<prompt> Child Breast fed at 30 hrs. of life develops yellowing of face, palm and soles not true is :Congenital obliteration of bile ductBreast milk jaundicePhysiological jaundiceDue to septicemia  <response>: Ans. is c physiological jaundice Child presents with severe jaundice at 30 hrs. of life or we can say 2nd day of life. Yellowing of face, palms and soles indicate that bilirubin level is 15 mgdl For explanation see O.P. Ghai 5the, P 143 Now we will have to look for conditions which can cause such an elevation in bilirubin level by 2nd days. Both septicemia and congenital obliteration of bile duct can present with severe jaundice on the 2nd day of life. The other 2 options Breast milk jaundice physiological jaundice cannot cause such an elevation in bilirubin by 2nd day of life. Now lets see them one by one. Breast milk jaundice In breast milk jaundice significant elevation in bilirubin occurs by 7th day of life reaching maximum concentration of 10-30 mgdl by 2nd-3rd week. Physiological jaundice For jaundice to be physiologic rather than pathologic following 4 criterias should be satisfied C.P.D.T. 15e, page 13. Clinical jaundice appears after 24 hrs. of age. Total bilirubin rises by less than 5 mgdl per day. Now we can easily exclude this, if the jaundice appears on 2nd day and per day rise in bilirubin is 5 mgdl, how can it reach 15 mg in the same day. Other two criterias for physiological jaundice. Peak bilirubin occurs at 3-5 days of age, with a total bilirubin of no more than 15 mgdl. Clinical jaundice is resolved by 1 week in the term infant and by 2 weeks in the preterm infant. 