Pediatric Nutrition Practice Questions

Q: Which of the following is NOT a feature of scurvy?

Metaphyseal widening. **Explanation:** Scurvy is caused by a deficiency of **Vitamin C (Ascorbic Acid)**, which is essential for collagen synthesis. In the skeletal system, this leads to defective osteoid formation. While the calcification of cartilage continues, the failure to form bone matrix results in specific radiological signs. **Why "Metaphyseal Widening" is the correct answer:** Metaphyseal widening (cupping and splaying) is a hallmark feature of **Rickets**, not Scurvy. In Scurvy, the metaphysis actually becomes fragile and thin (the "Trummerfeld zone" or zone of rarefaction), rather than widening. **Analysis of Incorrect Options:** * **Bony Thickening:** This refers to the **subperiosteal hemorrhage** characteristic of Scurvy. As the hemorrhage heals, the periosteum is lifted and new bone forms, leading to apparent thickening of the bone shaft. * **Epiphyseal Separation:** Due to the extreme fragility of the scorbutic zone (Trummerfeld zone) at the metaphysis, the epiphysis can easily displace or separate, often presenting as a "pseudo-paralysis." * **Dense Margin at Metaphysis:** Also known as the **Frankel Line**, this represents a zone of well-calcified cartilage that appears radiopaque (dense) because it hasn't been converted into bone. **High-Yield Clinical Pearls for NEET-PG:** * **Wimberger’s Sign:** A sharp, sclerotic margin surrounding a lucent center in the epiphysis (Ring sign). * **Pelkan Spur:** Marginal spurring at the metaphysis due to outward healing of subperiosteal hemorrhage. * **Clinical Triad:** Irritability (due to bone pain), Gingival bleeding, and Follicular hyperkeratosis (corkscrew hair). * **Key Differentiator:** Scurvy presents with **exquisite bone pain/tenderness**, whereas Rickets typically does not.

Q: A six-month-old infant, exclusively fed cow's milk, presents with petechiae, anemia, fever, and generalized tenderness. Examination reveals bilateral lower extremity swelling and a normal blood count. What is the most likely diagnosis?

Scurvy. ### Explanation **Correct Answer: D. Scurvy** The clinical presentation is classic for **Infantile Scurvy (Barlow’s Disease)**, caused by Vitamin C deficiency. * **Pathophysiology:** Vitamin C is essential for collagen synthesis. Deficiency leads to capillary fragility (causing **petechiae** and subperiosteal hemorrhages) and defective osteoid formation. * **Key Clues:** The infant is fed **exclusive cow’s milk**; boiling cow's milk destroys the heat-labile Vitamin C. * **Clinical Signs:** **Generalized tenderness** (pseudoparalysis) and lower extremity swelling occur due to painful **subperiosteal hemorrhages**. Fever and anemia are common systemic associations. **Why Incorrect Options are Wrong:** * **A. Arthritis:** While it causes swelling and pain, it typically involves the joint space rather than the bone shafts, and wouldn't explain petechiae or the specific dietary history. * **B. Poliomyelitis:** Presents with asymmetric flaccid paralysis and absent deep tendon reflexes, but it is **painless** and does not cause swelling or petechiae. * **C. Osteomyelitis:** While it causes fever and bone pain, it is usually localized to a single bone and would typically show an elevated WBC count (this patient has a normal blood count). **High-Yield NEET-PG Pearls for Scurvy:** 1. **Radiological Signs:** * **Frankel’s Line:** Dense zone of provisional calcification. * **Wimberger’s Ring Sign:** Circular opacification around the epiphysis. * **Pelkan Spur:** Marginal spurring. * **Trummerfeld Zone:** Lucent scorbutic zone (site of fractures). 2. **First Sign:** Irritability and generalized tenderness (pseudoparalysis). 3. **Gingival Changes:** Spongy, bleeding gums (only seen if teeth have erupted).

Q: What is the daily water requirement for a child weighing 30 kg, with a height of 123 cm and a Body Surface Area (BSA) of 1 m 2?

1700 ml. The daily water requirement for a pediatric patient can be calculated using two primary methods: the **Holliday-Segar Formula** (based on weight) and the **Body Surface Area (BSA) Method**. ### 1. Why 1700 ml is Correct While the Holliday-Segar formula is common for bedside maintenance, the **BSA method** is often considered more accurate for children over 10 kg as it better reflects metabolic demands and insensible water loss. * **Standard Rule:** Maintenance fluid requirement is **1500 ml/m²/day**. * **Calculation:** $1500 \text{ ml} \times 1 \text{ m}^2 (\text{BSA}) = 1500 \text{ ml}$. * **Adjusting for Activity/Growth:** In a stable but non-resting child, requirements typically range between **1500–1800 ml/m²/day**. Given the options, **1700 ml** is the most clinically appropriate estimate for a child of this size. ### 2. Analysis of Incorrect Options * **A. 1300 ml:** This is an underestimate. Using the Holliday-Segar formula ($1000 + 50 \times [30-20] = 1500 \text{ ml}$), even the minimum weight-based requirement is higher than this. * **C. 2000 ml:** This exceeds maintenance needs ($2000 \text{ ml/m}^2$) and is usually reserved for patients requiring hyperhydration (e.g., tumor lysis syndrome or sickle cell crisis). * **D. 2500 ml:** This represents significant over-hydration for a 30 kg child and risks fluid overload and hyponatremia. ### 3. High-Yield Clinical Pearls for NEET-PG * **Holliday-Segar Shortcut (100-50-20 Rule):** * 0–10 kg: 100 ml/kg * 11–20 kg: 1000 ml + 50 ml/kg for every kg >10 * >20 kg: 1500 ml + 20 ml/kg for every kg >20 * **Insensible Water Loss:** Approximately **400 ml/m²/day**. * **The "4-2-1" Rule:** Used for hourly maintenance rates (4 ml/kg for first 10kg, 2 ml/kg for next 10kg, 1 ml/kg thereafter). For this child: $40+20+10 = 70 \text{ ml/hr}$ ($\approx 1680 \text{ ml/day}$).

Q: In rickets, which of the following is typically NOT seen?

Increased acid phosphatase. In rickets, the fundamental pathology is a failure of mineralization of the osteoid matrix, usually due to Vitamin D deficiency. **Explanation of the Correct Answer:** * **B. Increased acid phosphatase:** This is the correct answer because acid phosphatase is a marker of **prostate tissue** or **lysosomal activity** (often elevated in Gaucher’s disease or prostatic carcinoma). It has no diagnostic role in rickets. In contrast, rickets is characterized by an increase in **Alkaline Phosphatase (ALP)**, which reflects compensatory osteoblastic activity attempting to mineralize the deficient bone matrix. **Explanation of Incorrect Options:** * **A. Craniotabes:** This is one of the earliest clinical signs of rickets (seen in infants <6 months). It refers to the softening of the skull bones, giving a "ping-pong ball" sensation upon pressure over the occipital or parietal bones. * **C. Bow legs (Genu Varum):** As the child begins to bear weight, the softened, unmineralized long bones of the lower limbs bend under gravity, leading to classic deformities like bow legs. * **D. Increased alkaline phosphatase:** This is the **earliest biochemical marker** of rickets. As osteoblasts work harder to lay down bone in a low-calcium/phosphate environment, they release high amounts of ALP into the serum. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Craniotabes (Clinical); Increased ALP (Biochemical); Cupping/Splaying of metaphysis (Radiological). * **Harrison’s Groove:** A horizontal depression along the lower border of the chest due to the pull of the diaphragm on soft ribs. * **Rachitic Rosary:** Palpable (and visible) enlargement of the costochondral junctions. * **Biochemical Profile:** Low/Normal Calcium, Low Phosphate, **High ALP**, and High PTH (Secondary Hyperparathyroidism).

Q: Which of the following is true about Vitamin D deficiency rickets?

X-ray of the knee joint is diagnostic. **Explanation:** **Vitamin D deficiency rickets** is a metabolic bone disease characterized by the failure of osteoid mineralization at the growth plates. **Why Option B is Correct:** Radiology is the gold standard for diagnosing rickets. An **X-ray of the knee joint** (specifically the distal femur and proximal tibia/fibula) or the **wrist** (distal radius/ulna) is diagnostic because these are areas of rapid bone growth. Classic findings include **cupping, fraying, and splaying** of the metaphysis, along with widening of the growth plate. **Why Other Options are Incorrect:** * **Option A:** The therapeutic dose of Vitamin D3 is **3,000–6,000 IU/day** (or a single "Stoss" dose of 3–6 lakh IU). 50–150 mg is a massive overdose; 1 mg of Vitamin D equals 40,000 IU. * **Option C:** The **Rickety Rosary** (prominence of costochondral junctions) is **non-tender**. In contrast, the "Scorbutic Rosary" seen in Vitamin D deficiency (Scurvy) is typically tender and angular. * **Option D:** While Vitamin D has immunomodulatory roles, **increased respiratory tract infections** are more classically and strongly associated with **Vitamin A deficiency** (due to squamous metaplasia of respiratory epithelium). **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign:** Craniotabes (softening of skull bones) is the earliest clinical sign, usually seen in infants <6 months. * **Biochemical Profile:** Low/Normal Calcium, **Low Phosphate**, and **Elevated Alkaline Phosphatase (ALP)**. Elevated ALP is the most sensitive biochemical marker for monitoring treatment response. * **Harrison’s Sulcus:** A groove along the lower border of the thorax caused by the pull of the diaphragm on soft ribs.

Q: Which of the following conditions can occur in an exclusively breastfed baby?

Jaundice. ### Explanation **Correct Option: A. Jaundice** Exclusively breastfed infants are prone to two types of jaundice: 1. **Breastfeeding Jaundice (Early onset):** Occurs in the first week of life due to inadequate milk intake, leading to dehydration and increased enterohepatic circulation of bilirubin. 2. **Breast Milk Jaundice (Late onset):** Occurs after the first week (peaks at 2 weeks). It is attributed to substances in breast milk (like $\beta$-glucuronidase or pregnane-3$\alpha$, 20$\beta$-diol) that inhibit bilirubin conjugation or increase its reabsorption. **Why Incorrect Options are Wrong:** * **B. Scurvy:** Breast milk is a rich source of Vitamin C. Scurvy (Vitamin C deficiency) is typically seen in infants fed exclusively on boiled cow’s milk, as heat destroys the vitamin. * **C. Tetany:** Breast milk has an ideal Calcium to Phosphorus ratio (2:1). Tetany (hypocalcemia) is more common in infants fed cow’s milk, which has a high phosphorus load that leads to hyperphosphatemia and secondary hypocalcemia. * **D. Eczema:** Breast milk contains secretory IgA and immunomodulators that provide a protective effect against atopy and allergic conditions like eczema. Exclusive breastfeeding is recommended to *prevent* early-onset allergic diseases. **High-Yield Clinical Pearls for NEET-PG:** * **Vitamin Supplementation:** Breast milk is deficient in **Vitamin D** and **Vitamin K**. All exclusively breastfed infants should receive Vitamin D (400 IU/day) from birth. * **Iron:** While breast milk has low iron content, its **bioavailability** is very high (50%) compared to cow’s milk (10%). * **Breast Milk Jaundice:** Treatment usually involves continuing breastfeeding; interruption is rarely necessary unless bilirubin levels exceed 20 mg/dL.

Question 1

Which of the following is NOT a feature of scurvy?

Accepted Answer

Metaphyseal widening

Answer

Bony thickening

Answer

Epiphyseal separation

Answer

Dense margin at metaphysis

Question 2

A 15-month-old child is feeding on cow milk mixed with water. The child presents with severe wasting, bipedal edema, and poor appetite. What is the most likely diagnosis?

Accepted Answer

Kwashiorkor

Answer

Marasmus

Answer

Kwashiorkor and Marasmus

Answer

None of the above

Question 3

Which of the following is not a parameter for the WHO classification of malnutrition?

Accepted Answer

Weight for age

Answer

Symmetrical edema

Answer

Weight for height

Answer

Height for age

Question 4

A six-month-old infant, exclusively fed cow's milk, presents with petechiae, anemia, fever, and generalized tenderness. Examination reveals bilateral lower extremity swelling and a normal blood count. What is the most likely diagnosis?

Accepted Answer

Scurvy

Answer

Arthritis

Answer

Poliomyelitis

Answer

Osteomyelitis

Question 5

What is the daily water requirement for a child weighing 30 kg, with a height of 123 cm and a Body Surface Area (BSA) of 1 m
2?

Accepted Answer

1700 ml

Answer

1300 ml

Answer

2000 ml

Answer

2500 ml

Question 6

In rickets, which of the following is typically NOT seen?

Accepted Answer

Increased acid phosphatase

Answer

Craniotabes

Answer

Bow legs

Answer

Increased alkaline phosphatase

Question 7

What advice would you give to a mother with a protein allergy who wishes to breastfeed her infant?

Accepted Answer

Reassure her that breastfeeding will not transmit the allergy to the infant.

Answer

Advise her to consult her primary health care provider for guidance.

Answer

Recommend using formula milk to prevent potential allergies.

Answer

Suggest alternating between breast milk and formula to minimize allergen exposure.

Question 8

Which of the following is true about Vitamin D deficiency rickets?

Accepted Answer

X-ray of the knee joint is diagnostic

Answer

Vitamin D3 given at a dose of 50–150 mg/day

Answer

Rickety rosary is tender

Answer

Increased chances of respiratory tract infection

Question 9

Which of the following conditions can occur in an exclusively breastfed baby?

Accepted Answer

Jaundice

Answer

Scurvy

Answer

Tetany

Answer

Eczema

Question 10

Breastfeeding is not contraindicated in which of the following maternal conditions?

Accepted Answer

Mother has hepatitis B infection

Answer

Mother has active herpes infection on the breast

Answer

Mother has active tuberculosis

Answer

Mother is on chemoprophylaxis for leukemia

Pediatric Nutrition — MCQs

Pediatric Nutrition — MCQs

On this page

Practice by Chapter

Want unlimited practice?