Paediatrics for NEET PG: six pictures from growth and milestones to the first days of life

Answer: D. Drawing 3, no head lag

Drawing 3, no head lag. Head control develops over the first few months. By about three to four months the head no longer falls back and stays in line with the trunk throughout the pull. Persistent head lag beyond six months should prompt evaluation for hypotonia, cerebral palsy or a neuromuscular disorder.

Why the closest rival loses: drawing 2 (B), partial lag, fits an earlier stage, about two months. Drawing 1 (A), complete lag, is the pattern of a newborn. Option C, the head lifted in anticipation, describes a later skill, around five to six months. No head lag by three to four months; sits with support by five to six.

Recallab question 55393 · Paediatrics › Growth & Development · reference: Ghai Essential Pediatrics

Answer: C. Twelve to eighteen months

Twelve to eighteen months. The soft spot a mother feels on the top of the head is the anterior fontanelle, the large diamond where the two frontal and the two parietal bones meet. It is the largest of the four gaps and the last to ossify. The size matters as much as the timing: one that stays open beyond eighteen months prompts thought about the thyroid, the bones and raised pressure.

Why the closest rival loses: six to eight weeks (D) is when the small triangular gap at the back, gap 2, shuts. Three months (A) and six months (B) are wrong by a year or half a year: the anterior gap is still open at both ages in nearly every infant. Diamond in front closes last; triangle behind closes first.

Recallab question 56481 · Paediatrics › Growth & Development · reference: Ghai Essential Pediatrics

Answer: A. Measurement 1

Measurement 1. Below two years, length is measured lying down on an infantometer, by two people: one holds the head against the fixed board with the eyes looking straight up, and the other holds the knees straight and brings the footboard to flat heels. The growth charts for children under two are built on length measured lying, which reads about 0.7 cm more than standing height, so the method has to match the chart.

Why the closest rival loses: measurement 2 (C) is standing height, used from two years: before that it reads short and does not match the length charts. Measurement 4 (B), with bent knees and no one at the head, reads falsely short. Measurement 3 (D), a tape along the curves of the body, overestimates and cannot be reproduced reliably. Under two, lie them down: two people, two ends.

Recallab question 57985 · Paediatrics › Growth & Development · reference: Ghai Essential Pediatrics

Answer: C. Measured oral rehydration solution

Measured oral rehydration solution. The column is chosen by counting signs, not by taking the worst one: two or more signs in a column place the child in that column. Three of the four circled findings lie in the second column, so the child has some dehydration and is treated on the middle plan: measured oral rehydration solution over four hours, with reassessment. The one circled sign in the third column does not move the classification.

Why the closest rival loses: intravenous Ringer lactate (A) belongs to the third column, which needs two of its signs, or to failure of the oral route. Extra home fluids only (B) belongs to the first column, and drinking eagerly is itself a sign of the second. Nasogastric oral rehydration solution (D) is the fallback for a child who cannot drink, and this child drinks eagerly. Two signs make the column: count them.

Recallab question 55052 · Paediatrics › Fluid & Electrolyte · reference: Ghai Essential Pediatrics

Answer: D. Infant 1, supine in a bare cot

Infant 1, supine in a bare cot. Babies should sleep on their backs on a firm mattress with no loose bedding and their feet to the foot of the cot. The supine position lowered sudden infant death rates sharply wherever it was adopted, while soft bedding and pillows can cover the face and cause rebreathing, and a vulnerable infant may fail to rouse. Healthy babies protect their airways on their backs.

Why the closest rival loses: infant 3 (A), propped on the side, is unstable: a baby on its side rolls prone easily. Infant 2 (B), prone on a soft pillow under a thick quilt, combines the two strongest risks. Turning the face sideways (C) does not rescue prone sleep. Back to sleep, feet to foot, nothing soft.

Recallab question 55251 · Paediatrics › Growth & Development · reference: Ghai Essential Pediatrics

Answer: D. Prone or side-lying nursing

Prone or side-lying nursing. This is the picture of Pierre Robin sequence: a small mandible leaves the tongue no room in front, so on the back the tongue falls against the back wall of the throat and obstructs breathing. Lying the baby prone or on the side lets gravity bring the tongue forward and the airway opens. Many babies improve as the mandible grows. If positioning fails, a nasopharyngeal airway is passed, and a few need mandibular distraction.

Why the closest rival loses: tongue-lip adhesion (B) is a surgical step for babies who fail positioning, not the first measure. Immediate intubation (C) is kept for failure of simpler measures. Early palate repair (A) is done at about nine to twelve months, and the cleft is not the cause of the obstruction. Small jaw, tongue back, cleft palate: lie them prone.

Recallab question 56184 · Paediatrics › Newborn Infants · reference: Nelson Textbook of Pediatrics