Pediatric Nutrition — MCQs
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A young patient presents with enlargement of costochondral junctions, gum bleeding, and a white line of Fraenkel at the metaphysis. The most likely diagnosis is:
A 5-month old formula fed infant has been brought with complaints of watery diarrhoea of 2 days duration and irritability of one day duration. He had been receiving WHO ORS at home. Physical examination reveals a markedly irritable child with a rather doughy skin and rapid pulse. The most likely diagnosis is-
Wimberger sign is seen in ?
Which combination of features is most characteristic of nutritional rickets?
Late metabolic acidosis is seen in-
Which of the following, if normal, would be most significant in making PEM unlikely?
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?
Which nutrient is most deficient in a child with kwashiorkor?
Fluid of choice for shock in a child with severe acute malnutrition + hypoglycemia
An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?
Pediatric Nutrition Indian Medical PG Practice Questions and MCQs
Question 381: A young patient presents with enlargement of costochondral junctions, gum bleeding, and a white line of Fraenkel at the metaphysis. The most likely diagnosis is:
- A. Rickets
- B. Hyperparathyroidism
- C. Scurvy (Correct Answer)
- D. Osteomalacia
Explanation: ***Scurvy*** - This presentation is classic for **scurvy**, a disease caused by severe **vitamin C deficiency**. - **Enlargement of costochondral junctions** (**rachitic rosary** in scurvy is due to subperiosteal hemorrhage), **gum bleeding** (due to impaired collagen synthesis affecting blood vessel integrity), and the **white line of Fraenkel** (a dense calcified metaphyseal line due to irregular calcification) are characteristic signs of infantile scurvy. *Rickets* - While rickets also causes **rachitic rosary**, it is due to **uncalcified cartilage** and not subperiosteal hemorrhage. - The primary cause is **vitamin D deficiency**, leading to defective bone mineralization, but typically does not cause gum bleeding or the specific "white line of Fraenkel." *Hyperparathyroidism* - Characterized by **increased parathyroid hormone (PTH)**, leading to bone resorption and elevated serum calcium levels. - Presents with symptoms like **bone pain**, **fractures**, and **renal stones**, but not typically gum bleeding or the specific radiological findings seen here. *Osteomalacia* - This is the adult form of **rickets**, caused by **vitamin D deficiency** or impaired phosphate metabolism, leading to inadequate mineralization of new bone (osteoid). - Symptoms include bone pain and muscle weakness, but not the gum bleeding or the specific metaphyseal changes (white line of Fraenkel) seen in childhood scurvy.
Question 382: A 5-month old formula fed infant has been brought with complaints of watery diarrhoea of 2 days duration and irritability of one day duration. He had been receiving WHO ORS at home. Physical examination reveals a markedly irritable child with a rather doughy skin and rapid pulse. The most likely diagnosis is-
- A. Hyponatremic dehydration
- B. Meningitis
- C. Encephalitis
- D. Hypernatremic dehydration (Correct Answer)
Explanation: ***Hypernatremic dehydration*** - **Doughy skin**, irritability, and a rapid pulse in an infant with diarrhea are classic signs of **hypernatremic dehydration**. - This condition occurs when water loss exceeds sodium loss, leading to a relatively higher sodium concentration in the body. - Despite receiving WHO ORS, hypernatremic dehydration can still develop if fluid losses are massive or if there is inadequate fluid intake. *Hyponatremic dehydration* - Characterized by **lethargy**, seizures, and a **tense anterior fontanelle** due to brain swelling. - Would typically present with normal or decreased skin turgor, not a "doughy" feel. *Meningitis* - While irritability is present, meningitis would typically also include **fever**, neck stiffness, and possibly a bulging fontanelle, which are not described. - The "doughy skin" is a strong indicator of fluid imbalance rather than central nervous system infection. *Encephalitis* - Presents with significant **neurological symptoms** like altered consciousness, seizures, focal deficits, and fever. - While irritability can be a symptom, it is not accompanied by the characteristic **doughy skin** seen in severe dehydration.
Question 383: Wimberger sign is seen in ?
- A. Osteoporosis
- B. Osteomalacia
- C. Scurvy (Correct Answer)
- D. Rickets
Explanation: ***Scurvy*** - Wimberger sign, characterized by a **dense band of calcified cartilage** at the metaphysis and a **rarefied zone beneath it**, is a classic radiographic sign of scurvy. - It reflects the impaired osteoid synthesis due to **vitamin C deficiency**, leading to weakened bone structure. *Osteoporosis* - Osteoporosis is characterized by **reduced bone mineral density** and increased bone porosity, leading to fragility fractures. - Radiographically, it appears as generalized **osteopenia** with thinning of cortical bone and prominent trabeculae, not specific metaphyseal changes like Wimberger sign. *Osteomalacia* - Osteomalacia is a condition of **defective bone mineralization** after epiphyseal closure, often due to **vitamin D deficiency**. - It presents with **Looser zones (pseudofractures)** and generalized radiolucency, distinct from the metaphyseal changes seen in Wimberger sign. *Rickets* - Rickets is a disorder of **impaired bone mineralization** in children, occurring before epiphyseal fusion, primarily due to **vitamin D deficiency**. - Radiographic features include **widened, cupped, and frayed metaphyses**, distinct from the dense and rarefied bands of Wimberger sign.
Question 384: Which combination of features is most characteristic of nutritional rickets?
- A. Widening of wrists, delayed dentition, muscle hypotonia, bowing of long bones (Correct Answer)
- B. Delayed dentition, muscle hypotonia, bowing of long bones
- C. Widening of wrists, delayed dentition, muscle hypotonia, bowing of long bones, early fontanelle closure
- D. Growth retardation only
Explanation: ***Widening of wrists, delayed dentition, muscle hypotonia, bowing of long bones*** - These are the classic and most characteristic signs of nutritional rickets, resulting from defective bone mineralization due to **vitamin D deficiency**. - **Widening of wrists** (epiphyseal enlargement), **delayed dentition**, **muscle hypotonia**, and **bowing of long bones** are all direct consequences of impaired calcium and phosphate deposition in growing bones. - This combination represents the most distinctive physical findings used for clinical diagnosis. *Delayed dentition, muscle hypotonia, bowing of long bones* - While these are indeed features of rickets, this option is incomplete as it omits the characteristic **widening of wrists** (epiphyseal enlargement). - Widening of wrists is one of the earliest and most diagnostic clinical signs of active rickets. *Widening of wrists, delayed dentition, muscle hypotonia, bowing of long bones, early fontanelle closure* - This option correctly lists several key features of rickets, but **early fontanelle closure** is incorrect. - Rickets typically causes **delayed fontanelle closure** due to impaired bone mineralization, not early closure. - Early fontanelle closure is associated with conditions like **craniosynostosis**, not rickets. *Growth retardation only* - While **growth retardation** can occur in severe rickets due to impaired bone development, it is too general and non-specific. - Many other conditions can cause growth retardation, and rickets presents with a distinct array of skeletal and muscular symptoms that are far more characteristic.
Question 385: Late metabolic acidosis is seen in-
- A. Term infant given formula feed
- B. Preterm baby getting cow milk (Correct Answer)
- C. Long term breast feeding
- D. None of the options
Explanation: ***Preterm baby getting cow milk*** - **Preterm infants** have immature kidneys with reduced ability to excrete **acidic metabolites**. - **Cow milk-based formulas** have a higher protein and mineral content, leading to a greater **acid load** which can exacerbate the metabolic acidosis in preterm infants. *Term infant given formula feed* - Term infants generally have more mature renal function capable of handling the **acid load** from formula feeding. - While formula feeding can contribute to a higher renal solute load than breast milk, it rarely results in **late metabolic acidosis** in otherwise healthy term infants. *Long term breast feeding* - **Breast milk** has a lower protein content and a more balanced mineral composition, resulting in a significantly lower **renal solute load** and acid load compared to formula. - It is protective against metabolic acidosis and is the preferred feeding method for infants. *None of the options* - This option is incorrect because **preterm infants fed cow milk-based formula** are indeed at risk for late metabolic acidosis due to their immature kidneys and the higher acid load from the formula.
Question 386: Which of the following, if normal, would be most significant in making PEM unlikely?
- A. Lean body mass (Correct Answer)
- B. Serum Potassium
- C. Skin fold thickness
- D. Extracellular fluid (ECF)
Explanation: ***Lean body mass*** - A normal **lean body mass** indicates adequate muscle and organ tissue, which is the primary component affected by **Protein-Energy Malnutrition (PEM)**. - Maintaining normal lean body mass despite potential weight loss makes significant PEM, especially the **marasmic type**, less likely. *Extracellular fluid (ECF)* - **Extracellular fluid (ECF)** can be normal or even increased in cases of **edematous PEM** (kwashiorkor) due to decreased oncotic pressure, making it an unreliable indicator for excluding PEM. - Normal ECF does not rule out the depletion of protein, fat, and muscle mass that characterizes PEM. *Serum Potassium* - **Serum potassium** levels can be normal or abnormal (low or high) in PEM depending on hydration status, renal function, and refeeding syndrome, making it a non-specific indicator for excluding the condition. - It does not directly reflect the overall **nutritional status** or body composition changes seen in PEM. *Skin fold thickness* - **Skin fold thickness** measures subcutaneous fat stores, which can be normal or even preserved in some forms of PEM, particularly **kwashiorkor**, even when severe protein deficiency exists. - While reduced skin fold thickness suggests **marasmus**, a normal value does not conclusively rule out **protein deficiency** or other forms of PEM.
Question 387: 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 388: Which nutrient is most deficient in a child with kwashiorkor?
- A. Protein (Correct Answer)
- B. Iron
- C. Calcium
- D. Vitamin D
Explanation: ***Protein*** - Kwashiorkor is classically defined as **protein deficiency** with relatively adequate calorie intake. - This leads to characteristic symptoms like **edema**, **ascites**, and **muscle wasting**. *Iron* - While **anemia** and iron deficiency can coexist with kwashiorkor, iron is not the primary defining nutritional deficiency. - Iron deficiency typically presents with **pallor**, fatigue, and pica, distinct from the edema seen in kwashiorkor. *Calcium* - **Calcium deficiency** is known to cause conditions like **rickets** (in children) or **osteoporosis** (in adults), affecting bone health. - It does not directly explain the widespread edema and skin changes characteristic of kwashiorkor. *Vitamin D* - **Vitamin D deficiency** primarily affects **bone mineralization**, leading to **rickets** in children and **osteomalacia** in adults. - It is not the main nutrient deficient in kwashiorkor, which is fundamentally a protein deficiency.
Question 389: Fluid of choice for shock in a child with severe acute malnutrition + hypoglycemia
- A. Normal saline
- B. Ringer lactate
- C. 10% dextrose
- D. Ringer lactate + 5% dextrose (Correct Answer)
Explanation: ***Ringer lactate + 5% dextrose*** - This combination provides both **electrolytes** (from Ringer lactate) to help correct **shock** and **glucose** (from 5% dextrose) to address **hypoglycemia** in a child with severe acute malnutrition (SAM). - Patients with SAM are at a high risk of **hypoglycemia** during shock, making glucose supplementation crucial. *Normal saline* - While suitable for initial fluid resuscitation in shock, it does **not contain glucose** and would not address the concomitant hypoglycemia. - Excessive use of normal saline can also lead to **hyperchloremic metabolic acidosis**, which is undesirable in already compromised patients. *Ringer lactate* - Ringer lactate provides **electrolytes** and is a good crystalloid for shock resuscitation, but it **lacks glucose** to correct hypoglycemia. - In SAM patients, where energy stores are depleted, simply providing Ringer lactate might not be sufficient to prevent or treat hypoglycemia. *10% dextrose* - 10% dextrose would effectively treat **hypoglycemia** but is not an appropriate fluid for fluid resuscitation in **shock**. - It would not adequately expand the intravascular volume or provide the necessary electrolytes for managing shock alone.
Question 390: An 8-month-old child was found to have features of vitamin A deficiency. What is the dose of oral vitamin A required?
- A. 50,000 IU
- B. 1,00,000 IU (Correct Answer)
- C. 75,000 IU
- D. 2,00,000 IU
Explanation: ***1,00,000 IU*** - For children aged **6-11 months** with clinical vitamin A deficiency, the recommended dose of oral vitamin A is **1,00,000 IU** (100,000 IU). - An 8-month-old child falls in this age category and requires this specific dose. - This dose is given as part of a **three-dose regimen**: on day 1 (immediately), day 2, and after 2-4 weeks as per **WHO guidelines**. *50,000 IU* - This dose is recommended for **infants less than 6 months** of age with vitamin A deficiency. - Using this dose for an 8-month-old would be **underdosing**, providing inadequate treatment for the deficiency. *75,000 IU* - This is **not a standard dose** for vitamin A supplementation in any age group for deficiency treatment. - Standard WHO guidelines specify 50,000 IU for infants <6 months, 100,000 IU for 6-11 months, and 200,000 IU for children 12-59 months. *2,00,000 IU* - This higher dose is used for children aged **12-59 months** (1-5 years) with vitamin A deficiency. - Administering 200,000 IU to an 8-month-old would be an **overdose**, potentially leading to **acute vitamin A toxicity** with symptoms like bulging fontanelle, vomiting, and irritability.
Practice by Chapter
Breastfeeding
Practice Questions
Infant Formula Feeding
Practice Questions
Complementary Feeding
Practice Questions
Nutritional Requirements by Age
Practice Questions
Malnutrition and Failure to Thrive
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Obesity in Children
Practice Questions
Vitamin Deficiencies
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Mineral Deficiencies
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Food Allergies and Intolerances
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Nutritional Management of Chronic Diseases
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Eating Disorders
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Parenteral and Enteral Nutrition
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