Vitamin A deficiency

Vitamin A deficiency

Q. 1

Vitamin A intoxication causes injury to

 A

Lysosomes

 B

Mitochondria

 C

Endoplasmic reticulum

 D Microtubules
Q. 1

Vitamin A intoxication causes injury to

 A

Lysosomes

 B

Mitochondria

 C

Endoplasmic reticulum

 D Microtubules
Ans. A

Explanation:

Lysosomes [Ref: O.P. Ghai 6/e, p 121; Harrison 16/e, p 4081

“Excess of vitamin A can lead to rupture of Lysosomal membranes” – O.P. Ghai, 6/e, p 121

Acute vitamin A intoxication

  • Acute toxicity was first noted in Arctic explorers who ate polar bear liver
  • Acute toxicity is also seen after administration of 150 mg in adults or 100 mg in children.
  • Manifestations of acute toxicity

increased ICP

– vertigo diplopia

bulging fontanels in children

– seizures

– exfoliative det-matitis

may be fatal

Chronic Vitamin A intoxication

  • Is seen in normal adults who ingest 15 ing/d of vitamin A for a period of several months and in children who ingest 6 mg/day
  • Manifestations of chronic toxicity

dry skin – cheliosis

– glossitis – vomiting – alopecia – bone pain

– hype rcakemia

– lymph node enlargement

–      hyperlipidenzia

– amenorrhea

– features of pseudotumor cereberi with increase of ICP and papilledema

  • Liver fibrosis with portal hypertension and bone demineralization may also result from chronic vit A intoxication.
  • Teratogenic effects of Vitamin A

spontaneous abortion

– craniofacial abnormalities

– valvular heart diseases


Q. 2

A 10 month old child weighing 8 kg is brought to the clinic due to repeated vomiting and persistent diarrhoea. On ophthalmological examination, Bitot’s spots are seen on the bulbar conjunctiva of both eyes. What is the recommended schedule of vitamin A therapy to be given to this child?

 A

2 lakh international units intramuscularly on day 0, 28

 B

1 lakh international units intramuscularly on day 0, 28

 C

2 lakh international units intramuscularly on day 0, 1, 28

 D

1 lakh international units intramuscularly on day 0, 1, 28

Q. 2

A 10 month old child weighing 8 kg is brought to the clinic due to repeated vomiting and persistent diarrhoea. On ophthalmological examination, Bitot’s spots are seen on the bulbar conjunctiva of both eyes. What is the recommended schedule of vitamin A therapy to be given to this child?

 A

2 lakh international units intramuscularly on day 0, 28

 B

1 lakh international units intramuscularly on day 0, 28

 C

2 lakh international units intramuscularly on day 0, 1, 28

 D

1 lakh international units intramuscularly on day 0, 1, 28

Ans. D

Explanation:

According to the WHO treatment schedule, Bitot’s spots are treated with Vitamin A at a dosage of 2 lakh IU orally or 1 lakh IU intramuscularly, immediately on diagnosis and repeated the following day and 4 weeks later, for children above 1 year of age.

This includes children of 8 kg or more, as children less than 8 kg and less than 1 year of age are given half the above dosage.

Though oral treatment is recommended, vitamin A is given intramuscularly in cases of repeated vomiting and severe diarrhoea.

Ref: Ophthalmology, By A. K. Khurana, 3rd Edition, Page 416, 417.


Q. 3

Vitamin A deficiency is characterized by all, EXCEPT:

 A

Bitot’s spot

 B

Xerophthalmia

 C

Night blindness

 D

Tranta’s spot

Q. 3

Vitamin A deficiency is characterized by all, EXCEPT:

 A

Bitot’s spot

 B

Xerophthalmia

 C

Night blindness

 D

Tranta’s spot

Ans. D

Explanation:

The most characteristic and specific signs of vitamin A deficiency are eye lesions. These develop before the age of 2 years. All the ocular manifestation of Vitamin A deficiency, term Xerophthalmia.

Xerophthalmia (Dry eye):

 

It has following stages: 1)Night blindness (earliest ocular symptom, conjunctival xerosis (earliest ocular sign) 3)Bitot’s spot 4)Corneal xerosis 5)Keratomalacia and corneal ulcers.

 

 

 

Tranta’s spot is seen in Vernal keratoconjunctivitis.

 

Ref: O.P.Ghai 6th Ed Page 120,121.

 

Quiz In Between


Q. 4

A child with dry skin and scaling is suspected of having vitamin A deficiency. What is the earliest feature of vitamin deficiency?

 A

Conjunctival xerosis

 B

Nyctalopia

 C

Retinopathy

 D

Pain

Q. 4

A child with dry skin and scaling is suspected of having vitamin A deficiency. What is the earliest feature of vitamin deficiency?

 A

Conjunctival xerosis

 B

Nyctalopia

 C

Retinopathy

 D

Pain

Ans. B

Explanation:

The earliest manifestations of vitamin A deficiency are ocular changes. Impaired dark adaptation (nyctalopia), is followed by xerophthalmia, and as corneal keratin desquamates and overgrowth of Corynebacterium xerosis on the sclera occurs, white patches known as Bitot spots develop. Severe deficiency may lead to corneal xerosis, ulceration, and keratomalacia, which may result in corneal perforation, prolapse of the iris, and blindness.

 
Ref: Jen M., Yan A.C. (2012). Chapter 130. Cutaneous Changes in Nutritional Disease. In K. Wolff (Ed), Fitzpatrick’s Dermatology in General Medicine, 8e.

 


Q. 5

The vitamin A supplement administered in -Prevention of nutritional blindness in children programme” contain –

 A

25,000 IU/ml

 B

1 Lakh IU/ml

 C

3 Lakh IU/ml

 D

5 Lakh IU/ml

Q. 5

The vitamin A supplement administered in -Prevention of nutritional blindness in children programme” contain –

 A

25,000 IU/ml

 B

1 Lakh IU/ml

 C

3 Lakh IU/ml

 D

5 Lakh IU/ml

Ans. B

Explanation:

Ans. is ‘b’ i.e., 1 Lakh IU/ml

o According to vitamin A prophylaxis programme children between 9 months and 5 years are given 9 megadoses of vitamin a concentrate at 6 month interval.

o The first two doses are integrated with measles vaccination and DPT Ist Booster.

o For infant the dose is 1 ml equivalent to 1 lakh IU and in children it is 2 ml i.e. 2 lakh IU.


Q. 6

The recommended oral dose of vitamin A to be given in a 10 month child with deficiency on each of day 1,2 and 28 is –

 A

50,000 IU

 B

1,00,000 IU

 C

2,00,0001U

 D

6,00,000 IU

Q. 6

The recommended oral dose of vitamin A to be given in a 10 month child with deficiency on each of day 1,2 and 28 is –

 A

50,000 IU

 B

1,00,000 IU

 C

2,00,0001U

 D

6,00,000 IU

Ans. B

Explanation:

Ans. is ‘b’ i.e., 1,00,000 IU

Quiz In Between


Q. 7

‘Vitamin A requirement in infant is-

 A

350 g

 B

600 g

 C

800 g

 D

1000 g

Q. 7

‘Vitamin A requirement in infant is-

 A

350 g

 B

600 g

 C

800 g

 D

1000 g

Ans. A

Explanation:

Ans. is ‘a’ i.e., 350 g 


Q. 8

The recommended daily requirement of vitamin A for pregnant woman is

 A

750 meg

 B

900 mg

 C

1200 mcg

 D

None

Q. 8

The recommended daily requirement of vitamin A for pregnant woman is

 A

750 meg

 B

900 mg

 C

1200 mcg

 D

None

Ans. D

Explanation:

Ans. is ‘None’

Vitamin ‘A’ requirment for a Pregnant woman is 800 mg/d.


Q. 9

The earliest clinical sign of Vitamin A deficiency is –

 A

Conjunctival xerosis

 B

Corneal xerosis

 C

Bitots spots

 D

Keratomalacia

Q. 9

The earliest clinical sign of Vitamin A deficiency is –

 A

Conjunctival xerosis

 B

Corneal xerosis

 C

Bitots spots

 D

Keratomalacia

Ans. A

Explanation:

Ans. is ‘a’ i.e., Conjunctival xerosis 

Quiz In Between


Q. 10

All the following drugs are used in acute anterior uveitis except

 A

Pilocarpine

 B

Atropine

 C

Timolol

 D

Propranolol

Q. 10

All the following drugs are used in acute anterior uveitis except

 A

Pilocarpine

 B

Atropine

 C

Timolol

 D

Propranolol

Ans. A

Explanation:

A i.e. Pilocarpine

  • Miotics eg pilocarpine or other cholinergics are contraindicated in treatment of anterior uveitis Q

as these increase chances of synechiae formation. It is also contraindicated in malignant glaucoma Q & post inflammatory glaucoma Q.

  • Mydriatic-cycloplegic drugs eg. atropine Q, homatropine, cyclopentolate are most effective drugs during acute phase of anterior uveitis. These act by

i)        Gives rest to eye by relieving iris sphincter and ciliary muscle spasmQ

ii)        Prevents formation of synechiae & break already formed synechiae

iii)    Reduce exudation by decreasing hyperemia & vascular permeability


Q. 11

All of the following are true about prevention of vitamin A deficiency by supplements except:

 A

Dose in children over 1 year is 2 lac IU orally

 B

Dose in infants less than 6 month (not being breast fed is 50 thousand IV orally)

 C

Dose in first trimester of pregnancy is 1 lac IU

 D

Under CSSM Programme first dose (1 lac IU) is given at 9 months of age along with measles

Q. 11

All of the following are true about prevention of vitamin A deficiency by supplements except:

 A

Dose in children over 1 year is 2 lac IU orally

 B

Dose in infants less than 6 month (not being breast fed is 50 thousand IV orally)

 C

Dose in first trimester of pregnancy is 1 lac IU

 D

Under CSSM Programme first dose (1 lac IU) is given at 9 months of age along with measles

Ans. C

Explanation:

Ans. Dose in first trimester of pregnancy is 1 lac IU


Q. 12

Following are seen in vitamin A deficiency EXCEPT:

March 2004

 A

Nightblindness

 B

Follicular hyperkeratosis

 C

Growth retardation

 D

Polyneuritis

Q. 12

Following are seen in vitamin A deficiency EXCEPT:

March 2004

 A

Nightblindness

 B

Follicular hyperkeratosis

 C

Growth retardation

 D

Polyneuritis

Ans. D

Explanation:

Ans. D i.e. Polyneuritis

Quiz In Between


Q. 13

First dose of vitamin A should be given at:

September 2005

 A

3 months

 B

6 months

 C

9 months

 D

12 months

Q. 13

First dose of vitamin A should be given at:

September 2005

 A

3 months

 B

6 months

 C

9 months

 D

12 months

Ans. C

Explanation:

Ans. C: 9 months

National programme for prevention of nutritional blindness focuses on

  • Promoting consumption of vitamin A rich foods by pregnant and lactating women and by children under 5 years of age.
  • Administration of massive doses of vitamin A up to 5 years. First dose of 100,000 IU with measles vaccination at 9 months and subsequent doses of 200,000 IU each, every 6 months up to the age of 5 years should be given.

Q. 14

Vitamin A prophylaxis is given to children every:

September 2007

 A

3 months

 B

6 months

 C

12 months

 D

18 months

Q. 14

Vitamin A prophylaxis is given to children every:

September 2007

 A

3 months

 B

6 months

 C

12 months

 D

18 months

Ans. B

Explanation:

Ans. B: 6 months

National programme for prevention of nutritional blindness focuses on

  • Promoting consumption of vitamin A rich foods by pregnant and lactating women and by children under 5 years of age.
  • Administration of massive doses of vitamin A up to 5 years. First dose of 100,000 IU with measles vaccination at 9 months and subsequent doses of 200,000 IU each, every 6 months up to the age of 5 years should be given.

Q. 15

1st symptom of vitamin A deficiency:          

March 2009

 A

Conjunctival xerosis

 B

Bitot’s spots

 C

Night blindness

 D

Corneal ulcer

Q. 15

1st symptom of vitamin A deficiency:          

March 2009

 A

Conjunctival xerosis

 B

Bitot’s spots

 C

Night blindness

 D

Corneal ulcer

Ans. C

Explanation:

Ans. C: Night blindness

Vitamin A deficiency is common in developing countries but rarely seen in developed countries. Night blindness is one of the first signs of vitamin A deficiency.

Xerophthalmia and complete blindness can also occur since Vitamin A has a major role in phototransduction.

Vitamin A deficiency also diminishes the ability to fight infections. In countries where children are not immunized, infectious disease like measles, have higher fatality rates.

Even mild, subclinical deficiency can also be a problem, as it may increase children’s risk of developing respiratory and diarrheal infections, decrease growth rate, slow bone development and decrease likelihood of survival from serious illness.

Quiz In Between


Q. 16

Under National Programme for Prevention of Nutritional Blindness, a child in the age group of 6-11 months is given a single dose of vitamin A is:

March 2005

 A

50,000 IU

 B

1,00,000 IU

 C

1,50,000 IU

 D

2,00,000 IU

Q. 16

Under National Programme for Prevention of Nutritional Blindness, a child in the age group of 6-11 months is given a single dose of vitamin A is:

March 2005

 A

50,000 IU

 B

1,00,000 IU

 C

1,50,000 IU

 D

2,00,000 IU

Ans. B

Explanation:

Ans. B: 1,00,000 IU

Nutritional blindness which affects over seven million children in India per year results mainly “from the deficiency of vitamin A coupled with protein-energy malnutrition.

In its severest form, it often result in loss of vision.

Vitamin A deficiency is assessed on the basis of conjuctival xerosis and Bitot’s spot.


Q. 17

Which of the following is uncommon symptom of deficiency of vitamin A:        

September 2010

 A

Night blindness

 B

Xerophthalmia

 C

Keratomalacia

 D

Polyneuropathy

Q. 17

Which of the following is uncommon symptom of deficiency of vitamin A:        

September 2010

 A

Night blindness

 B

Xerophthalmia

 C

Keratomalacia

 D

Polyneuropathy

Ans. D

Explanation:

Ans. D: Polyneuropathy

The most common cause of blindness in developing countries is vitamin A deficiency (VAD).

Vitamin A is required for vision, maintenance of integrity of epithelial linings, growth and immunity.

Deficiency leads to night blindness, dryness of the conjunctiva and cornea and finally liquefactive necrosis (keratomalacia) and ulceration of the cornea.


Q. 18

A child of age 9 needed prophylaxis of vitamin A. The dose and route of administration is:

September 2009

 A

1,00,000 IU intramuscularly

 B

1,00,000 IU orally

 C

2,00,000 IU intramuscularly

 D

2,00,000 IU orally

Q. 18

A child of age 9 needed prophylaxis of vitamin A. The dose and route of administration is:

September 2009

 A

1,00,000 IU intramuscularly

 B

1,00,000 IU orally

 C

2,00,000 IU intramuscularly

 D

2,00,000 IU orally

Ans. B

Explanation:

Ans. B: 1,00,000 IU Orally

Quiz In Between


Q. 19

How many doses of vitamin A are required to treat deficiency ‑

 A

1

 B

2

 C

3

 D

4

Q. 19

How many doses of vitamin A are required to treat deficiency ‑

 A

1

 B

2

 C

3

 D

4

Ans. C

Explanation:

Ans. is ‘c’ i.e., 3


Q. 20

First ocular sign of Vitamin A deficiency ‑

 A

Bitot’s spot

 B

Conjunctival xerosis

 C

Night blindness

 D

Keratomalacia

Q. 20

First ocular sign of Vitamin A deficiency ‑

 A

Bitot’s spot

 B

Conjunctival xerosis

 C

Night blindness

 D

Keratomalacia

Ans. B

Explanation:

Ans. is ‘b’ i.e., Conjunctival xerosis

Quiz In Between


Q. 21

A 10 month old child weighing 8kg has spots as marked by a red arrow in the picture below in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child ? 

 A

2 lakh units intramuscular (IM) on day 0, 14.


 B

lakh units IM on day 0, 14.

 C

2 lakh units IM on day 0, 1 and 14.


 D

1 lakh units IM on day 0, 1 and 14.

Q. 21

A 10 month old child weighing 8kg has spots as marked by a red arrow in the picture below in both eyes. Which of the following is the most appropriate schedule to prescribe vitamin A to this child ? 

 A

2 lakh units intramuscular (IM) on day 0, 14.


 B

lakh units IM on day 0, 14.

 C

2 lakh units IM on day 0, 1 and 14.


 D

1 lakh units IM on day 0, 1 and 14.

Ans. D

Explanation:

The child is having Bitot spots in both eyes.

The most appropriate schedule to prescribe vitamin A to this child is 1 lakh units IM on day 0, 1 and 14.


Q. 22

All the following statements are true about the cell modification marked by “E” in the image except:

 A

Divided into 2 types: epithelial and mesenchymal.

 B

Disordered cellular development

 C

May regress on removal of inciting stimulus

 D

May progress to carcinoma in situ

Q. 22

All the following statements are true about the cell modification marked by “E” in the image except:

 A

Divided into 2 types: epithelial and mesenchymal.

 B

Disordered cellular development

 C

May regress on removal of inciting stimulus

 D

May progress to carcinoma in situ

Ans. A

Explanation:

Ans:A.)Divided into 2 types: epithelial and mesenchymal.

Dysplasia is shown in the image.

DYSPLASIA

  • Dysplasia means ‘disordered cellular development’, also referred to as atypical hyperplasia.
  • Dysplasia occurs most often in epithelial cells.
  • Epithelial dysplasia is characterised by cellular proliferation and cytologic changes.
    • 1. Increased number of layers of epithelial cells
    • 2. Disorderly arrangement of cells from basal layer to the surface layer
    • 3. Loss of basal polarity i.e. nuclei lying away from basement membrane
    • 4. Cellular and nuclear pleomorphism
    • 5. Increased nucleocytoplasmic ratio
    • 6. Nuclear hyperchromatism
    • 7. Increased mitotic activity.
  • The two most common examples of dysplastic changes are the uterine cervix  and respiratory tract.
  • Dysplastic changes often occur due to chronic irritation or prolonged inflammation.
    • On removal of the inciting stimulus, the changes may disappear. In a proportion of cases, however, dysplasia progresses into carcinoma in situ (cancer confined to layers superficial to basement membrane) or invasive cancer.

Quiz In Between



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