Nutritional Deficiency Disorders Questions and Answers

Answer: C

The effects are mental retardation and congenital abnormalities of the foetus.

Iodine is needed to make thyroid hormones, which are essential for the development of the foetal brain and nervous system. Severe iodine deficiency in pregnancy can cause miscarriage, stillbirth, congenital abnormalities and cretinism, with mental retardation, deafness and stunted growth in the child.

The options placing the mental retardation or congenital abnormalities in the pregnant woman are wrong: a congenital abnormality is one present from birth, and these effects fall on the developing child, while the mother may develop goitre.

Answer: A

The keyed answer is essential fatty acids.

Phrynoderma, or 'toad skin', is a follicular hyperkeratosis: rough, horny papules around the hair follicles of the elbows, knees and buttocks. It was first linked to vitamin A deficiency, but Indian studies found that it often cleared with essential fatty acids (as in safflower oil) and B-complex vitamins, and Indian nutrition textbooks list it as a sign of essential fatty acid deficiency. Vitamin A is not among the options.

Thiamin deficiency causes beriberi, vitamin C deficiency scurvy, and vitamin D deficiency rickets and osteomalacia, none of which produces phrynoderma.

Answer: A

Marasmus is a form of adapted starvation.

In marasmus the body has adapted to a long-term shortage of energy and protein: it burns its fat stores and wastes its muscles to keep vital functions going, so the child is extremely thin but without oedema, and liver function and serum proteins are relatively preserved. Kwashiorkor, by contrast, is described as non-adapted (dysadaptive) starvation, with oedema and a fatty liver.

Mixed malnutrition is marasmic kwashiorkor, and 'severe undernutrition' is the broad category that includes both forms rather than what distinguishes marasmus.

Answer: A

Wernicke's encephalopathy is seen in alcoholics.

It is an acute brain disorder caused by deficiency of thiamine (vitamin B₁), marked by confusion, eye-movement paralysis and an unsteady gait. Chronic alcoholics are the classic group affected, because alcohol displaces food, reduces thiamine absorption and impairs its storage.

Cirrhosis, jaundice and peptic ulcer are diseases of the liver and gut. Cirrhosis can follow heavy drinking too, but it is a consequence for the liver, not the population in which the encephalopathy is described.

Answer: D

Of the four, the goitrogen is radish.

Goitrogens are substances that interfere with the uptake of iodine by the thyroid or with the making of thyroid hormone. Radish belongs to the cruciferous (cabbage) family, along with cabbage, cauliflower, turnip and mustard, whose glucosinolates release thiocyanates that compete with iodide. Eaten in large amounts on an iodine-poor diet, they can contribute to goitre.

Spinach, lentils and fish are not classed as goitrogens; fish, being a sea food, is actually a good source of iodine.

Answer: D

Keratomalacia leads to melting and wasting of the cornea.

Keratomalacia is the most severe stage of vitamin A deficiency in the eye (xerophthalmia). The cornea softens and ulcerates, and may liquefy and perforate, causing permanent blindness.

Night blindness, conjunctival xerosis and Bitot's spots are earlier stages of the same deficiency that come before keratomalacia; they are not what it leads to.

Answer: B

The clinical approach is iron supplementation.

Iron supplementation gives iron (often with folic acid) as tablets or syrup to individuals or vulnerable groups, such as pregnant women, adolescent girls and young children under Anemia Mukt Bharat. It acts directly on the body's iron stores and is delivered through the health system, which makes it the clinical or medical approach.

Food fortification and nutrition education are public-health and food-based approaches that work through the diet, and an 'integrated approach' combines several strategies rather than being a clinical measure in itself.

Answer: C

Cretinism is caused by a deficiency of iodine.

Iodine is needed to make the thyroid hormones T3 and T4. Severe iodine deficiency in the mother during pregnancy, or in early infancy, deprives the developing brain and skeleton of thyroid hormone and causes cretinism: intellectual disability, stunted growth, deaf-mutism and coarse features. Universal salt iodisation is the preventive measure.

Iron deficiency causes anaemia, zinc deficiency causes growth failure and poor wound healing, and selenium deficiency is linked with Keshan disease.

Answer: B

Folate deficiency causes megaloblastic anaemia.

Folate is needed for DNA synthesis. Without it, red cell precursors in the marrow cannot divide normally, so they grow into large, immature megaloblasts and the blood carries fewer, larger red cells (a macrocytic picture).

Pernicious anaemia is also megaloblastic, but the name is reserved for vitamin B12 deficiency caused by lack of intrinsic factor. Hypochromic anaemia, with pale small cells, is the picture of iron deficiency. Haemolytic anaemia comes from destruction of red cells, not from a nutrient shortage.

Answer: C

Essential fatty acid deficiency causes phrynoderma.

Phrynoderma, or 'toad skin', is a follicular hyperkeratosis: rough, horny papules around the hair follicles, especially on the elbows, knees and thighs. It is classically attributed to a lack of essential fatty acids (linoleic acid) and is also seen in vitamin A deficiency.

The other conditions belong to B vitamins: beriberi to thiamine deficiency, pellagra to niacin deficiency with its dermatitis, diarrhoea and dementia, and cheilosis (cracking at the corners of the lips) to riboflavin deficiency.