After an epidemic of measles in a village near Kanpur, some children reported with history of weight loss and blindness from corneal scarring. The most likely cause of this complication is deficiency of?

1. A

   Vitamin K

2. B

   Vitamin D

3. C

   Vitamin A

4. D

   Vitamin C

Appeared in: Maharashtra CHO - 2020

Explanation

• Measles infection significantly increases the body's metabolic requirements for Vitamin A, leading to rapid depletion of its stores.
• Vitamin A is essential for maintaining the health and integrity of epithelial tissues, including the cornea and conjunctiva of the eye.
• Deficiency of Vitamin A causes a condition called xerophthalmia, which progresses from dryness and night blindness to corneal ulceration (keratomalacia) and permanent scarring, causing blindness.
• Weight loss is also a common feature of severe measles, often exacerbated by complications like diarrhea, which further impairs nutrient absorption.

Why Other Options Were Wrong

• Option A: Vitamin K is essential for the synthesis of blood clotting factors. Its deficiency leads to bleeding disorders, such as easy bruising, prolonged bleeding time, and internal hemorrhage.
• Option B: Vitamin D is crucial for calcium absorption and bone mineralization. Its deficiency causes rickets in children, characterized by soft, weak bones and skeletal deformities like bowed legs.
• Option D: Vitamin C (ascorbic acid) is necessary for collagen synthesis. Its deficiency results in scurvy, which manifests as bleeding gums, poor wound healing, corkscrew hairs, and petechial hemorrhages.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Nutritional complications associated with measles infection as background academic context rather than a clinical decision trigger.
• The link between measles and Vitamin A deficiency is a critical public health issue, especially in developing countries. Nurses play a key role in identifying at-risk children and administering prophylactic Vitamin A.
• Administering Vitamin A to all children with measles is a simple, low-cost, and highly effective intervention that reduces mortality by up to 50% and prevents blindness.
• What if? A child with measles has a rash and fever but no visible eye signs like redness or dryness. The nursing action is still the same: administer the age-appropriate dose of Vitamin A immediately, as subclinical deficiency is common and can progress rapidly.

How to Approach the Question

• First, analyze the clinical scenario. The key elements are a recent measles epidemic followed by specific complications: blindness and corneal scarring.
• Next, evaluate the lead-in question, which asks for the 'most likely' nutritional deficiency causing these symptoms.
• Systematically review the options. For each vitamin, recall its primary function and the classic signs of its deficiency.
• Connect the specific complication (corneal scarring) to the known functions of the vitamins. Vitamin A is uniquely critical for vision and epithelial health of the eye.
• Recall or deduce the well-established link between measles infection and acute Vitamin A deficiency. Measles is a known precipitating factor for xerophthalmia.
• Eliminate the other options because their deficiency syndromes (bleeding, bone disease, scurvy) do not match the clinical presentation of corneal scarring.

Concept Tested & Keywords

• Concept Tested: Nutritional complications associated with measles infection.
• Stem keywords: measles, epidemic, weight loss, blindness, corneal scarring
• Lead-in keywords: most likely cause, deficiency
• Clinical cues: History of measles epidemic is a key clue linking the symptoms to a known complication of the disease.
• Clinical cues: Blindness from corneal scarring points directly to severe xerophthalmia.

Question ID

QuBE6hni-ay_t9dcfQkddk

Copy ID

Reference Book

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart A (pp 26-201 of 604) p. 151-153

E6 Medicine Harrison 22e Part 1 p. 1682-1684

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1966-1968