A child whose weight is 55% of the expected weight for age presents with severe muscle wasting, bilateral pedal edema and lethargy. According to the Wellcome classification of protein-energy malnutrition based on weight-for-age and edema, which category does this child fall under?

1. A

   Marasmic kwashiorkor

2. B

   Severe underweight

3. C

   Kwashiorkor

4. D

   Marasmus

Appeared in: NORCET-11 Prelims

Explanation

• Marasmic kwashiorkor is defined by weight less than 60% of expected and presence of edema.
• The child has both severe wasting (marasmus) and edema (kwashiorkor), fitting marasmic kwashiorkor.
• Wellcome classification specifically uses weight-for-age and edema to categorize PEM.
• Lethargy and muscle wasting are common in severe forms of PEM.

Why Other Options Were Wrong

• Option B: Severe underweight is a general term and not a specific category in the Wellcome classification. It does not account for the presence of edema, which is a key differentiator.
• Option C: Kwashiorkor is characterized by edema but typically occurs when weight is between 60% and 80% of expected. The child here has weight below 60% and severe wasting, which points to marasmic kwashiorkor, not pure kwashiorkor.
• Option D: Marasmus is diagnosed when weight is less than 60% of expected but without edema. The presence of edema in this child excludes pure marasmus.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Wellcome classification of protein-energy malnutrition using weight-for-age and edema as background academic context rather than a clinical decision trigger.
• Early identification of marasmic kwashiorkor is critical for prompt nutritional rehabilitation and prevention of complications.
• Nurses must assess both weight-for-age and the presence of edema to classify PEM accurately.
• What if? If the child had no edema but the same weight (55% of expected), the diagnosis would be marasmus, not marasmic kwashiorkor.

How to Approach the Question

• Identify the classification system being used (Wellcome classification).
• Note the key clinical findings: weight-for-age percentage and presence of edema.
• Match the findings to the correct category in the classification table.
• Eliminate options that do not fit both criteria (weight and edema).
• Choose the answer that fits all the clinical features described.

Concept Tested & Keywords

• Concept Tested: Wellcome classification of protein-energy malnutrition using weight-for-age and edema
• Stem keywords: child, weight 55% of expected, severe muscle wasting, bilateral pedal edema, lethargy
• Lead-in keywords: category, Wellcome classification, weight-for-age, edema
• Clinical cues: weight less than 60% of expected
• Clinical cues: presence of edema

Question ID

Qp5UCKFDzNE_I2-etMn1Vg

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Reference Book

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 191-193

E6 Nutrition Monika Sharma 3e p. 222-224