This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'Kwashiorkor is characterised by all of the following features except – \nSelect and explain. \nA. Edema., B. Patchy depigmentation of hair, C. Fatty liver, D. Fatty infiltration of  pancreas', 'role': 'user'}, {'content': 'Answer: D \nExplanation: Kwashiorkor and marasmus are manifestations of protein-energy malnutrition (PEM).\nMarasmus represents the compensated phase of PEM.\nKwashiorkor represents the uncompensated phase of PEM.\n\nKwashiorkor\n\nIt is characterized by following three essential features -\n\n1) Edema\n\nEdema starts in lower extremities and later involves upper limbs and the face.\nFace appears moon shaped and puffy.\n\ta Edema is caused by -\nHypoalbuminemia → Major factor\nIncreased capillary permeability due to infection.\nFree radical injury to the cell membrane.\n\n2) Markedly retarded growth\n\nMuscles of the upper limb are wasted, but the lower extremities appear swollen due to oedema. a Muscle wasting is masked by oedema.\n\n3) Psychomotor (mental) changes\n\nThe child is lethargic, listless and apathetic (in contrast to marasmus, where the child is alert and irritable).\nAppetite is impaired (in contrast to marasmus, where children show voracious appetite).\n\nOther features of kwashiorkor\n1) Hepatomegaly\n\nDue to fatty infiltration\n\n2) Hair changes in Kwashiorkor\n\n\nHair is thin, dry and brittle, easily pluckable\nStraight and hypopigmented\nFlag sign (Alternate bands of Hypo and hyperpigmented hair corresponding to the period of under and proper nutrition).\n\n3) Skin changes in Kwashiorkor\n\nLarge areas of skin show erythema followed by hyperpigmentation\nFlaky paint dermatitis → Hyperpigmentation patches desquamate to expose raw hypopigmented areas. It gives the appearance of paint flaking off the surface of the wood.\n\n4) Infections\n\nThese children suffer from recurrent episodes of diarrhoea, respiratory and skin infections.', 'role': 'assistant'}]