Food Allergies and Intolerances — MCQs
Fructose intolerance is due to deficiency of which enzyme?
A laborer's younger child is brought to the OPD with a swollen belly and dull face. He has been fed rice water (rice milk) in his diet mostly. On investigations, the child is found to have low serum protein and low albumin. What is the probable diagnosis?
An adolescent male developed vomiting and diarrhea 1 hour after having food from a restaurant. The most likely pathogen is?
A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?
AMPLE history involved all except?
In chronic allergy, which Ig is more persistent in the body?
According to WHO guidelines, exclusive breast feeding should be continued for minimum how many months?
History of dislike for sweet food items is typically present in:
IV dose of 1:10,000 concentration of epinephrine in a 2 kg preterm baby is:
A 2-hour-old neonate born by normal vaginal delivery has a scalp swelling, with normal cry and activity. What is the probable cause?
Food Allergies and Intolerances Indian Medical PG Practice Questions and MCQs
Question 1: Fructose intolerance is due to deficiency of which enzyme?
- A. Aldolase B (Correct Answer)
- B. Aldolase A
- C. Fructokinase
- D. Triokinase
Explanation: ***Aldolase B*** - **Hereditary fructose intolerance** is a genetic disorder caused by a deficiency in the enzyme **aldolase B**. - This deficiency leads to an accumulation of **fructose-1-phosphate** in the liver, kidneys, and small intestine, causing **hypoglycemia**, **vomiting**, and **liver damage** upon exposure to fructose. *Fructokinase* - A deficiency in **fructokinase** causes **essential fructosuria**, a benign metabolic disorder. - This condition is asymptomatic because **fructose** simply accumulates in the blood and urine without causing significant clinical problems. *Triokinase* - **Triokinase**, also known as **glycerol kinase**, is involved in glycerol metabolism, converting glycerol to **glycerol-3-phosphate**. - Its deficiency is not directly linked to fructose intolerance and typically presents with **hyperglycerolemia**. *Aldolase A* - **Aldolase A** is one of the three aldolase isoenzymes (A, B, and C) and is primarily involved in **glycolysis**, specifically in the breakdown of **fructose-1,6-bisphosphate**. - A deficiency in aldolase A can lead to **hemolytic anemia** and **myopathy**, not directly fructose intolerance.
Question 2: A laborer's younger child is brought to the OPD with a swollen belly and dull face. He has been fed rice water (rice milk) in his diet mostly. On investigations, the child is found to have low serum protein and low albumin. What is the probable diagnosis?
- A. Kwashiorkor (Correct Answer)
- B. Kawasaki disease
- C. Marasmus
- D. Indian childhood cirrhosis
- E. Nephrotic syndrome
Explanation: ***Kwashiorkor*** - The symptoms of a **swollen belly** (due to **edema** from low albumin), **dull face**, and a diet primarily of **rice water** (low in protein) are classic signs of Kwashiorkor. - Kwashiorkor is a form of severe protein-energy malnutrition characterized by **protein deficiency** that is greater than the calorie deficit, leading to **hypoalbuminemia** and fluid retention. - The **dietary history** of rice water (carbohydrate-rich but protein-poor) is the key distinguishing feature. *Kawasaki disease* - This is an **acute vasculitis** primarily affecting young children, presenting with fever, rash, conjunctivitis, mouth changes, and lymphadenopathy. - It does not involve a swollen belly or dull face as primary symptoms, nor is it linked to dietary protein deficiency. *Marasmus* - Marasmus is a form of severe malnutrition characterized by an **overall deficiency of calories** and nutrients, resulting in severe **wasting** of muscle and fat. - While it involves low weight and energy deficit, the prominent **edema** (swollen belly) seen in this case points away from marasmus. *Indian childhood cirrhosis* - This is a rare, **fatal liver disease** in young children, often characterized by jaundice, hepatosplenomegaly, and liver failure. - It is not primarily caused by protein deficiency and its symptoms are distinct from the presentation described. *Nephrotic syndrome* - While nephrotic syndrome also presents with **hypoalbuminemia and edema**, it would show **proteinuria** (>3.5 g/day), hyperlipidemia, and lipiduria on urinalysis. - The **dietary history** and absence of urinary findings distinguish kwashiorkor from nephrotic syndrome.
Question 3: An adolescent male developed vomiting and diarrhea 1 hour after having food from a restaurant. The most likely pathogen is?
- A. Clostridium perfringens
- B. Vibrio parahaemolyticus
- C. Staphylococcus aureus (Correct Answer)
- D. Salmonella
Explanation: ***Staphylococcus aureus*** - The rapid onset of symptoms (within 1 hour) strongly suggests **pre-formed toxin ingestion**, which is characteristic of *Staphylococcus aureus* food poisoning. - While the typical incubation period is **1-6 hours** (average 2-4 hours), onset within 1 hour can occur with **high toxin loads** in contaminated food. - **Vomiting** is often the predominant symptom, occurring shortly after consuming contaminated food, which distinguishes it from other bacterial causes. *Clostridium perfringens* - Onset of symptoms caused by *Clostridium perfringens* is typically **8-16 hours** after ingestion, which is much longer than observed here. - It primarily causes **diarrhea and abdominal cramps** due to toxin production in the intestine, with minimal vomiting. *Vibrio parahaemolyticus* - Symptoms usually appear **4-96 hours** (average 12-24 hours) after consuming contaminated seafood, which is a longer incubation period than described. - It typically causes **watery diarrhea**, abdominal cramps, nausea, and occasional vomiting, but not within 1 hour. *Salmonella* - The incubation period for *Salmonella* infection is typically **6-72 hours** (average 12-36 hours), making it highly unlikely for symptoms to appear within 1 hour. - **Diarrhea, fever, and abdominal cramps** are common with *Salmonella*, but rapid-onset vomiting from pre-formed toxin is not its mechanism.
Question 4: A baby from a second degree consanguineous marriage presents with diarrhoea and redness in the perianal diaper area. What is the most likely diagnosis?
- A. Fungal infection (Correct Answer)
- B. Shigella infection
- C. Salmonella infection
- D. Lactose intolerance
Explanation: ***Fungal infection (Candida diaper dermatitis)*** - **Diarrhea with perianal diaper rash** is the classic presentation of **Candida (fungal) diaper dermatitis**, the most common cause of diaper rash in infants with diarrhea. - **Diarrhea increases skin moisture and alters pH**, creating optimal conditions for **Candida albicans overgrowth**. - **Perianal involvement with bright erythema** is characteristic of Candida, often with **satellite lesions** and involvement of skin folds. - This is a **clinical diagnosis** based on distribution pattern and association with diarrhea; consanguinity is not directly relevant to this common condition. *Lactose intolerance* - **Congenital lactase deficiency** is extremely rare (< 50 cases worldwide) and unlikely to be the primary diagnosis. - While **secondary lactose intolerance** can occur with gastroenteritis causing diarrhea, it doesn't explain the **specific perianal rash pattern** described. - The perianal redness in lactose malabsorption would be **irritant contact dermatitis** from acidic stools, which would secondarily get infected with **Candida** - making fungal infection the more complete diagnosis. *Shigella infection* - Typically presents with **bloody diarrhea (dysentery)**, high fever, abdominal cramps, and tenesmus. - Would not specifically cause the **perianal diaper rash pattern** characteristic of Candida. - Consanguinity doesn't predispose to this bacterial infection. *Salmonella infection* - Usually presents with **fever, vomiting, and systemic symptoms** along with diarrhea. - May cause bloody or non-bloody diarrhea but doesn't explain the **characteristic perianal redness pattern**. - Not associated with consanguinity as it's an acquired infectious disease.
Question 5: AMPLE history involved all except?
- A. Last meal
- B. Pregnancy
- C. Personal history (Correct Answer)
- D. Allergy
Explanation: ***Personal history*** - The "P" in **AMPLE** stands for **Past medical history**, not Personal history. Personal history (social history) is a broader category that includes elements like smoking, alcohol use, and occupation, which are not specifically covered by the AMIPLE acronym. - While personal history is important for overall patient assessment, it is not a direct component of the focused **AMPLE** mnemonic used in emergency and critical care settings. *Last meal* - The "L" in **AMPLE** stands for **Last meal** (or Last oral intake). - This information is crucial for assessing aspiration risk, especially before procedures or surgery, and understanding metabolic status. *Pregnancy* - The "P" in **AMPLE** stands for **Past medical history or Pregnancy**. - For female patients of reproductive age, identifying pregnancy status is critical for medication administration, imaging decisions, and overall management. *Allergy* - The "A" in **AMPLE** stands for **Allergies**. - Knowing a patient's allergies is fundamental to prevent adverse reactions to medications, foods, and environmental factors during treatment.
Question 6: In chronic allergy, which Ig is more persistent in the body?
- A. Ig A
- B. Ig E (Correct Answer)
- C. Ig G
- D. Ig M
Explanation: ***Ig E*** - **IgE** is the primary antibody involved in **allergic reactions**, binding to receptors on **mast cells** and **basophils** to trigger histamine release. - In chronic allergy, sustained exposure to allergens leads to continuous production of IgE, making it a **persistent** and dominant immunoglobulin in the allergic response. *Ig A* - **IgA** is mainly found in **mucosal secretions**, such as tears, saliva, and gut, protecting against pathogens at these sites. - While important for immunity, IgA does not play a direct role in the **immediate hypersensitivity reactions** characteristic of chronic allergies. *Ig G* - **IgG** is the most abundant antibody in serum, providing **long-term immunity** against pathogens through neutralization, opsonization, and complement activation. - Though present, IgG is not the **primary mediator** of the **allergic response** in chronic allergy, instead often associated with protective immunity or certain non-IgE mediated hypersensitivities. *Ig M* - **IgM** is the first antibody produced during a **primary immune response** and is effective at activating the complement system. - It is predominantly found in the bloodstream and functions as a **short-term defender**, but it is not directly involved in the pathogenesis or persistence of chronic allergies.
Question 7: According to WHO guidelines, exclusive breast feeding should be continued for minimum how many months?
- A. 5 months
- B. 6 months (Correct Answer)
- C. 2 months
- D. 12 months
Explanation: ***6 months*** - The **World Health Organization (WHO)** strongly recommends exclusive breastfeeding for the first **six months** of an infant's life. - This provides all the necessary nutrients, antibodies, and fluids for healthy growth and development, without the need for additional food or drinks. *5 months* - While beneficial, stopping exclusive breastfeeding at 5 months is earlier than the **WHO-recommended duration**. - Infants benefit from the continued nutritional and immunological advantages of breast milk up to the six-month mark. *2 months* - Exclusive breastfeeding for only two months is significantly shorter than the **global recommendation**. - This period is insufficient to provide the full spectrum of benefits associated with prolonged exclusive breastfeeding. *12 months* - While breastfeeding can continue for 12 months or longer with complementary foods, **exclusive breastfeeding** is specifically recommended for the first six months. - After six months, complementary foods are introduced alongside continued breastfeeding.
Question 8: History of dislike for sweet food items is typically present in:
- A. Glycogen storage disease
- B. Diabetes mellitus
- C. Galactosemia
- D. Hereditary fructose intolerance (Correct Answer)
Explanation: ***Hereditary fructose intolerance*** - Patients with hereditary fructose intolerance develop severe symptoms like **nausea, vomiting, abdominal pain, and hypoglycemia** after ingesting fructose, leading to an aversive response and **dislike for sweet food items**. - This aversion is a protective mechanism, as avoiding fructose-containing foods (including many sweets) prevents the accumulation of toxic metabolites due to a deficiency in **hepatic aldolase B**. *Glycogen storage disease* - While glycogen storage diseases can cause hypoglycemia, they typically do not lead to a specific **aversion to sweet foods**. - The primary defect is in **glycogen synthesis or breakdown**, leading to symptoms like hepatomegaly, muscle weakness, and exercise intolerance. *Diabetes mellitus* - Patients with diabetes mellitus often have a **craving for sweet foods** due to uncontrolled blood glucose levels and insulin resistance, rather than a dislike. - The condition is characterized by **hyperglycemia** and may involve polydipsia, polyuria, and polyphagia. *Galactosemia* - Galactosemia involves an inability to metabolize galactose, leading to symptoms such as **vomiting, lethargy, and jaundice** upon milk ingestion [1]. - While patients will avoid milk, their aversion is not generally to all sweet foods, as sweet foods do not always contain galactose [1].
Question 9: IV dose of 1:10,000 concentration of epinephrine in a 2 kg preterm baby is:
- A. 0.1 ml
- B. 0.3 ml
- C. 0.2 ml (Correct Answer)
- D. 0.4 ml
Explanation: ***0.2 ml*** - The recommended **IV dose of 1:10,000 epinephrine** for neonatal resuscitation is **0.01 to 0.03 mg/kg**. - For a 2 kg baby: dose range = 0.02 to 0.06 mg - Since 1:10,000 epinephrine contains **0.1 mg/mL**, a dose of **0.2 mL delivers 0.02 mg** (0.01 mg/kg) - This represents the **recommended starting dose** at the lower end of the therapeutic range, which is preferred in neonatal resuscitation to minimize adverse effects while ensuring efficacy. *0.1 ml* - This volume delivers **0.01 mg** (0.005 mg/kg for a 2 kg infant) - This is **below the recommended minimum dose** of 0.01 mg/kg and would be **sub-therapeutic** - Insufficient for effective neonatal resuscitation *0.3 ml* - This volume delivers **0.03 mg** (0.015 mg/kg for a 2 kg infant) - This falls **within the recommended range** but is at the **mid-range** dose - While acceptable, the lower starting dose (0.2 mL) is typically preferred initially, with subsequent doses adjusted based on response *0.4 ml* - This volume delivers **0.04 mg** (0.02 mg/kg for a 2 kg infant) - This falls **within the recommended range** (0.01-0.03 mg/kg) and represents an appropriate therapeutic dose - However, **0.2 mL (0.01 mg/kg) is the standard initial dose** recommended by NRP (Neonatal Resuscitation Program) guidelines, making it the preferred answer for initial administration
Question 10: A 2-hour-old neonate born by normal vaginal delivery has a scalp swelling, with normal cry and activity. What is the probable cause?
- A. Focal subaponeurotic blood collection
- B. Chignon
- C. Depressed skull fracture
- D. Serosanguinous subcutaneous fluid (Correct Answer)
Explanation: ***Serosanguinous subcutaneous fluid*** - This description is consistent with **caput succedaneum**, a common finding in neonates after vaginal delivery. It is a **diffuse, edematous swelling of the scalp** that crosses suture lines, caused by pressure during birth. - The swelling arises from **serosanguinous fluid** accumulating in the **subcutaneous tissues** (between the skin and galea aponeurotica) and typically resolves within a few days. *Focal subaponeurotic blood collection* - This describes a **subgaleal hemorrhage**, which involves blood collection *between the scalp aponeurosis and the periosteum*. - Subgaleal hemorrhages can be very extensive and life-threatening, often presenting with signs of **hypovolemic shock** as it can accumulate a large amount of blood, which is inconsistent with the "normal cry and activity" of the neonate. *Chignon* - A chignon is a **localized scalp edema** or swelling that forms as a result of a **vacuum extractor** application during delivery. - While it is a scalp swelling, the question states "normal vaginal delivery" and does not mention vacuum extraction, making it less likely. *Depressed skull fracture* - A **depressed skull fracture** involves an indentation of the skull bone, which would be a **hard, bony defect** rather than a soft, fluid-filled swelling. - While it can occur during birth, it is usually a more severe injury and might present with neurological symptoms or a palpable bony depression, neither of which are described.
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