Watery stools for 3 days have left a boy of 18 months with SAM thirsty, with sunken eyes and a dry mouth. He drinks eagerly; his pulse is normal in volume, capillary refill 2 s, and he is alert. How should his dehydration be corrected?

ReSoMal 5 ml/kg every 30 minutes for 2 hours

Standard ORS 75 ml/kg over 4 hours

Ringer lactate 30 ml/kg IV in 30 minutes

Plain water freely until his eyes look normal

At a growth-monitoring session in an anganwadi, a boy of 2 years measures 80 cm and weighs 8.0 kg. For this length, the WHO median weight is 10.4 kg and 1 SD is about 0.9 kg. His MUAC is 12.0 cm, there is no pitting oedema, and he is alert, eats a test meal well and has no fever, cough or diarrhoea. His mother asks if he must be admitted. Working out his weight-for-length z-score, how should he be classified and managed?

MAM: community supplementary feeding with follow-up

Normal: routine growth monitoring only

Malnutrition (SAM and MAM) and micronutrient programmes

41 NEET-PG practice questions on Malnutrition (SAM and MAM) and micronutrient programmes, part of Paediatrics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Watery stools for 3 days have left a boy of 18 months with SAM thirsty, with sunken eyes and a dry mouth. He drinks eagerly; his pulse is normal in volume, capillary refill 2 s, and he is alert. How should his dehydration be corrected?
1. AStandard ORS 75 ml/kg over 4 hours
2. BRinger lactate 30 ml/kg IV in 30 minutes
3. CPlain water freely until his eyes look normal
4. DReSoMal 5 ml/kg every 30 minutes for 2 hours
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Answer: D · ReSoMal 5 ml/kg every 30 minutes for 2 hours
Children with SAM are rehydrated orally or by NG tube, slowly, with ReSoMal: 5 ml/kg every 30 minutes for 2 hours, then 5-10 ml/kg/hour for up to 10 hours, watching for overload. Signs of dehydration are hard to judge in SAM, and their weak hearts tolerate fast fluids poorly. IV fluids are kept for shock.
- A: Standard ORS has too much sodium and too little potassium for SAM.
- B: Rapid IV fluids can cause heart failure in SAM and are only for shock.
- C: Plain water does not replace electrolytes.
Remember this
Dehydration in SAM without shock: oral ReSoMal 5 ml/kg every 30 minutes for 2 hours, then 5-10 ml/kg/hour.
Question 2 · Easy
How much energy and protein does F-75 provide per 100 ml?
1. A100 kcal and 0.9 g protein
2. B75 kcal and 2.9 g protein
3. C75 kcal and 0.9 g protein
4. D100 kcal and 2.9 g protein
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Answer: C · 75 kcal and 0.9 g protein
F-75 gives 75 kcal and about 0.9 g protein per 100 ml; its low protein and sodium suit the fragile stabilisation phase. F-100 gives 100 kcal and about 2.9 g protein per 100 ml for catch-up growth in rehabilitation.
- A: This mixes F-100 energy with F-75 protein.
- B: F-75 has low protein, not 2.9 g.
- D: This is F-100, used in rehabilitation.
Remember this
F-75 = 75 kcal and 0.9 g protein per 100 ml; F-100 = 100 kcal and 2.9 g.
Question 3 · Easy
In a child aged 6-59 months, which mid-upper arm circumference defines severe acute malnutrition?
1. ABelow 12.5 cm
2. BBelow 10.5 cm
3. CBelow 11.5 cm
4. DBelow 13.5 cm
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Answer: C · Below 11.5 cm
A MUAC below 11.5 cm in children aged 6-59 months defines SAM, as do weight-for-height below -3 SD and bilateral pitting oedema. A MUAC of 11.5 to below 12.5 cm is moderate acute malnutrition. MUAC is quick, needs no scale and predicts death well.
- A: Below 12.5 cm marks the upper limit of MAM.
- B: Below 10.5 cm is not the WHO cut-off.
- D: A MUAC of 13.5 cm is normal.
Remember this
SAM: MUAC below 11.5 cm, WFH below -3 SD or bilateral pitting oedema; MAM: MUAC 11.5-12.5 cm.
Question 4 · Easy
A mother in a tribal hamlet of Attappadi says her son, now 4, stumbles about after dusk. Both eyes show triangular, foamy, greyish patches on the temporal bulbar conjunctiva, while the corneas are clear and lustrous. Under the WHO classification of xerophthalmia, how are these conjunctival lesions graded?
1. AX2
2. BXN
3. CX1A
4. DX1B
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Answer: D · X1B
Foamy, triangular, greyish patches on the bulbar conjunctiva are Bitot spots, graded X1B. X1A is conjunctival xerosis without Bitot spots, X2 is corneal xerosis and X3 is corneal ulceration or keratomalacia. Night blindness (XN) is the earliest symptom, and the child needs the full treatment course of vitamin A.
- A: X2 is corneal xerosis; his corneas are clear.
- B: XN is night blindness, the symptom he has, not the grade of these conjunctival lesions.
- C: X1A is dry, wrinkled conjunctiva without the foamy Bitot spot.
Remember this
Bitot spots are X1B; any corneal change (X2, X3) is an eye emergency.
Question 5 · Hard
At a growth-monitoring session in an anganwadi, a boy of 2 years measures 80 cm and weighs 8.0 kg. For this length, the WHO median weight is 10.4 kg and 1 SD is about 0.9 kg. His MUAC is 12.0 cm, there is no pitting oedema, and he is alert, eats a test meal well and has no fever, cough or diarrhoea. His mother asks if he must be admitted. Working out his weight-for-length z-score, how should he be classified and managed?
1. ASAM: admit to the NRC
2. BSAM: home treatment with RUTF
3. CNormal: routine growth monitoring only
4. DMAM: community supplementary feeding with follow-up
Show answerHide answer
Answer: D · MAM: community supplementary feeding with follow-up
The z-score is (observed - median) / SD = (8.0 - 10.4) / 0.9 = -2.7, which lies between -3 and -2 SD, so he has moderate acute malnutrition; his MUAC of 12.0 cm (11.5 to below 12.5) agrees. MAM without complications is managed in the community with supplementary food, counselling on feeding and regular follow-up. SAM would need a z-score below -3, MUAC below 11.5 cm or oedema.
- A: Admission is for SAM with complications or a failed appetite test.
- B: He does not meet SAM criteria, so RUTF treatment for SAM is not needed.
- C: A z-score of -2.7 is not normal.
Remember this
Weight-for-length z between -3 and -2 (or MUAC 11.5-12.5 cm) is MAM, managed in the community.
Question 6 · Medium
As the medical officer of a CHC, you counsel a mother whose first baby was born with a lumbosacral meningomyelocele. She is planning another pregnancy next year, is on no medicines, eats a mainly vegetarian diet and has a haemoglobin of 11.4 g/dL. Which folic acid advice is correct?
1. A400 µg daily only in the second trimester
2. B4-5 mg daily from at least 1 month before conception
3. C5 mg weekly with the iron tablet in pregnancy
4. D400 µg daily from the first missed period
Answer and explanation in LearnFree account
Question 7 · Hard
On the stabilisation phase of SAM under the WHO 10 steps: 1. Iron is started on day 1 to correct anaemia. 2. All children receive broad-spectrum antibiotics even without signs of infection. 3. Folic acid 5 mg is given on day 1. 4. F-75 is fed every 2-3 hours, day and night. Which statements are correct?
1. A1, 2, 3 and 4
2. B1, 2 and 3 only
3. C2, 3 and 4 only
4. D1 and 4 only
Answer and explanation in LearnFree account
Question 8 · Medium
A district programme officer reviews the anaemia plan for her district with the block medical officers. Consider these components of Anaemia Mukt Bharat: 1. Biannual deworming with albendazole 2. Testing with digital haemoglobinometers and point-of-care treatment 3. Fortified foods in government-funded nutrition programmes 4. Routine IV iron sucrose for all adolescent girls. Which belong to the strategy?
1. A1, 2 and 3 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 9 · Hard
In a district hospital NRC, a boy of 18 months (5.5 kg, weight-for-height below -3 SD) with diarrhoea is lethargic, with cold hands, a weak pulse of 168/min and capillary refill of 5 s. He is given 15 ml/kg of Ringer lactate with 5% dextrose over 1 hour, with glucose, warmth and antibiotics. After the hour his pulse is still 170/min, capillary refill is 4 s and he is no more alert; there are no crackles and the liver has not enlarged. His Hb is 6.5 g/dL. What should be done next?
1. ANormal saline 20 ml/kg as a rapid bolus
2. BA second 15 ml/kg bolus of Ringer lactate
3. CFresh whole blood 10 ml/kg slowly over 3 hours
4. DPacked red cells 20 ml/kg over 1 hour
Answer and explanation in LearnFree account
Question 10 · Hard
A boy weighing 7.5 kg with uncomplicated SAM starts outpatient treatment, with RUTF prescribed at 200 kcal/kg/day. His mother will come back to the PHC every week for review and a fresh ration. Each 92 g sachet provides 500 kcal. How many sachets should his mother take home for the coming week?
1. A14
2. B10
3. C28
4. D21
Answer and explanation in LearnFree account
Question 11 · Medium
Weight-for-length is below -3 SD in a breastfed infant of 4 months with visible wasting and a weak suck; her mother says she has little milk. There is no illness needing treatment. Which feeding approach is preferred?
1. AStop breastfeeding and give F-100 by bottle
2. BSupplementary suckling to rebuild breast milk
3. CBottle-feed diluted cow's milk
4. DStart RUTF paste three times a day
Answer and explanation in LearnFree account
Question 12 · Medium
The ward sister asks why iron syrup is not started on day 1 for a boy with SAM at the NRC, though he is pale with a haemoglobin of 8.2 g/dL. Which is the best explanation?
1. AAnaemia in SAM is never due to iron deficiency
2. BIron causes hypoglycaemia in the first week
3. CFree iron worsens infection and oxidant injury
4. DIron is absorbed only when given with F-100
Answer and explanation in LearnFree account
Question 13 · Medium
On day 1 at the NRC, a boy of 3 years with SAM, bilateral pedal oedema and lethargy is started on F-75. He has no obvious focus of infection and his temperature is 36.4 °C. Which antibiotic plan is recommended?
1. AIV ampicillin with gentamicin
2. BNo antibiotic unless fever appears
3. COral cotrimoxazole prophylaxis alone
4. DOral amoxicillin only after cultures return
Answer and explanation in LearnFree account
Question 14 · Medium
Axillary temperature of 34.6 °C is recorded at 4 a.m. in a girl of 14 months with marasmus, admitted the previous evening to an NRC in Jharkhand. Besides feeding her and checking blood glucose, what is the best way to warm her?
1. AWarm IV fluids
2. BA hot-water bottle against her skin
3. CA bath in warm water
4. DSkin-to-skin contact on the mother's chest, both covered
Answer and explanation in LearnFree account
Question 15 · Easy
Which anthropometric index below -2 SD indicates stunting, a marker of chronic undernutrition?
1. AMUAC-for-age
2. BWeight-for-age
3. CLength or height-for-age
4. DWeight-for-height
Answer and explanation in LearnFree account
Question 16 · Easy
At a community outreach session for wasted children, the ANM gives a mother sachets of a peanut-based paste and tells her not to mix it with water. The family has no refrigerator and cooks on a wood stove. Why can ready-to-use therapeutic food be stored and fed at home safely without cooking?
1. AIts low water content stops bacterial growth
2. BIt contains added antibiotics
3. CIts zinc content kills bacteria
4. DIt is sterilised by gamma irradiation
Answer and explanation in LearnFree account
Question 17 · Medium
Bilateral pitting oedema of the feet, legs, hands and face (grade +++) is found in a girl brought to a PHC with flaky-paint skin and sparse, pale hair. Weight-for-height is -1.8 SD and MUAC 12.2 cm, and she eats RUTF in the appetite test. What is the right decision?
1. AOutpatient RUTF, as she passed the appetite test
2. BRefer for inpatient care at an NRC
3. COral furosemide and review in one week
4. DSupplementary food, as she is only moderately wasted
Answer and explanation in LearnFree account
Question 18 · Medium
Blood glucose is 48 mg/dL on admission to the NRC in a boy of 2 years with SAM (weight-for-height below -3 SD). He is alert and can drink. Which is the most appropriate immediate step?
1. AWait for the first F-75 feed due in 4 hours
2. B50 ml of 10% glucose orally, then 2-hourly F-75
3. CIV 10% dextrose at maintenance rate for the next 24 hours
4. DIV 25% dextrose 4 ml/kg as a bolus
Answer and explanation in LearnFree account
Question 19 · Medium
In the paediatric isolation ward, a toddler of 18 months has had a measles rash for 2 days with diarrhoea and cough; the eyes are normal, he is not malnourished and he received his MR-1 dose late, at 13 months. Besides supportive care and nutrition, which vitamin A schedule should be ordered?
1. ANone, as the eyes are normal
2. B2,00,000 IU weekly for 4 weeks
3. C2,00,000 IU on 2 consecutive days
4. D1,00,000 IU as a single dose
Answer and explanation in LearnFree account
Question 20 · Medium
Serum phosphate is 1.6 mg/dL (normal 3.0-6.0) on day 3 of feeding in a severely wasted girl of 4 years who now has weakness, irritability and puffiness; her admission value was normal. Which mechanism best explains this?
1. AF-75 contains no phosphate
2. BPhosphate is lost in diarrhoeal stools
3. CInsulin drives phosphate into cells
4. DVitamin D excess from the mineral mix
Answer and explanation in LearnFree account
Question 21 · Medium
Anthropometry recorded at an anganwadi for a girl of 20 months: weight-for-length -3.4 SD, length-for-age -1.2 SD, weight-for-age -2.8 SD and MUAC 11.8 cm, with no pitting oedema of the feet. How should her nutritional status be classified?
1. ASevere underweight only, with no wasting
2. BSevere stunting with moderate wasting
3. CModerate acute malnutrition, as MUAC is above 11.5 cm
4. DSevere acute malnutrition, without stunting
Answer and explanation in LearnFree account
Question 22 · Easy
Per 100 mL, what does F-100 therapeutic milk provide?
1. A75 kcal and about 2.9 g protein
2. B100 kcal and about 2.9 g protein
3. C75 kcal and about 0.9 g protein
4. D100 kcal and about 0.9 g protein
Answer and explanation in LearnFree account
Question 23 · Medium
Haemoglobin rose from 7.2 to 11.6 g/dL (normal for age 11-14) over 8 weeks of oral ferrous sulfate in a toddler with nutritional iron deficiency; the reticulocyte count had peaked on day 8. His mother asks at the follow-up visit whether she can stop the syrup now. What should she be told?
1. AStop now, as haemoglobin is normal
2. BContinue 2-3 months more to refill stores
3. CStop iron and give vitamin C alone
4. DSwitch to IV iron to finish the course
Answer and explanation in LearnFree account
Question 24 · Medium
In the rehabilitation phase of SAM care, roughly how much energy should a child receive from F-100 or RUTF?
1. A80-100 kcal/kg/day
2. B150-220 kcal/kg/day
3. C40-60 kcal/kg/day
4. D250-300 kcal/kg/day
Answer and explanation in LearnFree account
Question 25 · Hard
In the eye OPD of a district hospital, an infant of 8 months with severe wasting who had measles 3 weeks ago has a hazy right cornea with a small ulcer covering less than a third of its surface; the left eye shows conjunctival xerosis. She has never had vitamin A. Which vitamin A treatment is right?
1. A2,00,000 IU orally on days 1, 2 and 14
2. B50,000 IU orally as a single dose
3. C1,00,000 IU once, then at 9 months
4. D1,00,000 IU orally on days 1, 2 and 14
Answer and explanation in LearnFree account

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Malnutrition (SAM and MAM) and micronutrient programmes

Watery stools for 3 days have left a boy of 18 months with SAM thirsty, with sunken eyes and a dry mouth. He drinks eagerly; his pulse is normal in volume, capillary refill 2 s, and he is alert. How should his dehydration be corrected?

How much energy and protein does F-75 provide per 100 ml?

In a child aged 6-59 months, which mid-upper arm circumference defines severe acute malnutrition?

As the medical officer of a CHC, you counsel a mother whose first baby was born with a lumbosacral meningomyelocele. She is planning another pregnancy next year, is on no medicines, eats a mainly vegetarian diet and has a haemoglobin of 11.4 g/dL. Which folic acid advice is correct?

A boy weighing 7.5 kg with uncomplicated SAM starts outpatient treatment, with RUTF prescribed at 200 kcal/kg/day. His mother will come back to the PHC every week for review and a fresh ration. Each 92 g sachet provides 500 kcal. How many sachets should his mother take home for the coming week?

Weight-for-length is below -3 SD in a breastfed infant of 4 months with visible wasting and a weak suck; her mother says she has little milk. There is no illness needing treatment. Which feeding approach is preferred?

The ward sister asks why iron syrup is not started on day 1 for a boy with SAM at the NRC, though he is pale with a haemoglobin of 8.2 g/dL. Which is the best explanation?

On day 1 at the NRC, a boy of 3 years with SAM, bilateral pedal oedema and lethargy is started on F-75. He has no obvious focus of infection and his temperature is 36.4 °C. Which antibiotic plan is recommended?

Axillary temperature of 34.6 °C is recorded at 4 a.m. in a girl of 14 months with marasmus, admitted the previous evening to an NRC in Jharkhand. Besides feeding her and checking blood glucose, what is the best way to warm her?

Which anthropometric index below -2 SD indicates stunting, a marker of chronic undernutrition?

At a community outreach session for wasted children, the ANM gives a mother sachets of a peanut-based paste and tells her not to mix it with water. The family has no refrigerator and cooks on a wood stove. Why can ready-to-use therapeutic food be stored and fed at home safely without cooking?

Bilateral pitting oedema of the feet, legs, hands and face (grade +++) is found in a girl brought to a PHC with flaky-paint skin and sparse, pale hair. Weight-for-height is -1.8 SD and MUAC 12.2 cm, and she eats RUTF in the appetite test. What is the right decision?

Blood glucose is 48 mg/dL on admission to the NRC in a boy of 2 years with SAM (weight-for-height below -3 SD). He is alert and can drink. Which is the most appropriate immediate step?

In the paediatric isolation ward, a toddler of 18 months has had a measles rash for 2 days with diarrhoea and cough; the eyes are normal, he is not malnourished and he received his MR-1 dose late, at 13 months. Besides supportive care and nutrition, which vitamin A schedule should be ordered?

Serum phosphate is 1.6 mg/dL (normal 3.0-6.0) on day 3 of feeding in a severely wasted girl of 4 years who now has weakness, irritability and puffiness; her admission value was normal. Which mechanism best explains this?

Anthropometry recorded at an anganwadi for a girl of 20 months: weight-for-length -3.4 SD, length-for-age -1.2 SD, weight-for-age -2.8 SD and MUAC 11.8 cm, with no pitting oedema of the feet. How should her nutritional status be classified?

Per 100 mL, what does F-100 therapeutic milk provide?

Haemoglobin rose from 7.2 to 11.6 g/dL (normal for age 11-14) over 8 weeks of oral ferrous sulfate in a toddler with nutritional iron deficiency; the reticulocyte count had peaked on day 8. His mother asks at the follow-up visit whether she can stop the syrup now. What should she be told?

In the rehabilitation phase of SAM care, roughly how much energy should a child receive from F-100 or RUTF?