Q1. Which finding alone is sufficient to diagnose severe acute malnutrition, regardless of weight? A. Sparse hair B. BILATERAL PITTING OEDEMA C. Irritability D. Pallor ANSWER: B — bilateral pitting oedema. Why: oedema adds weight and fills out the limbs and face, so a weight-based assessment can look falsely reassuring. Oedema alone therefore defines severe acute malnutrition. LEARNING POINT: MUAC is useful because it needs only a tape and is not distorted in the same way.

Q2. Vitamin A deficiency in children characteristically causes: A. Rickets B. Goitre C. NIGHT BLINDNESS progressing to corneal damage D. Bleeding gums ANSWER: C. Why: the sequence runs from night blindness through conjunctival and corneal changes to irreversible corneal damage. It also worsens measles and diarrhoea. LEARNING POINT: it remains a leading preventable cause of childhood blindness.

Q3. A severely malnourished child with diarrhoea is given rapid intravenous fluid and becomes breathless with an enlarging liver. The explanation is: A. Worsening diarrhoea B. FLUID OVERLOAD and heart failure from reductive adaptation C. Pneumonia D. Allergic reaction ANSWER: B. Why: every system has slowed to survive on less, including the myocardium, so rapid volume cannot be handled. Over- hydration is a recognised cause of death in this group. LEARNING POINT: rehydrate orally and slowly, with the specified formulation; reserve IV fluid for shock.

Q4. A child with severe acute malnutrition is lethargic and feeding poorly but is afebrile with a normal white cell count. Antibiotics are withheld. This is: A. Correct — there is no evidence of infection B. INCORRECT — the inflammatory response is blunted, so infection is often silent C. Correct if blood cultures are negative D. Correct in children over one year ANSWER: B. Why: severe malnutrition blunts the inflammatory response, so serious infection frequently occurs without fever or leucocytosis. Lethargy and poor feeding are themselves the warning signs. LEARNING POINT: antibiotics are given EMPIRICALLY in severe acute malnutrition.

Q5. During the STABILISATION phase of managing severe acute malnutrition, the aim is to: A. Achieve rapid catch-up weight gain B. Treat hypoglycaemia, hypothermia, dehydration, electrolytes and infection, feeding CAUTIOUSLY C. Give high-energy feeds immediately D. Discharge as soon as possible ANSWER: B. Why: weight gain belongs to the second, rehabilitation phase. Pushing energy intake before the child is stable risks refeeding syndrome, which can be fatal. LEARNING POINT: get the order wrong and the treatment causes harm.

Q6. Two toddlers are below the expected weight. One has tracked steadily along a low line since birth; the other has crossed two centiles downwards in six months. Which needs investigation? A. Both equally B. The child CROSSING CENTILES DOWNWARDS C. The child on the low line D. Neither ANSWER: B. Why: the trend carries the information. A small child growing steadily is usually constitutionally small; crossing centiles downwards is the abnormality even if the absolute weight is still within range. LEARNING POINT: consider intake first, then absorption, then chronic infection such as TB or HIV.

Q7. Why must feeding be started SLOWLY in severe acute malnutrition? A. The child will vomit B. Rapid refeeding shifts potassium, magnesium and phosphate into cells — REFEEDING SYNDROME C. Food is poorly tolerated for the first month D. It suppresses appetite ANSWER: B. Why: reintroducing energy drives glucose and electrolytes intracellularly, and the resulting deficits can cause arrhythmia and death. Small, frequent, low-volume feeds are used first, including overnight. LEARNING POINT: build up only during the rehabilitation phase.