Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CNSC Exam 2021 > ASPEN Self-Assessment: Fundamentals of Nutrition & Metabolism > Flashcards

ASPEN Self-Assessment: Fundamentals of Nutrition & Metabolism Flashcards

1
Q

What is the length range for the small bowel in adults?

A

400 to 800 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

(T/F) <100 cm without colon requires TPN

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

(T/F) <50 cm with colon requires TPN

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

(T/F) The small bowel correlates with weight.

A

FALSE It correlates with height, shorter length seen in women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does absorption primarily occur for each vitamin:

  • Vitamin K
  • Vitamin B1
  • Vitamin A
  • Vitamin B12
A
  • Vitamin K: Jejunum
  • Vitamin B1 (thiamine): Proximal small intestine, especially jejunum
  • Vitamin A: Upper SI
  • Vitamin B12: Dependent on normal GI function, reabsorbed via enterohepatic circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Accumulation of which trace element is associated with Wilson’s disease?

A

Copper

  • Wilson’s disease is characterized by a genetic mutation of copper metabolism.
  • Normal copper homeostasis is maintained via biliary excretion.
  • Toxicity can occur with impaired biliary excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

(TRUE/FALSE) The acute phase response to injury and infection suppresses iron transport.

Part 2: What happens to serum iron levels? Serum ferritin levels?

A

TRUE.

  • Serum iron levels decrease
  • Serum ferritin levels increase
  • The sequestering of iron into a storage form following injury and infection is thought to have several protective measures for the host. It reduces the availability of iron for iron-dependent microorganism proliferation and may reduce the potential for free radical production and oxidative damage to cell membranes and DNA.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain enterohepatic circulation.

A

Refers to the circulation of bile acids, bilirubin from the liver to the bile, followed by entry into the SI, absorption by the enterocyte (in the intestine) and transport back to the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Cholecystokinin? What is its function in relation to enterohepatic circulation?

A
  • It is an enteric hormone in the liver.
  • Which induces the gallbladder to contract and release bile into the SI, when fat and protein is present in the duodenum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The majority of dietary folate is reabsorbed via which mechanism?

What conditions may limit folate absorption?

A

Enterohepatic circulation.

  • Dietary folate is converted to monoglutamate by jejunal enzymes for entry into the intestinal cell. It undergoes further reduction before entry into the portal circulation for reabsorption via enterohepatic circulation.

Conditions that may limit folate absorption?

  • Zinc deficiency
  • Chronic alcohol consumption
  • Changes in jejunal pH
  • Impaired bile secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Explain the function of choline.

A

Required for lipid transport and metabolism.

  • Used as a treatment for hepatic steatosis.
  • Low plasma choline levels in long-term PN patients have been associated with elevated liver aminotransferase concentrations. Investigations reported that steatosis resolved following choline supplementation.
  • Currently, PN admixtures do not contain choline.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name 3 examples of monosaccharides:

Options: Galactose, sucrose, glucose, maltose, fructose, lactose

A
  1. Glucose
  2. Fructose
  3. Galactose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is phosphofructokinase?

A

Rate-limiting enzyme of glycolysis, which is inhibited when ATP is abundant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is the inhibition of phosphofructokinase important when ATP is abundant during glycolysis?

A

Allows the cell to divert glucose to be stored as glycogen

When ATP is limited, phosphofructokinase is activated.

Glycolysis = Breakdown of glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which two places is glycogen predominantly stored?

A

Liver

Skeletal Muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What measurement is reflective of the functional or long-term status of SELENIUM?

A

Plasma glutathione peroxidase.

  • Deficiency: <10.5 U/mL erythrocytes
  • Status can also be assessed by determining the selenium level in whole blood, plasma, serum, or erythrocytes.
  • Plasma levels of greater than 100mcg/L = Adequate levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What measurement does serum ceruloplasmin measure?

A

Copper status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Explain the function of CHROMIUM.

A

Chromium potentiates the action of insulin and is important in glucose, protein, and lipid metabolism.

Chromium deficiency impairs glucose and AA use which may result in HYPERGLYCEMIA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a common clinical sign/symptom of vitamin D toxicity?

A

Soft tissue calcification (may occur in lungs and cardiovasculature).

Other signs: confusion, psychosis, tremor, hypercalcemia, and hypercalciuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are common clinical signs/symptoms of vitamin D deficiency?

A
  • Hypocalcemia
  • Osteomalacia
  • Tetany
  • Osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some effective treatments in gastric phytobezoars?

A
  • Flushing with Cola
  • Enzymatic therapy with cellulase
  • Surgical removal

Specifically, treatment with PAPAIN (meat tenderizer) should be avoided because it breaks down normal tissue and is associated with peptic ulcer disease, esophagitis, and gastritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

(TRUE/FALSE)

Fiber and medications can be flushed together through the feeding tube.

A

FALSE.

Should be spaced apart.

Never manipulate the feeding bag system due to risk of microbial growth through touch contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Explain the Swinamer Equation.

A

Uses body surface area in addition to physiological variables to predict RMR (resting metabolic rate).

This equation has been found to predict RMR in about 55% of patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name some impacts that underfeeding has on critically ill patients.

A

Increases:

  • Infections
  • Complications
  • Days on antibiotics
  • Days on the ventilator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name some impacts overfeeding has on critically ill patients.

A

Negative effects:

  • Hyperglycemia
  • Liver dysfunction
  • Fluid overload
  • Respiratory compromise
  • Increased CO2 production
  • Lipogenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

(FILL IN THE BLANK)

[Insoluble/Soluble] fiber has stool softening effect resulting in faster transit time and more frequent bowel movements which provides relief from constipation.

[Insoluble/Soluble] fiber is fermented in the distal intestines and increases intestinal mucosal growth and promotes water and sodium absorption.

A
  1. Insoluble fiber
  2. Soluble fiber
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the approximate half-life of albumin?

A

20 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the approximate half-life of serum prealbumin?

A

2-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Define metabolic acidosis.

A

Metabolic acidosis: characterized by reduced pH, reduced [serum HCO3], and compensatory HYPERventilation resulting in a DECREASE in PCO2.

Causes:

  • GI loss of HCO3 (D, pancreatic or small bowel fistula)
  • Renal loss of HCO3 (T2 renal tubular acidosis, hyperparathyroidism, hypoaldsteronism)
  • Ingestion of ammonium chloride or PN containing chloride salts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Explain the chemical structure of fatty acids.

A

Molecules with an acidic carboxyl group at one end followed by a long chain of hydrogenated hydrophobic carbon atoms. Each FA is chemically characterized by the number of carbon atoms and double bonds present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How long are:

  • Short-chain FAs
  • Medium-chain FAs
  • Long-chain FAs
  • Very long-chain FAs
A
  • SCFAs (2-4 carbons)
  • MCFAs (6-12 carbons)
  • LCFAs (14-18 carbons)
  • Very long-chain (20 carbons or more)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What type of FA is butyric acid?

A

SCFA (has 4 carbons)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What type of FA is lauric acid?

A

MCFA (has 12 carbons)

34
Q

What type of FA is stearic acid?

A

LCFA (has 18 carbons)

35
Q

Explain the basic structure of a triglyceride.

A

Glycerol backbone with 3 FA molecules attached via an ester linkage.

36
Q

Triglycerides that require bile acids to facilitate enzymatic digestion and absorption contain FAs that are typically how long?

A

14 carbons in length.

The overwhelming majority of enteral dietary lipids (~90%) are ingested in the form of triglycerides. FAs of up to 10 carbons in length and glycerol can be absorbed DIRECTLY via the villi of the intestinal mucosa.

Long-chain triglycerides require bile salts for both enzymatic digestion and the formation of micelles.

37
Q

Where does the oxidation of FAs for ATP production occurs…?

A

Cells that contain mitochondria.

  • Mitochondria are organelles found in most eukaryotes whose primary function is to generate APT via oxidative phosphorylation, the major source of cellular energy.
  • FAs are transported into the mito. membrane and through the beta-oxidation pathway the FA is degraded and released as ATP.
38
Q

(TRUE/FALSE)

Red blood cells DO contain mitochondria in their cytoplasm.

A

FALSE

RBCs rely on the metabolic pathway of glycolysis for ATP for energy.

39
Q

What do both linoleic acid and alpha-linolenic acid require to enter the mitochondria?

A

L-carnitine

40
Q

Explain the breakdown of water in the body.

  • Intracellular
  • Extracellular
  • Transcellular
A

TBW (total body water is 50-60% of body weight; broken down into 3 compartments on front).

  • ICF = 2/3
  • ECF = 1/3
    • Intravascular space = 1/4
    • Interstitial space = 3/4
41
Q

What is the best treatment for mild hypercalcemia? Severe hypercalcemia?

A
  • Mild: Usually responds to hydration and ambulation; requiring no further intervention.
  • Severe: Initially treated with saline hydration to correct volume depletion; then furosemide after hydration to enhance renal calcium excretion. HD may be necessaary
42
Q

Absorption of large polypeptides, oligopeptides, and free AAs takes place in the?

A

Small intestine.

-HCL secreted by the parietal cells of the stomach denatures the protein and makes it more susceptible to enzymatic action. Converts the inactive pepsinogen to active pepsin. Pepsin activates other pepsinogen molecules or hydrolyzes specific peptide bonds into end products of large polypeptides, oligopeptides, and free AAs. This mixture known as acid chyme passes into the duodenum where the majority of protein digestion takes place.

43
Q

When determining nitrogen balance, urea accounts for what percentage of total urine nitrogen losses?

A

80%.

-Urinary urea nitrogen concentration is affected by stress and increased urinary excretion of non-urea nitrogen.

44
Q

Supplemental arginine is considered therapeutic for what?

A

Immune function and wound healing.

-Supplementation with arginine in the critically ill septic patient population remains controversial.

45
Q

Transformation of free LCFAs into acylcarnitines and transport into the mitochondria, requires what?

A

Carnitine.

  • It is a trimethyl AA similar in structure to choline
  • Primary deficiency is rare, it has been documented in preterm infants and chronic renal failure.
46
Q

Which organ is key for protein metabolism? Why?

A

Liver because of its high capacity for uptake and metabolism of aaS.

  • About 57% of the AAs extracted by the liver are either oxidized or used to synthesize plasma proteins.
47
Q

How does soluble fiber control diarrhea?

A

Soluble fiber has the ability to increase sodium and water absorption via its fermentation byproducts (SCFAs).

48
Q

What are two symptoms of abdominal discomfort?

A

Bloating and flatulence

49
Q

How does insoluble dietary fiber regulate normal defecation?

A

Increasing stool weight and bulk.

50
Q

Consumption of soluble fiber contributes to lower what?

A

Total cholesterol and LDL cholesterol.

  • Does not change or lower HDL cholesterol levels
  • May result in a small decrease in plasma glucose and A1C.
51
Q

(TRUE/FALSE)

Soluble fiber lowers the risk of developing colon cancer and reducing the recurrence of adenomas.

A

FALSE

Currently no clear evidence.

52
Q

During long-term starvation, what is the main energy source?

A

Fat acid oxidation.

  • Fat tissue becomes the main energy source for nearly all tissues.
  • After 14 days of fasting, adipose tissue can provide more than 90% of daily energy requirements.
  • Remember: high glucagon concentrations promote FA oxidation
53
Q

Sodium-glucose transporter 1 (SGLT-1) transports which two substrates into the enterocytes from the intestinal lumen?

Does this require energy?

A
  1. Glucose
  2. Galactose

Yes, energy is provided by hydrolysis of ATP; therefore, is an active transport system.

54
Q

Which 2 water-soluble vitamins do not require Na+ co-transporters for absorption?

A
  1. Vitamin B12
    1. Requires intrinsic factor (secreted by parietal cells in the stomach) for absorption, taken up by receptors in the distal ileum
  2. Folic Acid
    1. Absorbed by a carrier-mediated process, primarily in the proximal part of the small intestine.
55
Q

How are MCTs absorbed?

A

They are water-soluble, hydrolyzed and pass through the enterocytes directly into the portal circulation

56
Q

(TRUE/FALSE)

MCTs require the formation of micelles or bile salts for absorption.

A

FALSE.

They are water soluble

57
Q

Mucosal atrophy that accompanies bowel rest may result from an absence of what substrate?

A

Glutamine, the principal metabolic fuel for intestinal cells

  • Atrophic changes during bowel rest have been decreased with glutamine-enriched parenteral nutrition.
58
Q

What are symptoms of diarrhea, bloating, and flatulence after ingestion of sugar caused by?

A

Deficiency of brush border oligosaccharidases

  • This deficiency allows osmotically active undigested oligosaccharides to cause a shift of water into the intestinal lumen
  • Resulting in increased pressure increases further when colonic bacteria act on remaining oligosaccharides, thus increasing the number of osmotically active particles.
  • Formation of CO2 and H2 from disaccharides further increase symptoms.
59
Q

Where does the majority of fat digestion occur?

A

Duodenum (with pancreatic lipase)

  • Begins in the mouth (lingual lipase, ~10%) and stomach (gastric lipase, small amount)
60
Q

What is the role of bile acids in fat digestion?

A

Act as emulsifiers

61
Q

What is pancreatic exocrine deficiency?

A

The pancreas does not provide the digestive enzymes or they do not work normally

  • Symptoms: diarrhea, abdominal pain/distention/bloating/cramps/flatulence/weight loss
  • Treatment: Pancreatic enzyme replacement therapy
62
Q

What AA is conditionally essential and also a primary fuel source for enterocytes?

A

Glutamine

  • Most abundant AA in the body, and vital fuel for rapidly dividing cells
  • In some conditions: trauma, sepsis and exercise, the body’s glutamine requirement exceeds the rate of synthesis
  • Decreased levels are associated with intestinal mucosal atrophy, impaired immune function, and decreased protein synthesis
63
Q

What is the average nitrogen content of protein? Calculation?

A

Has been determined to be 16%

  • To calculate nitrogen content of a protein in a PN solution:
    • Total grams of protein x 0.16 OR
    • Total grams of protein / 6.25
64
Q

What is the protein recommendation for critically ill patients with trauma? What are two exceptions? What is their recommendation?

A

1.5 to 2.0 g/kg/day

Exceptions:

  • CRRT & BMI > 30 should get 2.0 to 2.5 g/kg/day
65
Q

What are two areas of the body that require a constant supply of glucose?

A

Brain and RBCs

66
Q

When does glycogenolysis start during fasting? When are stores depleted?

When is gluconeogenesis started? When does the body switch substrates after this?

Why does the body switch away from gluconeogenesis?

A

Glycogenolysis (breakdown of hepatic glycogen stores) begins 2-3 hours of fasting; with stores depleted after 24 hours.

Gluconeogenesis (from AA substrate) begins within 4-6 hours after the last meal. After 2 days of starvation, the brain switches its fuel source from glucose to ketone bodies.

The liver converts free FAs to ketone bodies. The adaptation of starvation with a ketone-based fuel system minimizes gluconeogenesis and further protein breakdown.

67
Q

What are the 3 organs in the body that have the necessary enzymes for gluconeogenesis?

A
  1. Liver (main site)
  2. Small intestine (under certain conditions)
  3. Kidney (under certain conditions)
68
Q

Explain AMDR. What 3 nutrients have established AMDRs?

A

AMDR = Acceptable Macronutrient Distribution Range

  • A range of intake for a particular energy source that is associated with reduced risk, rather than assisting in the treatment, of chronic disease.
    • Omega-3
    • Omega-6
    • Total Fat
69
Q

Explain Tolerable Upper Intake Level.

A

The highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population.

70
Q

Explain EAR.

A

EAR = Estimated Average Requirement.

  • The average daily nutrient intake level estimated to meet half the needs of healthy individuals in a particular life stage and gender group.
71
Q

What oils are included in commercial enteral formulas to provide a good source of linoleic and alpha-linolenic acids?

A
  • Corn
  • Soybean
  • Safflower
  • Canola oils
72
Q

What is the prominent clinical change seen with EFAD? What are other implications?

A

Dry, scaly rash

  • Increased susceptibility to infection
  • Impaired wound healing
  • Weight loss
  • Immune dysfunction
73
Q

(TRUE/FALSE)

The active transport of sodium out of the cell provides the energy for glucose transport.

A

TRUE

The transport of sodium out of the cell maintains the concentration gradient needed for sodium to shuttle more glucose into the mucosal cells.

74
Q

Explain pellagra.

A

Niacin deficiency disease; presents as the 3 ‘Ds’

  • Dermatitis
  • Diarrhea
  • Dementia

Food Sources include: meat, fish, poultry, enriched and fortified breads, and cereals

75
Q

What is ursodiol?

A

Ursodiol (ursodeoxycholic acid) is a form of bile acid that may potentially improve fat absorption.

Therefore, it facilitates absorption of fat.

76
Q

What does sulfamethoxazole/trimethoprim induce?

A

Hyperkalemia by impairing renal potassium excretion.

77
Q

What is the first-line therapy for hyperkalemic emergencies?

A

Calcium gluconate 1-2 grams IV over 10 minutes, with an effective onset time of 1-2 minutes.

Should be given to symptomatic patients or those with ECG changes to restore membrane excitability to normal.

Other options, but limited:

  • HD (access limited)
  • Insulin gtt with dextrose (15-45 min onset time)
  • Lasix (5-15 min onset time)
78
Q

What acid-base disorder is likely to occur with acute severe diarrhea?

A

Metabolic acidosis

  • Diarrhea induces GI losses of bicarbonate
79
Q

What are the most serious complications of hyperphosphatemia?

A

Metastatic and vascular calcification of non-skeletal tissues

80
Q

Define metabolic alkalosis.

A

Characterized by an elevation in pH, an increase in [serum HCO3], and compensatory HYPOventilation, resulting in a RISE of PCO2

Common Causes:

  • Loss of gastric acid (HCl) as a result of V or NG suction
  • Loss of intravascular volume and chloride as a result of diuretic use
  • Overzealous tx metabolic acidosis of bicarbonate OR an excess of acetate in PN solutions (which is metabolized to bicarb with a normally functioning liver)
  • Some renal impairment must exist for this condition to occur

Tx: Treatment of the underlying cause; aggressive K repletion when hypokalemia is present in hyperaldosteronism

*

81
Q

Define respiratory acidosis.

A

Characterized by reduced pH, an elevation in PCO2, and a variable increase in the [serum HCO3].

  • Almost always results from a decreased effective alveolar ventilation, not an increase in CO2 production

Causes:

  • Central depression of respiration
  • Drugs (opioids, sedatives)
  • Stroke
  • Head injury
  • Sleep apnea
  • Airway or pulmonary abnormalities (airway obstruction, asthma, COPD, severe pulmonary edema, ARDS, pneumothorax, smoke inhalation)
  • Neuromuscular abnormalities (Brainstem or cervical cord injury, Guillain-Barre syndrome), myasthenia gravis, MS)
  • Obesity HYPOventilation
  • Mech vent HYPOventilation
  • PN/EN OVERfeeding
82
Q

Define respiratory alkalosis:

A

Characterized by elevated pH, a decrease in PCO2, and a variable reduction in [serum HCO3]. Occurs when effective alveolar ventilation is increased beyond the level necessary to eliminate metabolically produced CO2.

Common Causes:

  • Central simulation of respiration
  • Anxiety, pain, fever
  • Brain tumors
  • Vascular accidents
  • Head trauma
  • Pregnancy
  • Catecholamines, Salicylate toxicity
  • Peripheral stimulation
  • Pulmonary embolus
  • Asthma
  • High altitudes
  • PNA
  • Pulmonary edema
  • Severe anemia
  • Mech vent HYPERventilation
  • Hepatic encephalopthy

CNSC Exam 2021 (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions