Pediatric Nutrition Practice Questions

Q: All are true about the child shown in the image except:

Delayed skin pinch. ***Delayed skin pinch*** - Delayed skin pinch, also known as **poor skin turgor**, is a sign of **dehydration**, which is more characteristic of **kwashiorkor** or severe acute malnutrition with significant fluid loss, rather than marasmus alone. - In marasmus, although there is severe wasting, **skin turgor is often preserved** due to the absence of significant edema. - This is the **EXCEPTION** - it is NOT a typical feature of pure marasmus. *Baggy pants appearance* - The **extreme loss of subcutaneous fat and muscle mass** in marasmus causes the skin around the buttocks and thighs to hang loosely, creating a "baggy pants" or "old man" appearance. - This is a **hallmark feature** indicating severe wasting in marasmus. *Apathy* - Children with severe marasmus often exhibit **apathy, irritability, and decreased activity**, reflecting their profound energy deficit and associated psychological distress. - This is a common neurological and behavioral manifestation of **severe malnutrition**. *Reduced MAC* - **Mid-upper arm circumference (MAC)** is severely reduced in marasmus due to the significant loss of both fat and muscle tissue in the upper arm. - A **MAC less than 11.5 cm** is a key diagnostic criterion for **severe acute malnutrition** in children aged 6-59 months.

Q: A 2-year-old child presents with delayed motor milestones and bowing of legs. X-ray of the wrist is shown. What is the most likely diagnosis?

Rickets. ***Rickets*** - The image displays characteristic radiographic findings of **rickets**, including **fraying, cupping**, and **widening of the metaphyses**, particularly evident at the distal radius and ulna. - These changes result from impaired mineralization of growing bone and cartilage at the **growth plates** due to vitamin D deficiency in children. *Scurvy* - Scurvy, caused by vitamin C deficiency, affects **collagen synthesis**, leading to subperiosteal hemorrhages and thinning of the cortex. - Radiographic features include a **dense metaphyseal line (Wimberger's sign)** and **epiphyseal separation**, which are not the primary features seen here. *Osteomalacia* - **Osteomalacia** is the adult form of rickets, characterized by defective mineralization of bone matrix. - While it features **pseudofractures (Looser zones)** and generalized osteopenia, it does not present with growth plate abnormalities like fraying and cupping, as growth plates are typically closed in adults. *Osteoporosis* - **Osteoporosis** involves a reduction in bone mass and density, leading to increased bone fragility and fracture risk. - Radiographically, it manifests as generalized **osteopenia** and trabecular thinning, without the specific metaphyseal irregularities seen in rickets.

Q: Which condition is characterized by the sign shown in the image?

Kwashiorkor. ***Kwashiorkor*** - The image shows sparse, dry, and discolored hair, sometimes described as having a **"flag sign"** due to alternating bands of light and dark hair, which is characteristic of **protein-energy malnutrition (PEM)**, specifically kwashiorkor. - Kwashiorkor results from a severe protein deficiency with relatively adequate calorie intake, leading to hair changes, **edema**, and a distended abdomen. *Marasmus* - Marasmus is characterized by severe muscle wasting and loss of subcutaneous fat due to a deficiency in both protein and overall calorie intake, but **hair changes are less prominent** than in kwashiorkor. - Individuals with marasmus appear incredibly emaciated and "skeletal" but typically do not exhibit the same degree of hair discoloration or edema. *Pellagra* - Pellagra is caused by a deficiency of **niacin (vitamin B3)** and is characterized by the "3 Ds": **dermatitis**, **diarrhea**, and **dementia**. - While it can affect hair quality, it does not typically present with the specific hair changes, such as the "flag sign," seen in the image. *None of above* - The distinct hair abnormalities depicted in the image are highly suggestive of a specific nutritional deficiency, making "None of the above" incorrect.

Q: The image shows:

Acute pancreatitis. ***Acute pancreatitis*** - The image shows an **enlarged, edematous pancreas** with surrounding **stranding of the peripancreatic fat**, indicated by the white arrows and suggesting inflammation. - There is also evidence of **fluid collection** adjacent to the pancreas, a common finding in acute pancreatitis. *Chronic pancreatitis* - Chronic pancreatitis typically presents with pancreatic **atrophy**, **calcifications** within the parenchyma and ducts, and **ductal dilation**. - While calcifications are present, the primary findings of a swollen pancreas and peripancreatic edema are more indicative of an acute process. *Pancreatic divisum* - Pancreatic divisum is a **congenital anomaly** where the dorsal and ventral pancreatic ducts fail to fuse, and it is a predisposing factor for pancreatitis, but the image shows findings of an inflammatory process rather than an anatomical variant. - The image exhibits signs of inflammation and fluid collection, not the distinct ductal anatomy of pancreatic divisum itself. *Artefact* - Artefacts on a CT scan can include **beam hardening**, **motion artefacts**, or **streak artefacts**, which typically appear as streaks, distorted images, or areas of abnormal signal. - The observed features—pancreatic enlargement, peripancreatic fat stranding, and fluid collection—are clear anatomical and pathological changes, not image anomalies.

Q: Which of the following is correct about the image shown? (Recent NEET Pattern 2016-17)

A = Kayser Fleischer ring, B = Arcus senilis. ***A = Kayser Fleischer ring, B = Arcus senilis*** - Image A displays a **Kayser-Fleischer ring**, a greenish-brown ring in the periphery of the cornea, characteristic of **Wilson's disease** due to copper deposition. - Image B shows **arcus senilis**, a milky-white or grayish ring around the cornea, which is a **common age-related change** due to lipid deposits, and can appear at any age. *A = Arcus senilis, B = Kayser-Fleischer ring* - This option incorrectly identifies the lesions; the ring in image A is associated with copper deposition, not lipid deposition. - The ring in image B is clearly a common lipid ring often seen in older individuals, contrasting with the distinct appearance of a Kayser-Fleischer ring. *A = Arcus senilis, B = Hudson-Stahli line* - Image A does not show arcus senilis; its color and location are consistent with copper deposition. - Image B does not depict a Hudson-Stahli line, which is a thin, brownish-linear deposit of iron in the corneal epithelium, typically horizontal and not circumferential. *A = Hudson-Stahli line, B = Arcus senilis* - Image A's appearance, as a circumferential greenish-brown deposit, is not consistent with a linear Hudson-Stahli line. - While image B correctly identifies arcus senilis, the identification of A as a Hudson-Stahli line is incorrect.

Q: Which of the following diseases will lead to the following appearance?

Paget's disease. ***Paget's disease*** - The image depicts a bowing of the legs and a generalized stooped posture, which are characteristic findings in advanced **Paget's disease of bone**. - **Paget's disease** is a chronic bone disorder characterized by abnormal bone remodeling, leading to enlarged and misshapen bones that can cause **kyphosis** and **bowed limbs**. *Polio* - **Polio** (poliomyelitis) primarily affects the nervous system, leading to **muscle weakness** and **paralysis**, which can result in limb deformities, but not typically the widespread bone enlargement and bowing seen here. - While polio can cause limb asymmetry and deformities due to muscle wasting, it does not involve the characteristic bone remodeling and generalized skeletal changes seen in the image. *Cerebellar lesion* - A **cerebellar lesion** primarily affects coordination, balance, and motor control, leading to ataxia, tremors, and gait disturbances. - It does not directly cause the skeletal deformities or bone bowing illustrated in the image. *Ankylosing Spondylitis* - **Ankylosing spondylitis** is a chronic inflammatory disease primarily affecting the axial skeleton, leading to progressive spinal stiffness and fusion (a "bamboo spine"). - While it can cause a significant **kyphosis** (forward curvature of the spine), it does not typically lead to the wide-set bowed legs or general bone enlargement often seen in Paget's disease.

Q: The bony deformity of 'pigeon chest' in children occurs due to deficiency of:

Vitamin D. ***Vitamin D*** - A deficiency in **Vitamin D** leads to **rickets** in children, impairing proper bone mineralization. - This softening of bones can cause skeletal deformities, including **pigeon chest** (pectus carinatum), where the sternum protrudes forward. *Vitamin K* - **Vitamin K** is crucial for **blood clotting** by synthesizing coagulation factors. - Its deficiency primarily leads to bleeding disorders, not skeletal deformities like pigeon chest. *Vitamin A* - **Vitamin A** is essential for **vision**, immune function, and cellular growth. - A deficiency can cause **night blindness** and impaired immunity, but it is not directly linked to bone deformities. *Vitamin E* - **Vitamin E** is a powerful **antioxidant** that protects cells from damage. - While essential for neurological function and immunity, its deficiency does not cause skeletal abnormalities such as pigeon chest.

Q: In the case of a 7 -year-old school-going child, which would be the most appropriate indicator to measure the current nutritional status?

Mid upper arm circumference. ***Mid upper arm circumference*** - **Mid-upper arm circumference (MUAC)** is the most appropriate indicator among the given options for assessing **current nutritional status** in a 7-year-old school-going child. - While traditionally emphasized for children 6-59 months, **MUAC is increasingly recognized as a valid indicator for school-aged children (5-15 years)** for detecting acute malnutrition and wasting. - MUAC is **age-independent, practical, and can be measured easily** in school settings, making it particularly useful for screening current nutritional status in this age group. - **Note:** Ideally, **BMI-for-age** is the gold standard recommended by WHO and IAP for children aged 5-19 years, but it is not among the options provided. *Weight for height* - **Weight-for-height (WFH)** is primarily recommended for **children under 5 years of age** or those with height 5 years), **BMI-for-age is the preferred indicator**, not WFH. - WFH becomes less accurate and less practical in older children, making it inappropriate as the primary indicator for a 7-year-old. *Birth weight* - **Birth weight** reflects **intrauterine growth and nutritional status at delivery**, not the current nutritional status of a 7-year-old child. - It is useful for assessing risk factors and early life influences but has no bearing on current nutritional assessment in school-aged children. *Head circumference* - **Head circumference** is primarily used to assess **brain growth** and detect conditions like **microcephaly or macrocephaly**, particularly in infancy and early childhood (up to 2-3 years). - In a 7-year-old, head growth has largely plateaued, and this measurement is **not useful for assessing current general nutritional status**.

Question 1

All statements about the disease shown are wrong except:

Accepted Answer

Loss of normal zone of provisional calcification adjacent to metaphysis

Answer

Nutritional rickets usually presents in school age, usually as widened wrists

Answer

Presentation in early infancy along with seizures or tetany

Answer

Excessive exposure to sunlight does not increase vitamin D production

Question 2

Select the false statement regarding the disease depicted in the picture?

Accepted Answer

Loss of fat from sucking pads of the cheeks is the earliest sign

Answer

There is muscle atrophy and resultant hypotonia

Answer

Besan panjiri is an energy dense food used in treatment

Answer

This is non-edematous severe childhood undernutrition

Question 3

All are true about the child shown in the image except:

Accepted Answer

Delayed skin pinch

Answer

Baggy pants appearance

Answer

Apathy

Answer

Reduced MAC

Question 4

A 2-year-old child presents with delayed motor milestones and bowing of legs. X-ray of the wrist is shown. What is the most likely diagnosis?

Accepted Answer

Rickets

Answer

Scurvy

Answer

Osteomalacia

Answer

Osteoporosis

Question 5

Which condition is characterized by the sign shown in the image?

Accepted Answer

Kwashiorkor

Answer

Marasmus

Answer

Pellagra

Answer

None of above

Question 6

The image shows:

Accepted Answer

Acute pancreatitis

Answer

Chronic pancreatitis

Answer

Pancreatic divisum

Answer

Artefact

Question 7

Which of the following is correct about the image shown? (Recent NEET Pattern 2016-17)

Accepted Answer

A = Kayser Fleischer ring, B = Arcus senilis

Answer

A = Arcus senilis, B = Kayser-Fleischer ring

Answer

A = Arcus senilis, B = Hudson-Stahli line

Answer

A = Hudson-Stahli line, B = Arcus senilis

Question 8

Which of the following diseases will lead to the following appearance?

Accepted Answer

Paget's disease

Answer

Polio

Answer

Cerebellar lesion

Answer

Ankylosing Spondylitis

Question 9

The bony deformity of 'pigeon chest' in children occurs due to deficiency of:

Accepted Answer

Vitamin D

Answer

Vitamin K

Answer

Vitamin A

Answer

Vitamin E

Question 10

In the case of a 7 -year-old school-going child, which would be the most appropriate indicator to measure the current nutritional status?

Accepted Answer

Mid upper arm circumference

Answer

Birth weight

Answer

Head circumference

Answer

Weight for height

Pediatric Nutrition — MCQs

Pediatric Nutrition — MCQs

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