Rapid Review, AIIMS MAY 2012

As announced earlier, 'Rapid Review, AIIMS MAY 2012' is being written based on a new template which has been designed by the editors in sync with the toppers of AIPGMEE 2012 and AIIMS May 2012.

The template will help to continue the sleekness of earlier Rapid Review format while taking a problem solving approach to each of the 200 MCQ's we have this time. The new layout intends to make the book more useful and reader friendly. The template is being previewed by a group of medicos preparing for the entrance exams and has already started receiving good reviews.

We are excited to reinvent Rapid Review format with 'Rapid Review, AIIMS MAY 2012' and believe all medicos will find the book more useful. The book is scheduled to hit the stands in early July. Preorders on edulanche.com/buy will be accepted from July 7th.

Glad to present a sample MCQ that has been cracked based on the new template designed for 'Rapid Review AIIMS May 2012'! We thank the toppers and expert editors for the template and hope this makes going through MCQ's more interesting in 'Rapid Review AIIMS May 2012'.

Good luck! 

 

        RAPID REVIEW: SAMPLE ANSWER & EXPLANATION

Courtesy: Dr. Harikrishnan (JR in Pediatrics, PGI)

Q1. Which of the following will favour the diagnosis of RDS in new born?

A. Receipt of antenatal steroids

B. Air bronchogram in chest X-ray

C. Manifests after 6 hours

D. Occurs after term gestation

Ans. B. Air bronchogram in chest Xray

Ref: Manual of  neonatal care by Cloherty 7e, p406

Exp:

  • Air bronchogram in x-ray is suggestive of RDS.
  • Characteristic x-ray finding: Low volume lungs with diffuse reticulogranular pattern and air bronchograms.

RESPIRATORY DISTRESS SYNDROME (RDS)

  • Formerly known as Hyaline membrane disease (HMD)
  • Occurs in preterm new borns soon after birth.

Factors responsible for RDS

  • Inadequate pulmonary surfactant
  • Increased water content in alveoli
  • Immature mechanisms for clearance of lung fluid
  • Lack of alveolar capillary apposition and
  • Low surface area for gas exchange

 

Perinatal risk factors

  • Prematurity
  • Maternal diabetes
  • Congenital malformations of thoracic cage causing lung hypoplasia. Eg. Diaphragmatic hernia
  • Genetic disorders in surfactant production. Eg. Surfactant protein B & C gene mutation.

 

Treatment of RDS

  • Includes O2 administration, surfactant therapy and artificial ventilation.

HIGH YIELD POINTS

* Antenatal detection by amniocentesis (Lecithin/ Sphingomyelin ratio <2 is highly predictive of RDS).

* Lamellar body count in Amniotic fluid >50,000 is suggestive of lung maturity.

* Presence of phosphatidyl glycerol in AF is a late sign of lung maturity.

* Foam stability index (FSI) is based on stability of foam formed when AF is shaken with alcohol. FSI is high when surfactant is present in AF.

 

TIPS ON OTHER OPTIONS

Opt. A: Antenatal steroids are protective against RDS as they induce lung maturity by accelerating surfactant production. Antenatal steroids should be given to pregnant women 24-34 wks gestation who are at high risk of preterm labour.

Opt. C: RDS usually manifests within few hours of lifewithtachypnea, retractions flaring of alae nasi, grunting and cyanosis.

Opt. D: Preterm birth is the MC etiologic factor for RDS.

 

Betamethasone is preferred over dexamethasone as dexa is potentially neurotoxic.

 

 

Please note: The text in green have been added for easy understanding of the layout and need not be there in the new book.