*On Demand by Aspirants...!!!🌀🌀* *⭕NURSING OFFICER* *MCQ QUIZ NO: 311* *⭕Series: Maha Rationale* *⭕Date: 13/02/2025* *⭕Sub: Paediatric -24* *⭕Day: Thursday* *1.Ans C* Type of spina bifida: Spina Bifida Occulta (commonest type of NTD): Posterior vertebrae arches fail to close, without hernial protrusion of meninges and spinal cord. • Spinal cord remains intact and meninges not expose outside of skin surface. In this hairy patch on back of child can be seen. Spina Bifida Cystica: O A defect in walls of spinal canal due to lack of union between the laminae of vertebrae. Spinal cord and its covering (meninges) protrude through defect and looks like a sack. • It again divided into two types, like: (i) Meningocele: • Only meninges with CSF protrude through the defect (sac like cyst filled with CSF), spinal cord not involve, so absent neurological defect (ii) Meningomyelocele or Myelomeningocele: A hernia of the spinal cord and meninges. • Spinal cord and meninges protrude by defects. Sac contains meninges, CSF, nerve root and spinal cord, which cover by a thin membrane. • Neurological defect is present. *2.Ans A* Refer MCQ No 1 *3.Ans D* Refer MCQ No 1 *4.Ans D* Refer MCQ No 1 *5.Ans D* Meningomyelocele usually found in lumbosacral spine with some neurological defects like impairment in urination, defecation and walking (spastic or flaccid paralysis) and decrease response to painful stimuli from torso downward. *6.Ans A* Ventriculoperitoneal shunt (VPS) is a shunt connecting the ventricles of brain to peritoneum, which is used to treat hydrocephalus. *7.Ans D* Place the child flat (to avoid rapid reduction of CSF) and on un-operative side to avoid pressure on the shunt valve. *8.Ans D* After surgery measuring of the both head and abdominal circumference is essential because if the rate at which CSF enters the abdominal cavity is higher than its capacity to absorb, it may cause ascites with abdominal distension and if VP shunt is blocked it may increase head circumference. *9.Ans C* After surgical repair of meningomyelocele, there is increase chance for hydrocephalus, infection, shock and increased ICP (bulging fontanels are most common indicator in infants). Because of increased chance for hydrocephalus measuring daily head circumference is essential. *10.Ans B* During preoperative period protecting the sac with sterile, moist (normal saline) and non-adherent dressing to maintain the moisture of sac and their contents are priority management. *11.Ans B* Refer MCQ No 10 *12.Ans C* Except option 'c' all other options are indicator of improper or malfunctioning of shunt. *13.Ans B* Measurement of head circumference, monitoring vital signs and neurological signs like pupillary reaction and level of consciousness are priority assessment postoperatively after a hydrocephalus surgery. It's use to monitor ICP. *14.Ans C* In spina bifida daily measurement of head circumference and bulging or widening of anterior fontanel is essential to detect the development of hydrocephalus. *15.Ans B* Reye's syndrome is an acute encephalopathy after a viral infection (4-7 days) which is characterized by cerebral edema and fatty change in liver cells. Use of aspirin trigger the situation in Reye's syndrome, so it should be avoided in viral infection. *16.Ans B* The main focus of attention in Reye's syndrome is monitoring and managing cerebral edema, so provide quiet environment with dim light to decrease stress on cerebral tissue. No need to monitor urine output, hearing loss and changing the position 2 hourly. *17.Ans C* Cerebral palsy (CP) is a term use for a group of non-progressive, non-curable and irreversible disorder characterized by impaired movement and posture due to defect into pyramidal and extra-pyramidal motor system. CP oftenly occurs with associated defects such as mental retardation (60% cases) or epilepsy (50%) *18.Ans B* Causes of cerebral palsy are maldevelopment of brain, perinatal hypoxia, birth trauma, maternal or fetal infections (e.g., meningitis, encephalitis), indirect hyperbilirubinemia, kernicterus, LBW and intrauterine or acquired infection *19.Ans B* Clinical features of cerebral palsy are asymmetric movements (scissoring leg movements), abnormal posturing (e.g., opisthotonos) irritability, crying, feeding difficulties, high pitch cry, poor head control and persistent primitive infantile reflex beyond 6 months (most primitive reflex disappear by 3 to 4 months of age.) *20.Ans D* Congenital cardiovascular disorder are structural abnormality of the heart and great blood vessels that occurs during intrauterine development. It's are classified on presence of cyanosis (cyanotic) or absence of cyanosis (acyanotic): • Acyanotic defects (left-to-right): Patent ductus arteriosus (PDA), atrial septal defects (ASD) and ventricular septal defects (VSD). Cyanotic defects (right-to-left): Tetralogy of Fallot, transposition of great vessels (TGA), tricuspid atresia and hypoplastic left heart syndrome. Obstructive heart disease: Coarctation of aorta (narrowing of aorta), pulmonary and aortic valve stenosis. It shows cyanosis so it also called cyanotic heart disease. *Regards:* *Maha Nursing ✍️ 🏆*