INI-CET High Yield Questions for Pediatrics

Mastering the INI-CET demands a strategic approach to preparation, with an emphasis on high-yield topics proving to be a successful tactic. This blog zeroes in on exactly that – a curated list of high-yield questions in pediatrics that are highly likely to appear on the INI-CET. By acquainting yourself with these questions and their detailed explanations, you'll deepen your understanding of obstetrics and gynecology concepts, enhancing your confidence and readiness for exam day.

1. A baby boy is brought to the OPD by his parents. On evaluation, he looks up towards the source of sound production diagonally. The baby is healthy and active. All milestones are attained up to the current age. What is the most likely age of this baby?

1. 10 months
2. 8 months
3. 4 months
4. 5 months

Correct Option A - 10 months:

• 10 months: Looks directly towards the source of sound production diagonally  

Incorrect Options:

Option B - 8 months:

• 7-8 months: Localizes sound produced above the level of ears

Option C - 4 months:

• 3-4 months: Turns head towards the source of sound

Option D - 5 months:

• 5-6 months: Turns head towards the source and then downwards if the source of sound is below the level of ears

2. An 18-month-old boy was brought by his mother to the pediatrician as the child appeared to have a large head size relative to his age, had facial abnormalities, with poor growth. His mother also reported that the child was vomiting and had been more irritable in the last few weeks. Physical examination revealed low muscle tone. Which of the following is the most likely diagnosis?

1. Smith-Lemli-Opitz syndrome
2. Rett syndrome
3. Glutaric aciduria type 1
4. Angelman syndrome

Option C: Glutaric aciduria type 1

• Glutaric aciduria type I is a rare autosomal recessive disorder caused by a deficiency of glutaryl CoA dehydrogenase. 
• Clinical manifestations include macrocephaly in infants, followed by neurological symptoms such as hypotonia, irritability, and feeding problems.
• The patient may present with acute encephalopathic findings such as loss of developmental milestones, seizures, rigidity, and dystonia.
• Glutaric acid and 3-hydroxyglutaric acid may be elevated in urine, blood, and CSF. Neuroimaging may reveal macrocephaly, fluid accumulation, striatal lesions, ventricular dilation, cortical atrophy, and fibrosis.
• Treatment involves a low-protein diet, high doses of riboflavin and l-carnitine, early diagnosis, prevention of catabolic states, and aggressive treatment during acute episodes.

Option A: Smith-Lemli-Opitz syndrome

• They have low muscle tone (hypotonia), have trouble eating, and grow more slowly than other babies. Most people with syndactyly have their second and third toes fused, and some have extra fingers or toes (polydactyly ).
• It is associated with microcephaly.

Option B: Rett syndrome

• X linked dominant inheritance.
• Mostly affects females (almost exclusively females)
• Normal head circumference at birth and normal early development.
• Deceleration of head growth and acquired microcephaly
• Loss of purposeful hand movements with the development of stereotypical hand-wringing movement

Option D: Angelman syndrome

• It is a defect of gene silencing.
• It is characterized by seizures, ataxia, mental retardation, and inappropriate laughter (happy puppets)
• It is associated with microcephaly.

3. A 5-year-old male child was brought to the clinic by his parents complaining of Thumb sucking. On examination, the child has attained normal developmental milestones. Which condition is seen in children with persistence of thumb sucking for more than 5 years?

1. Paronychia
2. Absence of teeth eruption
3. Skin rashes
4. Tooth discoloration

Correct Option  A - Paronychia:

• Infection around nail bed
• It is seen in children who have persistence of thumb sucking for more than 5 years

Incorrect Options:

Option B, C & D: Absence of teeth eruption / Skin rashes & Tooth discoloration: These are not seen in children who have persistence of thumb sucking for more than 5 years

4. A 15-year-old boy comes to the clinic accompanied by his father and complains of rashes over genitalia. After evaluation, the doctor diagnosed it as a fungal infection and prescribed an antifungal drug. He also has reddened scrotal skin. Which stage of puberty is associated with the finding mentioned?

1. Stage 5
2. Stage 4
3. Stage 3
4. Stage 2

Correct Option D - Stage 2:

• Stage 2 comprises of Enlargement of testes & scrotum, Scrotal skin reddens, and Slight or no enlargement of penis

Incorrect Options:

Option A - Stage 5:

• Adult genitalia (>20 ml)

Option B - Stage 4:

• Tests & scrotum longer
• Scrotal skin darker
• Penis increases in length & breadth, glans becomes more prominent.

Option C - Stage 3:

•  Further growth of testis
•  Penis increases in length.

5. A 1-day-old male baby was admitted to NICU after being delivered vaginally to a multiparous diabetic woman at home by a midwife. He had a weak cry, flaccid muscle tone, and a pulse of 98 bpm. He was immediately resuscitated for his poor APGAR score. The doctor examined him thoroughly for his physical and neuromuscular maturity. Which of the following tests is done to assess the passive tone of shoulder flexors in the Ballard score?

1. Scarf sign
2. Square Window
3. Arm recoil
4. Heel-to-ear

Option A: Scarf sign

• Scarf sign helps in assessing the neuromuscular maturity of a neonate. This manoeuvre is used to test the passive tone of the flexors of the shoulder girdle. The neonate lies supine, and the examiner brings the neonate's arm across the upper chest until the baby resists it. The point on the chest is noted to which the elbow is moved easily, and the score is noted according to the landmark.
• ENBS (Expanded New Ballard Score) is a commonly used technique to assess the gestational age of a neonate by using physical and neuromuscular criteria of maturity.
• Preterm babies are usually in a state of physiological hypotonia that increases throughout the fetal growth period.
• The neuromuscular criteria include posture, square window, arm recoil, popliteal angle, scarf sign, and heel-to-ear sign.
• Likewise, physical maturity scoring is done by assessing skin, lanugo, plantar surface, breast, eye/ear, and genitals.

Option B: Square Window

• A square window sign helps in the assessment of the flexibility of the wrist of a neonate.
• The examiner gently applies pressure on the dorsum of the hand while the fingers are straightened, forming an angle between the palm and forearm of the baby.
• The wrist has the least flexibility at the younger gestational age meaning a more premature baby would have a lesser angle.

Option C: Arm recoil

• This manoeuvre tests the passive flexor tone of the biceps muscle by measuring the recoil angle after a brief extension of the upper arm.
• The baby lies supine, and the examiner places his one hand beneath the baby's elbow. He flexes the elbow briefly and then extends it before releasing it. The recoil angle is noted to which the forearm springs back to flexion.
• The extremely premature neonate does not undergo any recoil.

Option D: Heel-to-ear

• This manoeuvre helps to assess the passive flexor tone of the pelvic girdle.
• It tests the passive or resistance to the extension of posterior hip flexor muscles
• The examiner brings the neonate’s foot towards the ipsilateral ear.
• In extremely premature neonates, the resistance to extension of posterior hip flexors is felt when the heel is at or near the ear.

Also Read: INI-CET Previous Year Question Papers

6. A 10-month-old baby boy is brought to the OPD by his parents. On examination, the pediatrician categorized the baby as a high-risk infant. Which among the following is a criterion for high-risk infants?

1. Polyhydramnios
2. Working mother
3. Malpresentation
4. 100 folic acid tablets were not taken during pregnancy

Correct Option A - Polyhydramnios:

• This is one of the criteria for high-risk infants

Incorrect Options:

Option B, C & D - Working mother / Malpresentation & 100 folic acid tablets were not taken during pregnancy: These are not criteria for high-risk infants

7. A 7-month-old baby presented in the emergency department with the complaint of having the following rash for 3 days. She has just started weaning and has had a history of loose stools for the last week. Her mother gives a history of similar episodes among her siblings, too. On examination, there is alopecia. What should be given for the management of this disease?

1. Calcium
2. Pyridoxine
3. Niacin
4. Zinc

Correct Option D - Zinc:

• The recent shift to weaning, diarrhea, and positive family, along with physical findings of alopecia, suggest zinc deficiency.
• A deficiency of zinc leads to acrodermatitis enteropathica.
• Rashes were seen, especially around the orifices.
• Acrodermatitis enteropathica is a genetic autosomal recessive disorder.
• It occurs due to a mutation in the SLC39A4 gene, which encodes the proteins involved in zinc transport.
• It is characterized by periorificial dermatitis, alopecia, and diarrhea.
• Treatment is oral zinc supplementation within pharmacological doses.
• Zinc is an essential trace element that plays a role in tissue repair, wound healing, carbohydrate tolerance, testicular hormone synthesis, and immune responses.
• The recommended intake is 2 mg/day in infants and 9 mg/day in adolescents.

Incorrect Options:

Option A - Calcium:

• Calcium deficiency is also a common problem in children
• It causes tetany, Rickets, and osteoporosis

Option B - Pyridoxine:

• Pyridoxine deficiency results in Peripheral neuropathy, refractory seizures, dermatitis, and microcytic anemia.

Option C - Niacin:

• Niacin deficiency causes pellagra.
• Pellagra is characterized by dermatitis (Casal necklace), diarrhea, and dementia

8. A 2-year-old with 12 hours of loose stools arrives at the pediatric ER. He shows signs of mild dehydration: sunken eyes, dry mouth, and slow skin pinch recovery. Despite this, he's conscious and drinking well. The consultant asks about the low-osmolarity ORS. What sodium concentration and total osmolarity are recommended for this case?

1. Na+ 90 mEq/L ; 311 mOsmol/L
2. Na+ 75 mEq/L ; 245 mOsmol/L
3. Na+ 60 mEq/L ; 245 mOsmol/L
4. Na+ 60 mEq/L; 240 mOsmol/L

Option B: Na+ 75 mEq/L; 245 mOsmol/L

• Low osmolar ORS is the first line in treating mild to moderate dehydration in children.
• According to World Health Organization (WHO), the composition of low osmolarity ORS is as follows:

Component	Low Osmolarity WHO ORS (mEq/L)
Glucose	75
Sodium	75
Potassium	20
Chloride	65
Citrate	10
Osmolarity	245 mosm/l

• Therefore, the Low osmolar ORS contains 75 mmol/L of Sodium and has a total osmolarity of 245 mOsm/L.

9. What is the cause of the symptoms in a 4-month-old girl presenting with recurrent infections, delayed umbilical cord separation, white mucosal patches with bleeding upon scraping, nonpurulent ear discharge, scaly erythematous skin lesions on the chest, and a leukocyte count of 38,700/mm3 with 90% neutrophils?

1. Chronic granulomatous disease
2. Chediak Higashi syndrome
3. Leukocyte adhesion deficiency type 1 (LAD1)
4. Myeloperoxidase deficiency

Option C: Leukocyte adhesion deficiency type 1 (LAD1)

• The above scenario depicts leukocyte adhesion deficiency type 1 (LAD1).
• Leukocyte adhesion deficiency type 1 (LAD1) is caused by an autosomal recessive defect in CD18, a subunit of beta-2 integrin, which results in the inability of leukocytes to migrate to the site of infection.
• Recurrent nonsuppurative bacterial infections (e.g., skin and mucosal infections) with minimal inflammation due to dysfunctional neutrophils
  • Impaired wound healing
  • Omphalitis.
  • Delayed separation of the umbilical cord (> 30 days postpartum)

Option A: Chronic granulomatous disease

• A congenital immunodeficiency syndrome caused by an X-linked or autosomal recessive defect in the phagocytic NADPH oxidase enzyme results in an inability of neutrophils and macrophages to produce superoxide radicals.
• Affected children typically present with recurrent, severe infections of the lungs, skin, bone, and lymph nodes by catalase-positive organisms (e.g., S. aureus, Serratia, Klebsiella, Aspergillus, and Burkholderia).

Option B: Chediak-Higashi syndrome

• A rare congenital immunodeficiency syndrome is caused by an autosomal recessive defect in the lysosomal trafficking regulator gene (LYST).
• This mutation results in a defect in neutrophil chemotaxis/microtubule polymerization.
• Clinical features include recurrent pyogenic infections, oculo-cutaneous albinism, mild bleeding diathesis, and progressive neuropathies.

Option D: Myeloperoxidase deficiency

• An autosomal recessive condition in which deficient or absent myeloperoxidase predisposes to recurrent candida infections; it does not present with such severely immunocompromised state
• Diagnosis can be made with a positive (normal) nitroblue tetrazolium test and immunohistochemical or genetic testing.

10. A patient presents to you with complaints of loss appetite for the last 4 months associated with weight loss and fever for 1 month. He also complained of frequent chest discomfort with a runny nose, cough that contained blood-stained mucus, and shortness of breath (since). Which of the following is characteristic of his diagnosis?

1. It is a form of cancer
2. Focal necrotizing glomerulonephritis
3. Positive for p-ANCA
4. Involves large vessels

Option B: Focal necrotizing glomerulonephritis

• It is a case of Wegener's granulomatosis.
• It is a necrotizing granulomatous vasculitis affecting the respiratory tract and kidneys.
• Due to focal necrotizing glomerulonephritis, the patient experiences pain in the kidney, but usually, its inflammation is symptomless.
• Its treatment involves steroids and cyclophosphamide, occasionally IVIG.

Option A: It is a form of cancer

• It is not a form of cancer.
• It is the result of inflammation within the tissues, which is known as granulomatous inflammation and blood vessel inflammation.

Option C: Positive for p-ANCA

• It is positive for c-ANCA.
• However, it is not the specific diagnostic test for the disease.

Option D: Involves large vessels

• It is an inflammatory disease of tissues and blood vessels.
• It primarily involves small vessels and is a small vessel vasculitis.

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