UPSC-CMS 2012 — Pediatrics

Q: Which is the most common laryngeal abnormality that produces laryngeal stridor in a newborn?

Laryngomalacia. ***Laryngomalacia*** - **Laryngomalacia** is the most common cause of **congenital laryngeal stridor**, accounting for 60-70% of cases. - It results from the **floppiness of supraglottic structures** (epiglottis and arytenoids) that collapse inward during inspiration, causing stridor. *Congenital vocal cord paralysis* - While it can cause stridor, **congenital vocal cord paralysis** is much less common than laryngomalacia. - It typically results from neurological issues, and the stridor quality may differ. *Congenital web* - A **congenital web** is a rare cause of stridor, usually presenting with a **high-pitched persistent stridor** and often a weak cry. - The severity depends on the extent of the web across the glottis. *Congenital subglottic stenosis* - **Congenital subglottic stenosis** is the third most common cause of congenital stridor (after laryngomalacia and vocal cord paralysis). - It is characterized by narrowing of the airway below the vocal cords and often presents with biphasic stridor and recurrent croup-like symptoms. [Practice more Pediatrics PYQs on OnCourse]

Q: Among the following, the best indicator for acute malnutrition in the under-fives is

Weight for height. ***Weight for height*** - **Weight-for-height** is the best indicator for **acute malnutrition** (wasting) in under-fives as it reflects recent nutritional deficits. - It compares a child's weight to the expected weight for a child of the same height, identifying if they are too thin for their height. *Height for age* - **Height-for-age** is an indicator of **chronic malnutrition (stunting)**, reflecting long-term nutritional deprivation. - It does not accurately capture acute, recent weight loss or wasting. *Head/chest circumference ratio* - The **head/chest circumference ratio** can be used as a screening tool in some contexts, but it is less precise and sensitive for assessing acute malnutrition than weight-for-height. - Its utility decreases beyond the first year of life as the chest circumference typically begins to exceed head circumference. *Mid arm circumference* - **Mid-upper arm circumference (MUAC)** is a useful **screening tool** for severe acute malnutrition, particularly in community settings. - However, **weight-for-height** is generally considered a more comprehensive and accurate indicator for diagnosing and assessing the severity of acute malnutrition across all severities. [Practice more Pediatrics PYQs on OnCourse]

Q: In infants and toddlers, craniotabes is a sign related to the deficiency of

Vitamin D. ***Vitamin D (Correct Answer)*** - **Craniotabes** refers to the softening of the cranial bones, characterized by a "ping-pong ball" sensation on palpation. - It is an **early clinical sign of rickets** in infants, which results from **vitamin D deficiency**. - **Vitamin D** is essential for the absorption and metabolism of **calcium and phosphate**, which are critical for proper bone mineralization. - Without adequate vitamin D, bones remain inadequately mineralized, leading to softening. *Vitamin K (Incorrect)* - **Vitamin K** plays a role in **blood coagulation** (clotting factors II, VII, IX, X) and bone metabolism through carboxylation of osteocalcin. - Deficiency manifests primarily as **bleeding disorders** (hemorrhagic disease of newborn), not skeletal abnormalities. - Does not cause craniotabes or bone softening. *Vitamin A (Incorrect)* - **Vitamin A** is essential for **vision** (rhodopsin formation), **immune function**, and **epithelial cell differentiation**. - Deficiency causes **night blindness** (earliest sign), **xerophthalmia**, **Bitot's spots**, and increased susceptibility to infections. - Not associated with skeletal manifestations like craniotabes. *Vitamin C (Incorrect)* - **Vitamin C** (ascorbic acid) is required for **collagen synthesis** (hydroxylation of proline and lysine). - Deficiency causes **scurvy**, characterized by **bleeding gums**, **petechiae**, **subperiosteal hemorrhages**, and impaired wound healing. - While scurvy affects bone matrix and periosteum, it does not cause the characteristic softening of cranial bones seen in craniotabes. [Practice more Pediatrics PYQs on OnCourse]

Q: A 9-month-old infant is brought to you for immunization. The infant has previously received the first dose of OPV and DPT. What will you do ?

Give the infant second dose of DPT/OPV. ***Give the infant second dose of DPT/OPV*** - As per the **Expanded Programme on Immunization (EPI)** guidelines, even if there's a delay, one should **continue the vaccination schedule** from where it left off, rather than restarting. - The 9-month-old is due for the **second dose of DPT and OPV**, as the first dose has already been administered. *Give the infant DT/OPV* - **DT (Diphtheria and Tetanus)** vaccine is generally given to older children who have contraindications to the pertussis component of DPT or as part of a different schedule. - At 9 months, the infant still requires the **pertussis component** for protection against whooping cough. *Repeat the first dose counting afresh* - There is **no clinical or immunological basis** for restarting the vaccination schedule (counting afresh) simply because of a delay. - Antibodies from the first dose are still present and contribute to the immune response upon subsequent doses; hence, previous doses are **considered valid**. *Give the infant a booster dose of DPT/Polio* - A **booster dose** is typically given much later in childhood (e.g., at 18 months or 5 years) to enhance and prolong immunity after the primary series is completed. - The infant first needs to **complete the primary series** of DPT and OPV, which involves a second and third dose. [Practice more Pediatrics PYQs on OnCourse]

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Which is the most common laryngeal abnormality that produces laryngeal stridor in a newborn?

Among the following, the best indicator for acute malnutrition in the under-fives is

In infants and toddlers, craniotabes is a sign related to the deficiency of

A 9-month-old infant is brought to you for immunization. The infant has previously received the first dose of OPV and DPT. What will you do ?

UPSC-CMS 2012 - Pediatrics UPSC-CMS Practice Questions and MCQs

Question 1: Which is the most common laryngeal abnormality that produces laryngeal stridor in a newborn?

A. Congenital vocal cord paralysis
B. Congenital web
C. Laryngomalacia (Correct Answer)
D. Congenital subglottic stenosis

Explanation: ***Laryngomalacia*** - **Laryngomalacia** is the most common cause of **congenital laryngeal stridor**, accounting for 60-70% of cases. - It results from the **floppiness of supraglottic structures** (epiglottis and arytenoids) that collapse inward during inspiration, causing stridor. *Congenital vocal cord paralysis* - While it can cause stridor, **congenital vocal cord paralysis** is much less common than laryngomalacia. - It typically results from neurological issues, and the stridor quality may differ. *Congenital web* - A **congenital web** is a rare cause of stridor, usually presenting with a **high-pitched persistent stridor** and often a weak cry. - The severity depends on the extent of the web across the glottis. *Congenital subglottic stenosis* - **Congenital subglottic stenosis** is the third most common cause of congenital stridor (after laryngomalacia and vocal cord paralysis). - It is characterized by narrowing of the airway below the vocal cords and often presents with biphasic stridor and recurrent croup-like symptoms.

Question 2: Among the following, the best indicator for acute malnutrition in the under-fives is

A. Height for age
B. Head/chest circumference ratio
C. Mid arm circumference
D. Weight for height (Correct Answer)

Explanation: ***Weight for height*** - **Weight-for-height** is the best indicator for **acute malnutrition** (wasting) in under-fives as it reflects recent nutritional deficits. - It compares a child's weight to the expected weight for a child of the same height, identifying if they are too thin for their height. *Height for age* - **Height-for-age** is an indicator of **chronic malnutrition (stunting)**, reflecting long-term nutritional deprivation. - It does not accurately capture acute, recent weight loss or wasting. *Head/chest circumference ratio* - The **head/chest circumference ratio** can be used as a screening tool in some contexts, but it is less precise and sensitive for assessing acute malnutrition than weight-for-height. - Its utility decreases beyond the first year of life as the chest circumference typically begins to exceed head circumference. *Mid arm circumference* - **Mid-upper arm circumference (MUAC)** is a useful **screening tool** for severe acute malnutrition, particularly in community settings. - However, **weight-for-height** is generally considered a more comprehensive and accurate indicator for diagnosing and assessing the severity of acute malnutrition across all severities.

Question 3: In infants and toddlers, craniotabes is a sign related to the deficiency of

A. Vitamin K
B. Vitamin D (Correct Answer)
C. Vitamin A
D. Vitamin C

Explanation: ***Vitamin D (Correct Answer)*** - **Craniotabes** refers to the softening of the cranial bones, characterized by a "ping-pong ball" sensation on palpation. - It is an **early clinical sign of rickets** in infants, which results from **vitamin D deficiency**. - **Vitamin D** is essential for the absorption and metabolism of **calcium and phosphate**, which are critical for proper bone mineralization. - Without adequate vitamin D, bones remain inadequately mineralized, leading to softening. *Vitamin K (Incorrect)* - **Vitamin K** plays a role in **blood coagulation** (clotting factors II, VII, IX, X) and bone metabolism through carboxylation of osteocalcin. - Deficiency manifests primarily as **bleeding disorders** (hemorrhagic disease of newborn), not skeletal abnormalities. - Does not cause craniotabes or bone softening. *Vitamin A (Incorrect)* - **Vitamin A** is essential for **vision** (rhodopsin formation), **immune function**, and **epithelial cell differentiation**. - Deficiency causes **night blindness** (earliest sign), **xerophthalmia**, **Bitot's spots**, and increased susceptibility to infections. - Not associated with skeletal manifestations like craniotabes. *Vitamin C (Incorrect)* - **Vitamin C** (ascorbic acid) is required for **collagen synthesis** (hydroxylation of proline and lysine). - Deficiency causes **scurvy**, characterized by **bleeding gums**, **petechiae**, **subperiosteal hemorrhages**, and impaired wound healing. - While scurvy affects bone matrix and periosteum, it does not cause the characteristic softening of cranial bones seen in craniotabes.

Question 4: A 9-month-old infant is brought to you for immunization. The infant has previously received the first dose of OPV and DPT. What will you do ?

A. Give the infant second dose of DPT/OPV (Correct Answer)
B. Give the infant DT/OPV
C. Repeat the first dose counting afresh
D. Give the infant a booster dose of DPT/Polio

Explanation: ***Give the infant second dose of DPT/OPV*** - As per the **Expanded Programme on Immunization (EPI)** guidelines, even if there's a delay, one should **continue the vaccination schedule** from where it left off, rather than restarting. - The 9-month-old is due for the **second dose of DPT and OPV**, as the first dose has already been administered. *Give the infant DT/OPV* - **DT (Diphtheria and Tetanus)** vaccine is generally given to older children who have contraindications to the pertussis component of DPT or as part of a different schedule. - At 9 months, the infant still requires the **pertussis component** for protection against whooping cough. *Repeat the first dose counting afresh* - There is **no clinical or immunological basis** for restarting the vaccination schedule (counting afresh) simply because of a delay. - Antibodies from the first dose are still present and contribute to the immune response upon subsequent doses; hence, previous doses are **considered valid**. *Give the infant a booster dose of DPT/Polio* - A **booster dose** is typically given much later in childhood (e.g., at 18 months or 5 years) to enhance and prolong immunity after the primary series is completed. - The infant first needs to **complete the primary series** of DPT and OPV, which involves a second and third dose.