A malnourished 4-year-old presents with dry, foamy, triangular white patches on the temporal bulbar conjunctiva of both eyes. The surface washes off with saline but recurs within days. Which vitamin deficiency does this sign indicate?

• A Vitamin B12
• B Vitamin C
• C Vitamin A ✓
• D Vitamin E

Explanation

Bitot spots, a triangular foamy plaque of desquamated keratinized epithelium on the bulbar conjunctiva, indicate xerosis from vitamin A deficiency. In the WHO xerophthalmia classification they correspond to stage X1C, following conjunctival xerosis (X1A). The key distractor is C12 deficiency, which causes nutritional amblyopia rather than any corneal or conjunctival surface change. Treatment includes high-dose oral vitamin A on day 1, day 2 and two weeks later.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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