Pediatric Nutrition — MCQs

Pediatric Nutrition Indian Medical PG Practice Questions and MCQs

Question 411: Which of the following is NOT a symptom of Kwashiorkor?

A. Hypertension (Correct Answer)
B. Hair changes and depigmentation
C. Edema
D. Growth retardation

Explanation: ***Hypertension*** - **Hypertension** is generally **NOT a direct symptom** of Kwashiorkor; rather, children with Kwashiorkor often have **low blood pressure** due to overall cardiovascular system depression. - While chronic malnutrition can have various systemic effects, elevated blood pressure is not a characteristic clinical feature of this condition. - This is the correct answer as the question asks what is NOT a symptom. *Hair changes and depigmentation* - This is a **classic symptom** of Kwashiorkor, characterized by sparse, brittle hair that may be discolored (e.g., reddish or yellowish - "flag sign"). - These changes reflect the severe protein deficiency interfering with hair follicle function and melanin production. *Edema* - **Edema**, particularly in the lower extremities and face, is a **hallmark symptom** of Kwashiorkor, caused by severe protein deficiency leading to decreased oncotic pressure. - This results in fluid shifting from the intravascular space into the interstitial space. *Growth retardation* - **Growth retardation** (stunting) is a common and severe symptom of Kwashiorkor, reflecting the long-term impact of inadequate protein and energy intake on physical development. - Both height and weight are significantly below age-appropriate norms.

Question 412: Which of the following statements about the differences between human milk and cow milk is NOT true?

A. Cow milk has comparatively more protein than human milk.
B. Cow milk has comparatively more calcium than human milk.
C. Cow milk has comparatively more casein than human milk.
D. Cow milk has comparatively more fat than human milk. (Correct Answer)

Explanation: ***Cow milk has comparatively more fat than human milk.*** - This statement is **incorrect** and is the answer to this "NOT true" question. Human milk generally has a **higher fat content** (3.5-4.5 g/100mL) than cow milk (~3.5 g/100mL), which is crucial for the rapid neurological development of infants. - The fat in human milk is also more **bioavailable** due to the presence of lipases, aiding digestion and absorption. - Human milk contains essential **long-chain polyunsaturated fatty acids (LCPUFAs)** like DHA and ARA that support brain and retinal development. *Cow milk has comparatively more protein than human milk.* - This statement is **true**. Cow milk contains significantly **more protein** (~3.3 g/100mL) compared to human milk (~1.0 g/100mL), particularly **casein protein**. - While more protein might seem beneficial, the higher protein load in cow milk is harder for an **infant's immature kidneys** to process and increases renal solute load. *Cow milk has comparatively more calcium than human milk.* - This statement is **true**. Cow milk contains approximately **120 mg/100mL calcium** compared to human milk which has about **30 mg/100mL**. - However, the **bioavailability** of calcium and the optimal calcium-to-phosphorus ratio in human milk favor better absorption despite the lower absolute amount. *Cow milk has comparatively more casein than human milk.* - This statement is **true**. Cow milk has a **casein-to-whey ratio of 80:20**, while human milk has a ratio of approximately **40:60** (more whey). - The predominance of whey proteins in human milk makes it easier to digest, forming softer curds in the infant's stomach.

Question 413: Acrodermatitis enteropathica is associated with a deficiency of which of the following?

A. Zinc (Correct Answer)
B. Manganese
C. Copper
D. Selenium

Explanation: ***Zinc*** - Acrodermatitis enteropathica is a rare, inherited metabolic disorder characterized by a **deficiency in zinc absorption** or utilization. - Clinical manifestations include a characteristic **periorificial and acral dermatitis**, alopecia, and diarrhea, all of which respond dramatically to zinc supplementation. *Manganese* - Manganese is a trace element essential for various enzyme functions, but its deficiency does not cause acrodermatitis enteropathica. - Deficiency symptoms include impaired growth, skeletal abnormalities, and reproductive problems. *Copper* - Copper deficiency can lead to anemia, neutropenia, and neurological problems, but it is not associated with acrodermatitis enteropathica. - Conditions like Menkes disease involve problems with copper transport and metabolism. *Selenium* - Selenium deficiency can contribute to Keshan disease (cardiomyopathy) and impaired immune function. - It is not directly linked to the dermatological and gastrointestinal symptoms seen in acrodermatitis enteropathica.

Question 414: In a child having diarrhoea with perianal moist crust, which condition is most likely diagnosed?

A. Acrodermatitis enteropathica (Correct Answer)
B. Pellagra
C. Riboflavin deficiency
D. Kwashiorkor

Explanation: ***Acrodermatitis enteropathica*** - This condition is a **zinc deficiency** syndrome, which can be either inherited or acquired. - It presents with a classic triad of **diarrhoea**, **dermatitis** (often periorificial and acral with moist, crusted lesions), and **alopecia**. - The **perianal moist crust** is a characteristic finding of the periorificial dermatitis seen in this condition. *Pellagra* - Pellagra is caused by **niacin (Vitamin B3) deficiency** and is characterized by the "4 D's": **dermatitis** (often sun-exposed areas), **diarrhoea**, **dementia**, and eventually death. - The dermatitis of pellagra is typically **symmetrical, hyperpigmented, and photosensitive**, not moist perianal crusts, differentiating it from the presented case. *Riboflavin deficiency* - **Riboflavin deficiency** typically manifests as **cheilosis**, angular stomatitis, glossitis, and seborrheic dermatitis, but not specifically perianal moist crusts with diarrhoea. - While it can affect mucous membranes, the specific perianal presentation with diarrhoea points away from this diagnosis. *Kwashiorkor* - **Kwashiorkor** is a form of protein-energy malnutrition that can present with **diarrhoea** and skin changes (flaky paint dermatosis, hypopigmentation). - However, the skin changes are typically **desquamating** and affect dependent areas, not the characteristic **moist, crusted periorificial lesions** seen in zinc deficiency. - Kwashiorkor also typically presents with **edema**, which is not mentioned in this case.

Question 415: What is the minimum weight gain recommended for a malnourished child during the catch-up growth phase of nutritional rehabilitation?

A. 5 gm/kg/day (Correct Answer)
B. 10 gm/kg/day
C. 15 gm/kg/day
D. 20 gm/kg/day

Explanation: ***Correct: 5 gm/kg/day*** - According to **WHO guidelines** for management of severe acute malnutrition and **IAP recommendations**, the **minimum acceptable weight gain** during the catch-up growth phase is **5 gm/kg/day**. - This represents the **threshold for adequate nutritional rehabilitation** - gains below this indicate inadequate recovery and require reassessment of the feeding protocol. - Weight gain of 5 gm/kg/day or more indicates that the child is responding to treatment. *Incorrect: 10 gm/kg/day* - A weight gain of **10 gm/kg/day** represents **good/satisfactory catch-up growth**, not the minimum requirement. - This is considered an **optimal target** rather than the minimum acceptable threshold. - While desirable, the question specifically asks for the minimum recommendation, which is 5 gm/kg/day. *Incorrect: 15 gm/kg/day* - A weight gain of **15 gm/kg/day** reflects **excellent catch-up growth** and is at the higher end of optimal targets. - This exceeds both the minimum requirement and the good target. - While indicating very successful rehabilitation, it is not the minimum recommendation. *Incorrect: 20 gm/kg/day* - A weight gain of **20 gm/kg/day** is an **exceptionally high rate** rarely achieved in clinical practice. - While theoretically possible with intensive feeding protocols, this far exceeds the minimum requirement. - Such high rates may require monitoring for refeeding syndrome and metabolic complications.

Question 416: What is the RDA (Recommended Dietary Allowance) for vitamin A in infants aged 0-6 months?

A. 400 mcg
B. 600 mcg
C. 800 mcg
D. 350 mcg (Correct Answer)

Explanation: ***350 mcg*** - The **Recommended Dietary Allowance (RDA)** for vitamin A in infants aged 0-6 months is specifically set at **350 micrograms (mcg)** of **retinol activity equivalents (RAE)**. - This level is based on the **average vitamin A intake from human milk** during this period, assuming adequate maternal nutrition. *600 mcg* - This value is higher than the recommended intake for infants aged 0-6 months and is closer to the RDA for **older infants** or **young children**. - Excessive vitamin A intake can be **toxic**, making adherence to age-specific RDAs crucial. *800 mcg* - This amount is significantly higher than the RDA for infants 0-6 months and approaches the RDA for **adults**. - Providing such a high dose to an infant could lead to **vitamin A toxicity**, with symptoms including irritability, increased intracranial pressure, and desquamation of the skin. *400 mcg* - While closer to the correct answer, **400 mcg** is still slightly above the established RDA of 350 mcg for this specific age group. - The precise RDA values are determined based on **extensive research** to ensure optimal health outcomes without risk of deficiency or toxicity.

Question 417: A 2-year-old child with a weight of 6.4 kg and vitamin A deficiency has what grade of malnutrition based on the expected weight of 12 kg?

A. First degree
B. Second degree
C. Third degree (Correct Answer)
D. Fourth degree

Explanation: ***Third degree*** - The child's current weight (6.4 kg) is 53.3% of the expected weight (12 kg), calculated as (6.4 / 12) * 100%. - A weight-for-age percentage **below 60%** of expected weight indicates **third-degree malnutrition** (severe malnutrition) using the Gómez classification. - The child's weight at 53.3% clearly falls into this severe malnutrition category. *First degree* - This degree of malnutrition is classified when the child's weight-for-age is between **75% and 90%** of the expected weight (mild malnutrition). - The given child's weight of 53.3% is much lower than this range. *Second degree* - This degree of malnutrition is indicated when the child's weight-for-age is between **60% and 75%** of the expected weight (moderate malnutrition). - The child's weight at 53.3% falls below this threshold. *Fourth degree* - The Gómez classification typically defines three degrees of malnutrition based on percentage of expected weight. - While other classifications exist, "fourth degree" is not standard in the Gómez classification system; such severe cases are generally grouped under **third-degree** or classified as **severe malnutrition**.

Question 418: Osmolarity of ReSoMal is

A. 200
B. 350
C. 300
D. 311 (Correct Answer)

Explanation: **Correct: 311** - The **osmolarity of ReSoMal is 311 mOsm/L**, making it slightly hypertonic but suitable for rehydration in severe malnutrition to minimize fluid shifts. - This specific osmolarity is designed to provide adequate electrolytes and glucose while avoiding the risks of hypotonic or overly hypertonic solutions in malnourished patients. *Incorrect: 200* - An osmolarity of 200 mOsm/L would be considered **hypotonic**, which could lead to shifts of fluid into cells and potentially cause cerebral edema, especially in malnourished individuals. - Such a low osmolarity is not appropriate for rehydration in patients with severe acute malnutrition (SAM) due to the risk of intracellular overhydration. *Incorrect: 300* - While 300 mOsm/L is close to physiological osmolarity, **ReSoMal is specifically formulated with 311 mOsm/L** to optimize rehydration for severely malnourished children. - Solutions around 300 mOsm/L are generally isotonic but lack the precise electrolyte and glucose balance needed for the complex physiological state of severe malnutrition. *Incorrect: 350* - An osmolarity of 350 mOsm/L would be **hypertonic**, meaning it has a higher solute concentration than body fluids. - This could draw water out of cells, leading to dehydration of intracellular compartments and potentially causing hypernatremia or osmotic diuresis, which is not suitable for rehydrating malnourished patients.

Question 419: A 6-month-old infant is exclusively fed on goat's milk. What condition is he most likely to develop?

A. Iron deficiency anemia
B. Anemia of chronic disease
C. Sideroblastic anemia
D. Megaloblastic anemia due to folate deficiency (Correct Answer)

Explanation: ***Megaloblastic anemia due to folate deficiency*** - Goat's milk is **severely deficient in folate (vitamin B9)**, containing <1 μg/100mL compared to the infant requirement of ~50 μg/day - Exclusive goat's milk feeding in infants classically leads to **megaloblastic anemia** due to this folate deficiency, historically known as "goat's milk anemia" - Folate is essential for DNA synthesis and red blood cell maturation; deficiency causes macrocytic anemia with hypersegmented neutrophils - This typically manifests at **4-6 months of age** when maternal folate stores are depleted *Iron deficiency anemia* - While both cow's milk and goat's milk are low in iron, iron deficiency typically develops later (after 6-9 months) - Iron deficiency causes **microcytic** anemia, not the **macrocytic** anemia seen with folate deficiency - Though a concern with goat's milk feeding, **folate deficiency** is the more immediate and specific consequence *Anemia of chronic disease* - This results from underlying chronic inflammatory or infectious conditions affecting iron utilization and erythropoiesis - Nothing in this infant's dietary history suggests chronic inflammation or infection - Not related to nutritional deficiency from goat's milk *Sideroblastic anemia* - Characterized by impaired heme synthesis with ring sideroblasts in bone marrow - Causes include genetic defects, myelodysplastic syndromes, or toxin exposure (lead, alcohol) - Not caused by dietary deficiencies from goat's milk feeding

Question 420: Colostrum contains all of the following in excess of milk, except:

A. Minerals
B. Immunoglobulins
C. Fat (Correct Answer)
D. Protein

Explanation: ***Fat*** - Colostrum has a **lower fat content** compared to mature milk. - While it provides concentrated nutrients in small volumes, its primary immunological role does not rely on high lipid levels, which increase as milk matures. *Protein* - Colostrum is significantly **richer in protein** than mature milk, especially **casein** and **whey proteins**. - These proteins contribute to its nutritional and immunological benefits. *Minerals* - Colostrum contains higher concentrations of several minerals, including **sodium**, **potassium**, **chloride**, and **zinc**, compared to mature milk. - These minerals are crucial for the newborn's initial growth and development. *Immunoglobulins* - Colostrum is often called "liquid gold" due to its extremely high concentration of **immunoglobulins**, particularly **IgA**. - These antibodies provide crucial **passive immunity** to the newborn, protecting against infections.

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

Practice Questions

Obesity in Children

Practice Questions

Vitamin Deficiencies

Practice Questions

Mineral Deficiencies

Practice Questions

Food Allergies and Intolerances

Practice Questions

Nutritional Management of Chronic Diseases

Practice Questions

Eating Disorders

Practice Questions

Parenteral and Enteral Nutrition

Practice Questions

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