[Music] so uh very good evening to all of you I hope I'm audible visible to all of you very good evening sorry for a little late uh starting this uh so very good evening to all of you are you all able to uh see me are you all able to hear me so uh welcome to this session where we will be discussing uh 25 important pediatric questions uh from uh for your upcoming January fmg exam and uh I have carefully selected the topics uh for these questions uh keeping in mind your fmg exam so I believe that these are the topics which are the important topics for your exams and at least these are the topics that you should definitely go through uh during your final revision uh when you're preparing for your exams so uh with this uh I will uh start thank you very much a you happy birthdays so uh it is not my birthday but anyway I'll take that as a compliment and I will start with my class uh so uh the first question is all of the following statements about newborns are correct except so he's asking all of the following statements are correct except so he's asking which of the following statement is not correct so the first choice is or first option is resusitation is needed in most newborns at Birth the second option is late Amal C clamping is preferred at Birth the Third third option is meconium is green in color and is usually passed by 24 hours of birth and the fourth option is that the mode of feeding of a newborn should take into consideration the gestational maturity of the newborn so which you feel is basically an incorrect statement he's asking all of the following are correct statements except so he's asking which of these is not a correct statement so there are some A's some B's some C's let me tell you late Amal cord clamping is preferred at Birth is actually a correct statement this is not an incorrect statement it's a correct statement usually when a child is born the cord clamping is done after birth and initially it was an early cord clamping that was recommended but now most of the guidelines recommend that the cord clamping should be delayed till 30 to 60 seconds of birth so this is not an incorrect statement it's a correct statement that late C clamping is recommended option C is moonium is green in color and is usually passed by 24 hours of birth now this again is a completely correct statement there is nothing incorrect about this statement it is a completely correct statement meconium that is the first stool of a newborn is usually passed within 24 hours of birth and it is a stool which is green in color mode of feeding of a newborn should take into consideration gestational maturity definitely yes so as I have told in my classes 34 weeks plus babies are given breastfeeds but babies who were born earlier than 34 weeks are not given breastfeed so this is again an incorrect statement so the only incorrect statement according to me is Choice a so those of you who have given Choice a as the correct answer are correct actually speaking when a newborn is delivered when a newborn is delivered almost 90% of the newborns usually require no resuscitation at Birth so basically what does resusitation mean resusitation means child should be given say tactile stimulation ambo bags intubation this actually is required in just in just 10% of total cases so he's saying resusitation needed in most new borns at Birth this is actually an incorrect statement resusitation as you can see is required in only 10% of the cases 90% of the newborn cases do not require resusitation so when a newborn is delivered and then we see whether the newborn is a term newborn he's breathing regularly and he's having a good uh tone so if all of these are yes that means this newborn baby does not require recitation and this is seen in almost 90% cases so you just hand over the baby to the mother resuscitation means child being given amboo bags child being given tectile simulation that means there is something wrong with the baby and this is required in only 10% of the total cases so resuscitation is required in only about 10% of cases 90% of the cases do not require resusitation after birth and first 1 minute time yes is the golden time for resusitation that is the time when you need to decide whether you have to start with ambo bags whether you have to give tactile stimulation or whether you should move on to chest uh compression or to incubation all of those are decided in the first 1 minute and then you subsequently keep on uh moving further in resistration step steps according to the response of the baby so there have been some who have given uh correct answer a but most of you have given yes most of you have given a correct answer a there have been some who have given a correct answer uh a but uh b c d are incorrect options according to me these are the babies b c d are the babies which are totally true for these babies so late C lamping yes it is run moonium yes it is green in color and mode of fitting yes it should be according to the gestation maturity of the new B coming to question number two a 6 and a half year old child is being investigated for short stature so the child is 6 and a half year old the child's upper segment to the lower segment ratio is 1.6 at Birth sorry at this time that means at 6 and A2 years the child's upper segment to lower segment ratio is 1.6 the family history of the child is normal and is not contributory to the case born age of the child now this is very important born age of the child is delayed so borage is not normal when the boneage is not normal a familiar short sture is ruled out because familiar short ster bone age equals the chronological age so familial short Seer is already ruled out plus family history is normal that means there is no history of short parents in the family so he's asking the most likely cause of short stretcher among these is so according to you the correct answer is constitutional delay but please see this you have missed out this 1.6 you have missed out this 1.6 upper segment to the lower segment ratio at Birth I have told in my classes is 1.7 is 1 and this ratio goes on changing with age so this ratio becomes at 1 year it becomes 1.6 is to 1 at 6 years it becomes 1.1 is to 1 and between 7 to 10 years it becomes 1 is to 1 so please see what is the upper segment to the lower segment ratio at 6 years at six years the upper segment to lower segment ratio is 1.1 is to1 that means the upper segment is 1.1 times the lower segment but in our case the upper segment to lower segment ratio for a child who is 6 years of age 6 and a half years of age is 1.6 ratio should be 1.1 here it is 1.6 so is this a proportionate short fure or disproportionate short short switcher now you answer is it a proportionate short switcher or disproportionate short switcher it is a disproportionate short switcher because the upper segment to the lower segment ratio is not matching with its age at 6 years it should be 1.1 is to1 but in our case it is 1.6 is to1 please identify the clues that are given in the question every question is not so simple there are clues in the question that you have to identify so this cannot be a constitutional delay because Constitution delay is not disproportionate and yes there have there are students who have given that what are the causes of disproportionate short such as c a car so congenital hypothyroidism acondroplasia rickets now you see congenital hypothyroidism acondroplasia rickets is there any option yes one option is conal hypo chartism just notice on the questions right so what I'm trying to say is that the upper segment to the lower segment ratio should be 1.1 is1 but the ratio is in this case 1.6 is to1 so this is a disproportionate short cure and if it is a disproportionate short CER it cannot be a constitutional delay familiar short CER already ruled out so the only type of short C that can be possible in this case is c a which are causes of disproportionate short CER which are C congenital hypothyroidism acondroplasia and rates yes so C is therefore the correct answer congenital hypothyroidism so now question is why not the growth hormone deficiency because growth hormone deficiency endocrinal disorders is again proportionate short s remember c a r disproportionate Fe proportionate Fe and E was endocrinal disorders growth hormone deficiency leads to proportionate short Stitcher our case is disproportionate short s so I hope you have all understood why C is the correct answer D is not the correct answer a is obviously not the correct answer B is not the correct answer the clue here is that the child has a disproportionate type of FL stature coming to question number three Mark out the incorrectly matched so which of these statements is incorrectly matched Milestone which is incorrectly matched with its age of first appearance so you wanted questions on Milestones now here is it's a very important topic for your exams so which is an incorrectly matched Milestone with its age so they are saying child transfers objects at about 6 months then they are saying the child shows the pinc grasp at about 9 months then they say the child has uh the tendency to speak in sentences at 12 months and then they are saying the child climbs stairs at the age of 24 months so which of these is incorrectly matched not correctly matched yes correct answer is yes answer is c c is incorrectly match child starts speaking in sentences from 2 years of age which means 24 months of age the child does not start speaking in sentences from 12 months of age the child starts speaking in monosyllables monosyllables at about four to 5 months the child starts speaking in B syllables at about 9 months the child starts speaking in Jans at about 15 months and the child starts speaking in sentences at 2 years of age so sentences is 2 years of age sentences is not 12 months sentences is 24 months rest all of them are correctly matched the child transfers objects from one hand to another hand correct it is at 6 months alar grasp appears at 6 to 7 months radial grasp appears at 8 to 9 months pins grasp appears at 9 months and a mature pins grasp appears at 12 months and the child starts climbing stairs at two years so all of these are correctly matched the only thing which is incorrectly matched is that the child starts speaking in sentences at 12 months no it is at 24 months coming to question number four question number four says a child with irritability diarrhea growth retardation alopatia and periorificial dermatitis now here again this is the clue periorificial dermatitis what is periorificial dermatitis periorificial dermatitis means a der heitis or redness or scaling around the mouth and the nose per orificial it means around the mouth and the nose includes these nasolabial folds these are the nasolabial folds so the dermatitis is surrounding the nasolabial folds in fact if I'm not wrong two years back or three years back this question was was asked in the fmg exam in the form of a image based question they showed a child who had redness and scaling around the mouth and the nose this is typical of which type of deficiency yes this is typical of zinc deficiency I told you zinc deficiency leads to d a d that is diarrhea alopa and dermatitis diarrhea alopa and dermatitis so zinc deficiency leads to a condition which is known as acrodermatitis entropa acrodermatitis entropa zinc deficiency leads to a condition which is called as acrodermatitis entropa so diarrhea is present in our patient alopatia is present in our patient dermatitis is present in our patient so so many Clues they are giving to you this is the case of zinc deficiency copper deficiency leads to which condition copper deficiency leads to Ming's disease it's a disease which is a neurological disorder which is associated with characteristic hair changes similarly selenium deficiency is associated with kishan's disease which is a type of cardiomyopathy so these are the disorders which are associated with specific deficiency of the micronutrients Yes means skinky hair disease coming to question number five a 2-year-old newborn is brought to the emergency a 2-year-old sorry a two- day old newborn I'm sorry sorry a two- day old newor is brought to the emergency with increasing breathing difficulty starting immediately from birth and a scoid abdomen so what is the clue here the clue here is scoid abdomen scafos means board shaped scafos means board shaped so the child has a board shaped abdomen a newborn presenting with a breathing difficulty and a boat shaped abdomen is indicative of which disperate which type of disorder in new bores I have explained this in my classes which is the disorder the child is suffering from if a newborn immediately after birth has a scoid abdomen a board shaped abdomen with breathing difficulty yes it is a diaphragmatic Heria yes very good it is a congenital diaphragmatic Heria it is a congenital diaphragmatic Heria just hold on for a second please so this is a case of A congenital diaphragmatic H and in A congenital diaphragmatic hernia as I told you there are abdominal contents that herniate into the chest cavity so the most common cause of death in these children is actually a pulmonary hypoplasia the lungs do not grow because the lungs do not have the space to grow and as you are correctly saying in these cases bag and M ventilation is contraindicated so the first treatment of these cases tangit dimatic Hera is intubation after intubation then nasogastric tube insertion then ventilation and finally the child should be taken in for a surgery now because all the abdominal contents have herniated into the chest cavity that is why the medm shifts towards the other side so that is why in our patient you can see the it is written the hard sounds are displaced towards the right because all the abdominal contents have entered into the chest cavity so the contents have obviously move towards the right so therefore which is contraindicated in these cases bag and mask ventilation is contraindicated he's saying all of the falling should be part of the initial management except which should not be part of the management you will never do ambo bags in these cases because if you do amboo bag in these cases you will push air into the stomach and remember the stomach right now is not in the abdomen in these cases it is in the chest cavity because the abdominal contents have herniated into the chest cavity so bag and mask ventilation is actually contraindicated in these cases what are the indications in which bag and mask ventilations are done in new BS bag and mask ventilation what are the indications for back and mask ventilation in a newborn indications so one indication of bagen mask ventilation in a newborn is any newborn who is having apnea who is having apnea and the child has not come out of apnea despite being given tectile stimulation so after birth if a child is in apnea we first give tectile stimulation but if the child does not come out of apnea despite giving tectile stimulation then bag and mass ventilation is given the second is any newborn baby who is either having apnea or is having a respiratory distress after birth say gasping after birth with important thing is heart rate less than 100 per minute now this is very important heart rate less than 100 per minute is an indication for bag and mass ventilation last year it was asked heart rate less than 60 per minute is an indication for chest compression but heart rate less than 100 per minute in a child in a newborn who is either gasping or is an apnea despite giving tectile simulation the child should be started on bag and mass ventilation important indication is that the child's heart rate should be less than 100 per minute these are the indications for bag and M ventilation and what is the contraindication for bag and M ventilation one of the most important contraindication for bag and MK ventilation is a congenital diomatic Heria that is one of the most important contraindications so please remember here what is the treatment that should not be given the treatment that should not be given here is bag and mass ventilation because this is a case of congenital diaphragmatic Heria and as I told you in congenital diaphragmatic Heria bag and mask ventilations are contraindicated coming to question number six question number six says a malish child is being evaluated in the Pediatric W so there is a child who is a malnourished child and is being evaluated in the Pediatric W the medical students are interested in knowing the best method so the medical students are interested in knowing the best method to evaluate acute malnutrition in the child so they want to know what is the best method to evaluate acute malnutrition in the child so they are saying which is the best possible criteria for diagnosing acute malnutrition now as you know very well there are two types of malnutrition one is acute malnutrition and one is chronic malnutrition in children so when we say which markers can be used for acute malnutrition one is weight for age and there is another marker which is known as weight for height but for chronic malnutrition there is only one marker mainly which is height for age so for acute malnutrition the best marker is weight for age and weight for height so two best markers now students are often confused here what is weight for height weight for age is weight according to age but what is weight for height remember we use this term weight for height when we were talking about severe acute malnutrition so one of the criteria for severe acute malnutrition is weight for height less than uh three standard deviations from the expected so now the question here is that what is weight for height so weight for height is weight of a supposedly Manish child compared to the weight of a normal child with the same height so you are comparing the weight of two children one is malnourished one is normal and what is common between the two the same height that means the weight of a child may be different from the weight of a normal child but the height of this malish child is the same as the height of a normal child which means this SM child does not have chronic malnutrition because height is not affected so weight for height means only weight is affected not height because the height of both children is the same malary child normal child so among weight for height and weight for age weight for height is actually considered as the best marker for acute malnutrition best marker weight for AGS can also be used but as you know weight is affected in chronic malnutrition also so the best marker for acute malnutrition according to me should be weight for height which is better than weight for age height for age can only be used in chronic malnutrition but weight for height is a better marker according to me then wait for age therefore for me the answer to question number six should be a I'm not saying that waight for age cannot be used this I'm not saying waight for age can also be used for acute malnutrition but his question is which is the best possible criteria which is the best possible criteria so best possible criteria according to me is weight for height now suppose they ask you which is the only marker which can be used for acute malnutrition and chronic malnutrition in children so which is the marker which can be used for acute malnutrition and chronic malnutrition that is one marker which can be used for acute also and chronic also now you see here weight for AG can be used Us in acute but it cannot be used in sorry weight for height is used in acute but it cannot be used in chronic because height is the same in acute uh and chronic malnutrition chronic malnutrition height is affected in acute malnutrition height is not affected so weight for height can be used as marker of acute malnutrition but it can never we use the markup for chronic malnutrition but wait for age weight gets affected in chronic malnutrition also so weight for age can be used in acute also it can be used as chronic also although in chronic malnutrition the best marker is height for age but weight for age can also be used as a marker so if someone asks you which is the marker for acute and chronic malnutrition in children it is weight for age so best marker for acute malnutrition weight for height best marker for chronic malnutrition height for age but which is the only marker which can be used in acute malnutrition also and chronic malnutrition also it is weight for age weight for age is the only marker which can be used in acute malnutrition also and chronic malnutrition also midam circumference malnutrition Mar but usually it is not considered the best markers the best markers are always weight and height mam circumference the major advantage is that mam circumferences age independent so it can be used when a large number of children are being evaluated you do not require to ask each child's age so when a number of children are being evaluated for malnutrition then the best marker possibly can be midarm circumference but usually within a group of children which is limited weight and height are always the better better markers and more commonly used markers than mam circumference and mam circumference plus as I told you is for Sam also CV recruit man nutrition also and if nothing else is mentioned in the question then wait for age is the best yes if nothing else is mentioned then wait for age weight for age is never the best marker no no no no this is never the best marker the best marker is weight for height waight for age is the best marker for acute also and chronic also but if you are asked only best marker for acute malnutrition only then weight for height is obviously better than weight for age coming to question number seven in a child with severe acute malnutrition in a child with malnutrition which of these options is an indicator ofor now this again is a very very important very very important question forer marasmus for your fmg exams so I've have specifically chosen three four questions on Mal nutrition because this is again a very very important marker good appetite and a hungry child so this is always an indicator that the child has marasmus monkey face appearan is again a child having marasmus a child having irritability and apathetic look this is a child who has for short mental changes yes mental changes child with severe wasting of muscles is again marasmus so the only thing that is seen in children with quer is irritability and apathetic Lo which means mental changes I have told you growth retardation growth retardation plus mental changes growth retardation plus mental changes plus edema this is a Triad that you see in children with quor so growth retardation mental changes and edema is a Triad that is seen in children with quor so these mental changes include this apathy irritability this is all the mental changes and alert kind of a look goes more in in favor of a child having marasmus edema goes in favor of korker sugar baby fat sugar baby appearance again a question of fmg recall question but in the case of marasmus you have a more wasted kind of an appearance then apathy irritability mental changes again goes in favor of korka alertness goes in favor of baras poor appetite anorexia goes in favor of for a voracious appetite eagerness to eat goes in favor of marasmus so which of the following then skin Changes hair changes go favor of foror while relatively less chances of skin changes and hair changes goes in favor of marasmus and yes as correctly said primarily protein deficiency is s while primar calorie deficiency is marasmus question number eight says a baby is delivered a baby is delivered a baby is delivered at 29 weeks gestation and is currently admitted in the NICU a group of medical students are evaluating the case so the baby is 29 weeks dation the baby is 29 weeks dation and the baby is delivered and is currently admitted in the NICU a group of medical students are evaluating the case so they are asking the medical students can expect all of these findings in the is pre-term baby so this is clearly a case of a pre-term baby so he's basically trying to ask which of the following will not be a finding because he's saying all the following can be seen except so basically he's trying to ask which of the following is not a feature of a pre-term baby yes deep Soul creases deep Soul creases are usually a feature of term and postterm babies plenty of Lano is a feature of pre-term baby Lano are the fetal hair so plenty of Lano is pre-term Baby Slow elastic recoil of the ear pre-term babies so because the ear cartilages are not there so when you press the ear it will only slowly go back to its original position again a feature of a pre-term baby then Thin Red Skin again a feature of pre-term babies in terms and postom babies who usually have more deated skin dry skin but preum babies have thin red skin their soul greases are very very superficial or sometimes absent the fetal hair Lano will be plenty over the uh forehead over the body their skin will be very thin and will be dark red in color if you press the their ear because of the deficiency of the ear cartilages the ear will only slowly go back to its original [Music] position so all of these are features of pre-term babies pre-term baby means a baby who is delivered earlier than uh 37 weeks of dation so 37 weeks earlier than that is pre-term 37 to 42 weeks is term and a baby born after 42 weeks is postterm baby postom babies have deated skin dry skin postom babies have long nails postom babies often are meconium State because most of the postone babies have some degree of breathing difficulty intrauterine so they pass meconium because of that in the intrauterine life so when a poster baby is delivered many times the postom baby will be stained with meconium stained like so these are features of postterm babies so please remember very very important topic for your exams is difference between pre terms and terms for term babies coming to question number nine during routine examination of an infant the Pediatric is checking the Primitive re neonatal reflexes so I've told about primitive neonatal reflexes my classes he will be considered uh he will be concerned sorry he will be concerned if the reflex shown in the image is persisting beyond what age so what is the reflex that you are seeing you are seeing a moros reflex what is the reflex you are seeing you seeing a moros reflex and what should be the timing of disappearance of the moros reflex let me see what your answer is what should be the timing of of disappearance of the moros reflex yes correct the answer should be 6 months because moros reflex normally should Disappear by 3 to 6 months I've told about these reflexes one is the grasp reflex then you have the rooting reflex then you have the moros reflex then you have the asymmetric tonic neck reflex so the timing of disappearance of these reflexes timing of disappearance of these reflexes Gras reflex disappears by about 3 months rooting reflex disappears by about 1 month moros reflex disappears by about 3 to 6 months so if moros is persisting beyond 6 6 months it is abnormal and similarly asymmetry tonic neck reflex disappears by 5 to 6 months so if moros reflex is persisting beyond 6 months it is abnormal it is considered abnormal as I told you these are primitive reflexes primitive reflexes means netive reflexes which appear in the intrauterine life and they disappear after birth because because they are primitive they have to disappear after birth so these primitive neonatal reflexes they gradually disappear after birth and they are suppressed by the more advanced part of the brain which is the frontal part of the brain the cerebral cortex so as the cerebral cortex matures after birth the cereal CeX causes suppression of these primitive reflexes so these primitive reflexes which have appeared during the intrauterine life they start disappearing after birth so if the reflex is persisting beyond the time it should disappear it is abnormal that means the problem was somewhere in the brain it was not able to suppress those reflexes so by seeing whether these primitive reflexes have disappeared or not you are indirectly trying to see whether the brain of the child is normal or not so it is basically a a noninvasive way of evaluating the brain of the child naturally the reflex is persisting and it has not disappeared after birth the time it should disappear that means there is a problem in the frontal part of the brain the Cal cortex it is not able to suppress these reflexes parachute reflex never disappears yes it's a reflex which appears after birth so it's not a primitive reflex and Par reflex never disappears it is known to persist throughout life so which reflex is not a primitive reflex parachute reflex is one of the reflexes which is not primitive there are other also but parachute reflex is one reflex which is not primitive then another question which is on neonatal resuscitation during the resuscitation in a pre-term newborn baby who is delivered at 36 weeks of gation oxygen concentration to be provided with positive pressure ventilation is so when start ambo bags when we start ambo bags now one part of the amboo bag can be connected to the oxygen source now the question is when I'm starting amboo bag in the baby during a neonatal resuscitation should I apply oxygen or should I not apply oxygen during Neal resusitation because as I've told in my classes if oxygen is given in very high concentration without monitoring then it can be very dangerous now you have to note what is the what is the baby's age the baby was delivered at 36 weeks of the station so as I told in my classes some of you are wrong some of you are correct as I've told in my classes that if a baby is born earlier than 35 weeks of gestation in that case 21 to 30% oxygen is needed but if a baby is born at 35 weeks gestation or more than that only room a is enough so this is the guideline if a baby is born earlier than 35 weeks of gestation 21% to 30% oxygen is needed so many of you are answering B 21 to 30% is if a baby is born earlier than 35 weeks c r Cas the baby is born at 36 weeks of gestation so he will come in the second category this category and if a baby is born at 35 weeks plus in that case 21% oxygen so those who have answered room here I think only one case where I can see room here in all other cases they have given the answer as B no answer is not B according to me the answer is a so you need to revise your notes properly again exams are coming although I think you have prepared well but sometimes what happens is there are very very small clues in the question which should you should be very well prepared just see what the child's maturity is it is 36 weeks of gestation 36 weeks weeks of gation will come here below 35 weeks it will be 21 to 30% oxgen but if a baby is born at 35 weeks plus then only room air is enough you don't need to provide any extra oxygen with the risk that there might be injury to the lungs I called it as Bronco pulmonary dysplasia so remember for your exams 21% for 35 weeks plus and 35 weeks and 21 to 30% for children who are less than 35 weeks so because in our case it is 36 weeks so the correct answer should be room air coming to question number 11 question number 11 says all of the foll following CTIC congenital heart disease in children are associated with pulmonary plethora except okay so what is pulmonary plethora pulmonary plethora what is meant by P AR plethora I told you there are two terms one is pulmonary olimia when I say pulmonary olimia it means decrease pulmonary blood flow decrease pulmonary blood flow but when I say pulmonary plethora pulmonary plethora it means increase pulmonary blood flow so he's saying all of the following CTIC ital heart diseases are associated with increase in the pulmonary blood flow except so where pulmonary blood flow is not increased pulmonary blood flow is in fact decreased so I told in my classes that Coptic congenital heart diseases I don't think this is a question which you should Mark wrong because I have in detail discussed about cenital heart disease in my classes so those who have attended my classes I don't think you should Mark this question wrong it's no chance because I've discussed uh pital heart diseases in great detail in my classes I mean in much more depth than what you require for your fmg in fact whatever I told in my classes I believe you can use those uh part those notes for your uh neat PG preparations also once you clear your mg so I I told Coptic conal heart diseases are divided up into two broad categories decreased pulmonary blood flow which means pulmonary oligemia and increased pulmonary blood flow which means pulmonary plethora decreased pulmonary blood flow further are divided up into those with rvh and those with LVH so decreased pulmonary blood flow with rvh is tough and decreased pulmonary blood Pro with LBH is tricuspid atreia so both tough and TripIt atesia are actually decreased pulmonary blood flow which means pulmonary oia you don't need to redraw this I've drawn this in my classes so must have made notes from them increased pulmonary blood flow is seen in transposition of great arteries it is seen in truncus arteriosis it is seen in total enamas pulm Venus return it is seen in hypoplastic left heart [Music] syndrome so these are decreased pulmonary blood flows and increased pulmonary blood flows as I told you when we say decreased pulmonary blood flow it means pulmonary oia and when I say increased pulmonary blood flow it means pulmonary plethora now coming back to my question he's saying all of the following are associated with pulmonary plethora except which means he's saying which is not associated with increased pulmonary blood flow answer is St as you can see DVR PGA and truncus arteriosis they all are associated with increase in the pulmonary blood flow so the only one which is associated with decrease in the pulmonary blood flow is stop so please for your exams be very very careful about what questions they are asking there was one student who said There one student who said we have to be very careful in seeing each and every line of a question this is correct you're going to be doors and it is very important that you need to be very very clear about each and every line of a question before you answer that question even one line not properly read you can mark the answer wrong to that question yes diseases starting with Coptic heart disease T question number 12 so again in a child with a CTIC congenital heart disease presenting with sinosis presenting with sinosis immediately after birth reduced pulmonary blood flow and ECG showing a left ventricle hypertrophy now you should be able to tell I've already told you here I've already told you here he's saying decrease pulmonary blood flow reduce pulmonary blood flow and ECG showing a left ventricle hypertrophy so I told you Coptic disease redu pulmonary blood flow with the right ventricle hypertrophy is tetrology ofet and with the left ventricle hypertrophy is is yes stas patrial so now where is it difficult CTIC heart diseases with reduced pulmonary blood flow can either be top or a Trias treesia so when I say a Coptic heart disease with reduced pulmonary blood flow with the right ventricle hypertrophy then you set off and when they say cytic heart disease with reduced pulmonary blood flow with a left ventrical hypertrophy you say trasp treesia yes and TGA TVR truncus arteriosis they all are associated with increase in the pulmonary blood flow so now you promise you won't make any wrong answer in the exam if a question on congenital heart diseases are asked you have to promise that please remember the questions that are asked on congenital heart dision fmg exams as far as I have seen in the last few years they are very very simple they can be easily answered if you are just a little careful about what questions they are asking don't be in a rush to answer the question little more difficulty in answering questions on kital heart disease is when you prepare for your need PG exam so need PG and ICT yes the questions are a little more difficult their approach is different but at least for fmg you have to promise these are very simple things just remember that table of congenital heart disease classification that I told you that is good enough for your exams very good so promise you will not make any mistake okay coming to question number 13 so again a very simple question a baby is brought to the emergency with severe sinosis just chest x-ray is shown now chest x-ray is very clear this is a very typical type of a chest x-ray he's saying which is the most likely congenital heart disease which has this typical presentation so what type of a x-ray presentation is this what type of X-ray presentation is this this is very very simple what type of X-ray presentation is this let me me see so let us see what type of an x-ray presentation is this which type of heart you are seeing you are seeing very clearly a heart which is which is yes which is not boot shaped heart in boot shaped heart it will be something like this don't confuse this with a boot boot shaped heart epex will be up this will be boot shaped this will be boot shaped but this is egg on a string appearance this is egg on a string appearance and egg on a string appearance is seen in TGA don't confuse it with the boot shaped heart boot shaped heart the epex of the heart will be up in eggon a string appearance the Epic of the heart will be sloping down so boot shaped heart boot shaped heart will be is seen in tough but egg on a string appearance is seen in TGA then snowman's heart or figure of weight appearance is seen in TVR box shaped heart is seen in Epstein and am and sign of three is seen in cooptation of aota so these are the X-ray pictures that you should remember for your exams yes boot shaped Heart is also called as F and so since what you are seeing on the X-ray the picture that you are seeing is an egg on a string appearance therefore in our case the answer is transposition of great arteries coming to the next question question number 14 so question number 14 says a newborn with fever irritability and intermittent stus posturing is diagnosed with neonatal menitis so there is a child who has been diagnosed with neonatal menitis remember that is a newborn who has been diagnosed with menitis he's saying all of the following can be possible eological causes for neonatal menitis except so which of these is not a cause of neonatal menitis so if you remember in my classes I've told you menitis caused in children between birth till 2 months and then menitis caused in children above 2 months so when we talk about neonatal menit the choices are very simple it is Group B streptococus worldwide eoli in India gella stfy focus orus and listeria apart from this the important causes of menitis which includes H influenza which includes streptococus pneumonia and which includes meningo cus which includes meno cocas they are known to cause menitis after the age of 2 months yes so H influenza will not be a cause of Neal menitis because as you are seeing H influenza streptococus pneumonia and meningo cocas usually are causes of menitis after the age of 2 months for neonatal men us just remember these causes group bpto coccus eoli Clea stus orus lisia just remember these causes five causes of Neal menitis group bpto cus eoli CLE stus orus and leria worldwide the most common cause is worldwide it is groupy shopus but in India the most common cause of neonatal menitis is eoli so eoli is the most common cause of neonatal menitis in India we are not talking about infant menitis we are talking about neonatal menitis neonatal period is the period which occurs in the first 28 days of life so we are talking about neonatal menitis not infant menitis so which is worldwide the most common cause of Nal menitis Group B streptococus but which is the most common cause of Nal menitis in India it is EOL so if you see our options staff orus leria eoli they all are causes of neonatal menitis except for H influenza which causes menitis usually after the age of 2 months so it is not a cause of neonatal menitis confusion there should be no confus confusion here what confusion do you have remember the causes group septo cus eoli C Staff leria first entro most of the entro bacteria Eola they all will cause penitis in the neonatal age group The Classical causes of penitis Staff which is H influenza streptococus pneumonia and meningococcus will be causes of menitis after the age of 2 months infant menitis will be menitis after 2 months so if you are asked infant menitis after two months whatever are the causes of menitis there will be infant menitis causes H influenza stonia Mingo cus but as far as I know there is no term there is no term which is referred to as infant menitis neonatal menitis is important but there is no term called as infant menitis okay you can say h influenza is for infant menitis it is not for Neal menitis I don't know which book you are referring to infant menitis there is no term as infant menitis we have neonatal menitis which is a specific term because menitis in newborns is little different from menitis in the remaining parts of ch coming to question number 15 question number 15 says a newborn is again so the question is again on a newborn a newborn is being evaluated for bilaterally enlarged kidneys with multiple small cysts in the cortex and the Meda so they are bilaterally enlarged kidneys bilateral so this is again a clue bilaterally enlarged kidneys with multiple small cysts so this appears to be a case of A congenital cystic disorder of the kidney congenital cystic disorder of the kidney so there are two conal cystic disorders of the kidney which are important there are many which are there but two which are important as I told you one is multi-cystic dysplastic kidney one is multicystic dysplastic kidney and the other is polycystic kidney disease polycystic kidney disease now as I told you multisys plastic kidney is usually unilateral affects one kidney while polycystic kidney disease is usually bilateral so this appears to be a case of a polycystic kidney disease because it's says bilaterally enlarged kidneys bilateral bilateral means both kidneys are affected it cannot be multicystic because multicystic tastic kidney will affect one kidney only so this appears to be a case of polycystic kidney disease sometimes polycystic kidney disease because of the number of cysts that are present on ultrasound may show a salt and pepper appearance that means those cysts may appear as black black black spots in a white background which appears as salt and pepper appearance but anyway salt and Pap pepper appearance forget it important thing to remember is if it is bilateral kidney involvement it is more likely to be polycystic kidney disease if it is a single kidney involvement it is more likely to be a multi-cystic dysplastic kidney and if it is a polycystic kidney disease then obviously which is the other organ to get affected it is liver fibrosis so yes C is the correct answer it's autosomal recessive polycystic kidney disease some students have given d as the correct d as the answer I don't know why they are thinking of D brain angiomatosis is never seen in polycystic kidney disease as I told in polycystic kidney disease there is mutation of pkd1 gene so PK HD1 Gene PK stands for polycystic kidney polycystic kidney and HD stands for hepatic disease so liver fibrosis liver fibrosis is likely to be present in these children mayang has said enosis of the brain why I don't know but enosis of the brain is not seen in these cases and in fact there are some who have given answer as a also where does a come from why will they be cysts in the lungs they will be cyst in the liver this is a polycystic kidney disease so cysts are not present in the lung s are present in the liver I don't think this was a difficult question this was a much simpler question only thing is rather than directly asking the question they are asking a question in a light slightly indirect manner please try to expect now these type of questions now the papers that we are seeing in the last one or two years fmg are not very very simple last paper also was not simple so now the papers that they are asking is slightly indirect questions which in which requires a little thinking that classical recall type of questions what is the most common what is the least common which is the largest which is the smallest that is now less likely to be asked there might still be some questions like this but they are less likely to be asked more likely to be asked are indirect questions so they could have very simply asked a polycystic kidney disease which is the other organ that is affected but first they want to see whether you are able to identify that this is a polycystic kidney so they intentionally put bilaterally enlarged kidneys with cysts so now you realize this is not a multis dis plastic it's a polyic IND disease then you see polyic disease autosomal recessive mutation in pkd1 G okay so what is HD hepatic disease so which is the other GG that will be affected liver fosis so don't be confused with autosomal dominant no don't be confused we are talking about a newon so how can you be confused with Auto dominant this is autosomal recessive polycystic kidney disease coming to question number 16 question number 16 says in a 5-year-old child with nephrotic syndrome and Persistence of protein UA despite 6 weeks of full dose pris Salon what is this condition called as when in a child with nephrotic syndrome proteinuria is persisting proteinuria is persisting despite 6 weeks of full dose pris Salon what is this condition called this condition is called as a steroid resistant nephrotic syndrome so this is called as a steroid resistant nephrotic syndrome when the child prota persists despite 6 weeks of full daily steroid therapy we call it as a steroid resistant nephrotic syndrome and what is the drug of choice for a steroid resistant nephrotic syndrome the drug of choice for a steroid resistant nephrotic syndrome is again why am I getting answer B it appears as if you have not read my notes I hope those students who are answering answer as B are those students who have not uh attended my class because in my classes I don't think students should miss out on this answer I very clearly told steroid dependent nephrotic syndrome drug of choice lamisol steroid resistant nephrotic syndrome drug of choice cyclosporin or tacrolimus or tacrolimus I don't know why cyclop fosite comes in the picture cyclop fosite can never be the picture yes cyclosporin or tacus is the answer so I sincerely hope I don't know if most of you are attending this uh session are you the students who have attended my classes yes if you have attended my classes because I normally take most classes uh which are in Delhi and in out station I take the class in jaur so there are some other outstation classes in Mist also which I know so I don't know if you have attended my class or not but if you have attended my classes in Mist then it is very clear steroid dependent nephrotic syndrome the drug of choice is lamisol steroid resistant nephrotic syndrome the drug of choice is cyclosporin or tacrolimus finish no cyclop fosmid here so cyclop fosmid in fact is never the drug of choice in steroid dependent or steroid restant in some steroid dependent nephrotic syndrome cyclosporin sorry cyclophos may become the drug of choice if there are severe steroid toxicities but leave that it is complicated just remember the main drug of choice for a steroid dependent netic syndrome is lamisol and the drug of choice for a steroid resistant nephrotic syndrome is cyclosporin or tacrolimus here tacrolimus is not given so the answer is cyclosporin yes so if there is a Persistence of protein UA despite 6 weeks of full do steroids then we call it as a steroid resistant nephrotic syndrome what is a steroid dependent nephrotic syndrome I told steroid dependent nephrotic syndrome is when there are relapses of protein UA when the child is shifted to alternate steroids or within two weeks of stopping the steroids coming to question number 17 so question number 17 says a 3-day old newborn with hypoxic ischemic and copy hi is hypoxic ischemic en kopy a 3-day old newborn with hypoxic esic en copath is brought to the emergency in seizures the child's abgar score was three and four at 1 and 5 minutes after birth which of the following anti-epileptic drugs should the neologist choose to abort these Cesar so now again it is very important to remember we are talking about a newborn who has come to you with fit because your answer will depend upon whether we are talking about a neonatal Caesar or we are talking about a childhood Caesar because if we are asking about neonatal Caesar your drug of choice will be different if you are asking asking about childhood childhood Caesar drug of choice is different and for a neonatal Caesar yes that for a Neal Caesar the drug of choice is pheno bariton so for a neonatal Caesar the drug of choice is pheno bariton so for a neonatal Caesar the drug of choice is phob bariton but for a childhood Cesar the drug of choice as I told you is either IV molim or IV lorasi so it is very important that you give the answer based upon what they are trying to ask if they're trying to ask a drug of choice for a neonatal season the answer should be pheno biton and most of you have answered phob biton but if they're asking about drug of choice for a childhood season then the drug of choic is either I medm or I either or iil or aipa there is one answer given B also B is not the answer Val it is never the drug of choice either for a Neal ceson or for a childhood seeson in case a child does not respond to Neal Caesar with phob biton then you can give other drugs such as phenin or you can think of leviter or sometimes even think of drugs like logain or sometimes think of even py doxin vitamin B6 given in high doses can be given for children who have refractory neonatal Caesar so intravenous feno intravenous levam intravenous lidocane intravenous pyod doxin vitamin B6 how for uh pregnancy and children children vro is not contraindicated children valro is given it is not contraindicated please remember this it's not contraindicated but for pregnancy yes vroid should be avoided right so fenin leviter lidocain py doxin these are drugs of choice that you use for refractory neonatal Caesar and which are the drugs of choice you use for refractory childhood Caesar for refractory childhood Caesar which are the drugs of choice so you can give again IV phenin If the child is not responding or IV leviter attan or you can even think of giving valro here so thank you Asif I hope uh you have found some benefit before you are labeling me as the best there are many other pediatric teachers faculties who are very very good so I don't think I'm the best but I do think that yes if if you have attended my classes and made notes properly then definitely uh there will be benefits uh I may be a small contributor to you clearing these exams so that is what I think right okay coming to question number 18 question number 18 says a child has been diagnosed with slow growing brain tumor which is located near the pitutary area so there is a slow growing brain tumor so there is a slow growing brain tumor so there is a child who has been diagnosed with a slow growing brain tumor located near the pitutary area so now again the catch in the question is pitutary area so a brain tumor located near the pitutary area the pitutary area is known as the celika and if there is a tumor which is lying if there is a tumor which is lying near the cellat tarika and starts causing calcification so that calcification will be called as suprasellar calcification the area where this tumor is rising so the area where this tumor is present is known as the cellat tarika area the pitutary area and because it is present near the pitutary area it can cause calcification in this area so this calcification is known as supracellular calcification so which is the brain tumor which is most likely to present with the supracellular calcification yes it is a cranio farena overall most common brain tumor in children so in children overall most common brain tumor is cere Esty overall most common malignant brain tumor overall most common malignant brain tumor is a medo blastoma so overall most common brain tumor is cere Esty but cere Esty is benign so if you are asked overall which is the most common malignant brain tumor the overall most common malignant brain tumor is metalo blastone so the catch word here is the catch word here is malignant yes overall most common malignant brain tumor is medo blastoma then most common brain tumor most common brain tum tumor of infants most common brain tumor of infants is a choid plexus tumor overall most common brain tumor of infants is choid Plexus tumor so if someone asks you which is overall the most common brain tumor of infants infants less than one year so overall most common in children is cereal aresty but in infants the most common brain tumor is corid plexus tumor and then if they ask you which is the most common brain tumor most common brain tumor which causes suprasellar calcification Supra Cellar calcification so because this brain tumor is present near the pitutary area answer is crano farena so our answer should be crano farena so repeat With Me overall most common brain tumor cerebr Esty but less than one year most common brain tumor infants it is corid Plexus tumor then most common malignant brain tumor medo blasto and most common brain tumor which is present near the pitutary area and causes supracellular calcification is a crano feren question number 19 says in a 10-month-old infant so in a 10-month-old infant with fever and weezing episode so this again the clue to the question is weezing it's very very important to be able to identify the clues you cannot make an answer wrong in the question if you are able to identify the clue you open a lock with a key so the key is the most important the moment the key is in the lock and the key is correct you open the lock similarly here the lock is the question the key is that clue with that question if you are able to put the key correctly in the lock the lock will open so you can understand this question that is given to you is a puzzle is like a lock only thing is in that lock you have to identify the key correct key put in the lock the question will easily open up and the answer will be very clear here here what is the Clue the clue will be vising episode so if there is a Strider episode Strider so Strider means upper respiratory problems but when they say vising episode it means lower respiratory problems and for lower respiratory problems the most common reason is obviously yes RSV RSV this is clearly a case of bronchiolitis this is clearly a case of bronchitis bronchitis first weing of infants first vising of infants is bronchitis this is all that you have to remember for your exams only thing to remember for your exams is first weezing of infants is brontis recurrent vising is Asa but first vising of which means there has never been a weezing episode weezing means those whistling like sound coming from the mouth it usually indicates problem is in the lower respiratory track Strider means a noisy breathing it means the problem is in the upper respiratory track so group epiglottitis they presented Striders bronchitis bronchitis pneumonias they're present with Ving lower respiratory tract is affected and first first reason in an infant is bronchitis bronchitis is never seen usually after 2 years of age most cases of bronchitis even in the first two years most cases of bronchitis will be in the first year of life I think if a question is given for bronchitis in your exams it will always be an infant so I think the first clue you will identify in the question will be that the question will be talking about a infant the second clue they will be asking about vising remember infant with vising usually means bronchitis and the third clue is no previous such history present no previous such history present means first reing so now everything falls in place first reing infant it is bronchitis and what is the most common cause of bronchitis in children it is rest respiratory sensial virus par influenza viruses are the most common cause of group in children H influenza is the most common cause of epiglottitis in children I think in adults the more common cause of epiglottitis is streptococus pneumonia but in children the most common causes of epiglotis are H influenza type B the most common cause of group in children are par influenza viruses yes first V is always Bron like this asthma is recit me is very good so most of you are talking the things that I discuss in my class so I can very easily from the things that some of the students are mentioning very easily I can understand that these are the students who have attended my class because these are the clues that I give in my class first vising infants bronchol and brontis means RSV respiratory sensial virus a 13 year old boy is brought to the neurology clinic with a history of early morning repetitive jerking so again the clue here is early morning repetitive jerking there is early morning repetitive jerking which means a Caesar that has resulted in objects dropping from the child's hands objects dropping from the child's hands so there was a Caesar in the morning that resulted in objects dropping from the child hand the second clue is that the child also has a family history positive so his brother has also been diagnosed so there is a family history that is positive this is the second clue the third clue is eg shows 4 to six Herz spikes and wave pattern this is again a very Ty typical EG pattern a three Herz spike and wave pattern on EG shows that the child has absent Caesar or disorganized EG which is called as hip sermia disorganized EG which means hip sermia indicates a child has infantile spms and a four to six Herz poly spikes four to six Herz poly spikes and wave pattern means the child has juvenile myoclonic epilepsies juvenile myoclonic epilepsies so our patient most likely has a juvenile miconic epilepsy first clue that EG is very typical four to six Herz poly Spike and wave pattern and in our question also poly spike and wave pattern is there the second clue is that in our patient the patient so because I'm talking about juvenile of these children has a positive family history so positive family history present in these cases at early morning Caesar that is usually present in juvenile miconic epilepsies juvenile miconic epilepsies a very easy clue is that most of these occur in morning Earths so age of the child matches with juvenile melonic epilepsy early morning ceson matches with juvenile melonic epilepsy then the child has a positive family history matches with juvenile malonic epilepsy and a typic EG matches with juvenile malonic epilepsy and therefore what should be the drug of choice for juvenile maic epilepsy it is sodium valid Act is the drug of choice for infantile spasms sodium valid is a drug which can be given for children who have juvenile miconic epilepsies it is also given as a drug of choice along with ethoxide or not along with either ethoxide or valid is also the drug of choice for children who have uh absent caeses coming to question number 21 question number 21 says an a week old child is brought with persistent vomiting starting from about 6 weeks of age initially intermittent after a few feeds and at the time of presentation after each feed so this was a child who is a 8 week old child so around two month old child the history is that the child started having vomitings when the child was about 6 weeks of age so the vomiting never started from birth the child started having vomiting starting from about 6 weeks of age initially those vomiting episodes were intermittent that means Sometimes they used to happen sometimes it did not used to happen but later when the child was brought to by the mother to the clinic the mother was very worried that the child is now having vomitings almost after each feed the child also appears to have abdominal contractions that are visible contractions in the abdomen and there is also a olive shaped Mass so which is the condition we are talking about yes we are talking about a kenite hypertrophic pyloric sosis A congenital hypertrophic pyloric sosis that means the pylorus part of the stomach the pylorus part of the stomach the gastric Outlet we call it as this part the pylorus part of the stomach the gastric Outlet is usually thickened starting from the time of birth we also have an acquired hypertropic pyloric sosis drugs like macro lies aromy is the most notorious so drugs like macro lies can cause equired hypertrophic pyic sosis that's not congenital but here we are talking about congenital hypertrophic pyloric sosis they usually have three PS p p and p so first p is peristaltic waves which can be seen in the abdomen second p is projectile vomitings so the child will have projectile vomitings but usually the projectile vomits vomiting will not start from birth it will start from about six weeks of age and the third p is a pyloric Mass so that thickened pylorus appears as a pyloric Mass which is Olive shape so if someone asks you which is the disorder which is associated with three PS peristaltic waves projectile vomitings and pyloric Mass it is hypotrophic pyloric sosis the peristaltic waves does not move from right to left they move from left to right so left to un like this that's the direction of the movement of the peristaltic waves nonbilious vomitings yes peristaltic waves from left side to right side and is the investigation of choice the investigation of choice is ultrasound after I think this is taught most commonly in surgery so I won't go into detail but but it is something which is very important pediatric question you may take it as a part of a pediatric surgery question or you may take it as a part of a pediatric medicine question but it is a very very important pediatric question what is the best way to diagnose a hypertrophic pyic sosis seeing the thickness of the pylorus on the ultrasound of the abdomen in fact the thickness of the pylorus also increases on the the ultrasound and the length of the pylorus also increases on the ultrasound so pylorus length and pylorus thickness they both increase on ultrasound that is the investigation of choice for hypertrophic pyin sosis I don't know why many happy birthday messages are being given to me it is not my birthday so I don't know why I'm repeating yes it's Dr vit's topics so I will leave it here only coming next to question number 22 a child with 8 to 10 episodes of watery diarrhea poor skin turg dry oral mucosa lethargy and poorly accepting feeds what is the treatment of choice so this is a child who is in dehydration now there are two things that you need to see when the child presents to you in dehydration is the child alert the child appears drowsy the child appears sorry the child is alert the child appears irritable the child appears drowsy or in unconscious so if the child appears to be very alert then this is most likely a child in no dehydration If the child appears to be irritable the child appears to be most likely in some dehydration and if the child appears to be drowsy or unconscious then the child most likely is in severe dehydration so this is the first Loop is the child alert yes then it is no dehydration is the child irritable yes then it is some dehydration is the child drowsy the child is in severe dehydration then give some water to drink see how the child is drinking water see how the child is drinking water the child does not appear to be thirsty not thirsty at all so when you giving water to the child to drink he does not appear to be thirsty he will drink some water but otherwise he does not appear to be thirsty so this is a child who is in no dehydration the child appears to be very very thirsty he's drinking water very very eagerly this is some dehydration and the child is refusing the water he is not refuses the water to drink or is not able to drink properly this isn't severe dehydration I think for your exams these are the two main Clues these are the two main clues that you should be able to identify sorry not this and this these are the two main clues that you should be able to identify First Consciousness level of the child and second how is the child drinking water these are the two main Clues by which you will be able to identify the child is in which category of dehydration no dehydration some dehydration severe dehydration and yes the remaining part will be then seeing the skin turg dryness of the oral mucosa dryness of the uh eyes so all of that is secondary but the most important way by which you will be able to identify is the Consciousness level of the child and how the child is drinking water now if you come back to our question our question the child has dry oral mucosa so obviously he cannot be no dehydration he appears to be lethargic so he's not irritable he's lethargic browsy and he's poorly accepting feeds so this again goes in favor of child having severe dehydration and for severe dehy ation the drug of choice is yes ringal atic but why this cannot be the answer this will be the correct answer only when you are giving the child uh IV fluid in malnutrition so when you're treating dehydration in malnutrition then ringal laate and 5% dextose will be given now here please remember nowhere have they mentioned that the child appears to have malnutrition now there have been many seas that are seen nowhere in the question they have mentioned that the child is malnutrition just see a child with 8 to 10 episodes of watery diarrhea poor skin tuger dry oral mucosa lethargy so this is purely a child presenting with dehydration which is because of diarrheas where is it written this is a malish child if it is not a malish child all dehydration episodes which has the dead need to be treated with plain ringal lactate but in case there is a malnutrition with dehydration episode particularly in a child who is in shock then you give ringal in 5% dextrose so please remember ringal lactate in 5% dextrose is only when we are talking about malnutrition here there is no case of malnutrition but dextrose osmotic diarhea I'm not giving dextrose I'm only giving ringal where am I saying dextrose answer will be ringal lactate only I hope you have all understood you have all understood why I'm saying here the answer will be ringal lactate because ringal lactate and 5% dextrose is for the treatment of see when we have dehydration Management in children no dehydration is treated with ORS some dehydration is treated with ORS and severe dehydration is treated with IV fluid and IV fluid of choice is IV ringal lactate or IV normal salite you can choose from them but ringal lactate is preferred ringal lactate is preferred but when we are talking about dehydration in a malish sh dehydration in malnutrition then the only case where IV fluid will be required will be CV dehydration in shock that is the only place where IV fluid is required and that IV fluid is ringal lactate in 5% dextrose so ringal lactate and 5% dextrose is only when you are treating severe dehydration in a child who is malish severe dehydration that to which shock all other types of dehydration and malnutrition are treated with ORS and that also a modified form of ORS you do not use a standard ORS in malnourish and I've clearly explained these things in my classes so in my question there is nothing which mentions that the child is malnutrition therefore the correct answer should be plain ringal lactate why should we give ringal lactate in 5% Str So my answer will be plain ringal lactate not ringal acate in 5% exose coming to the next question in a 36 we newborn baby delivered by cesarian section and developing breathing difficulty after birth most likely pathological mechanic M for breathing difficulties so this is a baby who is a 36 week newborn baby so I told most common cause of respiratory distress in newborn babies who were delivered earlier than 34 weeks is RDS respiratory distress syndrome also called as high membrane disease but the most common cause of respiratory distress in late pre-term babies late pre-term babies means babies who are born at about 35 36 weeks or interm babies is transient teep of the newborn in our patient the baby is 36 weeks our case the baby is 36 weeks so this baby is a late pre-term baby late preum baby this is a late pre-term baby and what is the second clue the second clue is that the baby was delivered by cesarian sections most of ttn BS are delivered by cesarian sections yes all of you are correct the answer is this is a case of transient teia of the newborn which is because of the retention of the fetal lung fluid the most likely reason why this is ttnb is because this baby is a late treat pre-m baby why will a late pre-m baby have high membrane disease surfacant is normally maximally produced at 34 weeks of intrauterine life so a baby who is born after 34 weeks is likely to have proper amount of suant in his lung so why will he have high membrane disease he's more likely to have a a ttnb and in case somebody ask you most common cause of respiratory distress in postterm babies that means after 42 weeks then it is most likely meconium aspiration so respiratory distress because of meconium aspiration so just remember most common cause of respiratory distress in uh newborn babies who are born earlier than 34 weeks is RDS most common cause of respir distress in late pre-term babies and in term babies is transient to kitney of the newborn and most common cause of respiratory distress in postterm babies that means babies who are born after 42 weeks as I told you postterm means a baby who is after 42 weeks and still inside the mother so these babies because of some amount of breathing difficulty they pass meconium intrauterine so when they delivered they meconium stain and some of the meconium may enter into the respiratory tract blocking the respiratory tract leading to meconium aspiration syndrome so because in our case the case is 36 weeks so in our case the answer is ttnb and what is ttnb due to it is because of retention of the fetal lung fluid coming to question number 24 an infant is delivered to a mother who had a history of poorly controlled type 2 diabetes and the child was on and the mother was on Metformin the mother's blood sugar is poorly controlled which of these complication in the infants is most specific to maternal diabetes so most common complication in infants of diabetic mothers and most specific complication in infants of diabetic mothers so most common complication infants of diabetic mothers is doodle tube defects and most specific complication and infants of diabetic mothers is sacral a Genesis or cordal regression syndrome so why will there be hypoglycemia here so most specific complication yes is sacral agenesis again why am why are some of the students answering hypoglycemia hypoglycemia is not the most specific complication the most specific complication seen in infants of diabetic mothers is sacral agenesis which is also called as cordal regression syndrome most common congenital heart defects in these babies is vsd ventricle sepal defects most specific congenital heart effect in these babies is transposition of great arteries and least common congenital heart defect in these babies is atrial sep effects so most common conial heart effect in these babies is ventricle sepal defects most specific congenital heart defect in these babies is transposition of great arteries and most and the least common cital heart effect in these babies is atrial sepal defs hypoglycemia large forestal age hypocalcemia small left colog those are other complications but if they ask you in the exam which is the most specific complication then it is sacral agenesis which is also called as the cordal regression syndrome so he's clearly asking in this infant which is the most specific complication to the maternal diabetes so most specific complication to maternal diabetes should be sacral agenesis or cration syndrome and coming to our last question question number 25 all of the following are indications of IV dexos Administration in a newborn baby who has hypoglycemia so neonatal hypoglycemia neonatal hypoglycemia is defined as blood sugar Which is less than 40 mg per dcil so Neal hypoglycemia is when the blood sugar is less than 40 mg per deciliter now Neal hypoglycemia can either be asymptomatic or it can be symptomatic that means either there may be some symptoms for example Prenos chiness this is a symptom of hypoglycemia newborns jitteriness or a Caesar a Caesar in a newborn it may be a uh manifestation of neonatal hypoglycemia or a very high pitch cry or a very low pitch cry these are some symptoms where a newborn becomes uh develops hypog symptoms of hypoglycemia but the very strange part is that Neal hypoglycemia can also be asymptomatic that means it can be completely without any symptoms remember when Neal hypoglycemia has symptoms treatment is always IV so first we give an IV bolus dextrose and then we start glucose infusion so IV symptomatic hypoglycemia is always treated in new bonds with intravenous Solutions but when the child is asymptomatic hypoglycemia we try to see what is the blood sugar level before deciding oral or I so if the blood sugar levels are only slightly low which means they are between 20 to 40 mg per decil slightly low then we try oral that means we try milk so give milk to the baby and recheck after recheck after 60 seconds that means 1 minute recheck blood sugar after 60 seconds but if the child is having asymptomatic hypoglycemia and the blood sugar is very very low which means it is less than 20 Mig per deciliter then again the treat M will be only I you're getting the point that I'm trying to say when a child has symptoms of hypoglycemia no matter how low the blood sugar is treatment is always I but when the child is asymptomatic that means we routinely was screening a newborn and suddenly we found hypoglycemia but right now the newborn is not having any symptoms of hypoglycemia check how much the blood sugar if it is not very low it is somewhere between 20 to 40 try giving milk to the baby and recheck blood sugar after 60 seconds if after 60 seconds we see that the blood sugar has now improved and it is now more than 40 after 60 seconds now you continue milk only and in case it Still Remains less than 40 then IV Dex so very easy to understand this very very easy to understand this see when a newborn has hypoglycemia see whether he has symptoms or no symptoms if he has symptoms do not check how low blood sugar is just less than 40 symptoms start I IV 10% dto first bolus is given Then followed by glucose infusion but if the child is asymptomatic but had hypoglycemia check how low is the blood sugar if the blood sugar is only slightly low 20 to 40 which means marginally low so in this case what you do is give milk to the baby and check blood sugar again after 60 seconds after 60 seconds the blood sugar now becomes more than 40 normal then continue milk but after 60 seconds the blood sugar Still Remains less than 40 then give I and if the child is asymptomatic hypoglycemia and the blood sugar is very low less than 20 then obviously IB is the so you understand once more just repeat after me once more glycemia symptomatic asymptomatic symptomatic always I asymptomatic 20 to 40 less than 20 20 to 40 milk repeat blood sugar after 60 seconds after 60 seconds blood sugar more than 40 Contin milk less than 40 I asymptomatic and less than 20 means I so what are the indications of giving IV dextrose indications first IV dextrose is given for all symptomatic hypoglycemia no matter how low the blood sugar is second it is given for all asymptomatic hypoglycemia where the blood sugar is very low which means less than 20 and third it is given for those cases of those cases of hypoglycemia where initially the blood to sugar was 20 to 40 and the child was asymptomatic but even after giving milk the blood sugar did not improve and remained less than 40 so these are the three broad indications for giving IV treatment so which is the which is the indication not for giving IV treatment that as I told you symptomatic and blood sugar less than 20 symptomatic means don't need to see how much is the blood sugar symptomatic means IV asymptomatic blood sugar less than 20 again IV the only indication asymptomatic blood sugar between 20 to 40 here you will try milk for the baby initially so the answer here should be D so I hope you have understood these questions please remember the topics that I have given in these questions or topics I want to convey through these questions they all are very important topics for your exams I wish you all the best for your uh fmg exams hope this session has been beneficial to you and you were able to derive some benefits uh from these topics those who have attended my classes definitely this would have been a reputation for them and uh uh I wish you all the best and I hope to see you uh all successful in the upcoming fgs so uh thank you very much for attending the session and goodbye