Dr Alok Gupta MD, FIAP, Jaipur

rdcu.be/Enz7 #Noise #Pollution effects baby inside the womb & continues to do so all thru the life. Noise Induced Hearing Loss #NIHL is permanent & maximum during intrauterine life & up to 2 decades. Avoid loud sounds, headphones, earbuds, personal hearing devices.

MCQ 2 — Neonatology A 37-week newborn with confirmed isoimmune hemolysis is receiving intensive phototherapy. At 40 hours of life, total serum bilirubin continues to rise and is now 1.5 mg/dL below the exchange transfusion threshold for this infant’s age, gestation and neurotoxicity risk factors. There are no signs of acute bilirubin encephalopathy. The hospital cannot perform an exchange transfusion. What is the most appropriate next step? A) Continue phototherapy locally and repeat bilirubin in six hours B.) Continue intensive phototherapy, start IV hydration and arrange urgent transfer to a unit that can perform exchange transfusion C) Give IVIG as the sole escalation measure and reassess before contacting a referral centre D) Arrange transfer only if bilirubin reaches the exchange threshold or neurological signs develop. Answer tonight on the Channel whatsapp.com/channel/0029Vb8… Dr ALOK GUPTA

Clinical MCQs of the Day 4 November 2026 MCQ 1 A 16-year-old girl has repeatedly elevated albumin-adjusted calcium of 11.3–11.6 mg/dL. PTH is within the laboratory reference range despite hypercalcaemia. Renal function and vitamin D are normal; calcium intake is adequate. She takes no lithium or thiazides. Her calcium-to-creatinine clearance ratio is 0.006. Her father has longstanding mild hypercalcaemia without renal stones. What is the most appropriate next step? A) Investigate an inherited calcium-sensing disorder with family assessment and genetic testing B.) Arrange parathyroid localisation imaging followed by surgery C) Diagnose vitamin D toxicity and begin glucocorticoids D) Exclude a PTH-related disorder because PTH is within range Please feel free to share with Colleagues & Students Answer on Channel in Afternoon whatsapp.com/channel/0029Vb8… Dr ALOK GUPTA

MCQ 2 03 October 2026 A 13-year-old boy develops headache, dizziness and bluish lips shortly after receiving topical benzocaine during a procedure. His lungs are clear, blood pressure is normal and pulse oximetry remains 85% despite high-concentration oxygen. An arterial blood gas shows PaO₂ 280 mmHg and a calculated oxygen saturation of 100%. Which investigation best resolves this discrepancy? A) Repeat arterial blood gas with calculated saturation alone B.) Blood co-oximetry measuring haemoglobin fractions C) CT pulmonary angiography D) Serum benzocaine concentration Answer tonight on Channel whatsapp.com/channel/0029Vb8… Dr ALOK GUPTA

A 14-year-old boy is evaluated for slowing linear growth, fatigue and delayed puberty. Repeated testing shows free T4 below the reference range with an inappropriately normal TSH. His 8 a.m. cortisol is 1.8 μg/dL, with a low ACTH. He has no recent glucocorticoid exposure and is hemodynamically stable. Pediatric endocrinology suspects multiple pituitary hormone deficiencies. Which treatment sequence is most appropriate? A) Start levothyroxine first, then reassess cortisol after thyroid function normalises B.) Start growth hormone before replacing either cortisol or thyroid hormone C) Establish hydrocortisone replacement before starting levothyroxine D) Withhold hormone replacement because TSH is normal Please feel free to share this with Colleagues & Students Answer in the Afternoon on the Channel. There are other updates on the channel. whatsapp.com/channel/0029Vb8… Dr ALOK GUPTA

A 5-week-old boy presents with fever, vomiting and dehydration. Sodium is 120 mmol/L, potassium 6.8 mmol/L on a non-haemolysed sample, and bicarbonate 14 mmol/L. Emergency treatment of the electrolyte abnormalities is started. Urine culture grows E. coli, and ultrasound shows hydroureteronephrosis. Pretreatment testing shows markedly elevated renin and aldosterone, with normal 17-hydroxyprogesterone. Electrolytes normalise after treatment of the infection and supportive care, without ongoing steroid replacement. What best explains the salt-wasting episode? A) Transient renal resistance to aldosterone associated with urinary infection and urinary tract abnormality B) Aldosterone deficiency from classic 21-hydroxylase deficiency C) Congenital aldosterone synthase deficiency D) Syndrome of inappropriate antidiuretic hormone secretion Answer tonight on channel whatsapp.com/channel/0029Vb8… Dr ALOK GUPTA

To all those whom I missed greeting in past few weeks !!

Off label use is not Illegal Use !!

MCQ of the Day October 31, 2026 A 12-day-old term infant presents with fever, poor feeding and focal seizures. ALT is 480 U/L. There are no skin vesicles, and the mother reports no history of genital herpes. After initial stabilisation, IV antibiotics and acyclovir are started. CSF obtained 12 hours after symptom onset has a normal cell count and a negative HSV PCR. Clinical suspicion of neonatal HSV infection remains high. What is the most appropriate next step regarding antiviral management? A) Stop acyclovir because the CSF HSV PCR is negative B)Change to oral acyclovir while awaiting blood PCR C) Withhold acyclovir until MRI confirms encephalitis D) Continue IV acyclovir and repeat CSF HSV PCR within 72 hours of starting treatment, with specialist input Please feel free to share with Colleagues & Students For Answer in afternoon , Please check the link to channel below & follow if you want whatsapp.com/channel/0029Vb8… Dr ALOK GUPTA

Clinical MCQs of the Day — 28 October 2026 (2) A 2-day-old term infant has two episodes of green, bilious vomiting. The abdomen is soft and only mildly distended; the infant is currently haemodynamically stable. What is the most appropriate next step? A) Reassure and continue feeds B) Observe for 24 hours before investigating C) Urgent evaluation for intestinal malrotation, with surgical consultation and appropriate imaging D) Trial of an anti-reflux medication Please feel free to share with Colleagues & Students Answer tonight on the channel link below whatsapp.com/channel/0029Vb8… @Alok Gupta

Clinical MCQ of the Day - 28 October 2026 A 10-year-old with steroid-sensitive nephrotic syndrome has a relapse and is treated with prednisolone. After remission, the family asks how to reduce future relapses. Which statement about daily versus alternate-day prednisolone maintenance is most accurate? A) Daily dosing is proven to prevent more relapses than alternate-day dosing B )Alternate-day dosing is generally used after remission; prolonged daily dosing has not shown clear additional benefit C) Prednisolone should be stopped as soon as urine protein becomes negative D) Daily low-dose prednisolone should continue indefinitely Please feel free to share with Colleagues & Students Answer in Afternoon will be available only on Channel whatsapp.com/channel/0029Vb8… Dr ALOK GUPTA

Humble Request to Vote & gather Support for Dr ALOK GUPTA for IAP President Elect 2027 (Please share with Your Colleagues & SRs)

Support and Vote for Dr ALOK GUPTA as IAP President Elect 2027 (Please Share with Your Colleagues & SRs)

Support and Vote for Dr ALOK GUPTA as IAP President Elect 2027