Paediatrics MCQs for AMC Part 1 Exam

ByAMC Wise

Question 4001

A 6-year-old child presents to the pediatric emergency department with a swollen, painful right knee and a fever of 101°F (38.3°C). The child is unable to bear weight on the affected leg. Physical examination reveals a warm, erythematous, and tender right knee joint with limited range of motion. Laboratory studies show an elevated white blood cell count and an erythrocyte sedimentation rate (ESR) of 80 mm/h. The joint aspiration demonstrates purulent synovial fluid with a white blood cell count of 45,000/mm³. What is the next step in the management of this patient?

  • A) Admit the child and Administer IV antibiotics after taking blood for culture
  • B) Initiate high-dose oral nonsteroidal anti-inflammatory drugs (NSAIDs)
  • C) Obtain a knee magnetic resonance imaging (MRI) to confirm diagnosis
  • D) Perform an urgent joint aspiration and initiate empiric intravenous antibiotics
  • E) Refer the child to physical therapy for joint mobilization

The correct answer is D) Perform an urgent joint aspiration and initiate empiric intravenous antibiotics.

In a pediatric patient with a clinical presentation suggestive of septic arthritis, such as a swollen, painful joint, fever, limited range of motion, and evidence of joint inflammation, prompt evaluation and treatment are essential. Septic arthritis in children is a medical emergency and requires immediate attention.

The next step in the management of this pediatric patient is to perform an urgent joint aspiration for diagnostic purposes and initiate empiric intravenous antibiotics. Joint aspiration is crucial for confirming the diagnosis, identifying the causative organism, and guiding appropriate antibiotic therapy.

Empiric antibiotic therapy should cover common pathogens responsible for septic arthritis in children, such as Staphylococcus aureus and Streptococcus species, until culture results are available.

Question 4002

A 10-year-old aboriginal boy presents to the GP clinic with a fever and joint pain for the past two weeks. On physical examination, you note redness and swelling of multiple joints, including the knees and elbows. He also has a faint rash on his trunk and upper arms. There is no evidence of heart murmurs, but you notice some minor swelling of his ankles. He reports a recent throat infection. What is the most likely diagnosis?

  • A) Rheumatic Fever
  • B) Infectious Mononucleosis
  • C) Kawasaki Disease
  • D) Juvenile Idiopathic Arthritis
  • E) Systemic Lupus Erythematosus

The correct answer is A) Rheumatic Fever.

Rheumatic fever is an autoimmune condition that can develop after a streptococcal throat infection (such as strep throat). It often presents with fever, sore throat, and joint pain, as well as other clinical features such as a characteristic rash called erythema marginatum, subcutaneous nodules, and carditis. The symptoms typically occur 2-4 weeks after the initial streptococcal infection.

In this scenario, the patient has a history of throat infection, joint pain, and a faint rash on the trunk and upper arms. These findings, along with the absence of heart murmurs and minor ankle swelling, are consistent with the diagnosis of rheumatic fever. It is important to diagnose and treat rheumatic fever promptly to prevent complications such as rheumatic heart disease.

Question 4003

A 3-year-old child is brought to the pediatric clinic due to recurrent episodes of cyanosis and squatting during physical activities. On examination, the child appears well but demonstrates cyanosis during crying. There is a systolic murmur heard over the upper left sternal border. The second heart sound is single. What is the most likely diagnosis?

  • A) Atrial Septal Defect
  • B) Tetralogy of Fallot
  • C) Ventricular Septal Defect
  • D) Patent Ductus Arteriosus
  • E) Coarctation of the Aorta

Answer: B) Tetralogy of Fallot

Tetralogy of Fallot is a congenital heart defect characterized by four main components: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy. This condition leads to decreased oxygen levels in the blood, which can cause cyanosis (bluish discoloration of the skin). The squatting posture adopted by children with Tetralogy of Fallot helps increase systemic vascular resistance, improving oxygenation. The single second heart sound and systolic murmur are consistent with this diagnosis.

Question 4004

A 4-year-old child is brought to the pediatric clinic with a fever, sore throat, and small red spots on the palms of their hands, soles of their feet, and in their mouth. On examination, you observe ulcers and blisters on these areas, along with a mild fever. The child’s guardian reports that a few other children in their daycare have similar symptoms. What is the most likely diagnosis?

  • A) Hand, Foot, and Mouth Disease
  • B) Chickenpox
  • C) Measles
  • D) Scarlet Fever
  • E) Coxsackievirus Infection

Answer: A) Hand, Foot, and Mouth Disease

Hand, Foot, and Mouth Disease is a common viral illness in children, typically caused by Coxsackieviruses. It presents with fever, sore throat, and characteristic red spots, ulcers, or blisters on the hands, feet, and in the mouth. It is highly contagious and often occurs in daycare or school settings. Other options listed may have different clinical features, making Hand, Foot, and Mouth Disease the most likely diagnosis in this case.

Question 4005

A 7-year-old child is brought to the pediatric clinic with swelling around their eyes, legs, and ankles. The child’s parents have noticed foamy urine and report that the child has been more fatigued than usual. On examination, you find generalized edema but no signs of hypertension. Laboratory tests reveal proteinuria and hypoalbuminemia. What is the most likely diagnosis?

  • A) Acute Glomerulonephritis
  • B) Polycystic Kidney Disease
  • C) Nephrotic Syndrome
  • D) Urinary Tract Infection
  • E) Hemolytic Uremic Syndrome

Answer: C) Nephrotic Syndrome

Nephrotic syndrome is characterized by the presence of significant proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia. It commonly presents with oedema, and foamy urine due to protein loss in the urine. Unlike acute glomerulonephritis, which often presents with hypertension and hematuria, and other conditions listed, nephrotic syndrome is the most likely diagnosis based on the provided clinical features.

Question 4006

A 6-month-old infant is brought to the pediatric emergency department with a cough, runny nose, and wheezing. On examination, you note increased respiratory effort with nasal flaring and chest retractions. The child’s oxygen saturation is 93% on room air. There is diffuse wheezing on auscultation. What is the most likely diagnosis?

  • A) Foreign body aspiration
  • B) Croup
  • C) Bronchiolitis
  • D) Asthma
  • E) Allergic Rhinitis

Answer: C) Bronchiolitis

Bronchiolitis is a common lower respiratory tract infection in infants, typically caused by respiratory syncytial virus (RSV). It often presents with cough, runny nose, wheezing, and increased respiratory effort, which can lead to nasal flaring and chest retractions. The diffuse wheezing is a characteristic finding in bronchiolitis. While other conditions listed can cause respiratory symptoms, bronchiolitis is the most likely diagnosis in this scenario.

Question 4007

A 3-day-old term infant is brought to the pediatric clinic. On examination, the baby appears healthy and well-nourished. However, you notice a yellowish discoloration of the skin and sclera. The mother reports that this started on the second day after birth. The baby is breastfeeding well, and there are no other concerning signs or symptoms. What is the most likely diagnosis?

  • A) Neonatal Hepatitis
  • B) ABO Incompatibility
  • C) Biliary Atresia
  • D) Hemolytic Disease of the Newborn
  • E) Physiological Jaundice

Answer: E) Physiological Jaundice

Physiological jaundice is a common condition in newborns, typically occurring after the first 24 hours of life. It is usually a benign and self-limited condition caused by the immaturity of the newborn’s liver to effectively process bilirubin. This type of jaundice is generally harmless and resolves on its own without treatment. The provided clinical features are consistent with physiological jaundice, and other causes listed are less likely in this scenario.

Question 4008

A 2-week-old full-term infant is brought to the pediatric clinic for a check-up. On examination, you hear a continuous, machine-like murmur in the upper left sternal border. The infant is feeding well and appears otherwise healthy. What is the most likely diagnosis?

  • A) Ventricular Septal Defect
  • B) Atrial Septal Defect
  • C) Coarctation of the Aorta
  • D) Tetralogy of Fallot
  • E) Patent Ductus Arteriosus

Answer: E) Patent Ductus Arteriosus

Patent Ductus Arteriosus (PDA) is a common congenital heart defect in which the ductus arteriosus, a fetal blood vessel that normally closes shortly after birth, remains open. This condition can lead to a continuous, machine-like murmur heard in the upper left sternal border. While other congenital heart defects may present with murmurs, the provided clinical features are most consistent with PDA in this case.

Question 4009

A 12-year-old child is brought to the pediatric clinic due to a family history of kidney problems. On examination, you palpate bilateral flank masses, and an abdominal ultrasound confirms the presence of multiple cysts in both kidneys. There is no evidence of hypertension, hematuria, or proteinuria. What is the most likely diagnosis?

  • A) Urinary Tract Infection
  • B) Nephrotic Syndrome
  • C) Wilms Tumor
  • D) Polycystic Kidney Disease
  • E) Acute Glomerulonephritis

Answer: D) Polycystic Kidney Disease

Polycystic Kidney Disease (PKD) is a genetic condition characterized by the development of multiple cysts in the kidneys, leading to bilateral flank masses. PKD can be asymptomatic or present with symptoms related to kidney enlargement and cyst growth. The absence of hypertension, hematuria, or proteinuria, along with the family history of kidney problems, is consistent with the diagnosis of PKD. Other conditions listed may have different clinical features and are less likely in this scenario.

Question 4010

A 9-year-old child is brought to the pediatric clinic with dark-colored urine, puffiness around the eyes, and elevated blood pressure. On examination, you note periorbital oedema and hypertension. Laboratory tests reveal hematuria and proteinuria, along with red blood cell casts in the urine. The child also reports a recent upper respiratory tract infection. What is the most likely diagnosis?

  • A) Nephrotic Syndrome
  • B) Poststreptococcal Glomerulonephritis
  • C) Nephritic Syndrome
  • D) Alport Syndrome
  • E) Minimal Change Disease

Answer: C) Nephritic Syndrome

Nephritic syndrome is characterized by hematuria, proteinuria, hypertension, and periorbital oedema. It often occurs after an upper respiratory tract infection, which can be caused by Streptococcus in the case of poststreptococcal glomerulonephritis. The presence of red blood cell casts in the urine is a key feature of nephritic syndrome. Other conditions listed may have different clinical features, making nephritic syndrome the most likely diagnosis in this scenario.

References

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