Vitamin A deficiency with measles — DTM&H MCQ
Instant feedback + full explanation. One question, done properly.
Educational content. Not a substitute for clinical judgement or local policy.
Reveal the answer and explanation
Correct answer: B — High-dose vitamin A according to age
The correct answer is B, high-dose vitamin A according to age. This child has classic xerophthalmia (night blindness plus Bitot spots) precipitated by measles, which depletes retinol stores and rapidly worsens underlying vitamin A deficiency, a recognised driver of corneal destruction and mortality in displaced and malnourished populations. WHO recommends immediate age-based high-dose vitamin A for any child with measles and clinical vitamin A deficiency: 50,000 IU for infants under 6 months, 100,000 IU for infants 6 to 11 months, and 200,000 IU for children 12 months and older, given on diagnosis and repeated the next day, with a third dose 2 to 4 weeks later if ocular signs are present. This regimen treats the deficiency, protects against corneal ulceration and keratomalacia, and reduces measles case fatality, making it the single most appropriate and time-critical intervention in this scenario. Why the other options are wrong: C. Nicotinamide for 2 weeks: this treats pellagra (niacin deficiency, causing dermatitis, diarrhoea, dementia), which has no relevance to xerophthalmia or Bitot spots. E. Thiamine before each feed: this is the treatment for beriberi or Wernicke encephalopathy from thiamine deficiency, not for retinol deficiency causing eye disease. D. Iron infusion immediately: even if the child is anaemic from malnutrition, iron does nothing for the acute risk of corneal ulceration and blindness, and is not the emergency priority; oral iron, not infusion, would be used in resource-limited settings regardless. A. Iodine drops as sole therapy: iodine deficiency causes goitre and developmental delay (cretinism), not night blindness or Bitot spots, and using it alone would leave the vision-threatening deficiency untreated. Key point: measles plus night blindness and Bitot spots signals vitamin A deficiency requiring immediate weight/age-appropriate high-dose vitamin A to prevent corneal blindness and reduce mortality.
Reference: World Health Organization / Cochrane Equity summary of WHO-UNICEF policy: vitamin A treatment for measles (age-based dosing 50,000 IU under 6 months, 100,000 IU 6-11 months, 200,000 IU 12 months and older, given on diagnosis and the following day) - https://methods.cochrane.org/equity/vitamin-measles