FMGE Pediatrics questions with answers

1. Q1. A child with diarrhoea is restless and irritable, drinks eagerly when offered fluid, and the skin pinch goes back slowly. Under IMNCI, how is this classified and treated?

   • A. No dehydration, treated with Plan A
   • B. Some dehydration, treated with Plan B
   • C. Severe dehydration, treated with Plan C
   • D. Persistent diarrhoea, referral only

   Answer: B. Some dehydration, treated with Plan B

2. Q2. A malnourished preschool child has a dry, lustreless conjunctiva with foamy triangular patches on the temporal bulbar conjunctiva. Which deficiency is this, and what are the patches called?

   • A. Vitamin C deficiency with subconjunctival haemorrhages
   • B. Riboflavin deficiency with angular blepharitis
   • C. Vitamin A deficiency with Bitot spots
   • D. Zinc deficiency with photophobia

   Answer: C. Vitamin A deficiency with Bitot spots

1. Q1. A six-week-old has prolonged jaundice, constipation, a large protruding tongue, an umbilical hernia and coarse dry skin. Why does newborn screening for this condition matter so much?

   • A. Down syndrome, because early karyotyping changes management
   • B. Congenital hypothyroidism, because thyroxine begun in the first weeks prevents irreversible intellectual disability
   • C. Galactosaemia, because withdrawing lactose reverses the features
   • D. Achondroplasia, because growth hormone improves final height

   Answer: B. Congenital hypothyroidism, because thyroxine begun in the first weeks prevents irreversible intellectual disability

2. Q2. A child can pedal a tricycle and climb stairs putting one foot on each step, but cannot yet hop on one foot. What is the most likely age?

   • A. 18 months
   • B. 5 years
   • C. 3 years
   • D. 6 years

   Answer: C. 3 years

1. Q1. A toddler swallows a handful of his mother's iron tablets and develops vomiting, haematemesis and a metabolic acidosis. Which antidote is given, and how does it work?

   • A. Sodium calcium edetate, which chelates divalent lead
   • B. Desferrioxamine, which chelates free iron and is excreted in the urine
   • C. Dimercaprol, which chelates arsenic and mercury
   • D. Penicillamine, which chelates copper

   Answer: B. Desferrioxamine, which chelates free iron and is excreted in the urine

2. Q2. In Scammon's growth curves, which tissue grows very little through childhood and then rises steeply at puberty?

   • A. Neural tissue
   • B. Lymphoid tissue
   • C. Genital and gonadal tissue
   • D. General somatic tissue

   Answer: C. Genital and gonadal tissue

1. Q1. What is the pattern of inheritance of neural tube defects, and what does that imply for prevention?

   • A. Autosomal recessive, so carrier testing is offered
   • B. X-linked dominant, so male fetuses are spared
   • C. Multifactorial, so periconceptional folic acid reduces recurrence risk
   • D. Autosomal dominant, so half of offspring are affected

   Answer: C. Multifactorial, so periconceptional folic acid reduces recurrence risk

2. Q2. A toddler fed mainly on rice water has pitting oedema of the legs, a distended abdomen, an apathetic expression and hypoalbuminaemia, with weight only mildly reduced. What is the diagnosis?

   • A. Marasmus
   • B. Kwashiorkor
   • C. Indian childhood cirrhosis
   • D. Nephrotic syndrome

   Answer: B. Kwashiorkor

1. Q1. Maternal antibody crosses the placenta and coats fetal red cells, which are then destroyed by splenic macrophages. Which type of hypersensitivity is haemolytic disease of the newborn?

   • A. Type I, IgE-mediated
   • B. Type II, antibody-mediated cytotoxicity
   • C. Type III, immune complex mediated
   • D. Type IV, cell mediated

   Answer: B. Type II, antibody-mediated cytotoxicity

2. Q2. Why is intramuscular vitamin K given to every newborn, and what does it prevent?

   • A. Gut flora are not yet established and placental transfer is poor, so clotting factors II, VII, IX and X are low, risking haemorrhagic disease of the newborn
   • B. Hepatic immaturity causes unconjugated hyperbilirubinaemia, risking kernicterus
   • C. Breast milk lacks vitamin C, risking scurvy
   • D. Vitamin A stores are low, risking keratomalacia

   Answer: A. Gut flora are not yet established and placental transfer is poor, so clotting factors II, VII, IX and X are low, risking haemorrhagic disease of the newborn

1. Q1. A 30 kg child is kept nil by mouth before surgery. Using the Holliday-Segar method, what is the daily maintenance fluid requirement?

   • A. 1000 mL
   • B. 1700 mL
   • C. 2500 mL
   • D. 3000 mL

   Answer: B. 1700 mL

2. Q2. A child has had repeated fractures with minimal trauma over two years, blue sclerae, abnormal dentition and a similarly affected parent. Which protein is defective?

   • A. Type II collagen
   • B. Fibrillin-1
   • C. Type I collagen
   • D. Dystrophin

   Answer: C. Type I collagen

1. Q1. A child is convulsing at home and no intravenous access is available. Which route and drug should be used first?

   • A. Buccal midazolam or rectal diazepam, since both are absorbed without venous access
   • B. Intramuscular phenytoin, which is reliably absorbed
   • C. Oral sodium valproate
   • D. Wait for intravenous access before giving anything

   Answer: A. Buccal midazolam or rectal diazepam, since both are absorbed without venous access

2. Q2. A child with immune thrombocytopenia has a platelet count of 40 x 10^9/L, scattered petechiae and occasional mild epistaxis, but no mucosal or serious bleeding. What is the appropriate management?

   • A. Immediate intravenous immunoglobulin
   • B. A course of high-dose corticosteroids
   • C. Anti-D immunoglobulin
   • D. Observation with education and safety advice, since treatment is guided by bleeding rather than the count

   Answer: D. Observation with education and safety advice, since treatment is guided by bleeding rather than the count

1. Q1. Under WHO criteria, what mid-upper arm circumference in a child aged 6 to 59 months indicates severe acute malnutrition?

   • A. Below 14.5 cm
   • B. Below 13.5 cm
   • C. Below 12.5 cm
   • D. Below 11.5 cm

   Answer: D. Below 11.5 cm

2. Q2. Which of the following disorders is inherited in an autosomal recessive pattern?

   • A. Hereditary spherocytosis
   • B. Osteogenesis imperfecta type I
   • C. Sickle cell anaemia
   • D. Von Willebrand disease

   Answer: C. Sickle cell anaemia

1. Q1. A 12 kg child with diarrhoea is restless and thirsty, with absent tears and a slow skin pinch. Under WHO Plan B, how much ORS should be given in the first four hours?

   • A. 300 ml
   • B. 600 ml
   • C. 900 ml, calculated at 75 ml per kg
   • D. 1200 ml

   Answer: C. 900 ml, calculated at 75 ml per kg

2. Q2. Why is newborn screening for congenital hypothyroidism performed on a blood spot rather than waiting for clinical signs?

   • A. Because clinical features appear immediately at birth
   • B. Because most affected newborns look normal at birth, and delay beyond the first weeks causes irreversible neurological damage
   • C. Because the condition resolves spontaneously
   • D. Because treatment is only effective after one year

   Answer: B. Because most affected newborns look normal at birth, and delay beyond the first weeks causes irreversible neurological damage

1. Q1. A continuous machinery murmur is heard below the left clavicle in an infant with bounding pulses. Which lesion, and why is the murmur continuous?

   • A. Ventricular septal defect, with systolic shunting
   • B. Atrial septal defect, with fixed splitting
   • C. Tetralogy of Fallot, with an ejection murmur
   • D. Patent ductus arteriosus, because aortic pressure exceeds pulmonary pressure throughout the cardiac cycle

   Answer: D. Patent ductus arteriosus, because aortic pressure exceeds pulmonary pressure throughout the cardiac cycle

2. Q2. Menkes kinky hair disease results from defective transport of which metal, and what is the biochemical consequence?

   • A. Zinc, impairing wound healing
   • B. Copper, impairing lysyl oxidase and so collagen and elastin cross-linking
   • C. Iron, impairing haem synthesis
   • D. Selenium, impairing glutathione peroxidase

   Answer: B. Copper, impairing lysyl oxidase and so collagen and elastin cross-linking

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.