FMGE 2026 - Pediatrics Practice Questions

Q: Mother noticed swelling in groin region while child was coughing and crying, what is diagnosis?

Indirect inguinal hernia. ***Indirect inguinal hernia*** - This is the **most common type of inguinal hernia** seen in children, resulting from a **patent processus vaginalis** that fails to close. - The swelling typically becomes prominent or increases in size with **increased intra-abdominal pressure**, such as during **coughing, crying, or straining**. *Direct inguinal hernia* - Rare in children, as it is typically an **acquired condition** resulting from weakness in the **Hesselbach triangle** floor, often seen in adults. - It does not involve the **patent processus vaginalis** and protrudes directly through the abdominal wall, typically medial to the **inferior epigastric vessels**. *Undescended testis* - Presents as an **empty scrotum**, rather than a reducible bulge, although it can be associated with a hernia. - The mass, if palpable in the inguinal canal, will typically feel like a firm **testicular body** rather than a compressible, reducible bowel segment. *Femoral hernia* - Located inferior to the **inguinal ligament** and medial to the **femoral vein**, appearing as a bulge in the upper thigh. - Extremely rare in children and carries a high risk of **incarceration** or strangulation due to the narrow nature of the **femoral ring**.

Q: A child is born with following finding what is best step in line of management?

Operate after 1 year age. ***Operate after 1 year age*** - This timing is typically associated with the surgical management of a **hydrocele of the canal of Nuck** or certain types of **inguinal hernias** that are asymptomatic and reducible in infants, allowing for potential closure or stabilization. - Waiting until 1 year reduces the **anesthetic risks** associated with early infancy and allows for more mature anatomical development of local structures. *Immediately operate* - Emergency surgery is reserved for **incarcerated** or **strangulated hernias** presenting with signs of bowel obstruction, severe pain, or skin changes. - It is not the standard of care for uncomplicated presentations, as it significantly increases the risk of **anesthetic complications** and **iatrogenic injury** to the spermatic cord in neonates. *Aspiration* - Aspiration is generally contraindicated in pediatric hydroceles due to the high risk of **infection** and the extremely high rate of **recurrence**. - It does not address the underlying patent **processus vaginalis**, which is the primary pathology in communicating hydroceles or inguinal hernias. *I & D* - Incision and drainage (I & D) is the treatment for **abscesses** and infection, not structural congenital malformations like hydroceles or hernias. - Performing I & D on a sterile hydrocele would introduce bacteria, leading to **pyocele** and potential damage to scrotal contents.

Q: A 5-year-old female is brought to OPD with a red mass protruding from the anal verge after defecation. On examination, the mass is 4 cm long and demonstrates concentric mucosal folds. What is the most appropriate initial management?

Conservative. ***Conservative management*** - Pediatric **rectal prolapse** is most commonly self-limiting and resolved by treating the underlying cause, such as **constipation**, **parasitic infection**, or **diarrhea**, and teaching the child to avoid prolonged straining. - Biofeedback or behavioral modifications, such as using a footstool while defecating to achieve a better anatomic position, are highly effective **initial management** strategies. *Injection Sclerotherapy* - This invasive procedure involves injecting an **irritant solution** into the perirectal space to create inflammation and fibrosis, which is generally reserved for patients who have failed long-term conservative treatment. - It carries significant risks, including **rectal ulceration**, **stricture formation**, and **perirectal abscess**, making it unsuitable as a primary approach. *Suture Rectopexy* - This is a surgical intervention indicated only for **refractory cases** or those unresponsive to comprehensive medical management and conservative measures. - It is overly aggressive for a typical 5-year-old presenting without red flags or complications, meaning surgery should be deferred until non-surgical avenues are exhausted. *Thiersch Stitch* - This procedure involves encircling the anal verge with a foreign material (like wire or suture) to narrow the anal opening, which is rarely indicated and primarily reserved for frail, elderly patients with **incontinence**. - It is associated with high rates of **fecal impaction** and infection, making it inappropriate and unnecessary for a pediatric patient.

Q: A chest X-ray of a 6-year-old child with recurrent episodes of cyanosis is given below. What is the most probable diagnosis?

Tetralogy of Fallot. ***Tetralogy of Fallot*** - This condition is classically associated with the **'boot-shaped heart'** (coeur en sabot) on chest X-ray, caused by right ventricular hypertrophy and a small main pulmonary artery segment. - It is the most common **cyanotic congenital heart disease** presenting in childhood, characterized by the tetrad of **ventricular septal defect**, **pulmonary stenosis**, **overriding aorta**, and **right ventricular hypertrophy**. *Transposition of the great arteries* - Classically presents with an **'egg on a side'** appearance on chest X-ray due to the narrow mediastinum and abnormal positioning of the great vessels. - Typically presents with severe cyanosis in the **neonatal period** rather than recurrent episodes in a 6-year-old, unless surgical intervention has occurred. *Tricuspid atresia* - Chest X-ray typically shows a **decreased pulmonary vascular markings** and a **left axis deviation** on ECG, distinct from the radiographic features of TOF. - Characterized by the complete absence of the tricuspid valve, leading to a hypoplastic right ventricle and reliance on an **atrial septal defect** for survival. *Total anomalous pulmonary venous connection* - Often presents with the classic **'snowman'** or **'figure-of-eight'** sign on chest X-ray due to the supracardiac type of anomalous drainage. - Typically presents with **pulmonary venous congestion** and cardiomegaly, unlike the decreased pulmonary flow usually seen in Tetralogy of Fallot.

Q: A child with low IQ, poor communication, presented with loss of bladder control/urinary incontinence. Which of the following is the most likely diagnosis?

Heller’s disease. ***Heller’s disease*** - Also known as **Childhood Disintegrative Disorder**, it is characterized by a marked regression in multiple areas of development, such as language, social skills, and bladder/bowel control, following a period of normal development for at least two years. - Diagnosis is often suspected when a child demonstrates a significant loss of previously acquired skills, often accompanied by global developmental delays (low IQ) and communication deficits. *Refsum’s disease* - This is a rare autosomal recessive metabolic disorder characterized by **phytanic acid accumulation** due to a deficiency in phytanoyl-CoA hydroxylase. - Clinical presentation typically includes **retinitis pigmentosa**, peripheral neuropathy, and cerebellar ataxia rather than developmental regression and urinary incontinence. *ADHD* - ADHD is a neurodevelopmental disorder marked by persistent patterns of **inattention**, **hyperactivity**, and **impulsivity** that interfere with functioning or development. - It does not involve the loss of previously acquired milestones or bladder control typically seen in degenerative or disintegrative disorders. *Weil’s disease* - This is the severe form of **Leptospirosis**, caused by infection with *Leptospira* bacteria, and presents with jaundice, acute kidney injury, and hemorrhage. - It is an acute infectious process, not a developmental disorder, and does not cause a loss of communication skills or developmental regression.

Q: A patient is shown using a metered -dose inhaler as shown in the image. Which of the following statements about spacer use is correct?

Decreases drug wastage & reduces oropharyngeal deposition. ***Decreases drug wastage & reduces oropharyngeal deposition*** - Spacers act as a reservoir, allowing the medication particles to slow down and suspend in the device, which ensures that more **medication reaches the lower airways** rather than impacting the back of the throat. - By minimizing **oropharyngeal deposition**, spacers significantly reduce the risk of common side effects like **oral candidiasis** and dysphonia, particularly with inhaled corticosteroids. *Increases systemic absorption of the drug* - The primary goal of a spacer is to improve **local delivery** to the lungs, not to increase systemic uptake. - In fact, by reducing deposition in the oropharynx, the amount of drug swallowed and subsequently absorbed into the **systemic circulation** from the GI tract is typically **decreased**. *Makes inhaler technique more complicated and less effective* - Spacers actually simplify the **coordination** required between actuating the inhaler and inhaling, making the process much easier for patients, especially children and the elderly. - They are proven to **improve overall drug delivery efficacy** in patients who struggle with the

Q: Factor V,X?

Haemophilus influenzae. ***Haemophilus influenzae*** - **Haemophilus influenzae** is a fastidious organism that requires specific growth factors found in blood to survive in culture media. - Specifically, it requires **Factor X (hemin)** and **Factor V (NAD or NADP)**, which are present in **chocolate agar** but not in standard blood agar. *Rubella* - **Rubella** is a viral pathogen (togavirus) and does not require bacterial nutrient agar factors like X or V for replication. - Viral growth requirements are strictly **intracellular**, relying on host cell machinery rather than external biochemical factors. *HSV* - **Herpes Simplex Virus (HSV)** is an obligate **intracellular virus** that propagates within host cells, not on artificial agar media. - It does not have metabolic requirements for heme or NAD, distinguishing it completely from bacterial nutritional needs. *EBV* - **Epstein-Barr Virus (EBV)** is a herpesvirus that exhibits **B-lymphocyte tropism** and requires specialized cell culture lines for laboratory study. - Like other viruses, its replication is driven by **viral genetic material** integrated into host cells, independent of bacterial growth factors.

Q: A 6-year-old child presents with joint pain and a purpuric rash over the buttocks and lower limbs. The rash is palpable and non -blanching. An image of the rash is shown. The child also complains of colicky abdominal pain. What is the most likely diagnos is?

Henoch –Schönlein purpura. ***Henoch-Schönlein purpura*** - This condition, also known as **IgA vasculitis**, classically presents with the triad of **palpable purpura** on dependent areas (lower limbs/buttocks), **arthritis/arthralgia**, and **abdominal pain** due to vasculitis of the bowel wall. - Diagnosis is supported by clinical presentation without significant thrombocytopenia, distinguishing it from platelet-related disorders. *Immune thrombocytopenic purpura* - Characterized by isolated **thrombocytopenia** resulting in **petechiae** and **ecchymoses** rather than palpable, raised lesions. - Abdominal pain and joint involvement are generally not features of this condition. *Acute rheumatic fever* - Presents with **migratory polyarthritis** and potential cardiac involvement following a **Group A Streptococcus** infection. - While it involves joints, it does not present with the characteristic palpable purpuric rash seen in vasculitis. *Kawasaki disease* - Manifests primarily as **prolonged high fever**, **conjunctivitis**, **mucosal changes** (strawberry tongue), and **polymorphous rash**. - The rash is typically not palpable purpura, and the condition is strongly associated with **coronary artery aneurysms**.

Q: A 19-year-old boy presents with long limbs and hypermobility of joints. Genetic analysis shows a mutation in the FBN1 gene. What is the most likely diagnosis?

Marfan syndrome. ***Marfan syndrome*** - This condition is caused by a mutation in the **FBN1 gene** on chromosome 15, which codes for **fibrillin-1**, a key component of connective tissue microfibrils. - Clinical features classically include **dolichostenomelia** (long limbs), **arachnodactyly** (long, thin fingers), **joint hypermobility**, and a high risk of **aortic root dilation** or dissection. *Ehlers–Danlos syndrome* - Primarily characterized by **skin hyperextensibility** and excessive tissue fragility, rather than the skeletal overgrowth seen in Marfan syndrome. - Mutations typically involve genes encoding **collagen** or enzymes involved in collagen processing (e.g., **ADAMTS2** or **PLOD1**), not the *FBN1* gene. *Homocystinuria* - Presents with a Marfanoid habitus but is distinct due to the presence of **intellectual disability** and **thrombotic events** (due to hypercoagulability). - It is an **autosomal recessive** metabolic disorder caused by **cystathionine beta-synthase deficiency**, not a fibrillin defect. *Loeys–Dietz syndrome* - While it shares features like aortic aneurysm and skeletal findings, it is often distinguished by **hypertelorism**, **bifid uvula**, and **cleft palate**. - It is caused by mutations in **TGFBR1** or **TGFBR2** genes, which regulate the TGF-beta signaling pathway, distinct from the *FBN1* pathology of Marfan syndrome.

Q: The most likely diagnosis is?

Thalassemia. ***Thalassemia*** - In pediatric populations, thalassemia often presents as a **microcytic hypochromic anemia** with a **disproportionately low MCV** compared to the red cell count (Mentzer Index < 13). - Hallmark findings include **hemoglobin electrophoresis** showing elevated HbA2 or HbF and target cells on the **peripheral blood smear**. *IDA* - Iron Deficiency Anemia (IDA) is characterized by **low ferritin** and **low serum iron**, which is the primary differentiator from thalassemia where ferritin is usually normal or high. - It typically presents with a **high Red Cell Distribution Width (RDW)**, whereas thalassemia minor often presents with a normal RDW. *Sideroblastic anemia* - This condition is characterized by the presence of **ringed sideroblasts** in the bone marrow, which are not seen in thalassemia. - It is classically associated with **elevated serum iron** and **ferritin** levels, caused by defective heme synthesis rather than globin chain production. *Anemia of chronic disease* - This type of anemia is typically **normocytic** or mildly microcytic and is associated with chronic inflammatory states. - It is differentiated by **low serum iron** but **normal or high ferritin** levels, indicating adequate iron stores that are sequestered and unavailable for erythropoiesis.

Question 1

Mother noticed swelling in groin region while child was coughing and crying, what is diagnosis?

Accepted Answer

Indirect inguinal hernia

Answer

Direct inguinal hernia

Answer

Undescended testis

Answer

Femoral hernia

Question 2

A child is born with following finding what is best step in line of management?

Accepted Answer

Operate after 1 year age

Answer

Immediately operate

Answer

Aspiration

Answer

I & D

Question 3

A 5-year-old female is brought to OPD with a red mass protruding from the anal verge after defecation. On examination, the mass is 4 cm long and demonstrates concentric mucosal folds. What is the most appropriate initial management?

Accepted Answer

Conservative

Answer

Injection Sclerotherapy

Answer

Suture Rectopexy

Answer

Thiersch Stitch

Question 4

A chest X-ray of a 6-year-old child with recurrent episodes of cyanosis is given below. What is the most probable diagnosis?

Accepted Answer

Tetralogy of Fallot

Answer

Transposition of the great arteries

Answer

Tricuspid atresia

Answer

Total anomalous pulmonary venous connection

Question 5

A child with low IQ, poor communication, presented with loss of bladder control/urinary incontinence. Which of the following is the most likely diagnosis?

Accepted Answer

Heller’s disease

Answer

Refsum’s disease

Answer

ADHD

Answer

Weil’s disease

Question 6

A patient is shown using a metered -dose inhaler as shown in the image. Which of the following statements about spacer use is correct?

Accepted Answer

Decreases drug wastage & reduces oropharyngeal deposition

Answer

Increases systemic absorption of the drug

Answer

Makes inhaler technique more complicated and less effective

Answer

Has no effect on drug delivery

Question 7

Factor V,X?

Accepted Answer

Haemophilus influenzae

Answer

Rubella

Answer

HSV

Answer

EBV

Question 8

A 6-year-old child presents with joint pain and a purpuric rash over the buttocks and lower limbs. The rash is palpable and non -blanching. An image of the rash is shown. The child also complains of colicky abdominal pain. What is the most likely diagnos is?

Accepted Answer

Henoch –Schönlein purpura

Answer

Immune thrombocytopenic purpura

Answer

Acute rheumatic fever

Answer

Kawasaki disease

Question 9

A 19-year-old boy presents with long limbs and hypermobility of joints. Genetic analysis shows a mutation in the FBN1 gene. What is the most likely diagnosis?

Accepted Answer

Marfan syndrome

Answer

Ehlers–Danlos syndrome

Answer

Homocystinuria

Answer

Loeys–Dietz syndrome

Question 10

The most likely diagnosis is?

Accepted Answer

Thalassemia

Answer

IDA

Answer

Sideroblastic anemia

Answer

Anemia of chronic disease

FMGE 2026 — Pediatrics