INICET Pediatrics Previous Year Questions (2018–2026)

The correct answer is No radiological investigation required.

An uncomplicated upper respiratory tract infection (common cold, pharyngitis, rhinitis) is a clinical diagnosis based on history and examination - sneezing, nasal congestion, sore throat, cough and low-grade fever. No imaging is needed when there are no complications. In fact, imaging is misleading: CT shows incidental sinus mucosal changes in over 80 percent of ordinary viral colds, which do not change management.

Imaging is reserved for suspected complications. A chest radiograph is used only if lower respiratory involvement or pneumonia is suspected; CT of the neck/chest or HRCT is for specific complications (abscess, mass, interstitial lung disease), not for a simple URTI. So this child needs no radiology.

Incorrect Options:

• Plain chest radiograph: only needed if a lower respiratory infection or pneumonia is suspected, not for an uncomplicated URTI.
• CT scan of neck and chest: reserved for suspected complications (abscess, deep-space infection, mass), not a simple URTI.
• HRCT: used for interstitial or chronic lung disease, not for an uncomplicated upper respiratory infection.

High-Yield Facts:

• Uncomplicated URTI is a clinical diagnosis - no imaging required.
• Imaging is only for suspected complications (pneumonia, abscess).
• CT shows incidental sinus changes in most ordinary colds - do not over-image.
• A child has on average 4 to 8 (up to 10) URTIs per year.

Figure 1: A normal chest radiograph - even if performed, imaging is normal in uncomplicated URTI, so it is not indicated.

Figure 2: The upper respiratory tract (nose, pharynx, larynx) - the site of URTI, diagnosed clinically.

The correct answer is Breastfeeding and reassessment.

This is mild, asymptomatic neonatal hypoglycaemia in a term baby (38 mg/dL at 3 hours). The standard first step is a trial of feeding (preferably breastfeeding) and a recheck of blood glucose in 30 to 60 minutes (oral dextrose gel may be added). Feeding provides substrate, keeps mother and baby together, and usually corrects transitional hypoglycaemia.

IV dextrose (a 2 mL/kg bolus of 10 percent dextrose then an infusion) is reserved for symptomatic hypoglycaemia, very low glucose (roughly under 25 mg/dL in the first hours), or failure to respond to feeding. Simply observing without feeding or rechecking is unsafe at this level. So breastfeeding with reassessment is correct.

Incorrect Options:

• IV dextrose bolus: reserved for symptomatic or very low glucose (about under 25 mg/dL early), or when feeding fails - not for mild asymptomatic hypoglycaemia.
• IV dextrose infusion over 2 hours: an IV approach for persistent or symptomatic hypoglycaemia, not the first step here.
• Observe: observation alone, without feeding and a glucose recheck, is inadequate at 38 mg/dL.

High-Yield Facts:

• Asymptomatic mild neonatal hypoglycaemia: feed (breastfeed) and recheck glucose.
• IV dextrose (bolus 2 mL/kg of 10 percent, then infusion) is for symptomatic or very low/persistent hypoglycaemia.
• Oral dextrose gel plus feeding is an effective first-line option that reduces NICU admission.
• At-risk: infants of diabetic mothers, preterm/late-preterm, SGA, LGA.

Figure 1: Breastfeeding - the first-line step for mild asymptomatic neonatal hypoglycaemia.

Figure 2: Recheck blood glucose after feeding - reassessment confirms the level has risen.

The correct answer is Detailed speech and hearing evaluation.

This child's gross motor (walking), fine motor (scribbling) and receptive language/cognition (obeys one-step commands) are normal, but expressive speech is delayed - by 18 to 24 months a toddler should have many words (10 to 20 or more), not just one. This is an isolated expressive speech/language delay. The most important first step is a hearing assessment together with a speech and language evaluation, because hearing impairment (often otitis media with effusion) is the commonest treatable cause of isolated speech delay.

The other options are wrong. Reassurance and waiting until 5 years would dangerously delay treatment. Autism cannot be diagnosed from speech delay alone when social and receptive skills are intact - and it is a clinical diagnosis after proper assessment, not made immediately. There are no seizures, so antiepileptics are not indicated.

Incorrect Options:

• Reassurance and follow up at 5 years: a single word at 20 months is delayed, and waiting that long would miss treatable causes.
• Diagnose as autism immediately: social and receptive skills are intact, and autism is a clinical diagnosis after assessment, not made from speech delay alone.
• Start antiepileptics: there is no seizure disorder here, so antiepileptics have no role.

High-Yield Facts:

• Isolated speech delay: first assess hearing (and do a speech/language evaluation).
• Hearing loss (often otitis media with effusion) is the commonest treatable cause.
• By 24 months expect about 50 words and 2-word phrases; concern if under 50 words or no phrases.
• Speech delay alone is not autism - assess social and receptive skills.

Figure 1: Hearing assessment - the key first evaluation in a child with isolated speech delay.

Figure 2: An audiogram - used to exclude hearing loss, the commonest treatable cause of speech delay.