Mineral Deficiencies — MCQs
A dental surgeon appointed in a rural health centre reports an increased incidence of dental caries in the people of that area. Research team confirmed that water supply of that area is deficient in
Selenium deficiency is seen in -
What is the recommended oral dose of vitamin A to be given in a 10-month-old child on each of days 1, 2, and 28?
As per WHO guidelines, iodine deficiency disorders are considered endemic in the community when the prevalence of goitre in school-age children exceeds what percentage?
Which vitamin deficiency is most commonly associated with rickets in children?
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 child was brought with pedal edema and cheilosis. Cardiomegaly was present. What is the vitamin deficiency associated with this clinical presentation?
A child of 8 kg has Bitot's spots in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child?
Which is the most specific clinical feature for diagnosis of Kwashiorkor?
"Hour-glass" shape of the chest and "tri-radiate pelvis" are seen radiologically in -
Mineral Deficiencies Indian Medical PG Practice Questions and MCQs
Question 1: A dental surgeon appointed in a rural health centre reports an increased incidence of dental caries in the people of that area. Research team confirmed that water supply of that area is deficient in
- A. Chloride
- B. Sodium
- C. Fluoride (Correct Answer)
- D. Calcium
Explanation: ***Fluoride*** - **Fluoride** strengthens tooth enamel, making it more resistant to acid attacks from bacteria and thus preventing **dental caries**. - A deficiency in the water supply would directly lead to decreased fluoride exposure, increasing the incidence of **tooth decay**. *Chloride* - **Chloride** is an essential electrolyte involved in fluid balance and nerve function, but it has no direct role in preventing **dental caries**. - Its presence or absence in drinking water does not significantly impact tooth decay rates. *Sodium* - **Sodium** is another essential electrolyte vital for nerve and muscle function, but it does not contribute to the prevention of **dental caries**. - Its levels in water are unrelated to tooth enamel strength or susceptibility to decay. *Calcium* - While **calcium** is a major component of tooth structure, its primary role in dental health is during tooth development and in maintaining bone density. - Deficiency in water supply is not typically linked to increased **dental caries** risk in the same way as fluoride deficiency, as systemic calcium intake is more critical.
Question 2: Selenium deficiency is seen in -
- A. Keshan disease (Correct Answer)
- B. Wilson disease
- C. Acrodermatitis enteropathica
- D. None of the options
Explanation: ***Keshan disease*** - **Keshan disease** is a form of **cardiomyopathy** caused by **selenium deficiency**, particularly prevalent in regions with selenium-poor soil. - It presents with **heart failure**, arrhythmias, and cardiac enlargement. *Wilson disease* - **Wilson disease** is a disorder of **copper metabolism**, leading to excessive copper accumulation in organs, primarily the liver and brain. - It is not related to selenium deficiency. *Acrodermatitis enteropathica* - **Acrodermatitis enteropathica** is a genetic disorder of **zinc deficiency**, characterized by dermatitis, diarrhea, and alopecia. - It does not involve selenium deficiency. *None of the options* - This option is incorrect because Keshan disease is directly linked to selenium deficiency.
Question 3: What is the recommended oral dose of vitamin A to be given in a 10-month-old child on each of days 1, 2, and 28?
- A. 50,000 IU
- B. 100,000 IU (Correct Answer)
- C. 200,000 IU
- D. 600,000 IU
Explanation: ***100,000 IU*** - The recommended oral dose of Vitamin A for infants aged 6-11 months is **100,000 IU** on day 1, day 2, and day 28 for the treatment of severe vitamin A deficiency or in high-risk areas. - This dosage helps to rapidly replenish vitamin A stores and reduce the risk of associated complications like **xerophthalmia**. *50,000 IU* - This dose is lower than the recommended amount for treating vitamin A deficiency in infants aged 6-11 months. - A 50,000 IU dose is typically given to infants under 6 months of age. *200,000 IU* - This dose is recommended for children 12 months and older, or for pregnant women with severe deficiency who are not experiencing night blindness. - Administering 200,000 IU to a 10-month-old child could pose a risk of **hypervitaminosis A** due to their smaller body weight and developing metabolic systems. *600,000 IU* - This dose is excessively high and would lead to significant **vitamin A toxicity**, especially in an infant. - It is not a therapeutic dose recommended for any age group in the context of vitamin A supplementation programs.
Question 4: As per WHO guidelines, iodine deficiency disorders are considered endemic in the community when the prevalence of goitre in school-age children exceeds what percentage?
- A. 5% (Correct Answer)
- B. 10%
- C. 15%
- D. 1%
Explanation: ***5%*** - According to **WHO guidelines**, iodine deficiency disorders are considered **endemic** when the prevalence of goitre in school-age children **exceeds 5%**. - This is the **specific threshold** established by WHO to classify a community as having endemic iodine deficiency requiring public health intervention. - School-age children (6-12 years) are used as the indicator population because they are the most sensitive group for detecting iodine deficiency. *1%* - This percentage is **below the WHO threshold** of 5% for defining endemic iodine deficiency. - A prevalence of 1% indicates mild iodine insufficiency but does not meet the criteria for endemicity requiring immediate widespread intervention. *10%* - While 10% prevalence certainly indicates a **moderate to severe public health problem**, this is not the WHO threshold for defining endemicity. - The threshold is **5%, not 10%** - any prevalence exceeding 5% (including 10%) would be classified as endemic. *15%* - This represents a **severe iodine deficiency problem**, but it is not the WHO threshold percentage. - The correct threshold is **5%** - both 10% and 15% exceed this threshold and would be classified as endemic, but they are not the defining cutoff point.
Question 5: Which vitamin deficiency is most commonly associated with rickets in children?
- A. Vitamin A
- B. Vitamin C
- C. Vitamin D (Correct Answer)
- D. Vitamin K
Explanation: ***Vitamin D*** - **Vitamin D** plays a crucial role in the absorption of **calcium** and **phosphate**, which are essential for proper **bone mineralization**. - A deficiency leads to impaired mineralization of newly formed bone matrix, resulting in soft, weak bones characteristic of **rickets** in children and **osteomalacia** in adults. *Vitamin A* - **Vitamin A** is primarily involved in **vision**, immune function, and cell growth and differentiation. - While essential for health, its deficiency is not directly linked to the skeletal deformities seen in rickets. *Vitamin C* - **Vitamin C** is vital for **collagen synthesis**, a key component of connective tissues, skin, and bone matrix. - Its deficiency causes **scurvy**, characterized by bleeding gums, poor wound healing, and joint pain, not the bone deformities of rickets. *Vitamin K* - **Vitamin K** is essential for **blood coagulation** and plays a role in bone metabolism through the carboxylation of certain bone proteins like **osteocalcin**. - However, its deficiency primarily leads to bleeding disorders and does not cause rickets.
Question 6: 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. Acute malnutrition
- C. Chronic malnutrition (Correct Answer)
- D. Acute or chronic malnutrition
Explanation: ***Chronic malnutrition*** - A **Height-for-Age z-score < -2.5 SD** indicates **stunting**, which is the hallmark of **chronic malnutrition** due to long-term nutritional deprivation. - The **Weight-for-Age z-score < -3.2 SD** (severe underweight) is consistent with chronic malnutrition, as stunted children typically have low weight-for-age. - The **Weight-for-Height z-score of -1.7 SD** is **NOT indicative of wasting** (which requires WHZ < -2 SD per WHO criteria). This value is within the mild range and does not suggest acute malnutrition. - The predominant finding is **chronic malnutrition (stunting)** without evidence of acute malnutrition. *Acute or chronic malnutrition* - While stunting (chronic component) is clearly present, there is **no acute malnutrition** by standard criteria. - Acute malnutrition requires **Weight-for-Height z-score < -2 SD** (moderate) or < -3 SD (severe). - The WHZ of -1.7 SD does not meet the threshold for wasting, so this option incorrectly suggests both components are present. *Moderate acute malnutrition* - **Moderate acute malnutrition (MAM)** is defined by **Weight-for-Height z-score between -2 and -3 SD**. - The given WHZ of -1.7 SD does **not meet** this criterion and therefore does not indicate MAM. *Acute malnutrition* - **Acute malnutrition** is defined by low **Weight-for-Height z-score** (wasting), indicating recent nutritional deficit. - The WHZ of -1.7 SD is **insufficient** to diagnose acute malnutrition (requires < -2 SD). - This option fails to account for the clear evidence of chronic malnutrition (stunting).
Question 7: A child was brought with pedal edema and cheilosis. Cardiomegaly was present. What is the vitamin deficiency associated with this clinical presentation?
- A. Riboflavin deficiency
- B. Thiamine deficiency (Correct Answer)
- C. Pyridoxine deficiency
- D. Niacin deficiency
Explanation: ***Thiamine deficiency*** - The combination of **pedal edema** and **cardiomegaly** suggests **wet beriberi**, which is caused by **thiamine (vitamin B1) deficiency**. - **Cheilosis** (cracking at the corners of the mouth) is also a feature that can be seen in various vitamin deficiencies, but the cardiac involvement is highly indicative of thiamine deficiency. *Riboflavin deficiency* - **Riboflavin (vitamin B2) deficiency** is characterized by **cheilosis**, glossitis, angular stomatitis, and seborrheic dermatitis. - It typically does not cause **cardiomegaly** or significant **pedal edema** without other concurrent nutritional deficiencies. *Pyridoxine deficiency* - **Pyridoxine (vitamin B6) deficiency** primarily manifests as **dermatitis**, **microcytic anemia**, and neurological symptoms like **peripheral neuropathy** and **seizures**. - It is not typically associated with **pedal edema** or **cardiomegaly**. *Niacin deficiency* - **Niacin (vitamin B3) deficiency** causes **pellagra**, characterized by the "3 Ds": **dermatitis**, **diarrhea**, and **dementia**. - While it can manifest with systemic issues, it does not typically present with the prominent **cardiomegaly** and **pedal edema** seen in this case.
Question 8: A child of 8 kg has Bitot's spots in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child?
- A. 2 lakh units orally on day 0, 14
- B. 2 lakh units orally on day 0, 1, 14 (Correct Answer)
- C. 1 lakh units orally on day 0, 14
- D. 1 lakh units orally on day 0, 1, 14
Explanation: ***2 lakh units orally on day 0, 1, 14*** - For a child weighing **8 kg** with **Bitot's spots (WHO classification X1B)**, the therapeutic dose is **200,000 IU** (2 lakh units) of vitamin A. - The standard WHO/IAP schedule for treating **vitamin A deficiency with ocular signs** is administration on **Day 0, Day 1, and Day 14** to rapidly replete stores and prevent progression. - The **oral route** is preferred for **Bitot's spots without corneal ulceration**, as it is effective, safe, and well-tolerated. - **IM route** is reserved for severe xerophthalmia (X2/X3 with corneal ulceration), persistent vomiting, or inability to take oral medications. *2 lakh units orally on day 0, 14* - Although the individual dose of **200,000 IU** is correct for this 8 kg child with **Bitot's spots**, this schedule misses the critical **Day 1 dose**. - The missing dose on Day 1 delays rapid **vitamin A replenishment**, which is crucial for preventing progression of **ocular damage** and achieving adequate tissue stores. *1 lakh units orally on day 0, 14* - This dose of **100,000 IU** is inadequate for a child weighing **8 kg or more** with clinical **vitamin A deficiency**. - WHO guidelines recommend **100,000 IU for children <8 kg** and **200,000 IU for children ≥8 kg**, making this dosage insufficient. - Additionally, the schedule is incomplete as it misses the **Day 1 dose**. *1 lakh units orally on day 0, 1, 14* - While the schedule of Day 0, Day 1, and Day 14 is appropriate, the **dose of 100,000 IU is inadequate** for a child weighing **8 kg**. - This lower dose may not provide sufficient **vitamin A replenishment** to reverse **Bitot's spots** and prevent progression to more severe xerophthalmia.
Question 9: Which is the most specific clinical feature for diagnosis of Kwashiorkor?
- A. Edema
- B. Fatty liver
- C. Low serum albumin
- D. Easy pluckable hair (Correct Answer)
Explanation: ***Easy pluckable hair*** - **Easy pluckable hair** is a highly specific clinical sign of Kwashiorkor, indicating severe **protein deficiency** affecting hair follicle integrity. - This symptom, often accompanied by changes in hair color and texture (e.g., **flag sign**), highlights the chronic lack of essential amino acids. *Edema* - **Edema** is a prominent feature of Kwashiorkor, resulting from low **oncotic pressure** due to **hypoalbuminemia**. - While characteristic, edema can also be seen in other conditions like **cardiac**, **renal**, or **hepatic failure**, making it less specific than hair changes. *Fatty liver* - **Fatty liver** (hepatic steatosis) is commonly observed in Kwashiorkor due to impaired synthesis and export of **VLDL** from the liver. - Although characteristic, fatty liver can also occur in **obesity**, **alcoholism**, and **diabetes**, reducing its specificity as a standalone diagnostic feature. *Low serum albumin* - **Low serum albumin** is a hallmark biochemical finding in Kwashiorkor, reflecting severe **protein malnutrition** and reduced hepatic synthesis. - While critical for diagnosis, hypoalbuminemia can also be caused by severe **liver disease**, **nephrotic syndrome**, or **malabsorption**, limiting its specificity for Kwashiorkor alone.
Question 10: "Hour-glass" shape of the chest and "tri-radiate pelvis" are seen radiologically in -
- A. Osteomalacia (Correct Answer)
- B. Myxedema
- C. Hyperthyroidism
- D. Hyperparathyroidism
Explanation: ***Osteomalacia*** - The "hour-glass" shape of the chest is caused by **ricketic rosary** and flaring of the lower ribs, while the "tri-radiate pelvis" is due to inward bending of the acetabula and outward bending of the iliac bones. - These radiological findings are characteristic of **bone demineralization** and softening seen in osteomalacia, which result from impaired bone mineralization due to **vitamin D deficiency** *Myxedema* - Myxedema is severe **hypothyroidism** characterized by skin and subcutaneous tissue swelling, not by specific skeletal deformities like those described. - While it can affect bone metabolism, it does not typically lead to the distinct "hour-glass chest" or "tri-radiate pelvis." *Hyperthyroidism* - **Hyperthyroidism** causes an **increased bone turnover** and can lead to **osteoporosis** over time, increasing fracture risk. - However, it does not manifest with the specific characteristic radiological deformities of the chest and pelvis associated with osteomalacia. *Hyperparathyroidism* - **Hyperparathyroidism** causes **increased bone resorption** leading to subperiosteal bone resorption, "salt and pepper skull," and brown tumors. - While it affects bone structure, it does not produce the specific "hour-glass chest" or "tri-radiate pelvis" deformities characteristic of osteomalacia.
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