Question 1: What is the most common cause of intestinal obstruction in neonates?
- A. Volvulus neonatorium
- B. Duodenal atresia (Correct Answer)
- C. Hirschsprung's disease
- D. Meconium ileus
Explanation: ***Duodenal atresia***
- **Duodenal atresia** is one of the **most common causes of intestinal obstruction** in neonates, accounting for approximately 30-40% of all neonatal intestinal obstructions.
- It is a **congenital malformation** where the duodenum is completely blocked, leading to the characteristic **"double-bubble" sign** on X-ray (one bubble in the stomach and one in the proximal duodenum).
- Strongly associated with **Down syndrome** (30% of cases) and **polyhydramnios** during pregnancy.
- Presents with **bilious vomiting** within the first 24-48 hours of life.
*Meconium ileus*
- **Meconium ileus** accounts for only **10-15%** of neonatal intestinal obstruction cases.
- It is strongly associated with **cystic fibrosis** (90% of meconium ileus cases have CF), with approximately 10-20% of CF newborns presenting with meconium ileus.
- Caused by thick, inspissated meconium obstructing the terminal ileum.
*Hirschsprung's disease*
- **Hirschsprung's disease** causes functional obstruction due to **absence of ganglion cells** in the distal bowel (aganglionic segment).
- Accounts for **15-20%** of neonatal intestinal obstruction cases.
- Typically presents with **delayed passage of meconium** (>48 hours), abdominal distension, and bilious vomiting.
*Volvulus neonatorium*
- **Volvulus neonatorium** involves twisting of the intestine, often due to **intestinal malrotation**, leading to obstruction and vascular compromise.
- Accounts for **10-15%** of cases and presents as a surgical emergency with bilious vomiting and potential bowel ischemia.
Question 2: With reference to mumps, consider the following statements:
1. The average age of incidence of mumps is higher than that of measles and chicken pox.
2. The mumps disease tends to be more severe in adults than in children.
Which of the statements given above is/are correct?
- A. Both 1 and 2 (Correct Answer)
- B. 2 only
- C. Neither 1 nor 2
- D. 1 only
Explanation: ***Both 1 and 2***
- The **average age of incidence** for **mumps** is typically higher than that of **measles** and **chickenpox** in developed countries, largely due to successful vaccination programs altering transmission patterns.
- While mumps is often benign in children, it tends to be **more severe in adults**, with a higher risk of complications such as **orchitis**, **meningitis**, and **pancreatitis**.
*2 only*
- This option correctly identifies that mumps is generally **more severe in adults**; however, it fails to acknowledge the shift in the average age of incidence.
- The statement that the **average age of incidence of mumps is higher** than that of measles and chickenpox is also correct.
*Neither 1 nor 2*
- This option is incorrect because both statements accurately reflect facts about mumps.
- Statement 1 is true as mumps epidemiology has changed over time with vaccination, and Statement 2 is true regarding the increased severity in adults.
*1 only*
- This option correctly states that the **average age of incidence of mumps is higher** than that of measles and chickenpox but omits the fact that the disease is also **more severe in adults**.
- The severity of mumps in adults is a well-documented clinical observation.