Growth/Development — MCQs

Q: A laborer's younger child is brought to the OPD with a swollen belly and dull face. He has been fed rice water (rice milk) in his diet mostly. On investigations, the child is found to have low serum protein and low albumin. What is the probable diagnosis?

Kwashiorkor. ***Kwashiorkor*** - The symptoms of a **swollen belly** (due to **edema** from low albumin), **dull face**, and a diet primarily of **rice water** (low in protein) are classic signs of Kwashiorkor. - Kwashiorkor is a form of severe protein-energy malnutrition characterized by **protein deficiency** that is greater than the calorie deficit, leading to **hypoalbuminemia** and fluid retention. - The **dietary history** of rice water (carbohydrate-rich but protein-poor) is the key distinguishing feature. *Kawasaki disease* - This is an **acute vasculitis** primarily affecting young children, presenting with fever, rash, conjunctivitis, mouth changes, and lymphadenopathy. - It does not involve a swollen belly or dull face as primary symptoms, nor is it linked to dietary protein deficiency. *Marasmus* - Marasmus is a form of severe malnutrition characterized by an **overall deficiency of calories** and nutrients, resulting in severe **wasting** of muscle and fat. - While it involves low weight and energy deficit, the prominent **edema** (swollen belly) seen in this case points away from marasmus. *Indian childhood cirrhosis* - This is a rare, **fatal liver disease** in young children, often characterized by jaundice, hepatosplenomegaly, and liver failure. - It is not primarily caused by protein deficiency and its symptoms are distinct from the presentation described. *Nephrotic syndrome* - While nephrotic syndrome also presents with **hypoalbuminemia and edema**, it would show **proteinuria** (>3.5 g/day), hyperlipidemia, and lipiduria on urinalysis. - The **dietary history** and absence of urinary findings distinguish kwashiorkor from nephrotic syndrome.

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