the primary pacemaker of the heart. Which coronary artery supplies it in approximately 60% of individuals? A: Right coronary artery (RCA) (Braunwald's Heart Disease; OP Ghai Cardiology)

ANATOMY & EMBRYOLOGY

Q9. The foramen ovale connects the two atria in fetal circulation. When does it functionally close after birth? A: Within hours to days after birth (due to reversal of pressure gradient); anatomical closure occurs by 3 months in most; probe-patent in ~25% adults (Nelson's Cardiology; OP Ghai)

Q10. The ductus venosus connects the umbilical vein to the inferior vena cava, bypassing the liver. It closes to form which ligament? A: Ligamentum venosum (OP Ghai Anatomy; Nelson's)

Q11. The primitive gut is divided into foregut, midgut, and hindgut. The midgut rotates around the superior mesenteric artery during development. Failure of this rotation results in which condition? A: Malrotation of the gut (intestinal malrotation) - may cause volvulus neonatorum (Nelson's GI; OP Ghai)

Q12. Thyroid gland develops from which pharyngeal pouch and migrates downward via which tract? A: Develops from the floor of the pharynx (foramen cecum at base of tongue); migrates via the thyroglossal duct. A persistent duct forms a thyroglossal cyst. (OP Ghai; Nelson's Endocrinology)

Q13. The cleft palate results from failure of fusion of which embryological structures? A: Failure of fusion of the palatine shelves (lateral palatal processes) - which normally fuse by 8-9 weeks of gestation (OP Ghai Embryology; Nelson's)

Q14. The neural tube defect anencephaly results from failure of closure of which neuropore? A: Anterior neuropore (cranial end) fails to close - Day 24-26 of gestation (Nelson's Neurology; OP Ghai)

Q15. The meckel's diverticulum is a remnant of which embryological structure and follows the "rule of 2s" - name three of the "2s". A: Remnant of vitello-intestinal duct (omphalomesenteric duct). Rule of 2s: 2% of population, 2 feet from ileocecal valve, 2 inches long, presents in first 2 years, 2 types of ectopic mucosa (gastric, pancreatic) (Nelson's GI; OP Ghai)

BIOCHEMISTRY

Q16. Glucose-6-phosphate dehydrogenase (G6PD) deficiency causes hemolytic anemia when exposed to oxidant stress. This enzyme is part of which metabolic pathway? A: Hexose monophosphate shunt (Pentose phosphate pathway) (Harper's Biochemistry; Nelson's Hematology; OP Ghai)

Q17. In a newborn with galactosemia, accumulation of which toxic metabolite causes cataracts, liver damage, and intellectual disability? A: Galactitol (from accumulation of galactose-1-phosphate and reduction of galactose) (Nelson's IEM; OP Ghai; Harper's Biochemistry)

Q18. The urea cycle takes place in two cellular compartments. Name both. A: Mitochondria (first two steps: carbamoyl phosphate synthetase I, ornithine transcarbamylase) and cytosol (remaining steps) (Harper's Biochemistry; Lippincott Biochemistry)

Q19. Maple syrup urine disease (MSUD) involves deficient decarboxylation of which three amino acids, giving urine the characteristic sweet smell? A: Leucine, Isoleucine, and Valine (branched-chain amino acids) - deficiency of branched-chain alpha-ketoacid dehydrogenase complex (Nelson's IEM; OP Ghai; Harper's)

Q20. Which enzyme is deficient in Gaucher's disease, and what substrate accumulates in macrophages? A: Glucocerebrosidase (beta-glucosidase) is deficient; glucocerebroside (glucosylceramide) accumulates (Nelson's IEM; Robbins Pathology; OP Ghai)

Q21. Vitamin B12 (cobalamin) deficiency in children presents with megaloblastic anemia. Which specific cell type in the stomach produces intrinsic factor necessary for B12 absorption? A: Parietal cells (oxyntic cells) of the gastric fundus (Nelson's; OP Ghai Nutrition)

Q22. The enzyme deficient in Lesch-Nyhan syndrome leads to accumulation of uric acid and neurological features including self-mutilation. Name the enzyme. A: Hypoxanthine-guanine phosphoribosyltransferase (HGPRT) (Nelson's; OP Ghai; Robbins)

PATHOLOGY

Q23. A "sunburst pattern" or "Codman's triangle" on X-ray of a bone in an adolescent suggests which tumor? A: Osteosarcoma (Codman's triangle = periosteal elevation; sunburst = perpendicular bone spicules) (Nelson's Oncology; Robbins Pathology; OP Ghai)

Q24. "Onion skin" periosteal reaction on X-ray of long bones in a child is characteristic of which primary bone tumor? A: Ewing's sarcoma (Nelson's Oncology; Robbins; OP Ghai)

Q25. Aschoff nodules are found in the myocardium in which condition and what do they consist of? A: Acute Rheumatic Fever (ARF) - Aschoff nodules are granulomas consisting of Aschoff cells (giant cells with owl-eye nuclei), lymphocytes, and fibrinoid necrosis (Nelson's Cardiology; Robbins Pathology; OP Ghai)

Q26. Which type of hypersensitivity reaction is responsible for serum sickness in children? A: Type III hypersensitivity (Immune complex-mediated / Arthus type) (Nelson's Immunology; Robbins Pathology; OP Ghai)

Q27. The histological hallmark of celiac disease is which specific finding on small intestinal biopsy? A: Villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes (IELs) (Nelson's GI; Robbins Pathology; OP Ghai)

IMMUNOLOGY

Q28. Bruton's agammaglobulinemia affects which cells? What is the mode of inheritance and the defective gene? A: Affects B cells (absent B cells, all immunoglobulins markedly reduced); X-linked recessive; defective gene: BTK (Bruton's tyrosine kinase) (Nelson's Immunology; OP Ghai)

Q29. In DiGeorge syndrome, which embryological structures fail to develop, leading to absent thymus and parathyroid glands? A: Failure of development of 3rd and 4th pharyngeal pouches; associated with 22q11.2 deletion (Nelson's Immunology; OP Ghai)

Q30. The complement pathway that is activated by antigen-antibody complexes is the classical pathway. Which complement component is shared between the classical and lectin pathways? A: C4, C2 (both classical and lectin pathways converge at C3 via the C3 convertase C4b2a) (Nelson's Immunology; Robbins Pathology)

Q31. Which immunoglobulin is the most abundant in secretions like breast milk, saliva, and intestinal mucosa? A: IgA (specifically secretory IgA, sIgA) - exists as a dimer with a J chain and secretory component (Nelson's Immunology; OP Ghai)

Q32. SCID (Severe Combined Immunodeficiency) most commonly results from deficiency of which enzyme in the autosomal recessive form? A: Adenosine deaminase (ADA) deficiency - leads to accumulation of toxic deoxyadenosine metabolites (Nelson's Immunology; OP Ghai)

Q33. What is the name of the test used to diagnose chronic granulomatous disease (CGD) in children with recurrent catalase-positive bacterial infections? A: Dihydrorhodamine (DHR) flow cytometry (or formerly the Nitroblue Tetrazolium / NBT test - defective NADPH oxidase fails to reduce NBT to formazan) (Nelson's Immunology; OP Ghai)

MICROBIOLOGY

Q34. The most common organism causing urinary tract infection (UTI) in children is? A: Escherichia coli (accounts for ~80% of UTIs in children) (OP Ghai Nephrology; Nelson's; Harriet Lane)

Q35. Which organism causes whooping cough (pertussis) and which specific toxin is responsible for the lymphocytosis seen in this disease? A: Bordetella pertussis; Pertussis toxin (PT) causes lymphocytosis by blocking lymphocyte egress from lymph nodes (Nelson's Infectious Diseases; OP Ghai)

Q36. The Weil-Felix test uses cross-reacting antigens from Proteus species. For which group of infections is this test used as a screening tool? A: Rickettsial infections (typhus, spotted fevers) (Nelson's Infectious Diseases; OP Ghai; Park's PSM)

Q37. Which capsulated bacterium was historically the most common cause of acute bacterial meningitis in children aged 2 months to 5 years before vaccination? A: Haemophilus influenzae type b (Hib) (Nelson's Infectious Diseases; OP Ghai)

Q38. The organism responsible for scarlet fever produces which toxin that causes the characteristic skin findings? A: Streptococcus pyogenes (Group A Streptococcus); toxin: Erythrogenic toxin (Streptococcal pyrogenic exotoxin / SPE) (Nelson's Infectious Diseases; OP Ghai)

Q39. The "school of fish" pattern on gram stain is characteristic of which organism causing soft tissue infections in children after water exposure or animal bites? A: Streptobacillus moniliformis causes rat-bite fever; the "school of fish/railroad tracks" pattern is seen with Haemophilus ducreyi (chancroid) - but for pediatric context, the "school of fish" Gram stain appearance is H. influenzae Corrected A: The "Chinese letters" pattern = Corynebacterium diphtheriae; "school of fish" = Haemophilus ducreyi; Gram stain "safety pin" = Yersinia pestis (Nelson's Infectious Diseases; OP Ghai Microbiology)

Q40. The Mantoux test (TST) uses purified protein derivative (PPD). What is the reading criterion for a positive test in an immunocompromised child (e.g., HIV positive)? A: ≥5 mm induration at 48-72 hours is considered positive in immunocompromised children (OP Ghai; Nelson's; WHO TB guidelines)

PHARMACOLOGY

Q41. Chloramphenicol in neonates causes which toxicity syndrome, and why are neonates particularly susceptible? A: Gray baby syndrome (cardiovascular collapse, abdominal distension, ashen-gray color); neonates are susceptible due to immature hepatic glucuronyl transferase (reduced conjugation) and immature renal excretion (Nelson's Pharmacology; OP Ghai)

Q42. Which antibiotic class is absolutely contraindicated in children under 8 years of age due to permanent tooth discoloration? A: Tetracyclines (bind to calcium in developing teeth and bones) (Nelson's Pharmacology; OP Ghai)

Q43. Digoxin toxicity in children presents with specific ECG changes. Name the earliest ECG sign of digoxin toxicity. A: Shortened QT interval (then ST depression "scooping", PR prolongation, followed by arrhythmias in severe toxicity) (Nelson's Cardiology/Pharmacology; OP Ghai)

Q44. The drug of choice for status epilepticus in children (first-line benzodiazepine administered intravenously) is? A: Lorazepam (IV); alternatively diazepam (IV or rectal) or midazolam (buccal/IM) if IV access unavailable (Nelson's Neurology; OP Ghai)

Q45. Aspirin (salicylate) is associated with which potentially fatal hepatoencephalopathy syndrome in children following a viral illness, especially influenza or chickenpox? A: Reye syndrome (Nelson's; OP Ghai)

ROUND 2 - GENERAL PEDIATRICS

Nutrition | Growth & Development | Fluid & Electrolytes | Behavioral Sciences

NUTRITION

Q46. Which vitamin deficiency causes night blindness (nyctalopia) and Bitot's spots on the conjunctiva in children? A: Vitamin A (Retinol) deficiency (OP Ghai Nutrition; Nelson's)

Q47. Scurvy (Vitamin C deficiency) in children presents with periosteal hemorrhage, bleeding gums, and perifollicular hemorrhage. What is the specific name of the subperiosteal hemorrhage seen radiologically at the metaphysis? A: Trümmerfeld zone (zone of rarefaction) and Pelkan spur (corner sign); the periosteal elevation due to subperiosteal hematoma is classically described as the "Pelkan spur" (OP Ghai Nutrition; Nelson's)

Q48. Pellagra results from deficiency of which vitamin? Name the classic triad of symptoms. A: Niacin (Vitamin B3 / Nicotinic acid) deficiency; classic triad: Dermatitis, Diarrhea, Dementia ("3 Ds") (OP Ghai Nutrition; Nelson's)

Q49. The World Health Organization (WHO) recommends exclusive breastfeeding for how long? Name two specific advantages of exclusive breastfeeding over formula. A: 6 months; advantages include: protection against infections (secretory IgA, lactoferrin), optimal nutrient bioavailability, reduced risk of SIDS, promotes bonding, reduces obesity risk, cognitive benefits (OP Ghai Nutrition; WHO guidelines)

Q50. Which amino acid is considered conditionally essential in preterm neonates and is deficient in total parenteral nutrition if not supplemented? A: Cysteine (and taurine) - preterm infants cannot synthesize from methionine due to immature hepatic cystathionase enzyme (Nelson's Neonatology/Nutrition; OP Ghai)

Q51. Zinc deficiency in children causes a specific syndrome of dwarfism, hypogonadism, and skin changes. Name this eponymous syndrome. A: Prasad syndrome (Zinc deficiency syndrome) - described by Ananda Prasad in Iran/Egypt; features: growth retardation, hypogonadism, rough skin, poor wound healing (OP Ghai Nutrition; Nelson's)

Q52. Acrodermatitis enteropathica is an autosomal recessive disorder of zinc absorption. Which specific transporter is defective? A: ZIP4 (SLC39A4) transporter in the enterocytes of the duodenum/jejunum (Nelson's IEM/Nutrition; OP Ghai)

Q53. The mid-upper arm circumference (MUAC) cutoff for severe acute malnutrition (SAM) in children aged 6-59 months is? A: Less than 11.5 cm (<115 mm) (WHO/IAP guidelines; OP Ghai Nutrition)

Q54. Iodine deficiency is the most common preventable cause of which condition worldwide? A: Intellectual disability (Cretinism / Congenital hypothyroidism) - also causes goiter, hypothyroidism, and endemic cretinism (OP Ghai; Nelson's; Park's PSM)

Q55. Which fat-soluble vitamin toxicity in a child causes pseudotumor cerebri (benign intracranial hypertension), hepatotoxicity, and alopecia? A: Vitamin A (hypervitaminosis A) toxicity (OP Ghai Nutrition; Nelson's)

GROWTH & DEVELOPMENT

Q56. At what age does a normal child's birth weight double, triple, and quadruple? A: Birth weight doubles by 5 months; triples by 1 year; quadruples by 2 years (OP Ghai Growth & Development; Nelson's)

Q57. The Denver Developmental Screening Test II (DDST-II) assesses development in four domains. Name all four domains. A: Personal-social, Fine motor-adaptive, Language, Gross motor (OP Ghai Developmental Pediatrics; Nelson's)

Q58. The posterior fontanelle closes at what age, and what is the anterior fontanelle's normal closing age? A: Posterior fontanelle: 6-8 weeks after birth; Anterior fontanelle: 12-18 months (mean 14 months) (OP Ghai Growth & Development; Nelson's)

Q59. A 9-month-old infant can pincer grasp, says "mama/dada" non-specifically, and waves "bye-bye." This corresponds to what age of development for the milestone of "pincer grasp"? A: Pincer grasp (inferior pincer) normally appears at 9 months; neat pincer at 12 months (OP Ghai Developmental Pediatrics; Nelson's)

Q60. The Tanner staging of puberty in boys describes genital and pubic hair development in stages 1-5. In which Tanner stage does the peak height velocity (PHV) occur in boys? A: Tanner Stage 3-4 (approximately; peak height velocity in boys occurs at ~13.5 years, during mid-puberty) (OP Ghai Growth & Puberty; Nelson's)

Q61. The bone age (skeletal maturity) is assessed radiologically using which standard atlas? A: Greulich and Pyle atlas (using left hand and wrist X-ray); alternatively the TW2 (Tanner-Whitehouse 2) method (OP Ghai Growth; Nelson's)

Q62. Constitutional delay of growth and puberty (CDGP) is the most common cause of short stature in boys. What is the bone age finding in CDGP? A: Bone age is delayed (matching height age, not chronological age); growth velocity is normal; family history of late puberty typically present (OP Ghai Endocrinology/Growth; Nelson's)

Q63. At what chronological age does the head circumference of a child normally equal the chest circumference? A: At 6 months of age (before 6 months, HC > CC; after 6 months, CC > HC) (OP Ghai Growth & Development; Nelson's)

FLUID & ELECTROLYTES

Q64. A 6-month-old child with severe dehydration (>10% body weight loss) shows skin turgor >2 seconds, sunken eyes, no tears, and a rapid feeble pulse. Which type of fluid and how much is given as the initial resuscitation bolus? A: Normal saline (0.9% NaCl) or Ringer's lactate, 20 mL/kg IV bolus over 15-30 minutes (repeat as needed) (Nelson's Fluid & Electrolytes; OP Ghai; WHO IMCI guidelines)

Q65. Hypernatremic dehydration (serum Na >150 mEq/L) is particularly dangerous to correct rapidly. Why, and what is the recommended rate of correction? A: Rapid correction causes cerebral edema (cells have adapted by producing idiogenic osmoles); recommend correction over 48 hours, reducing serum Na by no more than 0.5 mEq/L/hour (or 10-12 mEq/L/day) (Nelson's Fluid & Electrolytes; OP Ghai)

Q66. The Holliday-Segar method is used to calculate maintenance fluid requirements. For a child weighing 25 kg, what is the maintenance fluid requirement in mL/day? A: First 10 kg: 100 mL/kg = 1000 mL; next 10 kg: 50 mL/kg = 500 mL; remaining 5 kg: 20 mL/kg = 100 mL; Total = 1600 mL/day (Nelson's; OP Ghai; Harriet Lane)

Q67. Pyloric stenosis causes which specific electrolyte and acid-base disturbance? A: Hypochloremic, hypokalemic metabolic alkalosis (due to loss of HCl and K⁺ in vomiting; paradoxical aciduria) (Nelson's GI/Fluid; OP Ghai)

BEHAVIORAL SCIENCES

Q68. The diagnostic criteria for Autism Spectrum Disorder (ASD) require persistent deficits in two core domains. Name them. A: (1) Deficits in social communication and social interaction across multiple contexts; (2) Restricted, repetitive patterns of behavior, interests, or activities (DSM-5; Nelson's Behavioral Pediatrics; OP Ghai)

Q69. Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms must be present before which age to fulfill DSM-5 diagnostic criteria? A: Before 12 years of age (DSM-5; previously DSM-IV required onset before 7 years) (DSM-5; Nelson's Behavioral Pediatrics; OP Ghai)

Q70. The term for repeated, involuntary, purposeless motor or vocal behaviors in a child that last >1 year describes which condition? A: Tourette Disorder (Tourette Syndrome) - multiple motor AND one or more vocal tics for >1 year (Nelson's Behavioral Pediatrics; OP Ghai; DSM-5)

Q71. Enuresis (bedwetting) is considered pathological (not just developmental) in children above what age? A: 5 years of age (primary nocturnal enuresis is a clinical concern if wetting persists beyond age 5) (OP Ghai Behavioral Pediatrics; Nelson's)

ROUND 3 - INFECTIOUS DISEASES, VACCINES, IMMUNIZATION & NEONATOLOGY

INFECTIOUS DISEASES

Q72. The "strawberry tongue" (initially white coated then red) is seen in which two pediatric conditions? A: Scarlet fever (Group A Strep) and Kawasaki disease (Nelson's Infectious Diseases; OP Ghai)

Q73. Hand, foot, and mouth disease (HFMD) is caused most commonly by which two viruses? A: Coxsackievirus A16 and Enterovirus 71 (EV-A71) (Nelson's Infectious Diseases; OP Ghai)

Q74. The Hutchinson's triad of congenital syphilis in the late stage consists of which three components? A: Interstitial keratitis, Hutchinson's teeth (notched incisors), and Eighth nerve deafness (sensorineural hearing loss) (Nelson's Infectious Diseases; OP Ghai)

Q75. A child with HIV infection has a CD4 count of 150 cells/mm³ (age 3 years). Which opportunistic infection prophylaxis should be started? A: Cotrimoxazole (TMP-SMX) for Pneumocystis jirovecii pneumonia (PCP) prophylaxis; started when CD4 <500 or <25% in children <5 years (Nelson's Infectious Diseases/HIV; OP Ghai; NACO guidelines)

Q76. The classical triad of congenital rubella syndrome (Gregg's triad) is? A: Cataracts, Congenital heart disease (PDA/pulmonary stenosis), and Sensorineural deafness (Nelson's Infectious Diseases; OP Ghai)

Q77. Roseola infantum (Exanthem subitum / Sixth disease) is caused by which virus and what is the characteristic feature of the rash? A: Human Herpesvirus 6 (HHV-6); rash appears as the fever suddenly breaks (rose-pink maculopapular rash on trunk, lasting 1-2 days) (Nelson's Infectious Diseases; OP Ghai)

Q78. The specific sign - vesicular lesion on the pinna of the ear with ipsilateral facial nerve palsy and ear pain in a child - is called? A: Ramsay Hunt Syndrome (Herpes Zoster Oticus) - caused by reactivation of Varicella-Zoster Virus (VZV) in the geniculate ganglion (Nelson's Infectious Diseases; OP Ghai ENT)

Q79. Dengue hemorrhagic fever is classified into grades. What defines Grade III dengue hemorrhagic fever (DHF)? A: Grade III: Circulatory failure manifested by rapid/weak pulse, narrow pulse pressure (≤20 mmHg), or hypotension + restlessness (Dengue Shock Syndrome begins) (WHO Dengue Guidelines; OP Ghai; Nelson's)

Q80. The tourniquet test (Rumpel-Leede test) is positive in dengue when how many petechiae are seen in a 1-inch square area of the forearm? A: ≥10 petechiae per 1 square inch (or ≥20 per 2.5 cm²) (WHO Dengue Classification; OP Ghai; Nelson's)

Q81. The organism causing cat scratch disease in children, presenting with regional lymphadenopathy after cat scratch, is? A: Bartonella henselae (Nelson's Infectious Diseases; OP Ghai)

Q82. Erythema infectiosum (Fifth disease) is caused by which virus, and what is its pathognomonic sign? A: Parvovirus B19; pathognomonic: "Slapped cheek" appearance (bright red flush of cheeks with circumoral pallor) (Nelson's Infectious Diseases; OP Ghai)

Q83. The drug of choice for treatment of typhoid fever in children (where fluoroquinolone sensitivity is maintained) is? A: Ceftriaxone (IV) for severe/hospitalized cases; Azithromycin for uncomplicated outpatient typhoid; Cefixime for oral treatment (Nelson's Infectious Diseases; OP Ghai; WHO)

Q84. Malaria in children - which species of Plasmodium causes the most severe/cerebral malaria, and which causes the longest-lasting liver dormancy (hypnozoites)? A: Most severe: P. falciparum; longest liver dormancy (hypnozoites for up to 3-5 years): P. vivax and P. ovale (Nelson's Infectious Diseases; OP Ghai; Park's PSM)

VACCINES & IMMUNIZATION

Q85. BCG vaccine is a live attenuated vaccine derived from Mycobacterium bovis. It is most effective in preventing which specific form of tuberculosis in children? A: Miliary tuberculosis and Tuberculous meningitis (provides ~80% protection against these severe disseminated forms in children) (OP Ghai; Nelson's; Park's PSM)

Q86. Cold chain is the maintenance of vaccines at recommended temperatures from manufacture to administration. What is the recommended temperature range for most vaccines in the cold chain at the health centre level (PHC)? A: +2°C to +8°C (Park's PSM; NIS India; WHO EPI)

Q87. The Oral Polio Vaccine (OPV) is a trivalent live attenuated vaccine. Vaccine-associated paralytic poliomyelitis (VAPP) is associated with which serotype most commonly? A: Type 3 (most common); Type 1 also associated; Type 2 was removed from tOPV to form bOPV after wild poliovirus type 2 eradication (OP Ghai; Nelson's Infectious Diseases; Park's PSM)

Q88. The IAP (Indian Academy of Pediatrics) recommended immunization schedule 2023-24 includes the Rotavirus vaccine. Name the two oral rotavirus vaccines licensed in India. A: Rotavac (monovalent, Bharat Biotech) and Rotasiil (pentavalent, Serum Institute); also Rotarix (GlaxoSmithKline, 2-dose) and RotaTeq (Merck, 3-dose) are WHO-prequalified (IAP Immunization Schedule 2023-24; OP Ghai)

Q89. The hepatitis B vaccine schedule at birth is crucial for preventing perinatal transmission. A birth dose must be given within how many hours of birth for maximum effectiveness in preventing vertical transmission? A: Within 24 hours of birth (ideally within 12 hours) (IAP/NIS guidelines; OP Ghai; Nelson's)

Q90. The Varicella vaccine is a live attenuated vaccine. IAP recommends two doses - at what ages? A: 15 months (first dose) and 4-6 years (second dose) as per IAP 2023-24 schedule (IAP Immunization Schedule 2023-24; OP Ghai)

NEONATOLOGY

Q91. A preterm neonate at 28 weeks gestation develops increasing respiratory distress, grunting, and requires oxygen within 4 hours of birth. CXR shows a ground-glass appearance with air bronchograms. Name the condition and the specific surfactant protein most important for its pathogenesis. A: Respiratory Distress Syndrome (RDS) / Hyaline Membrane Disease (HMD); deficiency of Surfactant Protein B (SP-B) and dipalmitoylphosphatidylcholine (DPPC) is the primary cause (Nelson's Neonatology; OP Ghai)

Q92. The first-line treatment for neonatal seizures (after benzodiazepines) is which drug, and what is the loading dose? A: Phenobarbital (Phenobarbitone) - loading dose 20 mg/kg IV (can give additional 10 mg/kg boluses to maximum 40 mg/kg) (Nelson's Neonatology; OP Ghai; Harriet Lane)

Q93. Necrotizing enterocolitis (NEC) is graded by the modified Bell's staging criteria. What defines Stage IIA? A: Stage IIA: Mildly ill - signs of intestinal involvement (abdominal distension, bloody stools, absent bowel sounds), radiograph shows intestinal pneumatosis (intramural gas) (Nelson's Neonatology; OP Ghai)

Q94. In a newborn with cyanosis, the "Hyperoxia test" (100% O₂ for 10 minutes) is performed. A PaO₂ that does NOT rise above 150 mmHg suggests which type of pathology? A: Cyanotic congenital heart disease (fixed right-to-left shunt) rather than primary pulmonary disease (Nelson's Neonatology/Cardiology; OP Ghai)

Q95. The single most important risk factor for intraventricular hemorrhage (IVH) in neonates is? A: Prematurity (especially <32 weeks gestation); the germinal matrix is fragile and highly vascularized (Nelson's Neonatology; OP Ghai)

Q96. Retinopathy of prematurity (ROP) - Zone I, Stage 3+ disease is treated with which modality as per current evidence? A: Intravitreal anti-VEGF (bevacizumab) or laser photocoagulation - anti-VEGF (bevacizumab) has become preferred for Zone I posterior disease (Nelson's Ophthalmology/Neonatology; OP Ghai; BEAT-ROP trial)

Q97. A neonate presents with jitteriness, seizures, and a blood glucose of 35 mg/dL. What is the definition of significant hypoglycemia in a term neonate after 48 hours of age? A: Blood glucose <47 mg/dL (<2.6 mmol/L) - though treatment threshold varies; operational threshold for IV glucose: <45 mg/dL after 48 h in symptomatic or <35 mg/dL in the first 48 h (Nelson's Neonatology; OP Ghai; Harriet Lane)

Q98. Meconium aspiration syndrome (MAS) - Meconium stained amniotic fluid is seen in what percentage of deliveries, and what complication of MAS can cause severe hypoxia and requires NO inhalation? A: Meconium staining in 10-15% of deliveries; complication: Persistent Pulmonary Hypertension of the Newborn (PPHN) - treated with inhaled Nitric Oxide (iNO) (Nelson's Neonatology; OP Ghai)

ROUNDS 4 & 5 - SYSTEMS

Neurology | Pulmonology | Cardiology | Hepatology | Hematology | Nephrology | GI

CARDIOLOGY

Q99. The "boot-shaped heart" (Coeur en sabot) on chest X-ray is characteristic of which congenital heart defect? A: Tetralogy of Fallot (TOF) (Nelson's Cardiology; OP Ghai)

Q100. Name the four components of Tetralogy of Fallot. A: (1) Ventricular Septal Defect (VSD) - large, perimembranous; (2) Pulmonary stenosis (RVOTO); (3) Overriding aorta; (4) Right ventricular hypertrophy (RVH) (Nelson's Cardiology; OP Ghai)

Q101. Hypercyanotic spells ("Tet spells") in TOF are treated acutely with which specific maneuver and drug? A: Knee-chest position (increases systemic vascular resistance); Morphine sulfate (0.1 mg/kg IV/SC) to reduce infundibular spasm; supplemental O₂; IV fluids; propranolol if recurrent (Nelson's Cardiology; OP Ghai; Harriet Lane)

Q102. The Jones criteria (revised 2015) for diagnosis of Acute Rheumatic Fever. Name all five major criteria. A: (1) Carditis (clinical or subclinical/echocardiographic); (2) Polyarthritis (migratory); (3) Chorea (Sydenham's); (4) Erythema marginatum; (5) Subcutaneous nodules (Aschoff nodules over bony prominences) (Nelson's Cardiology; OP Ghai; AHA 2015 Jones Criteria)

Q103. Which valve is most commonly affected in Rheumatic Heart Disease and what is the most common lesion? A: Mitral valve; most common lesion: Mitral stenosis (though mitral regurgitation is the earliest lesion in acute rheumatic carditis) (Nelson's Cardiology; OP Ghai)

Q104. Coarctation of the aorta classically presents with hypertension in the upper limbs and decreased/delayed femoral pulses. The coarctation is most commonly located at which specific anatomical site? A: Just distal to the origin of the left subclavian artery, at the level of the ligamentum arteriosum (juxtaductal) (Nelson's Cardiology; OP Ghai)

Q105. The "3 sign" on chest X-ray and "reverse 3 sign (E sign)" on barium swallow are characteristic of which congenital heart defect? A: Coarctation of the Aorta (Nelson's Cardiology; OP Ghai)

Q106. Complete transposition of the great arteries (d-TGA) - which procedure is performed within the first 2 weeks of life (current surgical correction)? A: Arterial switch operation (Jatene procedure) - switch of aorta and pulmonary artery with coronary artery reimplantation (Nelson's Cardiology; OP Ghai)

Q107. Eisenmenger syndrome refers to reversal of shunt direction in a left-to-right shunt lesion. What is the mechanism? A: Initially left-to-right shunt → pulmonary hypertension → pulmonary vascular obstructive disease → when pulmonary pressure exceeds systemic, shunt reverses to right-to-left → cyanosis (Nelson's Cardiology; OP Ghai)

Q108. The drug of choice for maintenance of normal sinus rhythm in children with SVT (supraventricular tachycardia) after adenosine conversion is? A: Propranolol (beta-blocker) or digoxin (except in pre-excitation/WPW); Flecainide or amiodarone for refractory cases (Nelson's Cardiology; OP Ghai; Harriet Lane)

NEUROLOGY

Q109. The commonest type of pediatric brain tumor overall (including both benign and malignant) is located in which part of the brain? A: Posterior fossa / Infratentorial (60-70% of pediatric brain tumors are infratentorial); most common single tumor: Astrocytoma (pilocytic astrocytoma) (Nelson's Oncology/Neurology; OP Ghai)

Q110. Febrile seizures - a simple febrile seizure is defined by three criteria. Name them. A: (1) Generalized tonic-clonic; (2) Duration <15 minutes; (3) Does not recur within 24 hours (single episode per febrile illness); child aged 6 months to 5 years, no underlying neurological disorder (Nelson's Neurology; OP Ghai)

Q111. Infantile spasms (West syndrome) - name the triad. A: (1) Infantile spasms (brief, symmetric, usually flexor/extensor); (2) Hypsarrhythmia on EEG (chaotic, high-voltage, disorganized); (3) Developmental regression/arrest (Nelson's Neurology; OP Ghai)

Q112. The drug of choice for infantile spasms (West syndrome) as per current evidence is? A: ACTH (Adrenocorticotropic hormone) or Vigabatrin (especially for tuberous sclerosis); ACTH is first-line for cryptogenic/unknown etiology; combination of ACTH + vigabatrin may be used (Nelson's Neurology; OP Ghai; UKISS trial)

Q113. Duchenne muscular dystrophy (DMD) - the serum enzyme that is markedly elevated (10-200x normal) and is used for initial screening is? A: Creatine kinase (CK) / Creatine phosphokinase (CPK) - elevated from birth, highest in early life (Nelson's Neuromuscular; OP Ghai)

Q114. The specific genetic mutation in Spinal Muscular Atrophy (SMA) involves deletion of which gene on chromosome 5q? A: SMN1 (Survival Motor Neuron 1) gene - homozygous deletion of exon 7 and/or 8 (Nelson's Neurology; OP Ghai)

Q115. A child with neurofibromatosis type 1 (NF1) has multiple café-au-lait spots. How many spots of what minimum diameter are required for diagnosis? A: ≥6 café-au-lait macules, each ≥5 mm (prepubertal) or ≥15 mm (postpubertal) (Nelson's Genetics/Neurology; OP Ghai)

Q116. Bacterial meningitis in children - the CSF glucose to serum glucose ratio in bacterial meningitis is typically? A: <0.6 (i.e., CSF glucose less than 60% of simultaneous blood glucose); typically <40 mg/dL absolute CSF glucose (Nelson's Infectious Diseases/Neurology; OP Ghai)

Q117. The finding of "papilledema on fundoscopy" in a child with headache and vomiting is a contraindication to which procedure before what imaging? A: Contraindication to lumbar puncture before performing CT brain (to rule out raised ICP / herniation risk) (Nelson's Neurology; OP Ghai; Harriet Lane)

PULMONOLOGY

Q118. The GINA classification of asthma severity is based on symptom frequency and lung function. Name the four GINA severity categories. A: (1) Intermittent; (2) Mild persistent; (3) Moderate persistent; (4) Severe persistent (Nelson's Pulmonology; OP Ghai; GINA guidelines)

Q119. Which specific finding on spirometry defines obstructive lung disease? A: FEV1/FVC ratio < 0.80 (or <LLN - lower limit of normal); reduced FEV1 with relatively preserved FVC (Nelson's Pulmonology; OP Ghai)

Q120. Primary ciliary dyskinesia (Kartagener syndrome) - name the classic triad. A: (1) Bronchiectasis; (2) Sinusitis (pansinusitis); (3) Situs inversus (dextrocardia) (Nelson's Pulmonology; OP Ghai)

Q121. A 3-year-old presents with sudden onset choking, followed by a unilateral wheeze. CXR shows unilateral hyperinflation on the affected side. Name this condition and the most common site of lodgement. A: Foreign body aspiration; most common site: Right main bronchus (more vertical, wider in children) (Nelson's Pulmonology; OP Ghai)

Q122. The drug used for acute severe asthma as a first-line bronchodilator in children is? A: Salbutamol (Albuterol) - short-acting beta-2 agonist (SABA), given via nebuliser or MDI + spacer; IV magnesium sulphate for severe/life-threatening episodes (Nelson's Pulmonology; OP Ghai; GINA)

Q123. Bronchopulmonary dysplasia (BPD) is diagnosed in a preterm neonate. The "new BPD" is defined as oxygen dependency at what corrected gestational age? A: 36 weeks postmenstrual age (corrected gestational age) - oxygen dependency or respiratory support at 36 weeks CGA (Jobe & Bancalari criteria) (Nelson's Neonatology/Pulmonology; OP Ghai)

HEPATOLOGY

Q124. In neonatal hepatitis, the liver biopsy shows giant cell transformation. Which specific stain is used to identify bile in liver histopathology? A: Hall's bile stain (Bilirubin stain) - or routinely, the giant cell hepatitis pattern is identified on H&E stain (Nelson's Hepatology; Robbins Pathology; OP Ghai)

Q125. The most common cause of acute liver failure in children in India is? A: Viral hepatitis - specifically Hepatitis A virus (HAV) and Hepatitis E virus (HEV) (Hepatitis B in neonates/infants) (OP Ghai Hepatology; Nelson's)

Q126. In Wilson's disease, urinary copper excretion after D-penicillamine challenge (500 mg twice daily for 2 days) is diagnostic if it exceeds? A: >1600 μg/24 hours (post-penicillamine challenge; normal baseline >100 μg/24h in untreated Wilson's) (Nelson's Hepatology; OP Ghai)

Q127. The CFTR gene mutation causing Cystic Fibrosis is most commonly which specific mutation worldwide? A: ΔF508 (delta F508) / F508del - deletion of phenylalanine at position 508 in the CFTR protein; accounts for ~70% of CF alleles worldwide (Nelson's Pulmonology/GI; OP Ghai)

Q128. Alagille syndrome is a cholestatic liver disease with characteristic facial features and vertebral anomalies. What is the causative gene mutation? A: JAG1 gene mutation (on chromosome 20p12) - or NOTCH2; autosomal dominant inheritance (Nelson's Hepatology; OP Ghai)

HEMATOLOGY

Q129. The sickle cell crisis is caused by polymerization of which specific abnormal hemoglobin under deoxygenated conditions, and what is the amino acid substitution? A: Hemoglobin S (HbS) - Glutamic acid → Valine substitution at position 6 of the beta-globin chain (Nelson's Hematology; OP Ghai; Robbins Pathology)

Q130. A 5-year-old child develops sudden onset petechiae, purpura, and thrombocytopenia (platelets 10,000/mm³) following a recent viral URTI. There is no anemia, no lymphadenopathy. Name this condition and its typical natural history. A: Immune Thrombocytopenic Purpura (ITP) (Immune Thrombocytopenia); 80-90% of childhood ITP resolves spontaneously within 6 months without treatment (Nelson's Hematology; OP Ghai)

Q131. The coagulation factor deficient in Hemophilia B (Christmas disease) is? A: Factor IX (Christmas factor); X-linked recessive (Nelson's Hematology; OP Ghai)

Q132. The peripheral blood smear in iron deficiency anemia shows which specific RBC morphology? A: Microcytic, hypochromic anemia with pencil cells (elliptocytes), target cells, and anisocytosis; the RDW (Red cell Distribution Width) is increased (Nelson's Hematology; OP Ghai)

Q133. The most common malignancy in children overall is? A: Acute lymphoblastic leukemia (ALL) (~75-80% of all childhood leukemias; ~30% of all childhood cancers) (Nelson's Oncology; OP Ghai)

Q134. The Philadelphia chromosome (t(9;22)) in CML involves which two genes? A: Translocation of ABL1 gene (chromosome 9) and BCR gene (chromosome 22) → creates BCR-ABL1 fusion gene encoding a constitutively active tyrosine kinase (Nelson's Hematology/Oncology; Robbins Pathology; OP Ghai)

Q135. Fanconi anemia - name two characteristic congenital anomalies and the mode of inheritance. A: Anomalies include: absent/hypoplastic thumbs, absent/hypoplastic radii, café-au-lait spots, short stature, renal anomalies, microcephaly; Mode: Autosomal recessive (Nelson's Hematology; OP Ghai)

NEPHROLOGY

Q136. The ISKDC (International Study of Kidney Disease in Children) criteria for nephrotic syndrome remission is reduction of proteinuria to which level for three consecutive days? A: Trace or nil on urine dipstick for 3 consecutive days (or urine protein:creatinine ratio <0.2) (ISKDC criteria; Nelson's Nephrology; OP Ghai)

Q137. Henoch-Schönlein Purpura (HSP / IgA Vasculitis) - name the classic tetrad of clinical features. A: (1) Palpable purpura (buttocks/lower limbs); (2) Arthritis/arthralgia; (3) Abdominal pain (colicky); (4) Renal involvement (hematuria/proteinuria) (Nelson's Nephrology/Rheumatology; OP Ghai)

Q138. The VACTERL association includes urological anomalies. Expand the VACTERL acronym. A: Vertebral anomalies, Anal atresia, Cardiac defects, Tracheo-Esophageal fistula, Renal anomalies, Limb defects (radial ray anomalies) (Nelson's Congenital Malformations; OP Ghai)

Q139. Alport syndrome is an inherited nephritis with sensorineural deafness and ocular anomalies. The most common mutation affects which structural protein? A: Collagen type IV (COL4A5 gene) - X-linked dominant form (most common); also COL4A3/COL4A4 in autosomal forms (Nelson's Nephrology; OP Ghai; Robbins)

Q140. The daily protein excretion in nephrotic range proteinuria in children is defined as? A: >40 mg/m²/hour or urine protein:creatinine ratio >2.0 (or >3.5 g/1.73m²/day in older references) (Nelson's Nephrology; OP Ghai; ISKDC)

GASTROINTESTINAL

Q141. Hirschsprung's disease results from absence of ganglion cells in the bowel wall. The ganglion cells absent are from which plexuses? A: Meissner's (submucosal) plexus and Auerbach's (myenteric) plexus - absence of ganglion cells in the rectosigmoid region (in 80% of cases) (Nelson's GI; OP Ghai; Robbins Pathology)

Q142. The gold standard diagnostic test for Hirschsprung's disease is? A: Rectal suction biopsy - shows absence of ganglion cells with hypertrophied acetylcholinesterase-positive nerve fibers (stained by acetylcholinesterase histochemistry) (Nelson's GI; OP Ghai)

Q143. Which specific enzyme deficiency causes lactose intolerance, and where is this enzyme normally located in the gut? A: Lactase (lactase-phlorizin hydrolase) deficiency; located on the brush border (microvilli) of small intestinal enterocytes (Nelson's GI; OP Ghai; Harper's Biochemistry)

Q144. The "double-bubble sign" on abdominal X-ray in a newborn with bilious vomiting indicates which condition? A: Duodenal atresia (the two bubbles represent the distended stomach and proximal duodenum; associated with Down syndrome in 30% of cases) (Nelson's GI/Neonatology; OP Ghai)

Q145. In gastroesophageal reflux disease (GERD) in children, the gold standard investigation to correlate symptoms with acid reflux episodes is? A: 24-hour pH-impedance monitoring (combined pH-MII) - detects both acid and non-acid reflux episodes (Nelson's GI; OP Ghai)

ROUND 6 - SUBSPECIALTY & MISCELLANEOUS

Endocrinology | IEM | PSM | Ophthalmology | ENT | Dermatology | Dentistry

ENDOCRINOLOGY

Q146. The most common cause of hypothyroidism in children worldwide is which condition? A: Iodine deficiency (worldwide); in developed countries/India with adequate iodine: Hashimoto's (autoimmune) thyroiditis is the most common cause of acquired hypothyroidism in children (OP Ghai Endocrinology; Nelson's; Park's PSM)

Q147. Congenital hypothyroidism screening uses which hormone measured on the Guthrie card (neonatal screening), and what is the cutoff for referral? A: TSH (Thyroid Stimulating Hormone) - TSH >20 mIU/L on dried blood spot requires confirmatory testing; T4 (thyroxine) is measured in some programs (OP Ghai Endocrinology; Nelson's; Park's PSM)

Q148. The syndrome of precocious puberty, polyostotic fibrous dysplasia, and café-au-lait spots (with "coast of Maine" irregular borders) is called? A: McCune-Albright Syndrome - caused by activating mutation in GNAS1 gene (G-protein alpha subunit) (Nelson's Endocrinology; OP Ghai)

Q149. A 3-week-old female infant with ambiguous genitalia, salt-wasting crisis (hyponatremia, hyperkalemia), and markedly elevated 17-hydroxyprogesterone - the enzyme deficiency and the treatment? A: 21-hydroxylase deficiency (CYP21A2) - most common form of CAH; Treatment: Hydrocortisone (glucocorticoid replacement) + Fludrocortisone (mineralocorticoid) + salt supplementation in infancy (Nelson's Endocrinology; OP Ghai)

Q150. The Prader-Willi Syndrome is caused by loss of paternal contribution on which chromosome, and what is the most common mechanism? A: Loss of paternal contribution on chromosome 15q11-q13; most common mechanism: paternal deletion (~70%); maternal uniparental disomy (mUPD) in ~25% (Nelson's Genetics; OP Ghai)

Q151. Turner syndrome (45,X) - name four characteristic clinical features seen on examination of a newborn/child. A: Short stature, webbed neck (pterygium colli), low posterior hairline, wide-carrying angle (cubitus valgus), lymphedema of hands/feet at birth, shield chest, widely spaced nipples, congenital heart disease (bicuspid aortic valve/coarctation) (Nelson's Genetics/Endocrinology; OP Ghai)

Q152. Diabetes insipidus (DI) - central DI is treated with which hormone analogue and the route of administration in children? A: Desmopressin (DDAVP / 1-deamino-8-D-arginine vasopressin) - administered intranasally, orally, or subcutaneously (Nelson's Endocrinology; OP Ghai; Harriet Lane)

Q153. The triad of hypocalcemia, tetany, and absent parathyroid glands in a neonate with congenital heart disease points to which syndrome, and which chromosome is affected? A: DiGeorge Syndrome (22q11.2 deletion syndrome); Chromosome 22 (22q11.2) deletion (Nelson's Genetics/Endocrinology; OP Ghai)

INBORN ERRORS OF METABOLISM

Q154. A neonate develops encephalopathy, hyperammonemia (NH₃ >500 μmol/L), with normal anion gap but respiratory alkalosis. Which metabolic disorder category is most likely? A: Urea cycle disorder (e.g., OTC deficiency - Ornithine Transcarbamylase deficiency, the most common; X-linked) (Nelson's IEM; OP Ghai)

Q155. Niemann-Pick disease type A presents with hepatosplenomegaly and a cherry-red spot on the macula. What is the deficient enzyme? A: Sphingomyelinase (acid sphingomyelinase); substrate accumulating: sphingomyelin (Nelson's IEM; Robbins Pathology; OP Ghai)

Q156. Tay-Sachs disease presents with cherry-red spot and progressive neurodegeneration. The enzyme deficient is? A: Hexosaminidase A (beta-N-acetylhexosaminidase A) - substrate: GM2 ganglioside accumulates in neurons (Nelson's IEM; Robbins Pathology; OP Ghai)

Q157. The characteristic feature of homocystinuria that distinguishes it clinically from Marfan syndrome (which it resembles) is? A: Inferior (downward) dislocation of the lens (ectopia lentis) in homocystinuria vs. superior (upward) lens dislocation in Marfan syndrome; plus homocystinuria has intellectual disability, venous thrombosis, and fair skin/hair (Nelson's IEM; OP Ghai)

Q158. Glycogen storage disease Type I (Von Gierke's disease) - the enzyme deficient is? A: Glucose-6-phosphatase (G6Pase); presents with severe hypoglycemia, hepatomegaly, lactic acidosis, and hyperlipidemia (Nelson's IEM; Robbins Pathology; OP Ghai)

Q159. Glutaric aciduria type 1 (GA-1) is an IEM that commonly presents in infancy with macrocephaly and acute encephalopathic crises leading to striatal injury. The deficient enzyme is? A: Glutaryl-CoA dehydrogenase - leads to accumulation of glutaric acid and 3-hydroxyglutaric acid; autosomal recessive (Nelson's IEM; OP Ghai)

Q160. Isovaleric acidemia (IVA) presents with a characteristic smell. What does the child smell like and which enzyme is deficient? A: Child smells like "sweaty feet"; enzyme deficient: Isovaleryl-CoA dehydrogenase (Nelson's IEM; OP Ghai; Harper's Biochemistry)

PREVENTIVE & SOCIAL MEDICINE (PSM)

Q161. The Integrated Management of Neonatal and Childhood Illness (IMNCI) strategy uses which age classification for management of sick children? A: 0-2 months (young infant) and 2 months to 5 years (older children) (Park's PSM; OP Ghai; WHO IMCI)

Q162. The UNICEF concept of GOBI-FFF stands for? A: Growth monitoring, Oral rehydration therapy, Breastfeeding, Immunization; Female education, Family planning, Food supplementation (Park's PSM; OP Ghai Preventive Pediatrics)

Q163. The Vitamin A supplementation program in India gives high-dose Vitamin A to children between which ages and at what dose for the first dose? A: From 9 months to 5 years; First dose (9 months, with measles vaccine): 1 lakh IU (100,000 IU); subsequent doses every 6 months: 2 lakh IU (200,000 IU) (NIS/CSSM program India; OP Ghai; Park's PSM)

Q164. Oral Rehydration Therapy (ORT) was called "the most important medical advance of the 20th century." The physiological basis of ORT relies on which co-transport mechanism in the gut? A: Sodium-glucose co-transport (SGLT1) - glucose facilitates sodium absorption in the small intestine even during diarrhea; drives water absorption osmotically (Nelson's GI; OP Ghai; Harper's Biochemistry)

Q165. Under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), screening of children includes? A: Screening under School Health Programme for: vision defects, hearing impairment, dental caries, nutritional disorders, congenital anomalies, and common childhood diseases (Park's PSM; National Health Programs India)

OPHTHALMOLOGY

Q166. Retinoblastoma - the "rb gene" follows which model for tumor suppressor gene inactivation? A: Knudson's "two-hit hypothesis" - both alleles of RB1 must be inactivated; hereditary form: first hit germline, second hit somatic; sporadic form: both hits somatic (Nelson's Oncology; Robbins Pathology; OP Ghai)

Q167. Amblyopia (lazy eye) - the critical period for visual development beyond which amblyopia treatment becomes less effective is? A: First 7-9 years of life (critical/sensitive period); most effective treatment window is before age 7; the visual cortex remains somewhat plastic until ~9-10 years (Nelson's Ophthalmology; OP Ghai)

Q168. The vitamin A deficiency eye disease classification (WHO/Sommer) includes Bitot's spots (X1B). Name the stage at which corneal ulceration involving <1/3 of the corneal surface is classified. A: X2 stage (Corneal xerosis) leads to X3A (Corneal ulceration/keratomalacia <1/3 of corneal surface) (WHO/OP Ghai Nutrition/Ophthalmology; Nelson's)

Q169. A child with Down syndrome has a specific ophthalmologic finding of white specks on the iris arranged in a ring pattern. Name this finding. A: Brushfield spots - white/grey spots on the iris periphery, seen in ~85% of Down syndrome children (also seen in normal children but more prominent in trisomy 21) (Nelson's Genetics/Ophthalmology; OP Ghai)

ENT (OTORHINOLARYNGOLOGY)

Q170. The most common organism causing acute otitis media (AOM) in children is? A: Streptococcus pneumoniae (~40-50%), followed by Haemophilus influenzae (~25-30%) and Moraxella catarrhalis (Nelson's Infectious Diseases/ENT; OP Ghai; Harriet Lane)

Q171. Choanal atresia in a neonate presents with which classical symptom that worsens during feeding and improves with crying? A: Cyanosis that worsens with feeding (when the infant attempts nasal breathing while feeding) and relieves with crying (because mouth breathing occurs during crying). Neonates are obligate nasal breathers. (Nelson's ENT/Neonatology; OP Ghai)

Q172. The ARIA classification of allergic rhinitis divides it into which two main categories based on duration? A: Intermittent (symptoms <4 days/week or <4 weeks/year) and Persistent (≥4 days/week AND ≥4 consecutive weeks) (ARIA guidelines; Nelson's; OP Ghai ENT)

Q173. Epiglottitis (supraglottitis) in children classically presents with the "tripod position" and drooling. The most common organism before vaccination was? A: Haemophilus influenzae type b (Hib) - now rare due to Hib vaccination; currently S. pyogenes, S. aureus also causes epiglottitis (Nelson's ENT/Infectious; OP Ghai)

DERMATOLOGY

Q174. The Nikolsky sign (lateral pressure on skin causes skin to slide/separate) is positive in which two pediatric dermatological conditions? A: (1) Pemphigus vulgaris and (2) Staphylococcal Scalded Skin Syndrome (SSSS / Ritter's disease) in neonates; also seen in Toxic Epidermal Necrolysis (TEN) (Nelson's Dermatology; OP Ghai; Andrews' Dermatology)

Q175. Tinea capitis in children - the most common dermatophyte species causing non-inflammatory (endothrix) tinea capitis in India is? A: Trichophyton violaceum and T. tonsurans (endothrix pattern); Microsporum canis (ectothrix) fluoresces with Wood's lamp (Nelson's Dermatology; OP Ghai; Andrews' Dermatology)

Q176. Scabies in infants and young children is caused by which organism, and what is the drug of choice? A: Sarcoptes scabiei var. hominis; Drug of choice in children >2 months: Permethrin 5% cream (applied all over body including face/scalp in infants, washed off after 8-14 hours); alternative: Ivermectin (>15 kg) (Nelson's Dermatology; OP Ghai)

Q177. Ectodermal dysplasia (hypohidrotic form) presents with the classic triad of? A: (1) Hypotrichosis (sparse/absent hair and eyebrows); (2) Hypohidrosis (absent/reduced sweating, risk of hyperthermia); (3) Hypodontia (absent/conical teeth) (Nelson's Genetics/Dermatology; OP Ghai)

Q178. The ophiasis pattern of alopecia areata involves hair loss in which specific distribution? A: Band-like loss along the margins of the scalp (occipitotemporal region), resembling a snake - "ophiasis" from Greek for snake; particularly treatment-resistant form (Nelson's Dermatology; Andrews' Dermatology; OP Ghai)

Q179. Port-wine stain (nevus flammeus) on the face in the trigeminal distribution (V1/V2) combined with ipsilateral leptomeningeal angioma and glaucoma is called? A: Sturge-Weber syndrome (encephalotrigeminal angiomatosis) (Nelson's Neurology/Dermatology; OP Ghai)

DENTISTRY

Q180. The eruption of the first deciduous (primary) tooth in an infant normally occurs at what age, and which tooth erupts first? A: 6-8 months of age; first tooth: Lower central incisor (OP Ghai Dentistry/Growth; Nelson's)

Q181. Dental fluorosis results from excessive fluoride ingestion during tooth development. The optimal fluoride level in drinking water recommended by WHO is? A: 0.5-1.0 mg/L (0.5-1.0 ppm); dental fluorosis occurs at >1.5 mg/L; skeletal fluorosis at >4 mg/L (Park's PSM; OP Ghai; WHO)

Q182. The formula for estimating the number of primary (deciduous) teeth in a child aged 6-24 months is? A: Number of teeth = Age in months − 6 (OP Ghai Growth & Development; Nelson's)

TIE BREAKER QUESTIONS (10 extra, use 4 as needed)

TB.1 The TORCHES complex of congenital infections - expand the acronym and name the organism causing "blueberry muffin baby." A: Toxoplasma, Other (Syphilis, VZV, parvovirus B19, HIV, Zika), Rubella, CMV, HSV, Enterovirus, Syphilis; "Blueberry muffin baby" (purpuric skin lesions from extramedullary hematopoiesis) - Congenital Rubella and Congenital CMV (Nelson's Neonatology/Infectious; OP Ghai)

TB.2 The enzyme deficiency in classic PKU leads to a musty/mousy smell. The odor is due to accumulation of which specific metabolite in urine and sweat? A: Phenylacetic acid (phenylacetate) - derived from phenylalanine via alternative metabolic pathways; gives musty/mousy odor (Nelson's IEM; OP Ghai; Harper's Biochemistry)

TB.3 The "salt and pepper" retinal pigmentation on fundoscopy is characteristic of which congenital infection? A: Congenital Rubella (also seen in congenital syphilis); compared to "owl-eye" cells in CMV retinitis (Nelson's Infectious Diseases; OP Ghai Ophthalmology)

TB.4 The Kasabach-Merritt phenomenon involves a giant hemangioma causing thrombocytopenia and consumptive coagulopathy. The specific vascular tumor associated is? A: Kaposiform hemangioendothelioma (KHE) or Tufted angioma (NOT common infantile hemangioma) (Nelson's Hematology/Dermatology; OP Ghai)

TB.5 "Lisch nodules" (melanocytic iris hamartomas) are pathognomonic of which phakomatosis? A: Neurofibromatosis Type 1 (NF1) - present in >90% of patients with NF1 by adulthood (Nelson's Neurology/Ophthalmology; OP Ghai)

TB.6 The Barlow and Ortolani maneuvers are used to screen for which condition in neonates? A: Developmental Dysplasia of the Hip (DDH) - Ortolani: relocates a dislocated hip (clunk); Barlow: dislocates a dislocatable hip (Nelson's Orthopedics; OP Ghai)

TB.7 Which specific chromosome abnormality is associated with Wilms' tumor in the WAGR syndrome? A: Deletion of chromosome 11p13 (WT1 gene locus); WAGR = Wilms' tumor, Aniridia, Genitourinary anomalies, Range of developmental delays (Nelson's Oncology; Robbins; OP Ghai)

TB.8 The term "lipoid nephrosis" is a synonym for which renal condition and what is the immunofluorescence finding on kidney biopsy? A: Minimal Change Disease (MCD); immunofluorescence: negative (no immune deposits) (Nelson's Nephrology; Robbins Pathology; OP Ghai)

TB.9 The "rachitic rosary" in Vitamin D deficiency rickets is due to enlargement of which structures? A: Costochondral junctions (expansion/beading at the junction of ribs with costal cartilage) (OP Ghai Nutrition; Nelson's)

TB.10 The most common type of tracheo-esophageal fistula (TEF) is? A: Type C (Gross type C) - proximal esophageal atresia + distal TE fistula - accounts for ~85-87% of all TEF cases (Nelson's GI/Surgery; OP Ghai)

SUMMARY

Round	Topic	Questions Generated
Round 1	Basic Sciences	45 questions
Round 2	General Pediatrics	26 questions
Round 3	Infections/Vaccines/Neonatology	27 questions
Rounds 4 & 5	Systems	42 questions
Round 6	Subspecialty & Miscellaneous	37 questions
Tie Breakers	Mixed	10 questions
TOTAL		~182 questions

Important Notes on Using This Question Bank:

Each question has a specific, unique answer - no yes/no, no controversial answers
Questions covering different difficulty levels are present - mark easier ones for early rounds
Cross-check all answers with your latest copy of OP Ghai (9th Ed) and Nelson's (21st Ed) before finalizing, as some cut-offs and guidelines may have minor updates
For questions where "name one" vs "name all" matters, the question wording clarifies this
Spare questions should be selected from each round's pool and sealed separately per IAP instructions

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