Nutrition and Health Practice Questions

Q: The most sensitive indicator of environmental iodine deficiency is

Urinary iodine excretion. ***Urinary iodine excretion*** - **Urinary iodine excretion** reflects recent dietary iodine intake, making it the most sensitive and commonly used indicator for assessing current iodine status in a population. - A median urinary iodine concentration of less than 100 μg/L in a population indicates **iodine deficiency**. *Prevalence of neonatal hypothyroidism* - While reflecting severe iodine deficiency, **neonatal hypothyroidism** occurs later in the deficiency cascade and is not sensitive enough to detect mild to moderate deficiencies early. - It would indicate a long-standing, significant deficiency rather than an early environmental change. *Prevalence of cretinism* - **Cretinism** is a severe and irreversible consequence of prolonged and profound iodine deficiency during critical periods of development (fetal and early infancy). - Its prevalence indicates severe, chronic iodine deficiency and is not a sensitive marker for early or mild environmental iodine deficiency. *Prevalence of goitre* - The **prevalence of goitre** (enlarged thyroid gland) can be used as an indicator of iodine deficiency, but it is less sensitive than urinary iodine excretion. - Goitre develops over a longer period in response to chronic iodine deficiency and may not reflect recent changes in environmental iodine levels.

Q: For adolescents, what is the weekly iron and folic acid supplementation dose?

100 mg elemental iron and 500 microgram folic acid. ***100 mg elemental iron and 500 microgram folic acid*** - This is the **current recommended dosage** for India's **Weekly Iron and Folic Acid Supplementation (WIFS) program** for adolescents (10-19 years). - The **Government of India's National Health Mission** and **WHO guidelines** endorse this specific amount for weekly supplementation to prevent and control **iron deficiency anemia** in adolescents. - This dosage is used in school-based and community programs across India. *120 mg elemental iron and 400 microgram folic acid* - This was an **earlier recommendation** that has since been updated to the current standard of 100 mg + 500 mcg. - While previously used, current WIFS guidelines have standardized the dose at **100 mg elemental iron** and **500 mcg folic acid**. *60 mg elemental iron and 400 microgram folic acid* - **60 mg elemental iron** is typically a **daily therapeutic dose** or used for younger children, and is insufficient for weekly prophylactic supplementation in adolescents. - This lower dose would not provide adequate coverage for the weekly supplementation schedule. *150 mg elemental iron and 500 microgram folic acid* - This dose of **elemental iron (150 mg)** is higher than the standard weekly recommendation (100 mg) for routine adolescent supplementation. - The higher iron dose is not necessary for general prophylactic supplementation and could increase the risk of gastrointestinal side effects.

Q: A rapid mass screening method that can be employed by a paramedical worker for detecting malnutrition in pre-school (age: 1 to 5 years) children is:

Mid-arm circumference. ***Mid-arm circumference*** - **Mid-upper arm circumference (MUAC)** is a simple, quick, and effective anthropometric measure that can be used by paramedical workers for rapid screening of malnutrition in pre-school children. - It is particularly useful in community settings as it requires minimal training and readily available tools, making it ideal for **mass screening** in resource-limited environments. *Body Mass Index* - **Body Mass Index (BMI)** calculation requires both height and weight, which can be more challenging to accurately measure in young, uncooperative children during rapid field screenings. - While useful for assessing nutritional status, BMI charts can be complex, making them less suitable for rapid use by paramedical workers for mass screening. *Height for age* - **Height for age** is a key indicator for assessing **stunting (chronic malnutrition)** but requires accurate measurement of height, which can be difficult in young children, especially infants and toddlers who cannot stand independently. - Its primary use is for long-term monitoring of growth rather than a quick, immediate screening tool for acute malnutrition or overall nutritional status in a rapid mass campaign. *Weight for age* - **Weight for age** is an indicator for determining **underweight**, reflecting both acute and chronic malnutrition, but it requires accurate weighing scales and meticulous recording. - Although it is a standard anthropometric index, its application in rapid mass screening might be limited by the availability of reliable weighing scales and the time required for accurate measurements in a large population.

Q: Children of severe acute malnutrition discharged from Nutritional Rehabilitation Centres (NRCs) should be observed in the community by an Anganwadi Worker (AWW) as per which one of the following schedules?

Twice weekly in first month and then once a week. ***Twice weekly in first month and then once a week*** - According to national guidelines for the management of **Severe Acute Malnutrition (SAM)** in India, children discharged from NRCs require intensive follow-up to prevent relapse. - This specific schedule ensures close monitoring initially when the child is most vulnerable, gradually reducing frequency as their health stabilizes. *Once a week for first month and then twice weekly* - This option reverses the logical progression of follow-up frequency, suggesting increased visits after the first month, which is not aligned with standard protocols. - Initial follow-up for SAM children needs to be more frequent than once a week in the first month. *Twice weekly in first month and then once fortnightly* - While initial follow-up is appropriate, reducing the frequency to **once fortnightly** after the first month might be too infrequent for continued close monitoring of a child recovering from SAM. - This schedule could miss early signs of deterioration. *Once a week for first month and then once fortnightly* - This schedule provides insufficient monitoring both in the **initial critical month** (only once a week) and in the subsequent period (once fortnightly is too spread out). - It does not meet the recommended intensity of follow-up for children discharged after SAM treatment.

Q: An adult weighs 73 kgs and has a height of 1.75 meters. For the purpose of classification of overweight and obesity as per WHO recommendation, this person will be classified as:

Normal. ***Normal*** - This individual's **Body Mass Index (BMI)** is calculated as weight (kg) / height (m)^2. For 73 kg and 1.75 m, BMI = 73 / (1.75 * 1.75) = 73 / 3.0625 = **23.83 kg/m²**. - According to WHO classifications, a BMI between **18.5 and 24.9 kg/m²** falls within the **normal weight** range. *Underweight* - An individual is classified as **underweight** if their BMI is **less than 18.5 kg/m²**. - This option is incorrect because the calculated BMI of 23.83 kg/m² is well above this threshold. *Preobese* - The term **preobese** is often used interchangeably with **overweight**, specifically for a BMI between **25.0 and 29.9 kg/m²**. - This option is incorrect as the calculated BMI of 23.83 kg/m² does not fall into this range. *Overweight* - An individual is classified as **overweight** if their BMI is between **25.0 and 29.9 kg/m²**. - This option is incorrect because the calculated BMI of 23.83 kg/m² is below the threshold for overweight.

Q: Global hunger index combines four indicators EXCEPT:

Child morbidity. ***Child morbidity*** - **Child morbidity** is not used as an indicator in the Global Hunger Index. While related to health outcomes, the GHI focuses on specific measures of **undernutrition** and **child mortality**. - Morbidity refers to the prevalence of disease, which is a broader health measure and not specific to hunger assessment within the GHI framework. *Child stunting* - **Child stunting** is a key indicator in the GHI, measuring the proportion of children under the age of five who have low **height-for-age**. - This indicator reflects **chronic undernutrition** and its long-term impact on children's growth and development. - Stunting indicates inadequate nutrition over an extended period. *Child mortality* - **Child mortality** is included in the GHI and represents the mortality rate of children under the age of five. - This indicator reflects the fatal synergy between **inadequate nutrition** and unhealthy environments on young children. - It captures the ultimate consequence of food insecurity and undernutrition. *Undernourishment* - **Undernourishment** is one of the primary indicators in the GHI, measuring the proportion of the population whose **caloric intake is insufficient** to meet dietary energy requirements. - This indicator directly reflects the **food supply situation** and adequacy of dietary energy consumption at the population level.

Q: How much of Zinc supplement is recommended by WHO and UNICEF for infants less than 6 months of age after an episode of acute diarrhoea?

10 mg per day for 10–14 days. **10 mg per day for 10–14 days** - For infants less than 6 months of age, **WHO and UNICEF** recommend **10 mg of elemental zinc per day** for 10-14 days following an acute diarrheal episode. - This dosage helps to reduce the severity and duration of the current diarrheal episode and prevents future episodes for several months. *20 mg per day for 10–14 days* - This dosage is recommended for **children 6 months of age and older**, not for infants under 6 months. - Providing 20 mg elemental zinc to infants under 6 months could lead to **zinc toxicity** or other adverse effects. *6 mg per day for 7 days* - This recommendation is below the **standard therapeutic dose** for infants, which may not be sufficient to achieve the desired clinical benefit. - The duration of **7 days** is also shorter than the generally recommended 10-14 days. *5 mg per day for 7 days* - Similar to 6 mg, this dose is **insufficient** for effective treatment of acute diarrhea in infants. - The shortened duration of 7 days further reduces its potential therapeutic impact, increasing the risk of **recurrence or prolonged symptoms**.

Q: Which of the following measures can help reduce the risk of systemic hypertension? 1. Reduction in dietary intake of common salt 2. Maintaining healthy body weight 3. Increasing potassium rich foods in the diet Select the correct answer using the code given below:

1, 2 and 3. ***1, 2 and 3*** - **Reduction in dietary intake of common salt** (sodium) is crucial as excessive sodium leads to fluid retention and increased blood volume, directly contributing to **hypertension**. WHO recommends <5g/day salt intake. - **Maintaining healthy body weight** (controlling BMI) significantly reduces the risk of hypertension, as obesity is a major independent risk factor. Even 5-10% weight loss can substantially lower blood pressure. - **Increasing potassium-rich foods** helps counteract the effects of sodium, promoting sodium excretion and relaxing blood vessel walls, thereby lowering blood pressure. Recommended intake is 3.5-5g/day. *2 and 3 only* - This option is incorrect because **reducing salt intake** (measure 1) is a fundamental and highly effective strategy for preventing and managing hypertension. - Excluding salt reduction from the recommended measures would disregard a cornerstone of cardiovascular health proven by DASH diet trials. *1 and 2 only* - This option is flawed because **increasing potassium-rich foods** (measure 3) is a recognized dietary intervention that contributes to blood pressure control. - Potassium helps counterbalance sodium effects, and its omission makes this answer incomplete. *1 and 3 only* - This option is incorrect as it excludes **maintaining healthy body weight** (measure 2), which is a critical and well-established lifestyle modification for preventing and managing hypertension. - Obesity is a significant risk factor, and weight management is essential for blood pressure control.

Q: A 55-year-old patient from Chhattisgarh presents with progressive muscle weakness, stiffness of both lower limbs, and complete paralysis. What is the most important history that should be asked?

Dietary history. ***Dietary history*** - In a patient from **Chhattisgarh** with progressive muscle weakness and paralysis, a detailed **dietary history** is crucial to investigate potential **lathyrism**. - **Lathyrism** is a neurotoxic disorder caused by the consumption of **Lathyrus sativus (Khesari dal)**, a legume common in this region, especially during famines or droughts. *Medical history* - While important for general assessment, a broad medical history might not immediately pinpoint the specific dietary toxin relevant to progressive paralysis in this region. - It would likely cover existing conditions and medications, but not specifically focus on the unique risk of **lathyrism** from regional food consumption. *History of present illness* - This history would detail the onset, progression, and characteristics of the muscle weakness and paralysis. - While essential for understanding the clinical course, it would not inherently identify the underlying cause without specifically probing dietary factors that could lead to such symptoms in this geographical context. *Socioeconomic history* - This history can provide context about living conditions and access to food, which might indirectly suggest dietary patterns. - However, it does not directly ask about specific food intake or the consumption of potentially toxic staples like **Khesari dal**, which is a more direct and critical line of questioning.

Q: Which of the following is not included in the Global Hunger Index?

Infant Mortality Rate (IMR). ***Infant Mortality Rate (IMR)*** - The **Infant Mortality Rate (IMR)** measures deaths of infants under one year of age and is an indicator of overall community health and access to medical care, but it is **not directly included** in the GHI calculation. - While related to health and well-being, the GHI focuses on direct measures of **food insecurity** and its immediate consequences on children. *Undernourishment* - **Undernourishment**, defined as the proportion of the population that is consuming insufficient caloric energy, is a **direct component** of the GHI. - It reflects the overall **food supply** and access at the population level. *Under 5 mortality rate* - The **Under-5 Mortality Rate** (child mortality) is a key indicator in the GHI, reflecting the fatal consequences of a combination of **inadequate nutrition** and unhealthy environments. - It captures deaths of children before their fifth birthday, which can be heavily influenced by **nutritional status**. *Child undernutrition* - **Child undernutrition** is represented in the GHI by two indicators: **child stunting** (low height for age) and **child wasting** (low weight for height). - These are crucial measures reflecting **chronic** and **acute undernutrition** in children, respectively.

Question 1

The most sensitive indicator of environmental iodine deficiency is

Accepted Answer

Urinary iodine excretion

Answer

Prevalence of neonatal hypothyroidism

Answer

Prevalence of cretinism

Answer

Prevalence of goitre

Question 2

For adolescents, what is the weekly iron and folic acid supplementation dose?

Accepted Answer

100 mg elemental iron and 500 microgram folic acid

Answer

60 mg elemental iron and 400 microgram folic acid

Answer

120 mg elemental iron and 400 microgram folic acid

Answer

150 mg elemental iron and 500 microgram folic acid

Question 3

A rapid mass screening method that can be employed by a paramedical worker for detecting malnutrition in pre-school (age: 1 to 5 years) children is:

Accepted Answer

Mid-arm circumference

Answer

Body Mass Index

Answer

Height for age

Answer

Weight for age

Question 4

Children of severe acute malnutrition discharged from Nutritional Rehabilitation Centres (NRCs) should be observed in the community by an Anganwadi Worker (AWW) as per which one of the following schedules?

Accepted Answer

Twice weekly in first month and then once a week

Answer

Once a week for first month and then twice weekly

Answer

Twice weekly in first month and then once fortnightly

Answer

Once a week for first month and then once fortnightly

Question 5

An adult weighs 73 kgs and has a height of 1.75 meters. For the purpose of classification of overweight and obesity as per WHO recommendation, this person will be classified as:

Accepted Answer

Normal

Answer

Underweight

Answer

Preobese

Answer

Overweight

Question 6

Global hunger index combines four indicators EXCEPT:

Accepted Answer

Child morbidity

Answer

Child stunting

Answer

Child mortality

Answer

Undernourishment

Question 7

How much of Zinc supplement is recommended by WHO and UNICEF for infants less than 6 months of age after an episode of acute diarrhoea?

Accepted Answer

10 mg per day for 10–14 days

Answer

20 mg per day for 10–14 days

Answer

6 mg per day for 7 days

Answer

5 mg per day for 7 days

Question 8

Which of the following measures can help reduce the risk of systemic hypertension?

1. Reduction in dietary intake of common salt
2. Maintaining healthy body weight
3. Increasing potassium rich foods in the diet

Select the correct answer using the code given below:

Accepted Answer

1, 2 and 3

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1 and 3 only

Question 9

A 55-year-old patient from Chhattisgarh presents with progressive muscle weakness, stiffness of both lower limbs, and complete paralysis. What is the most important history that should be asked?

Accepted Answer

Dietary history

Answer

Medical history

Answer

History of present illness

Answer

Socioeconomic history

Question 10

Which of the following is not included in the Global Hunger Index?

Accepted Answer

Infant Mortality Rate (IMR)

Answer

Undernourishment

Answer

Under 5 mortality rate

Answer

Child undernutrition

Nutrition and Health — MCQs

Nutrition and Health — MCQs

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