INI-CET Pediatrics: High-Yield Image-Based Questions and Clues

Q1. By which age the milestone given in the image below is achieved by the child?

1. ​1 month
2. 2 months
3. 3 months
4. None of the above.

Correct Answer: 3) 3 months

Explanation:

The image depicts ventral suspension of the child (this co relates with neck holding milestone which also develops by 3 months)

• Method: The child is held in a prone position and then lifted from the couch, with the examiner supporting the chest and abdomen of the child with the palm of his hand.

Q2. A 12-year-old child’s growth chart shows a distinctive pattern in the graph depicting their growth over time as shown in the image below. In this clinical scenario, what does the graph primarily indicate about the child’s growth patterns?​

1. ​Gonadal development
2. Somatic growth
3. Brain growth
4. Lymphoid growth

Correct Answer: B) Somatic growth

Explanation:

In this clinical scenario, the sigmoid (S-shaped) curve primarily indicates the pattern of somatic growth, which refers to the child's height growth during childhood and adolescence.

Q3. A one-year-old child presents with macrocephaly, developmental delay, a significant reduction in motor skills, poor muscle tone, and a low IQ. At birth the child was normal. Fundoscopy reveals the following. What is the most likely diagnosis?​

1. ​Tay-Sachs disease
2. Infantile Hydrocephalus
3. Congenital brain malformation
4. Rett syndrome

Correct Answer: A) Tay Sachs Disease

Explanation:

• Tay-Sachs disease is a rare, inherited disorder that affects the nervous system. It is caused by a deficiency in an enzyme called Hexosaminidase A (Hex-A).
• This enzyme is crucial for breaking down a type of fat called GM2 ganglioside, which accumulates in the nerve cells of the brain and spinal cord when the enzyme is deficient.
• Macrocephaly is a notable feature in the early stages of Tay-Sachs disease.

Q4.  Match the following.

A.  ​	1. Scaphocephaly
B.  ​	2. Plagiocephaly
C.  ​	3. Brachycephaly
D.  ​	4. Trigonocephaly

1. A-3, B-2, C-4, D-1
2. A-2, B-3, C-4, D-1
3. A-3, B-1, C-4, D-2
4. A-1, B-4, C-3, D-2

Correct Answer: C) A-3, B-1, C-4, D-2

Explanation:

• The above images illustrate the different types of craniosynostosis.
• Craniosynostosis occurs when one or more skull sutures close prematurely, potentially leading to varying impacts on a child's neurodevelopment depending on the number of sutures affected and the severity of complications.

Posterior fontanelle: This smaller fontanelle at the back of the head usually closes within 2 months of birth.

Anterior fontanelle: This larger fontanelle at the top of the head usually closes between 7 and 18 months.​

Q5. A 2-year-old child presents for evaluation with an abnormal head shape and a distinctive hand deformity as shown in the image. The child's head exhibits early closure of cranial sutures, leading to an unusually shaped skull. Based on these clinical features, which of the following conditions is the most likely diagnosis?

1. Crouzon syndrome
2. Apert syndrome
3. Pfeiffer syndrome
4. Carpenter syndrome

​Correct Answer: B) Apert Syndrome

Explanation:

• Apert syndrome is a genetic condition that involves both craniosynostosis and a characteristic "mitten hand" deformity.
• Apert syndrome is usually a sporadic condition, although autosomal dominant inheritance can occur.
• It is associated with premature fusion of multiple sutures, including the coronal, sagittal, squamosal, and lambdoid sutures.
• Apert syndrome is characterized by syndactyly of the 2nd, 3rd, and 4th fingers, which may be joined to the thumb and the 5th finger known as mitten hand deformity.
• Similar abnormalities often occur in the feet.
• All patients have progressive calcification and fusion of the bones of the hands, feet, and cervical spine.

Q6.  Match the following graphical representations with their respective cause of short stature.

i) Familial short stature	​​​
ii) Constitutional delay
iii) Pre-natal onset pathologic short stature

1. i-A, ii-B, iii-C
2. i-B, ii-A, iii-C
3. i-C, ii-B, iii-A
4. i-A, ii-C, iii-B

Correct Answer: B) i-B, ii-A, iii-C

Explanation:

Difference between familial and constitutional short stature:

Features	Familial short stature	Constitutional delay in growth
Sex	Both equally affected	More common in boys
Length at birth	Normal	Normal (starts falling < 5th centile in 1st 3 years of life)
Family history	Short stature	Delayed puberty
Parents stature	Short (one or both)	Average
Height velocity	Normal	Normal
Puberty	Normal	Delayed
Bone age (BA) and chronological age (CA)	BA = CA > height age	CA > BA = height age
Final height	Short, but normal for target height	Normal

Q7. Match the following images with their distinguishing features

a) Benign capillary malformation	​​​
b) Contains eosinophils	​​​
c) Contains melanocytes	​​​
d) Contains keratin	​​​

1. 1-b, 2-a, 3-d, 4-c
2. 1-c, 2-d, 3-b, 4-a
3. 1-a, 2-b, 3-c, 4-d
4. 1-d, 2-c, 3-a, 4-b

Correct Answer: D) 1-d, 2-c, 3-a, 4-b

Explanation:

Condition	Features
Milia ​	A common benign skin condition characterized by small white papular cystic lesions which are superficial benign keratinous cysts, usually 3 mm in size. Predominantly found on the face and nose.
Mongolian Spots/ Dermal melanocytosis ​	Slate-blue, well-defined areas of pigmentation that appear on the buttocks, back, and occasionally other areas of the body. Collection of melanocytes in the deeper layers of the skin. Present in over 50% of Black, Native American, and Asian infants, and sometimes in white infants as well. These benign patches have no known anthropologic significance. Usually fades within the first year of life.
Stork bites/ Salmon Patch/ Angel kiss ​	The benign capillary malformation can appear as flat red patches on a newborn's forehead and upper eyelids. Do not need treatment because they are harmless and will fade over time.
Erythema toxicum neonatorum ​	Small, white papules on an erythematous base, contain eosinophils and they develop 1-3 days after birth. Benign rash, which typically lasts up to a week. Usually found on the face, torso, and limbs.

Q8.  A 6-hour-old term baby shifted to emergency brought with severe respiratory distress. Chest X-ray is given below. Which of the initial clinical interventions should not be done on this patient?

1. Intubation and insertion of nasogastric tube
2. Bag and mask ventilation
3. Administration of fluids
4. Put the baby in a radiant warmer.

​Correct Answer: B) Bag and mask ventilation

Explanation: The described clinical presentation with a history of sudden noisy breathing and given X-ray is suggestive of congenital diaphragmatic hernia.

• Bag and Mask ventilation is contraindicated in congenital diaphragmatic hernia.
• During the Bag and mask ventilation, the mask envelops both the nose and mouth, directing air through both the trachea and esophagus.
• However, the air passing through the esophagus can result in an extension of bowel loops leading to a mediastinal shift and reduced space for the lungs to expand.
• Immediate steps of management include: Put the baby in a radiant warmer → Endotracheal intubation→ Placement of a nasogastric tube→ Administration of fluids

Q9.  A primigravida with a complicated pregnancy underwent a cesarean section at 32 weeks of gestation. Soon after birth, the baby developed grunting, cyanosis, and a significantly elevated respiratory rate. A chest X-ray was performed immediately. Which of the following findings would not be seen on the given radiograph?

1. ​Ground glass haziness of lungs
2. Box-shaped heart
3. Presence of air bronchogram
4. Reticulogranular pattern

Correct Answer: B) Box-shaped heart

Explanation:

• The most likely diagnosis in this scenario is Respiratory Distress Syndrome (RDS), also known as hyaline membrane disease (HMD), a common condition in preterm infants (<34 weeks of gestation) caused by surfactant deficiency.
• Typical X-ray findings in RDS include:
  • Ground glass haziness of lungs: Represents diffuse alveolar atelectasis, commonly seen in RDS.
  • Presence of air bronchogram: Air-filled bronchi are visible against the hazy, collapsed alveoli, a classic feature of RDS.air bronchogram can be seen in parenchymal pathology of lung such as consolidation, pulmonary alveolar proteinosis.
  • Reticulogranular pattern: Another term for the ground-glass appearance, indicating the fine, granular pattern throughout the lungs characteristic of RDS.

Q10.  A day-old preterm infant is admitted with severe respiratory distress. Physical examination shows a scaphoid abdomen and a chest X-ray image is given below. Despite intensive care, the infant's condition deteriorates. Which of the following statements about the suspected condition is correct?

1. Bochdalek typically occurs on the right side.
2. Morgagni involves the posterior diaphragm.
3. Morgagni is associated with poor prognosis.
4. The condition is mostly sporadic.

​Correct Answer: D) The condition is mostly sporadic.

Explanation: The given clinical scenario of a preterm infant with severe respiratory distress with a scaphoid abdomen and x-ray showing bowel loops in the thorax points towards Congenital Diaphragmatic Hernia (CDH), which is mostly sporadic.

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