Correct Answer - B
Ans. is 'b' i.e., Menarche > 16 year
Delayed Puberty
More common in boy than girl
Most common cause in constitutional delay
Girls-Delayed puberty is defined as
Lack of secondary sexual character by age of 17 years
Absence of menarche by age of 16 year 5 year after pubertal onset.
Boys-Lack of pubertal changes by the age of 14 years.
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Correct Answer - B
Answer- B. Immediate attempt to reduction using barium edema
Correction of intussusception by barium enema is the initial
management of choice. If it fails, surgical correction is done.

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Correct Answer - D
Most neonates develop visible jaundice due to elevation of
unconjugated bilirubin concentration during their first week.
This common condition is called Physiological jaundice.
It lasts for 5 days in term infants & 7 days in preterm infants.
It doesnot require any treatment & disappers spontaneously. In
pathological jaundice clinical jaundice will appear in the first 24hrs of
life.
Ref: Nelson, 18th Edition, Pages 760-761; O P Ghai, 6th Edition,
Pages 170-171.

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Correct Answer - D
Not associated with increased morbidity REF: Nelson 17
1h edition
page 687
KERNICTERUS OR BILIRUBIN ENCEPHALOPATHY:
Kernicterus, or bilirubin encephalopathy, is a neurologic syndrome
resulting from the deposition of unconjugated bilirubin in the basal
ganglia and brainstem nuclei.
The greatest risk associated with hyperbilirubinemia is the
development of kernicterus (bilirubin encephalopathy) at high
indirect serum bilirubin levels.
The level of serum bilirubin associated with kernicterus is dependent
in part on the cause of the jaundice. Kernicterus has developed
when bilirubin levels exceed 30 mg/dL, although the range is wide
(21-50 mg/dL).
Its onset is usually in the 1st wk of life, but it may_be delayed to the
2nd-3rd wk.
Kernicterus develops at lower bilirubin levels in preterm infants and
in the presence of asphyxia, intraventricular hemorrhage, hemolysis,
or drugs that displace bilirubin from albumin. The exact serum
bilirubin level that is harmful for VLBW infants is unclear. Kernicterus
does occur in patients with breast milk jaundice but is very
uncommon.
The surface of the brain is usually pale yellow. On cutting, certain
regions are characteristically stained yellow by unconjugated
bilirubin

Overt neurologic signs have a grave prognosis; 75% or more of such
infants die, and 80% of affected survivors have bilateral
choreoathetosis with involuntary muscle spasms. Mental retardation, deafness, and spastic quadriplegia are common. Infants at risk should have screening hearing tests.

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Correct Answer - C
Answer- C. Increase in 02 tension at birth
The mechanism producing the initial constriction of ductus arteriosus
is not completely understood, but the increase in arterial 02 tension
plays an important role.
One more factor which helps in closure of the ductus arteriosus is
the decrease in concentration of prostaglandins at the time of birth.

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Correct Answer - D
Not associated with increased morbidity REF: Nelson 171h edition
page 687
KERNICTERUS OR BILIRUBIN ENCEPHALOPATHY:
Kernicterus, or bilirubin encephalopathy, is a neurologic syndrome resulting from the deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei.

The greatest risk associated with hyperbilirubinemia is the
development of kernicterus (bilirubin encephalopathy) at high
indirect serum bilirubin levels.
The level of serum bilirubin associated with kernicterus is dependent in part on the cause of the jaundice. Kernicterus has developed when bilirubin levels exceed 30 mg/dL, although the range is wide (21-50 mg/dL).
Its onset is usually in the 1st wk of life, but it may_be delayed to the
2nd-3rd wk.
Kernicterus develops at lower bilirubin levels in preterm infants and in the presence of asphyxia, intraventricular hemorrhage, hemolysis, or drugs that displace bilirubin from albumin. The exact serum bilirubin level that is harmful for VLBW infants is unclear. Kernicterus does occur in patients with breast milk jaundice but is very uncommon.

The surface of the brain is usually pale yellow. On cutting, certain regions arecharacteristically stained yellow by unconjugated bilirubin

Overt neurologic signs have a grave prognosis; 75% or more of such
infants die, and 80% of affected survivors have bilateral
choreoathetosis with involuntary muscle spasms. Mental retardation, deafness, and spastic quadriplegia are common. Infants at risk should have screening hearing tests

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Correct Answer - D
Raynaud's Phenomenon is not mentioned in association with Juvenile Idiopathic Arthritis
(JIA).
Ref: Current Diagnosis and Treatment in Rheumatology, 2nd Edition, Pages 196-197;
Nelson’s Textbook of Pediatrics, 18th Edition, Page 1003; Primer on The Rheumatic
Diseases By John H. Klippel, Page 145

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Correct Answer - C
Answer- C. Vinblastine
Treatment of ALL is divided into 4 stages. The total duration of
treatment ranges between 2 and 2.5 years.

1. Induction of remission
Induction therapy is used to attain remision, i.e., to eradicate the
leukemic cells from bone marrow.
Drugs used are 4 Vincristine, Prednisolone, L - Asparginase,
Anthracycline. Duration of therapy is 4-6 weeks..

2. CNS therapy
Most children with leukemia have subclinical CNS involvement at the
time of diagnosis. Moreover, CNS acts as a sanctuary site where
leukemic cells are protected from systemic chemotherapy because
of blood brain barrier. So, treatment to keep leukemia cells from
spreading to the CNS is often started with induction.
Treatment include 4 Intrathecal methotrexate plus cranial radiation.

3. Intensification
If the patient goes into remission, the next step is to intensify the
therapy for a short period.
Drugs used are 4 Methotrexate, L - Asparginase,
Epipodophyllotoxin, Cyclophosphamide, Cytarabine.

4. Maintenance therapyAfter consolidation, the patient is generally put on a maintenance
therapy to maintaine the remission state and prevent relapse.
Drugs used are 4 6-mercaptopurine, Methotrexate, Prednisolone,
Vincristine. Duration of maintenace therapy is 2-2.5 years.

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Correct Answer - C
Answer- C. 9 months

6 months → Drops one object when another is offered
7 months → Transfers object & unidextrous approach
9 months → - immature Pincer grasp
12 — 13 months → Casting appear, mouthing disappear , mature grip
15 months → Feeds himself with cup, slight spillage

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Next Deferred till further orders from Health ministry
https://www.nmc.org.in/

Correct Answer - D
Answer- D. All of the above
The hallmark of many degenerative disorders is neurological
regression.

Loss of only language skills – autism – suspected.

Regression of both language and motor milestones → Rett's
syndrome.

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