8/25/17

Question 1

High risk diet

Answer 1

Habitual food intake that is predictive of risk for chronic overconsumption diseases (CVD, type II diabetes, obesity, cancer) or underconsumption diseases (anorexia, bulimia)

Question 2

Anorexia Nervosa

Answer 2

0.3% of the pop.

Weight loss or improper growth, maintenance of body weight less than 85% of expected, extreme fear of weight gain and irrational weight perception, amenorrhea in women

Relate body to self worth

Accompanied often by depression, OCD, anxiety

Subtypes: restricting type, binge then purge

Question 3

Bulimia Nervosa

Answer 3

1% of pop.

Repeated binge eating followed by inappropriate compensatory behavior (puke, fast, laxative, excess exercise)

Over at least 3 months at least twice a week have irrational perception of body status

Often have depression

Subtypes: purging or non-purging

Question 4

Muscle dysmorphia or Big-orexia

Answer 4

Repeated obsession with appearance/muscles

Inappropriate compensatory behaviors like frequently check mirror, excessive exercise and dieting to get perfect body (Adonis complex)

Irrational perception of weight status

Often use steroids, can’t maintain jobs or relationships

Question 5

Eating Disorders Not Otherwise Specified (EDNOS)

Answer 5

Any eating disorder that doesn’t completely fit the criteria of a specific eating disorder (anorexia Nervosa but with regular menses)

Binge eating disorder: repeated binges without compensatory behaviors of bulimia Nervosa, they are often fat

Pica: eats weird stuff like toilet paper

Question 6

Prudent diet

Answer 6

Lower fat, higher fruits and veggies and whole grains

Question 7

Mediterranean diet

Answer 7

Abundant in plant foods (veggies and legumes)

Low in red meat, eggs, and wine

Moderate in chicken, fish, cheese, low fat dairy

Fruit as dessert

Lower risk of cardiac death

Question 8

DASH Diet

Answer 8

Dietary Approaches to Stop Hypertension

Increased intake of low sodium and high potassium foods

Fruits, veggies, whole grains, lean meats, and dairy

Reduction in BP in normotensive and hypertensive patients

Associated with lower serum homocysteine (marker of heart disease) and lipid peroxidation

Question 9

Problems of vegetarian diet

Answer 9

Equally poor to regular diets in Vitamins A, C, E, and magnesium

Usually low in B12, protein, iron, and zinc

Question 10

How to release ammonia

Answer 10

An AA undergoes a transamination with alpha-ketoglutarate via an transaminase/aminotransferase

Form Glu that undergoes oxidative deamination to release NH4+, also get alpha-keto acid

Question 11

Ammonia transport from peripheral tissues

Answer 11

Brain and muscle

Ammonia is toxic if cross BBB so need different form

Move in plasma: Glutamine synthetase adds NH4+ to Glu to make Gln, also move via Ala by transamination with pyruvate

Gln can be converted back to Glu and NH4+ in liver and kidneys

Liver is ultimate detoxification site and makes urea

Question 12

Urea Cycle

Answer 12

Form carbamoyl phosphate from CO2, NH4+, and ATP in the liver mitochondria via Carbamoyl Phosphate Synthase I

CPS I is stimulated by Arg and Glu (which is converted to N-Acetyl Glu for stimulation)

Carbamoyl phosphate condenses with ornithine to make citruline, leaves for cytosol while ornithine enters mitochondria

Use ATP to add Asp to citruline to get Arginosuccinate and PP

Cleave arginosuccinate to get fumarate and Arg

Arg undergoes hydrolysis by arginase to give off urea and ornithine

Overall: use 3 ATP, urea has one N from NH4+ and other from Asp, fumarate goes to TCA cycle

Question 13

Blood Urea Nitrogen

Answer 13

Urea made in liver travels to kidneys via the vasculature

Renal failure gives rise to sharp elevation in blood urea levels (BUN) called uremia

Metabolic test to see if defects in kidney function

Question 14

Hyperammonemia

Answer 14

Defect in liver function leading to failure to detoxify ammonia, congenital (rare) or acquired

Neurological symptoms since NH3 crosses BBB

Tremors, slur speech, vomit, cerebral edema, blurred vision, coma, death

Congenital form has a defect in any of the 5 urea cycle enzymes (worse if early one), don’t need urea cycle enzymes in utero so live births

Treatment: restrict protein diet and supplement with essential AAs, have alternative pathway for nitrogen excretion

Na benzoate combines with Gly to make hip pirate and eliminate N, is half as effective as urea

Acquired: liver cirrhosis from alcohol or hepatitis, bacteria can make urease to break down urea into NH3 (certain UTIs can cause kidney stones)

Hepatic Encephalopathy: mild neuropsychiatric alterations to coma

Question 15

Standard Precautions

Answer 15

Minimum infection prevention measures that apply to all patient care (regardless of infection status) in any healthcare setting

1. Hand hygiene
2. Use of PPE
3. Respiratory hygiene and cough etiquette
4. Safe injection practices
5. Safe handling of contaminated equipment/surfaces

Question 16

Three instances to use soap/water over alcohol hand rub

Answer 16

1. Visibly soiled
2. Direct contact with blood or other body fluids with ungloved hands
3. Patient has norovirus

Question 17

Protective Gown Use

Answer 17

When blood or body fluid can be splattered on the body

When working with a patient in contact isolation

Wear once and take off before leaving the room

Goes from neck to knees, wear 2 if too small

Cuffs of gloves overlap gown

Question 18

Airborne PPE Precautions

Answer 18

Mask if BFs can be sprayed on face, mask if eyes

Wear mask if patients are in respiratory (droplet) isolation

Wear N95 Respirator (duck billed mask) if active airborne infection like TB, staff must be properly fit tested

Remove from back with ungloved hands