Pediatric Nutrition Practice Questions

Q: Which of the following is an absolute contraindication for breastfeeding?

Galactosemia in infant. ***Galactosemia in infant***- **Galactosemia** is an absolute contraindication as the infant lacks the enzyme needed to metabolize **galactose** found in breast milk (**lactose**).- Ingestion of breast milk leads to the accumulation of toxic metabolites, potentially causing **liver failure**, **cataracts**, and **developmental delay**.*HIV positive mother*- In resource-rich settings, **HIV** is generally considered a contraindication, but it is not universally absolute; in low-resource settings, exclusive breastfeeding might be recommended if formula feeding is unsafe.- Effective maternal **Antiretroviral Therapy (ART)** significantly reduces the risk of transmission via breast milk, making it a relative risk based on local context and ART adherence.*Hepatitis C in mother*- **Hepatitis C virus (HCV)** is generally **not transmitted** through breast milk, and breastfeeding is usually considered safe.- Breastfeeding is only cautioned against if the mother has **bleeding or fissured nipples**, which could theoretically allow blood-borne virus transmission.*Tuberculosis in mother*- Mothers with routine, **active pulmonary TB** can breastfeed if they are on appropriate treatment and wear a mask, as the bacteria is rarely excreted in milk.- If the mother has newly diagnosed, **untreated active TB**, temporary separation and feeding expressed milk may be necessary until she is non-infectious, but breastfeeding is not permanently contraindicated.

Q: An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

100,000 IU. ***100,000 IU*** - This is the correct **single dose per day** of Vitamin A for infants aged 6 to 11 months in the therapeutic regimen for Vitamin A deficiency or measles. - According to **WHO guidelines**, the therapeutic protocol for this age group involves administering **100,000 IU on Day 1** and **100,000 IU on Day 2** (and a third dose on Day 14 for severe deficiency). - This dose is both safe and effective for treating deficiency in this specific age group. *25,000 IU* - This dose is significantly lower than the recommended therapeutic level for infants 6-11 months and would be **ineffective** for treating Vitamin A deficiency. - Doses of this magnitude are not part of standardized WHO supplementation protocols for this age group. *50,000 IU* - This is the standard single dose recommended for **infants under 6 months** of age (1-5 months) for both prophylactic and therapeutic purposes. - For an 8-month-old infant (6–11 months age group), 50,000 IU is **insufficient** for effective therapeutic intervention. *200,000 IU* - This is the standard single dose for **children aged 12 months to 5 years** for routine supplementation. - Giving 200,000 IU as a single dose to an 8-month-old infant carries significant risk of **acute hypervitaminosis A toxicity** including symptoms such as bulging fontanelle, nausea, vomiting, and headache.

Q: A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?

Within 1 hour. ***Within 1 hour***- The World Health Organization (WHO) and UNICEF strongly recommend initiating breastfeeding within the **first hour** of birth, often termed **early initiation**.- This practice stimulates early **suckling reflexes**, encourages bonding, and ensures the baby receives **colostrum**, which is rich in antibodies.*After 1 hour*- While better than waiting several hours, delaying beyond the first hour can miss the infant's period of **quiet alertness** immediately post-delivery, when they are most receptive to suckling.- The first hour is critical for the establishment of a successful maternal-infant bond and **optimal milk production signaling**.*After 4-6 hours*- Delaying breastfeeding significantly reduces the likelihood of successful **exclusive breastfeeding** later on, as the infant may become sleepy or less keen to latch.- Waiting this long deprives the newborn of the crucial **colostrum** and its protective immunological and nutritional benefits during a vulnerable period.*After 24 hours*- This is considered a significant and unnecessary delay, which greatly increases the risk of **neonatal hypothermia, hypoglycemia**, and poor feeding outcomes.- It is strictly against standard guidelines and often necessitates artificial formula supplementation, undermining the goal of achieving **exclusive breastfeeding**.

Q: Which of the following is not true regarding Marasmus in a child?

Protein loss is responsible for edema in this patient. ***Protein loss is responsible for edema in this patient*** - This statement is **false** because **marasmus** is primarily a **caloric-energy** deficiency, leading to severe wasting and **no edema**. - Edema is the characteristic feature of **Kwashiorkor**, which is primarily due to protein deficiency/loss, leading to decreased oncotic pressure. *Seen due to carbohydrate (caloric) deficiency* - Marasmus results from a severe deficiency of **calories** (energy), often due to inadequate intake of **carbohydrates** and fats. - This leads to the body breaking down its own stores, including muscle and fat, for energy. *Child appears emaciated with loss of subcutaneous fat* - The child with marasmus appears severely wasted, or **emaciated** (looks like 'an old man/woman' or 'skin and bones'). - There is visible loss of **subcutaneous fat** (pinching a fold of skin feels loose, without the layer of fat underneath). *Weight-for-age is less than 60% of expected* - Marasmus is a severe form of Protein Energy Malnutrition (PEM), traditionally documented when the **weight-for-age** is less than **60%** of the expected weight (compared to the standard reference). - The **Gomez classification** uses <60% weight-for-age to define **grade III** (severe) malnutrition, which corresponds to marasmus.

Q: Which of the following is/are incorrect regarding breastfeeding technique? 1. Infant's chin should be touching the breast 2. Infant's lower lip should be inverted during latching to the breast 3. A greater part of areola above the breast should be covered than below 4. Infant's cheeks should appear full during effective sucking.

2 & 3. **Correct Answer: 2 & 3** Statements 2 and 3 describe **incorrect breastfeeding techniques**: ***Statement 2 (Incorrect)*** - The infant's lower lip should be **everted (rolled outward)**, not inverted - Proper latching requires lips to be wide open, resembling a 'fish mouth' - An inverted lower lip indicates **poor latch** and inadequate breast tissue in the mouth ***Statement 3 (Incorrect)*** - A **greater part of the areola below** the nipple should be covered, not above - This ensures the nipple points toward the roof of the mouth - Asymmetric latch with more lower areola covered is essential for effective milk transfer *Statement 1 (Correct)* - Infant's chin touching the breast is a sign of **proper positioning** - Helps achieve a deep latch and facilitates swallowing - Slightly extends the neck for optimal sucking mechanics *Statement 4 (Correct)* - **Full cheeks** during sucking indicate effective milk transfer - Shows proper seal of lips around the breast - Dimpled or hollow cheeks suggest **ineffective suction** or poor latch *Why other options are incorrect:* - **1 & 4**: Both are correct breastfeeding techniques - **2, 3 & 4**: Incorrectly includes statement 4, which describes proper technique - **1, 2, 3 & 4**: Incorrectly includes statements 1 and 4, which are both correct

Q: A child is brought from a rural village with complaints of dry skin as shown in the image. Which vitamin deficiency is anticipated?

Vitamin A deficiency. ***Vitamin A deficiency*** - **Xerosis cutis**, or dry, scaly skin, is a common dermatological manifestation of **vitamin A deficiency**, especially in children from rural areas where dietary intake might be suboptimal. - Severe vitamin A deficiency can lead to **follicular hyperkeratosis** (phrynoderma or "toad skin"), where hair follicles become prominent and hyperkeratotic, resembling the appearance shown in the image. *Vitamin B2 deficiency* - **Vitamin B2 (riboflavin) deficiency** primarily manifests as **cheilosis** (cracks at the corners of the mouth), **angular stomatitis**, and **glossitis**. - While it can cause some skin changes, it typically does not present with widespread severe dry, scaly skin or follicular hyperkeratosis. *Vitamin E deficiency* - **Vitamin E deficiency** is rare and usually associated with neurological symptoms like **ataxia** and **peripheral neuropathy**, as it is an antioxidant crucial for nerve function. - It does not typically cause dry skin or specific dermatological lesions like those seen in the image. *Vitamin B6 deficiency* - **Vitamin B6 (pyridoxine) deficiency** can cause **seborrheic dermatitis-like rash**, which is characterized by red, greasy, scaly patches, often on the face and scalp. - This presentation is distinct from the generalized dry, scaly skin and follicular hyperkeratosis seen in the image.

Q: The following image shows the presence of?

Harrison sulcus. ***Harrison sulcus*** - The image clearly shows a **horizontal groove** along the lower border of the thorax, corresponding to the attachment of the diaphragm, which is characteristic of **Harrison sulcus**. - This finding is typically associated with **rickets** or other conditions causing chronic inspiratory effort, leading to the inward pulling of the ribs. *Pectus excavatum* - **Pectus excavatum** is characterized by a **caved-in or sunken appearance of the sternum**, which is not depicted in the image. - The chest wall in the image shows a horizontal indentation, not a sternal depression. *Rachitic rosary* - **Rachitic rosary** presents as visible or palpable **swellings at the costochondral junctions**, resembling beads. - While rickets could be a cause of the depicted finding, the image specifically highlights a sulcus and not the characteristic bead-like prominences of a rachitic rosary. *Kyphoscoliosis* - **Kyphoscoliosis** involves an **abnormal curvature of the spine** in both the sagittal (kyphosis) and coronal (scoliosis) planes. - The image focuses on the anterior chest wall and does not provide views of the spine to assess for kyphoscoliosis.

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.

Question 1

Which of the following is an absolute contraindication for breastfeeding?

Accepted Answer

Galactosemia in infant

Answer

HIV positive mother

Answer

Tuberculosis in mother

Answer

Hepatitis C in mother

Question 2

An 8-month-old infant is being treated with vitamin A supplementation over 2 consecutive days for Vitamin A deficiency. What is the recommended dose to be given each day?

Accepted Answer

100,000 IU

Answer

25,000 IU

Answer

50,000 IU

Answer

200,000 IU

Question 3

A primigravida delivers a healthy baby via normal delivery. After how many hours should she initiate breastfeeding?

Accepted Answer

Within 1 hour

Answer

After 24 hours

Answer

After 4-6 hours

Answer

After 1 hour

Question 4

Which of the following is not true regarding Marasmus in a child?

Accepted Answer

Protein loss is responsible for edema in this patient

Answer

Weight-for-age is less than 60 % of expected

Answer

Seen due to carbohydrate (caloric) deficiency

Answer

Child appears emaciated with loss of subcutaneous fat

Question 5

Which of the following is/are incorrect regarding breastfeeding technique? 1. Infant's chin should be touching the breast 2. Infant's lower lip should be inverted during latching to the breast 3. A greater part of areola above the breast should be covered than below 4. Infant's cheeks should appear full during effective sucking.

Accepted Answer

2 & 3

Answer

1 & 4

Answer

2, 3 & 4

Answer

1, 2, 3 & 4

Question 6

A child is brought from a rural village with complaints of dry skin as shown in the image. Which vitamin deficiency is anticipated?

Accepted Answer

Vitamin A deficiency

Answer

Vitamin B2 deficiency

Answer

Vitamin E deficiency

Answer

Vitamin B6 deficiency

Question 7

The following image shows the presence of?

Accepted Answer

Harrison sulcus

Answer

Pectus excavatum

Answer

Rachitic rosary

Answer

Kyphoscoliosis

Question 8

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 9

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 10

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

Pediatric Nutrition — MCQs

Pediatric Nutrition — MCQs

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