You are on page 1of 21

Growth and Development 1

Growth and Development

Questions
1. The most unlikely cause for neonatal seizures on Day 2, in an
infant is
a. Metabolic
b. Birth Asphyxia
c. Intraventricular Hemorrhage
d. Neonatal tetanus

2. A full term neonate is having episodes of cyanosis and apnea


which worsen on feeding and seems better when he is crying.
The next step to establish a quick immediate diagnosis is
a. Echocardiogram
b. Bronchoscopy
c. Upper GI
d. Nasal exploration with a catheter

3. All of the following are seen in infants with Laryngomalacia, except,


a. Stridor beginning at (or) shortly after birth
b. No evidence of significant Expiratory obstruction
c. Stridor is typically loudest during feeding
d. Usually increases during crying

4. Which of the following childhood problems improves with increase


in age
a. Conduct disorder
b. Emotional problems
c. Temper tantrum
d. Sleep disorder

5. An Infant exhibits stranger reaction by


a. 4 months
b. 6 months
c. 10 months
d. 1 year

1
2 Paediatrics
6. Vocabulary of a 3 year old child is
a. 100 words
b. 150 words
c. 250 words
d. 500 words

7. “Handedness” is evident in a child by


a. 2 years
b. 3 years
c. 4 years
d. 5 years

8. The Hormone not essential for inutero fetal growth is


a. Insulin
b. Insulin like growth factor
c. Somatotropic hormone
d. Thyroxine

9. A child can walk up and down stairs, alternating his feet by


a. 3 years
b. 2 years
c. 4 years
d. None of the above

10. External Genitalia can be clearly differentiated in a fetus by


a. 12 weeks
b. 20 weeks
c. 8 weeks
d. 10 weeks

11. Child changes rattle from one hand to another at the age of
a. 3 Months
b. 6 Months
c. 8 Months
d. 1 Year

12. Visual acuity reaches Adult level by


a. 3 years
b. 4 years
c. 5 years
d. 7 years
Growth and Development 3
13. Pincer grasp is seen at
a. 3 months
b. 9 months
c. 5 months
d. 7 months

14. A child starts to take self decisions by the age of


a. 7 years
b. 3 years
c. 10 years
d. 12 years

15. Deciduous Dentition is completed by the age of


a. 6 months
b. 6 weeks
c. 6 years
d. None of the above

16. Fatty acids necessary during 0 to 6 months of age for brain are
a. Arachidonic acid
b. Linoleic acid
c. Both of the above
d. None of the above

17. The triad of Autistic Spectrum Disorders (ASD) are all except.
a. Impaired social interaction
b. Impaired learning
c. Impaired Communication
d. Impaired imagination

18. Breast Milk at room temperature can be stored for


a. 7 hours
b. 24 hours
c. 4 hours
d. 10 hours

19. Nipple Confusion occurs when


a. A Baby is allowed to suckle on one side most of the times
b. A suckling baby is pulled half way and placed on the opposite side
during feeding
c. When the baby is positioned incorrectly
d. None of the above
4 Paediatrics
20. Order of development of 2º sexual characteristics in a male is
a. Testis development – Axillary hair – Pubic hair – beard
b. Testis development – Pubic hair – Auxillary hair - beard
c. Beard – Axillary hair – Pubic hair – Testis development
d. Axillary hair – Pubic hair – beard – Testis development

21. Order of development of 2º sexual characteristics in female is


a. Thelarche – Menarche – Pubarche – Adrenarche (Axillary Hair)
b. Menarche – Thelarche – Pubarche – Adrenarche (Axillary Hair)
c. Adrenarche (Axillary hair) – Thelarche – Pubarche – Menarche
d. Menarche – Pubarche – Adrenarche – Thelarche

22. An Infant sits with minimal support, rolls over from supine to prone
position, reaches for a toy, does not have a pincer grasp – the
developmental age is
a. 3 Months
b. 4 Months
c. 6 Months
d. 8 Months

23. Incorrect about Thumb sucking


a. Can lead to malocclusion
b. Is a source of pleasure
c. Is a sign of insecurity
d. Must be treated at 1 year to prevent stubborness

24. Two Infants are born at 36 weeks. Infant A weighs 2.6 Kg, Infant B
weighs 1.6 Kg. Infant B is more likely to have
a. Congenital malformations
b. Low Hematocrit
c. Hyperglycaemia
d. None of the above

25. Which of the following drugs given during the last 2 weeks of
pregnancy is most likely to have deleterious effects on the fetus
a. Propranolol
b. Penicillin
c. Heparin
d. Phenytoin

26. The most uncommon manifestation / sign in Neonatal meningitis


is
a. Lethargy
b. Neck stiffness
c. Vomiting
d. Hypothermia
Growth and Development 5
27. The most common Intra cranial tumor in 2 – 12 years age group is
a. Cerebellar Astrocytoma
b. Medulloblastoma
c. Ependymoma
d. Choroid plexus papilloma

28. The Important Prognostic Anthropometric measurement in a


newborn is
a. Weight
b. Head circumference
c. Length
d. None of the above

29. In a standard growth chart; Head circumference is included for


the age upto
a. 1 Year
b. 3 Years
c. 2 Years
d. 5 Years

30. The brain size of a one year old Infant in relation to an adult brain
is
a. 67%
b. 75%
c. 90%
d. 60%

31. The average normal blood pressure of a 3 year old child is


a. 75/50 mmHg
b. 90/60 mmHg
c. 65/45 mmHg
d. None of the above

32. All are early indications for Exchange blood transfusion in Infants
with Rh-Hemolytic Disease except
a. Cord Hb > 12g/dL
b. Cord Bilirubin 5 mg/dL (or) more
c. Unconjugated Bilirubin > 10 mg/dL – 24 hrs
d. Rise of Bilirubin more than 0.5 mg/dL/hour

33. Two carpal bones are radiologically seen in the wrist X-ray by the
end of
a. 1 Year
b. 2 years
c. 4 years
d. 12 years
6 Paediatrics
34. IQ between 50-70 indicates
a. Moderate Mental Retardation
b. Mild Mental Retardation
c. Severe Mental retardation
d. Profound MR

35. Weight gain during first 3 months of age


a. 250 gm/month
b. 500 gm/month
c. 350 gm/month
d. 750 gm/month

36. Length of the babies is recorded upto


a. 1 Year
b. 2 Years
c. 21/2 years
d. 11/2 years

37. Head circumference at 12 years of age is


a. 48 cm
b. 50 cm
c. 52 cm
d. 49 cm

38. Anthropometric measure that does not show much change in 1–


4 years is
a. Abdominal circumference
b. Head circumference
c. Skinfold thickness
d. Mid arm circumference

39. A 5 year old child is assessed to have developmental age of 1


year. His IQ is
a. 20
b. 40
c. 80
d. 100

40. Shakir tape is used to measure


a. Height
b. Length
c. Midarm circumference
d. Head circumference
e. Chest circumference
Growth and Development 7
41. Skeletal age of Infants of 8 months age is assesed by
a. X ray of Pelvis
b. X ray of Radius&ulna
c. X ray of skull
d. X ray of shoulder

42. Capacity of stomach in a newborn is


a. 20 ml
b. 30 ml
c. 50 ml
d. 100 ml

43. Vomiting on the first day in a newborn is due to


a. Esophageal atresia
b. Pyloric stenosis
c. Amniotic fluid gastritis
d. Congenital megacolon

44. Air in the jejunum in an X ray of an Infant can be seen in


a. 2–3 Hrs
b. 15 Min.–60 Min.
c. 3 Hrs to 6 Hrs
d. 24 Hrs.

45. Large doses of Vit K administered to a new born may result in


a. Hyperammonemia
b. Hypobilirubinaemia
c. Prolonged Hyperbilirubinaemia
d. Prolonged bleeding time

46. Foetal scalp Blood pH; Less than –– is abnormal


a. 7.25
b. 7.3
c. 7.35
d. 7.4

47. Neonatal seizures – cause of which carries the best prognosis;


a. Birth asphyxia
b. Hypoglycaemia
c. Meningitis
d. Late onset Hypocalcemia
8 Paediatrics
48. The normal heart rate at Birth is
a. 60–80 bpm
b. 80–110 bpm
c. 70–120 bpm
d. 110–150 bpm

49. In Neonatal necrotising enterocolitis all of following are found


except
a. Blood in stools
b. Delayed gastric emptying
c. Temperature instability
d. Increased Bowel sounds

50. Umbilical cord usually falls after


a. 5–10 days
b. 3 days
c. 14 days
d. None of the above

51. The bone most frequently fractured during delivery is the


a. Radius
b. Clavicle
c. Ulna
d. Femur

52. The Characteristics of caput succedaeneum, are all except


a. Crosses midline
b. Crosses the suture line
c. Does not disappear within 2–3 days
d. None of the above

53. All are true about Cephalohematoma except


a. Limited to sutural lines
b. Subperiosteal hemorrhage
c. Visible several hours after birth
d. Requires I and D

54. A child following delivery, incomplete moro’s reflex, grasp


preserved one UL; Abduction and supination difficulty. The lesion
is at the level of
a. C8 T1
b. C2 – C3
c. C5 C6
d. C6 C7
Growth and Development 9
55. 25% of Infants void within
a. 72 hrs
b. 48 hrs
c. 24 hrs
d. 8 hrs

56. Most common cause of convulsions on the first day of life in a


neonate is
a. Anoxia
b. Head injury
c. Hypoglycaemia
d. Meningitis

57. Most common cause of respiratory distress after birth in the first
24 hrs is
a. Neonatal sepsis
b. Meconium Aspiration
c. Pneumonia
d. Air embolism

58. All of the following increase the risk of respiratory distress


syndrome (RDS), except
a. Maternal diabetes
b. Alkalosis
c. Caesarean section
d. Maternal diabetes

59. All are true regarding use of prenatal corticosteroids in the


prevention of HMD, in cases of preterm labour except;
a. All mothers at risk of preterm delivery between 24–34 wks need the
therapy
b. Maternal Hypertension is not a contraindication
c. Maternal diabetes is not a contraindication
d. The effect of one course lasts for 2 weeks

60. True regarding Transient Tachypnoea of newborn is


a. Benign self limiting disease
b. Usually occurs in Preterm neonates
c. Chest X ray shows absent vascular markings
d. Significant respiratory distress is present

61. Low birth weight baby is defined as


a. Birth weight <1500 gms
b. Birth weight <1500–2000 gms
c. Birth weight <2500 gms
d. None of the above
10 Paediatrics
62. All are seen during hypothermia in early neonate except;
a. Bradycardia
b. Excess shivering
c. Fall in core temperature
d. Metabolic acidosis
Growth and Development 11

Growth and Development

Answers
1. (d) Neonatal tetanus
Ref : (1) O.P.Ghai – 6th Edition 2005 Page 164
(2) Nelson’s Essentials of paediatrics – 3rd Edn. Page 217 to 222
Neonatal tetanus is very rare nowadays. The clinical features usually
start on Day 5 to Day 10 and NEVER IN FIRST TWO DAYS, rarely
after 2 weeks. Common Metabolic causes are (1) hypoglycaemia
(2) hypocalcaemia. Birth Asphyxia is the most common cause of
Neonatal seizures.

2. (d) Nasal exploration with a catheter


Ref : Nelson’s Essentials page 475
The Diagnosis is Bilateral choanal atresia :
(1) Infants are mostly obligate Nasal breathers
(2) Immediate diagnosis → bedside-passing a narrow 8 Fr. Catheter.
(3) Confirmatory: Endoscopy and CT Scan
(4) Oral airway –– Lifesaving
(5) Treatment –– Surgical

3. (d) Usually increases during crying


Ref : Nelson’s Essl Pediatrics Page 475.
(1) Stridor due to laryngomalacia, usually diminishes during sleep
(or) when the child is crying (↑ed Muscle tone may hold the
supraglottic structures out of airstream)
(2) No treatment is needed usually

4. (c) Temper tantrum (or) Oppositionalism


(1) From the age of 18 months to 3 years child begins to develop
autonomy and starts separating from primary caregivers.
(2) They tend to do the opposite of what has been requested and get
frustated when they can’t express their autonomy.
(3) Some children show their frustration by physical aggression
(Biting, kicking, hitting) (or) resistance. This physical aggression
is known as Temper tantrum.
(4) Reaches a peak → 2nd to 3rd year of life and subsides at 3 to 6
years.

11
12 Paediatrics
5. (b) 6 Months
Ref : O.P.G : Page 57
(1) By 6-7 months, an infant can differentiate between strangers and
primary caregivers.
It develops fear of strangers and turns away or runs toward primary
caregiver in sight of strangers.
(2) It is a normal phenomenon, may last upto 13 months.

6. (c) 250 words


Ref : O.P.G : 47
18 months – 6 – 20 words
3 years – 250 words
2 years – uses Pronouns
1 year – 2 words with meaning

7. (b) 3 years
Ref : Nelson Page 44

8. (c) Somatotropic Hormone


Ref : O.P.G : 2nd page
Insulin and Insulin like growth factor are most essential for fetal
growth. Thyroxine is also essential. Somatotropic Hormone (or)
Growth hormone is not essential for fetal growth in utero.

9. (a) 3 years
Ref : O.P.G : Page 46
Climb upstairs – 2 years
Coordinated climbing – 3 years

10. (d) 10 weeks


Ref : Nelson page 27
8 weeks– Ovaries and Testis distinguishable
10 weeks – External genitalia distinguishable

11. (b) 6 months


Ref : Nelson Page 33 Table
3– months – Holds rattle
5–6 months – Transfers any object from hand to hand.

12. (d) 7 years


Ref : O.P.G. Page 46.
Binocular vision develops by 3 – 6 months.
Adult acuity and depth perception by 6–7 years.
Growth and Development 13
13. (b) 9 months
Ref : Page 44 Table
3 months– Grasp appears
5 months– Bidextrous Grasp with Reaching
7 months– Palmar grasp
9 months– Pincer grasp

14. (a) 7 years


Ref : Page 51
A child starts to make self evaluations and decisions from 6 years
and this continues upto 12 years during which refinement occurs.
Self esteem becomes a central issue.

15. (d) None of the above


Ref : Nelson Page 1204 (Table)
Deciduous dentition appears by 6–7 months. Lower central incisor
is usually the first tooth to erupt and completed by 20 – 30 months
(second molars) – last deciduous tooth to erupt. First permanent
dentition 6 - 7 years (3 tooth)
(1) Lower central incisor and first molar
(2) Upper First molar

16. (c) Both of the above


Ref : Nelson page 154.

17. (b) Impaired Learning


Ref : O.P.G. Page 65
♦ (a), (c), (d) are the classic triad of ASD
♦ Onset usually before 3 years
♦ Impaired learning is associated finding.

18. (d) 10 hours


Ref : O.P.G. Page 151
Expressed Breast milk can be stored for
1) 10 hours at Room temperature
2) 24 hours in a Refrigerator
3) 3 months –– at –20º C in a freezer.

19. (d) None of the above


Ref : O.P.G. Page 149
NIPPLE CONFUSION occurs in a baby who has been fed with bottle
feeds, when put on to suckle at the breast. It finds very difficult and
confusing to feed at the breast.

20. (b) Testis development – Pubic hair – Axillary hair - Beard


Ref : Nelson (55)
14 Paediatrics
21. (a) Thelarche – Menarche – Pubarche – Adrenarche (Axillary Hair)
Ref : Nelson (55)

22. (b) 4 months


Ref : Nelson (55)
Pincer grasp – 9 months
Palmar grasp – 3 months – 4 months

23. (d) Must be treated at 1 year to prevent stubborness.


Ref : O.P.G. (55)
Thumb sucking usually between 1–4 years. Intervention required
only if it persists beyond 4–6 years.

24. (a) Congenital malformations


Ref : Behrman 16/e. 475 – 477
Macmillan 3/e. PP 206–209.
♦ Small for Date babies have different complications than appropriate
for date preterm infants.
♦ Congenital malformations, Asphyxia and Meconuim aspiration
Syndrome are common. Pneumothorax, Pulmonary hemorrhage
are more common than Hyaline membrane disease in these
infants.
♦ Neonatal symptomatic hypoglycaemia and elevated (or) normal
Hematocrit are common.

25. (a) Propranolol


♦ Pencillin and Heparin have not been shown to cause ill effects on
the fetus.
♦ Phenytoin – causes Fetal hydantoin Syndrome when given in first
trimester.
♦ Propranolol – causes decrease in Heart rate, low cardiac output at
times of ↑ ed demand and may cause hypoglycaemia.

26. (b) Neck stiffness


Ref : IAP Textbook 2nde / Page 299 Behrman 1b/e – 544 – 546.
(1) The signs and symptoms of Neonatal meningitis are subtle and
nonspecific
(2) Neck stiffness is usually seen in older children.
(3) Temperature instability, Irritability, Vomiting, bulging AF, Lethargy
are common.

27. (a) Cerebellar Astrocytoma


Ref : I A P text book 2nd edition – Page 306, 307
(1) Commonest Intracranial tumors in 2-12 yrs → INFRA TENTORIAL
IN LOCATION
Growth and Development 15
(2) Of the Infra tentorial tumors, cerebellar astrocytoma, medullob-
lastoma and brain stem gliomas are in order most common.
(3) Less than 2 years and adolescence, Infratentorial = Supratentorial
tumors.
(4) *Commonest Intra Cranial Tumor in general is secondary
metastasis.

28. (a) Weight


Ref : I A P : 76 page chapter (7.1)
♦ In any Newborn, be it Term / Preterm weight is the most important
measurement. Appropriate weight for date babies tend to do well
(prognostic point) than small / low birth weight babies.
♦ Among low birth weight babies, those with normal or near normal
Head circumference have a good prognosis.

29. (b) 3 years


Ref : I A P text book Page 79

30. (c) 90%


Ref : I A P – Page (79),
(1) At Birth : 67% Adult Brain Size
(2) At One year : 90%
♦ Brain Growth is most rapid in 20 – 36 weeks of Intrauterine life and
then in the first year of life.

31. (b) 90/60 mm Hg


Ref : I A P 2nd edition Page 31
The average normal BP in children
♦ New born 65/45 mm Hg
♦ 1 Year 75/50 mm Hg
♦ 3 Years 90/60 mm Hg
♦ 10 years 100/70 mm Hg

32. (a) Cord Hb > 12 g/dl


Ref : I A P Page 73
Cord Hb < 10 mg/dl is an early indication.

33. (a) 1 year


Ref : Nelson – Page 37
Capitate and Hamate appear as early as 2 – 3 months

34. (b) Mild Mental Retardation


Ref : O.P.G. 543
Mental age
Intelligence Quotient = × 100
Chronological age
16 Paediatrics
♦ Mild MR – 51 – 70
♦ Moderate MR – 36 – 50 Sub Normal Intelligence - 71 – 89
♦ Severe MR – 21 – 35 Normal Intelligence - 90 – 100
♦ Profound MR – 0 – 20

35. (d) 750gm / month


Ref : O.P.G. – 4th page

First 4 months – 30gm / day


Next 4 months – 20gm / day Wt. gain
Last 4 months – 10gm / day
♦ Average Birth Wt. : 3 Kg – (O.P.G – 4)
♦ By 10th day : Birth Wt. is regained (3) Kg
♦ 5 months : Doubles Birth weight (6) Kg
♦ 12 months : Tribles Birth Wt. (9) Kg
♦ 24 months : Quadruples Birth Wt. (12) Kg; ie (1/5) of adult weight
Height at 2 yrs = (1/2) Adult Height; (i.e) (85–90 cm)

36. (b) 2 years


Ref : O.P.G. 4
♦ Length of a Neonate is 50 cm
3 months – 60 cm
9 months – 70 cm
1 year – 75 cm
2 years – 90 cm

37. (c) 52 cm
At Birth – 35 cm
3 months– 40 cm
12 months – 45 cm
2 years – 48 cm
12 years – 52 cm
Increase in Head circumference >1 cm/2 weeks → Hydrocephalous
Head circumference equals chest circumference at 1 year.

38. (d) Mid arm circumference


Ref : Nelson 2131
Between 1 – 4 years the subcutaneous fat gets gradually replaced
by increase in muscle mass. Both occur equally. Hence the loss of
fat equals increase in muscle. So there is little change in Midarm
circumference between 1 – 4 years.
Growth and Development 17
39. (a) 20

Mental age
IQ = × 100
Chronological age
1
= × 100
5
IQ = 20

40. (c) Midarm Circumference

41. (d) X ray of shoulder


Ref : O.P.G – 6
♦ 3 – 6 months – X ray shoulder
♦ 1 – 13 yrs – Hands & wrist
♦ 12 – 14 yrs – Elbow and Hip

42. (b) 30 ml
Ref : Chaurasia Vol II 4/e – Page 238

43. (a) Esophageal atresia


Ref : Nelson 588
(1) Vomiting from esophageal atresia occurs with the first feed.
(2) The diagnosis is suspected when excess, unusual drooling of
saliva is observed and resistance is encountered on attempting
to pass a catheter into stomach.
(3) Vomiting in pyloric obstruction can occur anytime but mostly
occurs in 4th to 6th week.

44. (b) 15 min. – 60 min.


Ref : Nelson – 588
Air can be demonstrated in the X ray of an infant in
(a) Jejunum – 15 – 60 min.
(b) Ileum – 2 – 3 hrs.
(c) Colon – 3 hrs.
Absence of rectal gas in 24 hr film → Abnormal.

45. (c) Prolonged Hyperbilirubinaemia


Ref : Nelson 190
♦ Hypoprothrombinaemia – due to deficiency of Vit K. otherwise
called Hemorrhagic Disease of new born. Prevented by prophyl-
actic administration of Vit K.
♦ Hyperbilirubinaemia is caused by administration of large doses
of Synthetic Vit K analogues. It does not occur with Synthetic Vit K
analogues.
18 Paediatrics
46. (a) 7.25
Ref : Nelson 538
Fetal scalp blood pH ; during normal labour, decreases from 7.33 to
7.25. Any value less than 7.25 indicates Fetal distress, and pH less
than 7.2 requires active intervention. Acidosis is mainly due to hypoxia
induced Lactic Acidosis and monitoring of fetal scalp blood lactate
levels also shows the condition of the fetus.

47. (d) Late onset hypocalcaemia

48. (d) 110 – 150 bpm


Ref : Nelson 280 – Table 57.1

Age Heart Rate Resp. Rate


Preterm 120 – 170 40 – 70
0 – 3 months 100 – 150 35 – 55
3 – 6 months 90 – 120 30 – 45
6 – 12 months 80 – 120 25 – 40
1 – 3 yrs. 70 – 110 20 – 30
3 – 6 yrs. 65 – 110 20 – 25
6 – 12 yrs. 60 – 95 14 – 22 (near
12 yrs. 55 – 85 12 – 18 Adult values)

49. (c) Temperature Instability


Ref : Nelson 590.
NEC – Neonatal Necrotizing Enterocolitis
♦ NEC is the most common life threatening emergency of GIT in
neonates
♦ Common in LBW and PreMature babies
♦ Distal ileum and Proximal colon are the commonest sites to be
involved.
♦ Less common in Infants fed on Breast milk.
♦ Rarely occurs before initiation of enteral feeds.
♦ DIC, Shock, Acidosis are sequelae.

50. (a) 5 – 10 days


Ref : Nelson – 608

51. (b) Clavicle


Ref : Nelson 572

52. (c) Does not disappear within 2–3 days


Ref : Nelson 562
Caput Succedaneum
Growth and Development 19
It is a diffuse edematous sometimes ecchymotic swelling of the
layers of scalp in the presenting part of the baby during delivery.
It is seen during birth
♦ Usually disappears in 3–5 days
♦ Large caput indicates prolonged labour.
♦ Moulding of the head and overriding of parietal bones usually
seen.
♦ Crosses Midline and Sutural lines.

53. (d) Requires I and D


Ref : Nelson 562
Caphalohematoma is a subperiosteal hemorrhage limited to a
cranial bone. It is viable several hours after birth.
I & D contraindicated.
May cause Hyperbilirubinaemia and prolongation of physiological
jaundice.

54. (c) C5 C6
Ref : Nelson 565
Erb’s paralysis due to pulling of the infant vigorously by the arm. C8
T1 – Klumpkis paralysis

55. (c) 24 hrs.


♦ Urine is passed usually during birth (or) immediately after birth.
♦ 95% of all infants void within 24 hrs.
Meconium :
99% → Pass within 48 hrs.

56. (a) Anoxia


Ref : O.P.G. Page 511
Nelson P: 567
Hypoxic ischaemic encephalopathy is the most common cause of
neonatal convlusions(50%). Sepsis, meningitis are the next common
causes. Metabolic disturbances, like hypoglycaemia, hypocalcaemia
and dyselectrolytemia account for 25%.

57. (b) Meconium Aspiration


Ref : O.P.G. 167 Table.
Commonest cause of respiratory distress in a preterm neonate ––
Hyaline Membrane disease. Post term and SFD babies, with H/o
Meconium aspiration may develop respiratory distress in 15% of
cases. Thin meconium causes, chemical pneumonitis, thick
meconium causes airway obstruction causing areas of atelectasis
and emphysema.
20 Paediatrics
58. (b) Alkalosis
Ref : O.P.G : 166
RDS :- Respiratory Distress Syndrome almost always occurs in
PRETERM (< 34 weeks) babies. Surfactant production starts after
34 weeks and optimum levels occur only after 36 – 37 weeks.
Surfactant is a lipoprotein containing phosphotydyl choline and
phosphotydyl glycerol. Secreted by Type II Alveolar cells.
It helps to reduce surface tension (soap like effect) and thus prevents
the collapse of alveoli during expiration. Respiratory distress is
evident within SIX hours of life.
Lecithin / Sphingomyelin ratio – Prenatal diagnosis – normal > 2 -
and indicates adequate lung maturity. Test – shake test. A simple
bed side test. Where the amniotic fluid is mixed with absolute alcohol
in a test tube and shook for 15 minutes. Copious bubbles indicates
adequate surfactant and thus lung maturity.
Treatment
♦ Intratracheal administration of surfactant is now recommended.
♦ Ventilatory support - Intermittent Mandatory ventilation –– severe
disease (IMV). Mild disease – Continuous Positive Airway Pressure
(CPAP).

59. (d) The Effect of one course lasts for 2 weeks


Ref : O.P.G: 168 Table
The benefits of prenatal corticosteroids are
(1) 50% reduction in reduction of RDS
(2) 40% reduction in mortality in babies with RDS
Chorioamnionitis is a contraindication for the therapy.
Treatment schedule :
(1) Inj. Betamethasone 12 mg Intramuscular every 24 hours ; 2 doses
-(preferred drug)
(2) Alternatively, Inj. dexamethasone 6mg i.m every 12 hours (4)
doses.
Optimal effect occurs after 24 hrs of initiating treatment.
One course lasts for 7 days.
Hence if labour prolongs / continues after the expected preterm date
(i.e. example 34 – 36 weeks) the course should be repeated on the
7th day to have the desired effect.

60. (a) Benign self limiting disease


Ref : O.P.G. 168
TTN :
(1) Occurs in Term Neonates
(2) Due to delay in clearance of lung fluids
(3) No respiratory distress or very minimal
(4) Oxygen treatment in adequate
Growth and Development 21
(5) X ray shows Prominent vascular markings and prominent
interlobar fissure.
(6) Prognosis – good.

61. (c) Birth wt < 2500 gms.


Ref : Nelson 550
Low Birth weight : < 2500 gms
Very low birth weight : < 1500 gms
Normal Birth weight : < 3.5 Kg

62. (b) Excess shivering


Ref : Nelson 528
Shivering mechanism is not developed in a neonate. Non shivering
thermogenesis occuring in Brown fat (nape of neck) accounts for the
source of heat in an infant.

You might also like