Nutritional Deficiency Disorders Questions and Answers

Answer: B

Hidden hunger refers to micronutrient deficiency.

Hidden hunger is a lack of vitamins and minerals, such as iron, iodine, vitamin A, zinc and folate, in people who may be eating enough calories. It is called hidden because there may be no visible signs until the deficiency is severe, yet it impairs growth, immunity and cognitive development.

Calcium and iron are single micronutrients, so each names only one part of the problem. Macronutrient (energy and protein) deficiency is the visible undernutrition of marasmus and kwashiorkor, the opposite of hidden hunger.

Answer: C

The manifestations are 1 and 3: general pallor and paleness of nail beds and soft palate.

Iron deficiency anaemia lowers haemoglobin, so the skin and mucous membranes look pale. Pallor is looked for in the conjunctiva, tongue, palms, nail beds and soft palate. Other features include tiredness, breathlessness on exertion, spoon-shaped nails (koilonychia) and, in children, poor attention and learning.

Red discoloration of the conjunctiva is the opposite of what anaemia produces: the conjunctiva becomes pale. High attention span and memory are also the opposite of the reduced attention seen in anaemic children. So every option including 2 or 4 is wrong.

Answer: A

The terms are marasmus, kwashiorkor.

Marasmus results from severe deficiency of both energy and protein, usually in infants: the child is extremely wasted, with loss of muscle and fat, an 'old man' face and no oedema. Kwashiorkor results mainly from protein deficiency with relatively adequate energy: the child has oedema, skin and hair changes, an enlarged fatty liver and apathy.

Reversing the two terms gives the third option. Anaemia is a reduction in haemoglobin, commonly from iron deficiency, not a form of protein-energy malnutrition, so the options naming it are wrong.

Answer: B

The keyed answer is Lachrymal xerosis.

Xerophthalmia covers the eye changes caused by vitamin A deficiency. The WHO classification lists night blindness, conjunctival xerosis, Bitot's spots, corneal xerosis, corneal ulceration with keratomalacia, corneal scars and xerophthalmic fundus, which is the retinal change.

Conjunctival and corneal xerosis are stages of that scheme, and the retinal change is its xerophthalmic fundus, so the options naming them fit. Dryness of the lachrymal (tear) gland is not a stage in that list, so it is the one that does not fall under xerophthalmia. The term 'retinal xerosis' is not a standard name, which makes it the near-miss option.

Answer: B

The underlying cause is malnutrition.

WHO and UNICEF estimate that undernutrition is the underlying cause in about half of all deaths of children under five. A malnourished child has weaker immunity, so common illnesses such as diarrhoea, pneumonia and measles become far more often fatal.

Measles is one of the diseases that kill malnourished children, but it is not behind half of all deaths. Smallpox was eradicated in 1980, and HIV/AIDS accounts for a small share of under-five deaths in India.

Answer: A

The correct matching is 1-d, 2-a, 3-b, 4-c.

The WHO classification of xerophthalmia, the eye signs of vitamin A deficiency, uses these codes:

• XN: night blindness, the earliest sign (1-d).
• X1A: conjunctival xerosis, a dry, wrinkled conjunctiva (2-a).
• X1B: Bitot's spots, foamy grey patches on the conjunctiva (3-b).
• X2: corneal xerosis, a dry, hazy cornea (4-c).

The more severe stages X3A and X3B are corneal ulceration and keratomalacia. Every other option misplaces night blindness or swaps the conjunctival and corneal codes.

Answer: C

The correct matching is i-c, ii-d, iii-b, iv-a.

• Vitamin A deficiency causes night blindness (c).
• Riboflavin (vitamin B2) deficiency causes glossitis, angular stomatitis and cheilosis (d).
• Cyanocobalamin (vitamin B12) deficiency causes pernicious anaemia (b).
• Niacin deficiency causes pellagra (a).

The last option has the first two pairs right but swaps B12 and niacin, giving pellagra to B12, which is the trap.

Answer: D

A non-pregnant woman's haemoglobin should be ≥ 12 g/dl.

The WHO cut-offs for anaemia are a haemoglobin level below 12 g/dl in non-pregnant women, below 11 g/dl in pregnant women and below 13 g/dl in adult men. A non-pregnant woman with 12 g/dl or more is therefore not anaemic.

11 g/dl is the threshold for pregnancy, which is lower because blood volume expands and dilutes the haemoglobin. 9 and 10 g/dl fall in the range of moderate anaemia, so they cannot be the normal level.

Answer: A

Niacin deficiency leads to pellagra.

Pellagra is known by the three Ds: dermatitis on sun-exposed skin, diarrhoea and dementia, and if untreated a fourth D, death. It is seen in people whose staple is maize, which is poor in available niacin and in tryptophan, from which the body can make niacin.

Beriberi is caused by thiamine (vitamin B1) deficiency, scurvy by vitamin C deficiency, and xerosis (dryness of the conjunctiva and cornea) by vitamin A deficiency.

Answer: C

The diet should be rich in iron and vitamin C.

Iron is needed to make haemoglobin. Most dietary iron in Indian diets is non-haem iron from plant foods, which is poorly absorbed. Vitamin C (ascorbic acid) converts it into a form the intestine absorbs much better, so foods such as amla, citrus fruits and guava eaten with iron-rich meals increase the iron the body actually takes up.

Folic acid is important in nutritional anaemia, but it treats megaloblastic anaemia, not iron absorption. Vitamins A and D do not have this direct role.