A 2-year-old child presents with bilateral pitting pedal oedema, sparse reddish hair, skin changes (flaky paint dermatosis) and a miserable affect, but weight is only mildly reduced. The most likely diagnosis and the predominant macronutrient deficiency is:

• A Marasmus — severe caloric deficiency
• B Marasmic-Kwashiorkor — mixed caloric and protein deficiency
• C Kwashiorkor — predominantly protein deficiency ✓
• D Nutritional oedema — thiamine deficiency

Explanation

The clinical triad of bilateral oedema, skin/hair changes (flaky paint dermatosis, flag sign, reddish hair) and psychomotor changes with relatively preserved weight is characteristic of Kwashiorkor, which results from predominantly protein deficiency with relative carbohydrate sufficiency. Marasmus presents with severe wasting (< 60% expected weight for age) without oedema. Thiamine deficiency causes beriberi, not flaky paint dermatosis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.