Failure to Thrive — MCQs
A 5-year-old has the following anthropometry findings: Weight/age < -3.2 SD, Height/age < -2.5 SD, Weight/height < -1.7 SD. What is the most likely diagnosis?
What is the maintenance fluid requirement in a 6 kg child ?
Organic causes of constipation in infants include all of the following EXCEPT:
Which is true about an infant with failure to thrive and the following findings?
Which of the following is NOT a feature of HIV infection in childhood -
Most common symptom of HIV infection in infants is:
A child presented at 10 weeks with recurrent episode of pneumonia and failure to thrive. X-ray shows cardiomegaly & pulmonary plethora. What is the diagnosis?
A 1-month old baby present with frequent vomiting and failure to thrive. There are features of moderate dehydration. Blood sodium in 122 mEq/l and potassium is 6.1 mEq/l. The most likely diagnosis is?
A 6-year-old child with an IQ of 50. Which of the following developmental milestones can the child achieve?
What is the most common chromosomal syndrome in children?
Failure to Thrive Indian Medical PG Practice Questions and MCQs
Question 1: A 5-year-old has the following anthropometry findings: Weight/age < -3.2 SD, Height/age < -2.5 SD, Weight/height < -1.7 SD. What is the most likely diagnosis?
- A. Moderate acute malnutrition
- B. Chronic malnutrition
- C. Severe Acute Malnutrition
- D. Severe Acute Malnutrition with stunting (Correct Answer)
Explanation: ***Severe Acute Malnutrition with stunting*** - This child has **both acute and chronic malnutrition** indicators that must be identified together for accurate diagnosis and management. - **Height-for-age < -2.5 SD** confirms **stunting (chronic malnutrition)**, indicating long-term nutritional deprivation. - **Weight-for-age < -3.2 SD** indicates **severe underweight**, which in the context of stunting reflects the combined impact of both chronic and acute malnutrition. - **Weight-for-height < -1.7 SD** shows mild wasting, indicating an acute component, though not meeting the < -3 SD threshold for SAM by W/H alone. - The combination of severe underweight, stunting, and wasting requires the comprehensive diagnosis of **SAM with stunting** for appropriate clinical management and nutritional rehabilitation. *Severe Acute Malnutrition (without mentioning stunting)* - While this child has severe underweight, diagnosing only SAM **ignores the documented stunting** (H/A < -2.5 SD). - SAM is typically defined by **Weight-for-height < -3 SD**, but this child's W/H is only -1.7 SD, not meeting the strict SAM criteria by this parameter alone. - In pediatric nutrition, when stunting coexists with severe underweight, both components must be identified as they have different management implications. *Moderate acute malnutrition* - Moderate acute malnutrition requires **Weight-for-height between -2 SD and -3 SD** or MUAC between 11.5-12.5 cm. - This child's W/A is **< -3.2 SD** (severe underweight, not moderate), making this diagnosis inadequate. - The presence of stunting and severe underweight indicates a more serious condition than moderate acute malnutrition. *Chronic malnutrition* - While **Height-for-age < -2.5 SD confirms chronic malnutrition (stunting)**, this diagnosis alone doesn't capture the full clinical picture. - The **Weight-for-age < -3.2 SD** indicates severe underweight with an acute wasting component, requiring urgent intervention beyond addressing chronic malnutrition alone. - A diagnosis of only "chronic malnutrition" would underestimate the severity and miss the acute component requiring immediate management.
Question 2: What is the maintenance fluid requirement in a 6 kg child ?
- A. 240 ml/day
- B. 600 ml/day (Correct Answer)
- C. 300 ml/day
- D. 1200 ml/day
Explanation: **600 ml/day** - The **Holliday-Segar formula** is used to calculate maintenance fluid requirements. For the first 10 kg of body weight, the requirement is 100 ml/kg/day. - For a 6 kg child, the calculation is 6 kg * 100 ml/kg/day = **600 ml/day**. *240 ml/day* - This value is significantly **lower** than the recommended maintenance fluid for a 6 kg child, which would lead to **dehydration**. - It does not align with the standard Holliday-Segar formula for this weight. *300 ml/day* - This amount is **insufficient** for a 6 kg child's daily maintenance fluid needs and would risk **hypovolemia**. - It represents roughly half of the calculated requirement based on standard pediatric guidelines. *1200 ml/day* - This volume is significantly **higher** than the maintenance fluid requirement for a 6 kg child and could lead to **fluid overload** and hyponatremia. - This calculation might be appropriate for a much heavier child or in situations of increased fluid loss.
Question 3: Organic causes of constipation in infants include all of the following EXCEPT:
- A. Hirschsprung's disease
- B. Cystic fibrosis
- C. Hypothyroidism
- D. Infantile dyschezia (Correct Answer)
Explanation: ***Infantile dyschezia*** - This is a **functional condition** where infants strain and cry before passing a soft stool, due to a lack of coordination between relaxing the pelvic floor and increasing intra-abdominal pressure. It is not an organic cause of constipation. - The stool consistency in infantile dyschezia is typically **soft**, differentiating it from true constipation. *Hirschsprung's disease* - This is an **organic cause of constipation** due to the absence of **ganglion cells** in the distal colon, leading to a functional obstruction. - Infants typically present with **failure to pass meconium** within the first 24-48 hours of life, distended abdomen, and forceful expulsion of stool upon rectal examination. *Cystic fibrosis* - This is an **organic cause of constipation** in infants due to the production of thick, sticky intestinal secretions, often leading to **meconium ileus** at birth. - Constipation can also result from **pancreatic insufficiency**, which impairs fat digestion and absorption, leading to hard, dry stools later in infancy. *Hypothyroidism* - This is an **organic cause of constipation** because thyroid hormones are essential for normal gastrointestinal motility. - Infants with hypothyroidism often present with **decreased bowel movements**, lethargy, poor feeding, and prolonged jaundice.
Question 4: Which is true about an infant with failure to thrive and the following findings?
- A. Hypokalemia
- B. Metabolic alkalosis
- C. Increased urinary sodium (Correct Answer)
- D. Increased cortisol
Explanation: ***Increased urinary sodium*** - This image displays an infant with **ambiguous genitalia**, specifically severe clitoromegaly. This is a classic presentation of **congenital adrenal hyperplasia (CAH)** due to **21-hydroxylase deficiency**. - In salt-wasting CAH, deficient **aldosterone** production leads to **renal sodium loss**, resulting in increased urinary sodium, **hyponatremia**, and **hypotension**, contributing to failure to thrive. *Hypokalemia* - **Hypokalemia** is not typically seen in salt-wasting CAH; rather, **hyperkalemia** is more common due to the lack of aldosterone's mineralocorticoid effect, which normally promotes potassium excretion. - The absence of aldosterone causes sodium to be excreted and potassium to be retained. *Metabolic alkalosis* - **Metabolic alkalosis** is not characteristic of salt-wasting CAH; instead, these infants often develop **metabolic acidosis** due to the loss of sodium bicarbonate and impaired acid excretion. - The primary electrolyte disturbance points towards acidosis, not alkalosis. *Increased cortisol* - In 21-hydroxylase deficiency, the enzyme responsible for converting precursors to **cortisol** and aldosterone is deficient, leading to **decreased cortisol** production. - The adrenal glands instead shunt precursors towards androgen synthesis, causing **adrenal hyperplasia** and the virilization seen in the image.
Question 5: Which of the following is NOT a feature of HIV infection in childhood -
- A. Failure to thrive
- B. Hepatomegaly
- C. Kaposi sarcoma (Correct Answer)
- D. Lymphoid interstitial pneumonitis
Explanation: ***Kaposi sarcoma*** - While Kaposi's sarcoma is a common HIV-associated malignancy in adults, it is **very rare in HIV-infected children**. - Its presence in children with HIV usually suggests a **more aggressive and rapidly progressing disease course**, but it is not a typical or common feature. *Failure to thrive* - **Failure to thrive** is a very common manifestation of HIV infection in children, often due to **poor nutrient absorption**, increased metabolic demands, and chronic infections. - It leads to **poor weight gain and growth faltering**, negatively impacting overall development. *Hepatomegaly* - **Hepatomegaly**, or an enlarged liver, is a frequent finding in HIV-infected children due to various causes such as **opportunistic infections**, drug side effects, and direct HIV involvement of the liver. - It can be a clinical sign indicating **inflammation or dysfunction** of the liver. *Lymphoid interstitial pneumonitis* - **Lymphoid interstitial pneumonitis (LIP)** is a prevalent pulmonary complication specific to HIV infection in children, characterized by **lymphocytic infiltration of the alveolar septa and peribronchial spaces**. - It often leads to **chronic cough**, hypoxemia, and is considered an **AIDS-defining condition** in pediatric HIV.
Question 6: Most common symptom of HIV infection in infants is:
- A. GI infection
- B. Lymphadenopathy
- C. Failure to thrive (Correct Answer)
- D. Persistent cough
Explanation: ***Failure to thrive*** - **Failure to thrive** is a very common and early symptom of HIV infection in infants, characterized by inadequate weight gain and growth velocity. - Infants with HIV have compromised immune systems, making them susceptible to recurrent infections and chronic inflammation that can lead to growth faltering. *GI infection* - While **gastrointestinal infections** (e.g., chronic diarrhea) are common in infants with AIDS, they are often a *contributing factor* to failure to thrive rather than the single most common *presenting symptom* of AIDS itself. - They can lead to malabsorption and nutrient loss, exacerbating the poor growth associated with HIV. *Lymphadenopathy* - **Generalized lymphadenopathy** is a common sign of HIV infection in infants and children but is often **asymptomatic** and not typically the *MC symptom* that prompts medical attention. - It reflects generalized immune activation but may not be recognized as the primary problem by caregivers. *Persistent cough* - A **persistent cough** can be a symptom of various opportunistic infections in infants with AIDS, such as *Pneumocystis jirovecii* pneumonia (PCP) or recurrent respiratory infections. - While significant, it is a symptom of a specific complication rather than the overarching, most frequently observed sign of untreated HIV.
Question 7: A child presented at 10 weeks with recurrent episode of pneumonia and failure to thrive. X-ray shows cardiomegaly & pulmonary plethora. What is the diagnosis?
- A. VSD (Correct Answer)
- B. TOF
- C. Patent foramen ovale
- D. ASD
Explanation: ***VSD*** - **Ventricular septal defect (VSD)** is the most common cause of this presentation in early infancy (symptoms typically appear at **6-10 weeks** of age). - Large VSDs cause significant **left-to-right shunt** leading to pulmonary overcirculation, resulting in **recurrent pneumonia** and **failure to thrive**. - **Cardiomegaly** (due to volume overload of left atrium and ventricle) and **pulmonary plethora** (increased pulmonary vascular markings) on X-ray are classic findings. - The infant may also present with tachypnea, feeding difficulties, and poor weight gain. *TOF* - **Tetralogy of Fallot (TOF)** is a **cyanotic heart defect** with right-to-left shunt, presenting with cyanosis and hypoxic spells, not recurrent pneumonia. - X-ray shows **boot-shaped heart** and **pulmonary oligemia** (decreased pulmonary vascular markings), not pulmonary plethora. - Does not typically cause failure to thrive in the same manner as acyanotic left-to-right shunt lesions. *Patent foramen ovale* - A **patent foramen ovale (PFO)** is a normal variant in infants and typically remains **asymptomatic**. - Does not cause significant hemodynamic shunting in the absence of elevated right atrial pressure. - Does not cause **cardiomegaly**, **pulmonary plethora**, recurrent pneumonia, or failure to thrive. *ASD* - An **atrial septal defect (ASD)** also causes left-to-right shunt with pulmonary plethora, but the shunt develops **gradually** over time. - ASD typically presents **later in childhood or adulthood** with milder symptoms (fatigue, exercise intolerance) due to lower pressure gradient across atria. - **Recurrent pneumonia and failure to thrive at 10 weeks** are uncommon with isolated ASD, as the hemodynamic changes are less pronounced in early infancy compared to VSD. - When symptomatic in infancy, large ASDs present later (around 6 months to 1 year) rather than at 10 weeks.
Question 8: A 1-month old baby present with frequent vomiting and failure to thrive. There are features of moderate dehydration. Blood sodium in 122 mEq/l and potassium is 6.1 mEq/l. The most likely diagnosis is?
- A. 11β-hydroxylase deficiency
- B. 21-hydroxylase deficiency (Correct Answer)
- C. Gitelman syndrome
- D. Bartter syndrome
Explanation: ***21-hydroxylase deficiency*** - This condition presents in infancy with **salt-wasting adrenal crisis** due to impaired cortisol and aldosterone synthesis, leading to **hyponatremia**, **hyperkalemia**, **dehydration**, and **vomiting**. - The deficiency in 21-hydroxylase blocks the synthesis of **aldosterone**, causing sodium loss and potassium retention, consistent with the electrolyte abnormalities. *11β-hydroxylase deficiency* - This deficiency causes an accumulation of **11-deoxycorticosterone (DOC)**, which has mineralocorticoid activity, leading to **hypertension** and **hypokalemia**, rather than hyponatremia and hyperkalemia. - While it can cause virilization, the electrolyte imbalance is distinctly different from the case presented. *Gitelman syndrome* - This is a **renal tubulopathy** characterized by reabsorptive defects in the distal convoluted tubule, leading to **hypokalemia**, **metabolic alkalosis**, **hypomagnesemia**, and **hypocalciuria**. - It would not typically present with severe hyponatremia or hyperkalemia in a neonate with salt wasting. *Bartter syndrome* - This is a **renal tubulopathy** affecting the thick ascending limb of the loop of Henle, resulting in significant salt loss, **hypokalemia**, **metabolic alkalosis**, and **hypercalciuria**. - Like Gitelman syndrome, it is associated with hypokalemia, which contradicts the hyperkalemia seen in the patient.
Question 9: A 6-year-old child with an IQ of 50. Which of the following developmental milestones can the child achieve?
- A. Identify colours (Correct Answer)
- B. Read a sentence
- C. Ride a bicycle
- D. Copy a triangle
Explanation: **Explanation:** The core concept in this question is determining the **Mental Age (MA)** of a child based on their **Intelligence Quotient (IQ)** and **Chronological Age (CA)**. Using the formula: **IQ = (Mental Age / Chronological Age) × 100** * 50 = (MA / 6) × 100 * MA = (50 × 6) / 100 = **3 years** Therefore, this 6-year-old child will only be able to achieve developmental milestones corresponding to a **3-year-old child.** * **Option A (Correct):** Identifying colors is a milestone typically achieved by **3 years** of age. Since the child’s mental age is 3, they can perform this task. * **Option B (Incorrect):** Reading a sentence is a complex skill usually acquired around **6 years** of age (Grade 1 level). * **Option C (Incorrect):** While a child learns to ride a tricycle at 3 years, riding a bicycle (usually with training wheels) is a milestone for **4–5 years**. * **Option D (Incorrect):** Copying a triangle is a fine motor milestone for a **5-year-old**. A 3-year-old can only copy a circle. **High-Yield Clinical Pearls for NEET-PG:** 1. **IQ Classification:** An IQ of 50–70 is classified as Mild Mental Retardation (Educable), while 35–50 is Moderate (Trainable). 2. **Drawing Milestones (High Yield):** * Circle: 3 years * Cross/Square: 4 years * Triangle: 5 years * Diamond: 6 years 3. **Rule of Thumb:** If a question provides IQ and Age, always calculate the Mental Age first to identify the corresponding milestone.
Question 10: What is the most common chromosomal syndrome in children?
- A. Fragile X syndrome
- B. Trisomy 17
- C. Trisomy 21 (Correct Answer)
- D. Trisomy 13
Explanation: **Explanation:** **Trisomy 21 (Down Syndrome)** is the most common chromosomal disorder and the leading genetic cause of intellectual disability worldwide. It occurs in approximately 1 in 700 to 800 live births. The primary underlying mechanism is **meiotic non-disjunction** (95% of cases), which is strongly associated with advanced maternal age. Because Trisomy 21 is the most "viable" autosomal trisomy, these children often survive into adulthood, contributing to its high prevalence in the pediatric population. **Analysis of Incorrect Options:** * **Fragile X Syndrome:** While it is the most common cause of *inherited* intellectual disability, it is a single-gene disorder (CGG repeat expansion in the FMR1 gene) rather than a chromosomal numerical or structural syndrome. * **Trisomy 17:** This is extremely rare and usually incompatible with life. Most cases result in early spontaneous abortion. (Note: Trisomy 18, or Edwards syndrome, is the second most common autosomal trisomy). * **Trisomy 13 (Patau Syndrome):** This is the third most common autosomal trisomy but is much rarer than Trisomy 21 (1 in 10,000 births). It presents with severe malformations (holoprosencephaly, polydactyly, cleft lip/palate) and carries a very poor prognosis, with most infants dying within the first year of life. **High-Yield Clinical Pearls for NEET-PG:** * **Most common mechanism:** Maternal Meiotic Non-disjunction (95%). * **Recurrence risk:** Highest in **Robertsonian Translocation** (if the mother is a 21;21 carrier, the risk is 100%). * **Cardiac defect:** Endocardial Cushion Defect (Atrioventricular Septal Defect) is the most common. * **GI association:** Duodenal atresia ("Double bubble" sign). * **Screening:** Increased Nuchal Translucency (USG) and decreased PAPP-A in the first trimester.
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