UPSC-CMS 2024 — Pediatrics

Q: Which of the following is correct regarding "witch's milk"?

It is seen in full-term infants.. ***It is seen in full-term infants.*** - **Witch's milk** (neonatal galactorrhea) is a physiological phenomenon observed in newborns due to the **withdrawal of maternal hormones** (estrogens, progesterone, and prolactin) after birth. - These maternal hormones cross the placenta during pregnancy and stimulate the fetal breast tissue. - While it can occur in both preterm and term infants, it is **more commonly and prominently observed in full-term infants** who have had greater exposure to maternal hormones. - This condition typically appears 3-5 days after birth and resolves spontaneously within a few weeks. *It is caused by stimulation of foetal breast by calcitonin.* - **Calcitonin** is a hormone involved in calcium and bone metabolism, not breast development or milk production. - **Witch's milk** is caused by the withdrawal of maternal hormones (estrogens, progesterone, and prolactin) after birth, not calcitonin. *It is seen only in preterm infants.* - This is incorrect as witch's milk can occur in **both preterm and full-term infants**. - It is actually **more common in full-term newborns** due to their longer exposure to maternal hormones in utero. *It is caused by stimulation of foetal breast by progesterone.* - While **progesterone** is one of the maternal hormones involved, the mechanism is more accurately described as a **withdrawal phenomenon** rather than ongoing stimulation. - After birth, the sudden **withdrawal of maternal estrogens, progesterone, and prolactin** triggers the breast tissue to secrete milk. - The wording "stimulation by progesterone" is misleading as it suggests active stimulation rather than the withdrawal mechanism that actually causes the milk secretion. [Practice more Pediatrics PYQs on OnCourse]

Q: A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

Cephalhaematoma. ***Cephalhaematoma*** - A **cephalhaematoma** is a collection of blood between the **pericranium** and the skull bone, which is characteristically limited by the **suture lines**. This perfectly matches the clinical description. - It is often associated with **traumatic deliveries** like forceps delivery due to shearing forces on the skull and can appear hours to days after birth. *Subgaleal haemorrhage* - A **subgaleal haemorrhage** involves bleeding into the **potential space between the epicranial aponeurosis and the periosteum** (galea aponeurotica). - Unlike cephalhaematoma, it is **not limited by suture lines** and can spread across the entire scalp, potentially leading to significant blood loss. *Caput succedaneum* - **Caput succedaneum** is an **oedematous swelling of the fetal scalp** caused by pressure during head engagement, leading to fluid accumulation above the periosteum. - It is present at birth, often **crosses suture lines**, and usually resolves within a few days, differentiating it from a blood collection limited by sutures. *Intraventricular haemorrhage* - **Intraventricular haemorrhage** is bleeding into the brain's ventricular system and is a serious condition most commonly seen in **premature infants**. - It involves **bleeding within the brain** itself, not an external scalp swelling, and presents with neurological symptoms. [Practice more Pediatrics PYQs on OnCourse]

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Which of the following is correct regarding "witch's milk"?

A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

UPSC-CMS 2024 - Pediatrics UPSC-CMS Practice Questions and MCQs

Question 1: Which of the following is correct regarding "witch's milk"?

A. It is caused by stimulation of foetal breast by calcitonin.
B. It is seen only in preterm infants.
C. It is caused by stimulation of foetal breast by progesterone.
D. It is seen in full-term infants. (Correct Answer)

Explanation: ***It is seen in full-term infants.*** - **Witch's milk** (neonatal galactorrhea) is a physiological phenomenon observed in newborns due to the **withdrawal of maternal hormones** (estrogens, progesterone, and prolactin) after birth. - These maternal hormones cross the placenta during pregnancy and stimulate the fetal breast tissue. - While it can occur in both preterm and term infants, it is **more commonly and prominently observed in full-term infants** who have had greater exposure to maternal hormones. - This condition typically appears 3-5 days after birth and resolves spontaneously within a few weeks. *It is caused by stimulation of foetal breast by calcitonin.* - **Calcitonin** is a hormone involved in calcium and bone metabolism, not breast development or milk production. - **Witch's milk** is caused by the withdrawal of maternal hormones (estrogens, progesterone, and prolactin) after birth, not calcitonin. *It is seen only in preterm infants.* - This is incorrect as witch's milk can occur in **both preterm and full-term infants**. - It is actually **more common in full-term newborns** due to their longer exposure to maternal hormones in utero. *It is caused by stimulation of foetal breast by progesterone.* - While **progesterone** is one of the maternal hormones involved, the mechanism is more accurately described as a **withdrawal phenomenon** rather than ongoing stimulation. - After birth, the sudden **withdrawal of maternal estrogens, progesterone, and prolactin** triggers the breast tissue to secrete milk. - The wording "stimulation by progesterone" is misleading as it suggests active stimulation rather than the withdrawal mechanism that actually causes the milk secretion.

Question 2: A 30-year-old female P2L2 had a forceps delivery 2 days back. There was injury to head of baby resulting in collection of blood in soft tissue between pericranium and flat bone of skull, limited by suture line. What is the probable diagnosis?

A. Cephalhaematoma (Correct Answer)
B. Subgaleal haemorrhage
C. Caput succedaneum
D. Intraventricular haemorrhage

Explanation: ***Cephalhaematoma*** - A **cephalhaematoma** is a collection of blood between the **pericranium** and the skull bone, which is characteristically limited by the **suture lines**. This perfectly matches the clinical description. - It is often associated with **traumatic deliveries** like forceps delivery due to shearing forces on the skull and can appear hours to days after birth. *Subgaleal haemorrhage* - A **subgaleal haemorrhage** involves bleeding into the **potential space between the epicranial aponeurosis and the periosteum** (galea aponeurotica). - Unlike cephalhaematoma, it is **not limited by suture lines** and can spread across the entire scalp, potentially leading to significant blood loss. *Caput succedaneum* - **Caput succedaneum** is an **oedematous swelling of the fetal scalp** caused by pressure during head engagement, leading to fluid accumulation above the periosteum. - It is present at birth, often **crosses suture lines**, and usually resolves within a few days, differentiating it from a blood collection limited by sutures. *Intraventricular haemorrhage* - **Intraventricular haemorrhage** is bleeding into the brain's ventricular system and is a serious condition most commonly seen in **premature infants**. - It involves **bleeding within the brain** itself, not an external scalp swelling, and presents with neurological symptoms.