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PE12.1-8,PE13.1-4 | Micronutrients — Practice Quiz
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A 2-year-old child in rural Rajasthan presents with night blindness and dry, rough skin. On examination, foamy white triangular patches are seen on the temporal bulbar conjunctiva bilaterally. What is the MOST appropriate immediate management?
Correct. For xerophthalmia in children >1 year, WHO/IAP recommends Vitamin A 2 lakh (200,000) IU orally on day 1, day 2, and at 2 weeks. The Bitot spots described are characteristic of VAD.
Bitot's spots are pathognomonic of Vitamin A deficiency (xerophthalmia). Therapeutic dose in children >1 year is 2 lakh IU orally × 3 doses. Prophylactic dose: 1 lakh IU at 9 months, then 2 lakh IU 6-monthly until age 5.
Incorrect. For xerophthalmia in children >1 year, the standard treatment is 2 lakh IU orally on day 1, day 2, and 2 weeks later — this three-dose schedule is crucial for adequate liver stores.
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A 9-month-old exclusively breastfed infant in northern India is brought with bowing of the legs. X-ray of the wrists shows widening and cupping of the metaphyses with fraying. Serum calcium is low and alkaline phosphatase is markedly elevated. Which statement about prophylaxis is CORRECT?
Correct. IAP recommends 400 IU/day of Vitamin D from birth (especially for exclusively breastfed infants) as prophylaxis against nutritional rickets. Breast milk contains very little Vitamin D.
Nutritional rickets in breastfed infants results from inadequate Vitamin D in breast milk. IAP recommends 400 IU/day from birth as prophylaxis. Treatment (stoss therapy): a single large dose of 600,000 IU (stoss) is used therapeutically.
Incorrect. The standard IAP prophylactic dose of Vitamin D is 400 IU/day from birth. 200 IU/day is insufficient; 800 IU/day is above the standard prophylactic dose.
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A term male neonate, day 3 of life, presents with spontaneous bleeding from the umbilical stump and oozing from the injection site. Prothrombin time is prolonged. He received no injections at birth. Which prophylactic measure would have prevented this?
Correct. The standard prophylaxis for Vitamin K deficiency bleeding (VKDB) is Vitamin K 1 mg IM at birth for all term neonates. The 0.5 mg dose is reserved for infants weighing <1.5 kg.
VKDB (formerly haemorrhagic disease of the newborn) is prevented by Vitamin K prophylaxis: 1 mg IM for term neonates, 0.5 mg IM for neonates <1.5 kg. Classic VKDB occurs day 2–7; late VKDB at 2–8 weeks (often associated with breastfeeding and cholestasis).
Incorrect. The standard prophylactic dose for term neonates is Vitamin K 1 mg IM at birth. The 0.5 mg dose is only for very low birth weight (<1.5 kg) infants.
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A 6-year-old child is brought with complaints of fatigue, pallor, and poor appetite. CBC shows Hb 8.5 g/dL, MCV 65 fL, MCH 19 pg, and low serum ferritin. What is the appropriate iron supplementation dose for a child of this age?
Correct. The therapeutic dose for iron deficiency anaemia in children is elemental iron 3–6 mg/kg/day in 2–3 divided doses. This is weight-based; adult fixed-dose tablets are inappropriate in children.
IDA treatment in children: elemental iron 3–6 mg/kg/day in 2–3 divided doses for 3 months after Hb normalisation to replenish stores. Prophylactic NIPI (National Iron Plus Initiative) dose: 1 mg/kg/day for 100 days/year (6 months–5 years).
Incorrect. The therapeutic dose for IDA in children is elemental iron 3–6 mg/kg/day in divided doses. 1 mg/kg/day is below therapeutic range; 10 mg/kg/day is excessive.
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During a household visit in a mountainous district, a community health worker finds a 4-year-old with an enlarged neck swelling, mental slowing, and growth retardation. The mother reports no use of iodised salt. This child likely suffers from iodine deficiency disorder. What is the minimum iodine concentration required in iodised salt at the point of production under India's Universal Salt Iodisation programme?
Correct. Under India's Universal Salt Iodisation (USI) programme, salt must contain a minimum of 15 ppm iodine at the consumer level (30 ppm at production, to account for losses in transport/storage). The minimum at consumer level is 15 ppm.
Universal Salt Iodisation (USI): minimum 30 ppm at production, minimum 15 ppm at consumer level. IDD spectrum: cretinism (most severe, congenital hypothyroidism), goitre, cognitive impairment, and subclinical effects. Endemic goitre = goitre prevalence >10% in community.
Incorrect. The minimum iodine content in iodised salt at the consumer level under India's USI programme is 15 ppm (at production it is 30 ppm to allow for losses).
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A 10-month-old infant is exclusively breastfed by a vegan mother. He presents with developmental regression (lost sitting), hypotonia, macrocytic anaemia, and a smooth tongue. On examination, skin is pale and there are depigmented patches. What is the most likely deficiency?
Correct. Vitamin B12 deficiency in exclusively breastfed infants of vegan mothers is a classic scenario. It presents with neurological regression, hypotonia, macrocytic anaemia, and skin depigmentation. B12 is found ONLY in animal products.
B12 deficiency in breastfed infants of vegan mothers: neurological regression, hypotonia, macrocytic anaemia, glossitis. B12 is present only in animal products. Breastfeeding by a vegan mother with low B12 is a major risk. Treatment: hydroxocobalamin or cyanocobalamin IM.
Incorrect. The combination of neurological regression, macrocytic anaemia, and a vegan breastfeeding mother points to Vitamin B12 deficiency — the only B-complex vitamin found exclusively in animal products.
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A 3-year-old child presents with irritability, swollen painful gums with bleeding, perifollicular haemorrhages on the thighs, and refusal to walk due to leg pain. Blood tests show no infections; diet history reveals no fruits or vegetables for 6 months. What is the MOST likely diagnosis?
Correct. Scurvy results from Vitamin C deficiency. The classic triad in children: bleeding gums (gingivitis), perifollicular haemorrhages, and subperiosteal haemorrhages causing limb pain and pseudoparalysis. Vitamin C is absent from a diet with no fruits/vegetables.
Scurvy in children classically presents at 6–24 months on formula without Vitamin C. Key features: bleeding gums, perifollicular haemorrhages, 'frog-leg' pseudoparalysis (subperiosteal haemorrhage). X-ray: Trümmerfeld zone, Frankel's line, Pelkan spurs. Treatment: Vitamin C 100–300 mg/day.
Incorrect. Bleeding gums, perifollicular haemorrhages, and limb pain with diet devoid of fruits/vegetables is the classic presentation of scurvy (Vitamin C deficiency). Rickets causes bony deformities; iron deficiency causes pallor/fatigue; Vitamin K deficiency causes coagulopathy.
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The National Iron Plus Initiative (NIPI) recommends iron and folic acid supplementation for young children. According to NIPI, which of the following is the CORRECT dosing schedule for a child aged 6 months to 5 years?
Correct. NIPI for 6 months–5 years: elemental iron 1 mg/kg/day (up to maximum 30 mg/day) + folic acid 100 mcg/day for 100 consecutive days per year (bi-annual dose strategy).
NIPI age groups: 6 mo–5 yr (1 mg/kg/day elemental iron + 100 mcg FA for 100 days/year); 5–10 yr (30 mg Fe + 250 mcg FA weekly); 10–19 yr (45 mg Fe + 400 mcg FA weekly — WIFS). Adolescent girls continue WIFS throughout. Programme aims to reduce prevalence of IDA.
Incorrect. The NIPI schedule for 6 months–5 years is elemental iron 1 mg/kg/day (max 30 mg/day) + folic acid 100 mcg/day for 100 consecutive days per year. This is a prophylactic programme dose, distinct from the therapeutic IDA dose.
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A 2-year-old child presents with failure to thrive, tetany, and bowing of the legs. Parents report no supplementation. Serum Vitamin D is low, but calcium and phosphate are also low. A bone X-ray shows cupped metaphyses. Which additional mineral supplement should be given ALONGSIDE Vitamin D for treatment of nutritional rickets?
Correct. In nutritional rickets, Vitamin D alone is insufficient if dietary calcium is also deficient (calcium-deficiency rickets). Calcium supplementation 500–1000 mg/day is given alongside Vitamin D, especially when dietary intake is poor (common in India due to low dairy consumption).
Nutritional rickets treatment: Vitamin D (stoss 600,000 IU or daily 2000–4000 IU) PLUS calcium 500–1000 mg/day when dietary calcium is insufficient. Calcium-deficiency rickets is common in South Asia. Always check serum calcium, phosphate, alkaline phosphatase, and Vitamin D level.
Incorrect. When rickets coexists with low calcium (as reflected by hypocalcaemia and tetany), calcium 500–1000 mg/day must be supplemented alongside Vitamin D. Zinc and iron do not address the calcium/Vitamin D axis.
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A 2-year-old is brought for routine vaccination. The community health worker notes this visit coincides with the first visit since the child's 9-month immunisation. According to the National Immunization Schedule, which Vitamin A dose and route is due NOW?
Correct. At 9 months under NIS, 1 lakh IU of Vitamin A is given. After that, 2 lakh IU is given 6-monthly until the child is 5 years old. At 2 years, this child is due a 2 lakh IU oral dose.
National Immunization Schedule — Vitamin A: 1 lakh IU at 9 months with MR vaccine (first dose); then 2 lakh IU every 6 months from 12 months to 5 years. Total of 9 doses given over the programme. All doses are given ORALLY.
Incorrect. After the initial 1 lakh IU dose at 9 months, all subsequent prophylactic doses are 2 lakh IU orally every 6 months until age 5. A 2-year-old is due their 2 lakh IU dose.
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