Obesity in Children — 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?
2 months old child having birth weight 2kg, with poor feeding, very sleepy and wheezing. The diagnosis is?
What is the BMI classification for an obese person?
Obesity is associated with all of the following conditions except:
All of the following are primarily restrictive operations for morbid obesity, except which of the following?
Which condition has the maximum relative risk attributed to obesity?
A 5-year-old child was admitted to the hospital for a prolapsing rectal mass and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. What is the likely diagnosis?
Juvenile polyp is a type of which of the following?
Which of the following Mapleson circuit breathing system is used in children?
A 7-year-old child has steroid dependent Nephrotic syndrome. His weight is 30 kg and height is 106 cm. He is having truncal obesity with sub-capsular bilateral cataracts. Which is the best drug for this patient?
Obesity in Children 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: 2 months old child having birth weight 2kg, with poor feeding, very sleepy and wheezing. The diagnosis is?
- A. Very severe disease (Correct Answer)
- B. No evidence of pneumonia
- C. Severe respiratory infection
- D. No diagnosis
Explanation: ***Very severe disease*** - According to **WHO/IMNCI (Integrated Management of Neonatal and Childhood Illness) classification** for young infants (0-2 months), the presence of **danger signs** automatically classifies the condition as "Very severe disease" - This infant presents with two critical danger signs: **poor feeding** and **lethargy (very sleepy)**, along with respiratory symptoms (wheezing) - In young infants, any danger sign (poor feeding, lethargic/unconscious, convulsions, severe chest indrawing, central cyanosis) requires immediate classification as "Very severe disease" and **urgent referral** to higher center - This is a specific diagnostic classification used in pediatric emergency protocols, not a general term *Severe respiratory infection* - While the child has respiratory symptoms (wheezing), this classification would only be appropriate if respiratory distress was present **without danger signs** - The presence of danger signs (poor feeding, lethargy) escalates the classification to "Very severe disease" in the WHO/IMNCI protocol - In young infants (0-2 months), the classification system prioritizes danger signs over organ-specific diagnoses *No evidence of pneumonia* - This is incorrect as the infant clearly presents with respiratory symptoms (wheezing) and systemic signs of illness - The presence of wheezing, poor feeding, and lethargy indicates serious illness requiring urgent evaluation and treatment - This option contradicts the clinical presentation *No diagnosis* - This is incorrect as the WHO/IMNCI classification provides a clear diagnostic framework - The presence of danger signs in a young infant mandates classification as "Very severe disease" - A working diagnosis is essential for guiding appropriate management and urgent referral
Question 3: What is the BMI classification for an obese person?
- A. Less than 18.5
- B. 18.5-24.9
- C. 25-29.9
- D. ≥30 (Correct Answer)
Explanation: ***≥30*** - A **Body Mass Index (BMI)** of **30 kg/m² or higher** is the standard WHO classification for **obesity**. - This classification indicates a significant accumulation of body fat that poses increased health risks including cardiovascular disease, type 2 diabetes, and certain cancers. *Less than 18.5* - A BMI in this range indicates that an individual is **underweight**, which also carries potential health risks associated with insufficient body mass. - This is the opposite end of the spectrum from obesity. *18.5-24.9* - This range represents a **healthy weight** or **normal BMI**, indicating a balanced proportion of weight to height. - Individuals in this category generally have the lowest health risks associated with body weight. *25-29.9* - A BMI within this range indicates **overweight**, which is a precursor to obesity if lifestyle changes are not made. - While not categorized as obese, it still carries increased health risks compared to a normal BMI.
Question 4: Obesity is associated with all of the following conditions except:
- A. Hypoventilation
- B. Diabetes Mellitus
- C. Hypertension
- D. Hyperventilation (Correct Answer)
Explanation: ***Hyperventilation*** - Obesity is generally associated with **hypoventilation**, as seen in **Obesity Hypoventilation Syndrome (OHS)**, due to excess weight restricting chest and diaphragm movement [1], [3]. - **Hyperventilation**, which involves increased depth and rate of breathing, is not a typical direct complication of obesity. *Hypoventilation* - **Obesity Hypoventilation Syndrome (OHS)** is a recognized complication where increased adipose tissue impairs respiratory mechanics, leading to **chronic hypoventilation** [3]. - This results in elevated arterial carbon dioxide (hypercapnia) and reduced oxygen (hypoxemia), especially during sleep, commonly known as **sleep apnea** [3]. *Hypertension* - Obesity often leads to **insulin resistance** and activation of the **renin-angiotensin-aldosterone system**, both contributing to higher blood pressure. - The increased body mass also requires a greater cardiac output, placing more strain on the cardiovascular system. *Diabetes Mellitus* - Obesity is a primary risk factor for **Type 2 Diabetes Mellitus**, as excess adipose tissue promotes **insulin resistance** in peripheral tissues [2]. - This resistance forces the pancreas to produce more insulin, eventually leading to pancreatic beta-cell exhaustion.
Question 5: All of the following are primarily restrictive operations for morbid obesity, except which of the following?
- A. Laparoscopic adjustable gastric banding
- B. Roux-en-Y operation (Correct Answer)
- C. Vertical band gastroplasty
- D. Duodenal switch operation
Explanation: **Roux-en-Y operation** - The **Roux-en-Y gastric bypass** is considered a **malabsorptive as well as a restrictive procedure** because it creates a small gastric pouch and bypasses a significant portion of the small intestine. - This dual mechanism leads to greater weight loss compared to purely restrictive surgeries. *Vertical band gastroplasty* - **Vertical band gastroplasty** is a **purely restrictive procedure** that creates a small pouch and restricts outflow, but does not involve nutrient malabsorption. - It is less commonly performed now due to higher rates of weight regain and complications compared to other bariatric surgeries. *Laparoscopic adjustable gastric banding* - **Laparoscopic adjustable gastric banding** is a **purely restrictive procedure** where an inflatable band is placed around the upper part of the stomach to create a small pouch. - This limits the amount of food that can be consumed at one time and slows gastric emptying, but does not alter nutrient absorption. *Switch duodenal operation* - The **duodenal switch operation** (biliopancreatic diversion with duodenal switch) is primarily a **malabsorptive procedure** with a restrictive component. - While it includes creation of a small gastric pouch, its most significant effect on weight loss comes from bypassing a large portion of the small intestine, leading to **significant malabsorption**.
Question 6: Which condition has the maximum relative risk attributed to obesity?
- A. Hypertension
- B. CHD
- C. DM (Correct Answer)
- D. Cancer
Explanation: ***DM*** - Obesity is a major risk factor for Type 2 Diabetes Mellitus (T2DM), with a **relative risk often exceeding 3-7 times that of normal-weight individuals**, and even higher for severe obesity. - The link is primarily due to **insulin resistance** caused by increased adipose tissue. *Hypertension* - Obesity significantly increases the risk of hypertension, with a relative risk typically in the range of **2 to 3 times higher** than normal-weight individuals. - The mechanisms involve increased **blood volume**, **sympathetic nervous system activity**, and **renal sodium reabsorption**. *CHD* - Obesity is a strong independent risk factor for Coronary Heart Disease (CHD), contributing to a relative risk of approximately **1.5 to 2.5 times higher** than normal weight. - It often acts by exacerbating other risk factors like **hypertension**, **dyslipidemia**, and **diabetes**. *Cancer* - Obesity is linked to various cancers, including endometrial, esophageal adenocarcinoma, renal cell, and breast cancer in postmenopausal women, with relative risks typically ranging from **1.2 to 2 times higher** for specific cancers. - The pathways include **chronic inflammation**, altered **hormone levels** (e.g., estrogen), and **insulin-like growth factor signaling**.
Question 7: A 5-year-old child was admitted to the hospital for a prolapsing rectal mass and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. What is the likely diagnosis?
- A. Adenoma (precancerous lesion in adults)
- B. Juvenile polyp (Hamartoma) (Correct Answer)
- C. Carcinoma (malignant tumor, rare in children)
- D. Choristoma (benign growth of normal tissue in an abnormal location)
Explanation: ***Juvenile polyp (Hamartoma)*** - **Juvenile polyps** are the most common cause of rectal bleeding in children, often presenting as a **prolapsing rectal mass** and **painless bleeding**. - Histologically, they are characterized by **enlarged, inflamed glands filled with mucin**, consistent with a hamartomatous origin. *Adenoma (precancerous lesion in adults)* - While adenomas can cause rectal bleeding and prolapse, they are typically found in **adults** and are considered **precancerous lesions** [1]. - The patient's young age (5-year-old) makes an adenoma highly unlikely [1]. *Carcinoma (malignant tumor, rare in children)* - **Colorectal carcinoma** is exceedingly **rare in children** and usually presents with more aggressive symptoms than painless bleeding, such as weight loss or anemia [2]. - The histological description of inflamed, mucin-filled glands is not typical for carcinoma [2]. *Choristoma (benign growth of normal tissue in an abnormal location)* - A **choristoma** is a benign growth of normal tissue in an abnormal location, but it does not typically present as a rectal mass or cause rectal bleeding. - The microscopic findings of enlarged and inflamed glands filled with mucin are not characteristic of a choristoma. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 371-372. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.
Question 8: Juvenile polyp is a type of which of the following?
- A. Hamartomatous polyp (Correct Answer)
- B. Lymphoid polyp
- C. Hyperplastic type
- D. Inflammatory polyp
Explanation: ***Hamartomatous polyp*** - Juvenile polyps are classified as **hamartomatous polyps**, characterized by an excessive growth of tissue normally present in the area. - They are typically found in children and can be associated with **Juvenile Polyposis Syndrome** if multiple polyps are present [1]. *Hyperplastic type* - Hyperplastic polyps are usually small, **sessile polyps** found mainly in the colon and are not associated with significant risk of malignancy. - They do not have the **hamartomatous** features characteristic of juvenile polyps. *Lymphoid polyp* - Lymphoid polyps are composed primarily of **lymphoid tissue** and are often incidental findings in children; they are not the same as juvenile polyps. - These polyps are more common in the **ileum** and do not exhibit the same histological characteristics as hamartomatous polyps. *Inflammatory polyp* - Inflammatory polyps arise as a result of **inflammation** and are commonly associated with conditions like **ulcerative colitis**. - They differ from juvenile polyps, which arise from abnormal growth and are typically **non-inflammatory** in nature. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 813.
Question 9: Which of the following Mapleson circuit breathing system is used in children?
- A. Ayers T tube (Correct Answer)
- B. Mapelson D
- C. Mapelson C
- D. Mapelson A
Explanation: ***Ayers T tube*** - The **Ayers T tube** is a modification of the Mapleson D circuit, specifically designed for use in **paediatric patients** due to its low dead space and resistance. - It utilizes a T-piece for fresh gas flow and minimal tubing, making it ideal for the smaller tidal volumes and faster respiratory rates of children. *Mapelson D* - The **Mapleson D circuit** is commonly used in adults for both spontaneous and controlled ventilation due to its efficiency in CO2 removal. - While it has a relatively low resistance, its larger tubing volume and higher fresh gas flow requirements generally make it less suitable for neonates and infants compared to specialized paediatric circuits. *Mapelson C* - The **Mapleson C circuit** is less commonly used in modern anaesthesia practice and is primarily employed for resuscitation or short procedures, particularly in adults. - Its design has a large reservoir bag located close to the patient, leading to higher dead space and making it generally unsuitable for paediatric patients where precise control of CO2 and minimal resistance are crucial. *Mapelson A* - The **Mapleson A circuit**, also known as the Magill circuit, is highly efficient for spontaneous ventilation due to its ability to prevent rebreathing with low fresh gas flows. - However, it is not well-suited for controlled ventilation and its design, with the reservoir bag at the machine end, makes it less practical for paediatric use where lightweight and low-resistance circuits operating close to the patient are preferred.
Question 10: A 7-year-old child has steroid dependent Nephrotic syndrome. His weight is 30 kg and height is 106 cm. He is having truncal obesity with sub-capsular bilateral cataracts. Which is the best drug for this patient?
- A. Azathioprine
- B. Levamisole (Correct Answer)
- C. Cyclophosphamide
- D. Mycophenolate
Explanation: ***Levamisole*** - Levamisole is an effective **steroid-sparing agent** for **steroid-dependent nephrotic syndrome** in children. - It helps reduce the frequency of relapses and allows for **reduction in steroid dosage**, thereby mitigating steroid-related adverse effects like **truncal obesity and cataracts**. - It has a **favorable safety profile** compared to alkylating agents, with main side effects being neutropenia (reversible) and rare vasculitis. - Given as **2.5 mg/kg on alternate days**, it is well-tolerated and effective in maintaining remission while minimizing steroid exposure. - Recent guidelines increasingly favor levamisole as an initial steroid-sparing agent due to its safety and efficacy. *Cyclophosphamide* - Cyclophosphamide is a potent immunosuppressant that can induce sustained remission in steroid-dependent nephrotic syndrome. - However, it carries significant risks including **gonadotoxicity** (infertility risk), **hemorrhagic cystitis**, **bone marrow suppression**, and **malignancy risk**. - Due to these serious adverse effects, it is now typically reserved for **cases resistant to other steroid-sparing agents** or when calcineurin inhibitors are not available/tolerated. - While effective, it is not the first-line steroid-sparing agent in current practice. *Azathioprine* - Azathioprine has **limited efficacy** in steroid-dependent nephrotic syndrome. - It is generally less effective than other immunosuppressants like cyclophosphamide, levamisole, or calcineurin inhibitors. - Not considered a preferred steroid-sparing agent for this condition. *Mycophenolate* - Mycophenolate Mofetil (MMF) is an alternative steroid-sparing agent with emerging evidence of efficacy in steroid-dependent nephrotic syndrome. - Studies show variable results, with some suggesting efficacy comparable to cyclophosphamide but with better safety profile. - While a reasonable option, **levamisole is typically preferred** as initial steroid-sparing therapy due to established efficacy, ease of administration, and safety profile.
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