Which of the following is the earliest symptom of vitamin A deficiency in a young child?

PGIMER NO - 2020

Child Health Nursing (Pediatrics)

Easy

Appeared in: PGIMER NO - 2020

Explanation

Night blindness (nyctalopia) is the first clinical symptom of Vitamin A deficiency.
It occurs because Vitamin A is essential for producing rhodopsin, the pigment in the retina's rod cells that allows for vision in low light.
A lack of Vitamin A impairs the regeneration of rhodopsin, causing difficulty with dark adaptation.
In the WHO classification of xerophthalmia, Night Blindness (XN) is designated as the earliest stage.

Option A: Keratomalacia is a late, severe, and destructive stage of Vitamin A deficiency involving liquefaction of the cornea. It is a medical emergency that leads to permanent blindness, not an early symptom.
Option B: Bitot's spots are a clinical sign (X1B) that appears after the onset of night blindness (XN) and conjunctival xerosis (X1A). They are accumulations of keratin and inflammatory cells on the conjunctiva.
Option D: Diplopia, or double vision, is not a recognized symptom of Vitamin A deficiency. It is typically associated with neurological conditions, cranial nerve palsies, or problems with the extraocular muscles.

Clinical Relevance

Nursing practice connection: Use the key finding related to Early clinical manifestations of Vitamin A deficiency to guide bedside assessment, documentation, and the next nursing action.
Nurses play a critical role in identifying early Vitamin A deficiency, especially in non-verbal children, by asking parents about the child's behavior in dim light (e.g., clumsiness, inactivity at dusk).
This condition is a significant public health problem in India. Nurses are integral to the National Vitamin A Prophylaxis Programme, administering high-dose Vitamin A supplements to children under five to prevent blindness.
Patient education on dietary sources of Vitamin A (e.g., green leafy vegetables, carrots, papaya, mangoes, milk, eggs) is a key nursing intervention for prevention.

How to Approach the Question

First, identify the core of the question: it's asking for the 'earliest symptom' of Vitamin A deficiency.
Differentiate between a 'symptom' (a subjective feeling, like difficulty seeing) and a 'sign' (an objective finding, like a spot on the eye).
Recall the pathophysiology of Vitamin A in vision. Its role in rhodopsin for night vision is primary.
Mentally arrange the given options according to the progression of xerophthalmia (the disease caused by Vitamin A deficiency).
Night blindness (XN) comes first. Bitot's spots (X1B) come later. Keratomalacia (X3B) is a very late and severe stage.
Eliminate Diplopia as it is unrelated to Vitamin A deficiency. This leaves Night blindness as the correct earliest symptom.

Concept Tested & Keywords

Concept Tested: Early clinical manifestations of Vitamin A deficiency
Stem keywords: earliest symptom, vitamin A deficiency, young child
Lead-in keywords: Which
Clinical cues: The question asks for the 'earliest symptom', which is a subjective experience reported by the patient (or observed by parents in a young child).

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