This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'Common presentations of Juvenile Hypothyroidism – \nSelect and explain. \nA. Growth retardation, B. Mental ratardation within 2 years, C. Umbilical Hernia, D. All of these', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Features of juvenile (congenital) hypothyroidism are :\n\nOpen posterior fontanel and wide sutures\nLarge tongue → Can cause respiratory difficulties\nRough dry skin which is cool & mottled\nHypotonia, large abdomen, flaccid muscles\nSleepy, little cry, poor feed & chocking spells during feeding.\nShort neck with a thick supraclavicular pad of fat may be present.\xa0\nMarked physical & mental retardation, delayed social smile.\nShort stature, normal head size with short extremities.\nDelayed relaxation of deep tendon reflexes.\nAn umbilical hernia\nEdematous, characteristic facies\nConstipation\nPallor, hypothermia\nSexual precocity occasionally\nRefractory anaemia common\nDelayed dentition\nOpen mouth with protuberant tongue\nSlow pulse, cardiomegaly & Heart murmur.\nProlongation of physiological jaundice due to delayed maturation of glucuronide conjugation.\n\nClinical features of acquired hypothyroidism\xa0\n\nGrowth retardation\nDisproportionately large head and trunk as compared to limbs\nIncreased upper and lower body segment ratio\nGross mental retardation is not usually present\nDelayed skeletal maturation\nDelayed dental development\nPuffy face\nLethargy\nCold intolerance\nDelayed puberty\nMyopathy\nPseudotumor cerebri\n\nNote: In congenital hypothyroidism there is hypotonia. Rarely the muscle may appear hypertrophied (pseudohypertrophy) with an athletic appearance → Kocher-Debre-Semelaigne syndrome gives infant Hercules appearance.', 'role': 'assistant'}]