Protein Energy Malnutrition MCQs

Discharge criteria for SAM child Child is alert and active , eating atleast 120-130 kcal/kg/day with consistent weight gain of atleast 5g/kg/day on exclusive oral feeding Child is receiving adequate micronutrients Child is free of infections Child has completed immunization appropriate for age The caretaker has been sensitized for home-based care . Tags : Topic : SEVERE ACUTE MALNUTRITION Difficulty level : MUST KNOW PYQ : NEET PG 2021; FMGE JAN 2022; AIIMS JULY 2020; FMGE JUNE 2022 Reference : Ghai's essential pediatrics, 9 th ed., pg. 107

The current subunit Hepatitis B vaccine is derived from surface antigen, i.e., HBsAg. The vaccine is based upon DNA recombinant technology and uses Aluminium as an adjuvant. The hepatitis B vaccine is made by taking the part of the virus that makes surface protein ("surface protein gene") and putting it into yeast cells. The yeast cells then produce many copies of the protein that are subsequently used to make the vaccine. Reference: OP Ghai 10 th Edition, Page 198

The child was having a trigger factor in the form of sore throat & 2 weeks later, she presented with non-blanchable, palpable petechial rash on dependent parts, renal and joint involvement. This translates to a diagnosis of Henoch-Schoenlein Purpura, HSP- Also known as IgA Vasculitis. Management of HSP is Conservative- More than 90% improve in about 4 weeks. Steroids, e.g., Prednisolone are indicated in severe GIT involvement Reference: OP Ghai 10 th Edition, Page 661

Let us evaluate the options sequentially Option A is True: Risk factors for tubercular meningitis include young age, household contact, recent measles and protein-energy malnutrition. Option B is True: As per IAP-NTEP Guidelines and OP Ghai 10 th Edition, ATT comprises 2 months of Intensive therapy + 10 months of Maintenance Therapy. Total Duration of ATT is 12 months Option C is True. Basal cistern exudates are the CT scan hallmark of the disease. Option D is False. Intravenous Dexamethasone is followed by oral steroids for 6-8 weeks to prevent sequelae in most children. Reference: OP Ghai 10 th Edition, Page 586 - 587.

Children with type 1 diabetes mellitus are at increased risk of thyroid disease and should be screened annually. His static height and his lethargy would support this diagnosis. He is also at increased risk of coeliac disease and this should also be considered but is less likely as his appetite is good and his weight is satisfactory. Eating disorders can co-exist with diabetes mellitus but he does not have the clinical features of anorexia nervosa. (Option a) GH deficiency is not an autoimmune problem. Would not explain his lethargy. (Option b) Blood and mucus in the stool would be expected with ulcerative colitis and anorexia and malaise and abnormal full blood count and C-reactive protein would be expected with Crohn's disease. (Option d) TAGS: Topic: DIABETES Difficulty level: GOOD TO KNOW PYQ: NEET PG 2022 Reference: Nelson textbook of pediatrics, 21 st ed., pg. 3022

IgE mediated cow's milk protein allergies have a rapid onset of up to 2 hours after ingestion, whereas non-IgE mediated are more delay and may not present until up to a week after ingestion. Both IgE and non-IgE mediated cow's milk protein allergy can cause pruritis, erythema, and lower respiratory tract infections including wheezing, coughing, and shortness of breath. Loose stools is more characteristic of non-IgE mediated allergies. Tags: Topic: MILK PROTEIN ALLERGY Difficulty level: MAY KNOW Reference: Nelson pediatric symptom-based diagnosis, pg no: 236

Absolute amount of calcium is less in breast milk than animal milk but since the calcium: phosphorous ratio is 2:1, the absorption is better. Key points to note: Vitamins deficient in breast milk: Vit K, Vit D, Vit B1. Mineral deficient in breast milk: Fluoride. Breast milk has more lactose but less fat, protein, and calcium than animal milk. Breast milk is rich in whey protein (better) compared to casein of animal milk. Breast milk also has more taurine and cysteine. Breast milk has more MUFA, PUFA and is especially rich in DHA, i.e. Docosahexaenoic Acid. Reference: Care of Newborn by Meharban Singh, 8 th Edition, Page Number-221.

A school-going-aged boy developing acute nephritic syndrome 2 weeks after a boil (pyoderma) indicates a likely diagnosis of Post-Streptococcal Glomerulonephritis. Kindly note that BP of 120/80 is Hypertension in a 6-year-old boy. Regarding other options Option A- Minimal Change Disease usually does not have gross hematuria & tends to have massive proteinuria (3+ or 4+) Option B- IgA Nephropathy presents with acute nephritic syndrome within 2-6 days of preceding sore throat or pyoderma, not 2 weeks after. Option D- HSP nephritis will also have palpable purpura, joint involvement with GIT manifestations and since these are not mentioned, unlikely to be the answer here. Reference: OP Ghai 10 th Edition Pages 496-497