Breastfeeding/ Malnutrition/ Vitamin A & D

Question 1

The major risk period for growth stunting or impaired linear growth is

Answer 1

Between 4 months to 2 years of age

Question 2

Which of the following statements in NOT true regarding Recommended Daily Allowance (RDA):
A. The average daily nutrient intake level estimated to meet the requirements for 50% of the population, assuming normal distribution
B. An estimate of the daily average nutrient intake to meet the nutritional needs of >97% of the individuals to avoid deficiency in the population.
C. Can be used as a guideline for individuals to avoid deficiency in the population
D. The RDA coincides with 2 SD from the mean of normal distribution of daily reference intakes
E. All are correct

Answer 2

A. The average daily nutrient intake level estimated to meet the requirements for 50% of the population, assuming normal distribution

Question 3

the success of breastfeeding initiation and continuation depends on the following

Answer 3

Education about breastfeeding

Hospital breastfeeding practices and policies

Question 4

This substance found in breastmilk exerts its beneficial property in immunomodulation, iron chelation, antimicrobial action and trophic for intestinal growth:

Answer 4

Lactoferrin

Question 5

This condition is characterized by persistent nipple pain and infant refusal to feed, thus, both mother and infant should receive treatment while continuing breastfeeding:

Answer 5

Candidiasis

Question 6

The following will prevent breasts to be engorged:
A. Wearing a supportive bra in between feedings
B. Cold compress should be applied prior to breastfeeding
C. Breastfeeding immediately at signs of infant hunger
D. All of the above

Answer 6

C. Breastfeeding immediately at signs of infant hunger

Question 7

True of mastitis in breastfeeding women, EXCEPT:
A. Mastitis occurs in 2-3% of lactating women and is usually bilateral.
B. Its symptoms may include myalgia and fever with fatigue, nausea, vomiting and headache.
C. Diagnosis is confirmed by physical examination.
D. All of the above

Answer 7

A. Mastitis occurs in 2-3% of lactating women and is usually bilateral.

Question 8

Signs of insufficient milk intake, EXCEPT:
A. Lethargy
B. Hypernatremic dehydration
C. Weight loss >7% of BW
D. All of the above
E. None of the above

Answer 8

E. None of the above

Question 9

Disorder characterized by persistently high serum indirect bilirubin in a thriving healthy baby that becomes evident after the first week of life

Answer 9

Breastmilk jaundice

Question 10

Breastfeeding is generally contraindicated in:

Answer 10

Chemotherapy

Question 11

A mother diagnosed to have TB Disease underwent ceasarian section. On your routine history taking, no medications were started yet. What is your feeding management for the newborn?
A. Give cow milk formula in lieu of breastmilk since breastfeeding is contraindicated.
B. Initiate breastfeeding but advise mother to wear a mask since TB is an airborne disease.
C. May give cow milk formula until the mother completes her intensive phase TB treatment.
D. A and C
E. None of the above

Answer 11

e. none of the above

Question 12

Organism/s notably found in powdered cow milk formula causing outbreaks of infections especially in premature infant.

Answer 12

Enterobacter sakazakii

Question 13

The child’s height/weight minus the median height/weight for the age and sex of the child divided by the relevant standard deviation is the

Answer 13

z-score

Question 14

The following is/are used for screening wasted children in humanitarian emergencies and some field settings:

Answer 14

Mid upper arm circumference

Question 15

The median urinary iodine concentration in children ages 6-12 years is used to assess the prevalence of deficiency in the general population. What level indicates sufficient iodine intake?

Answer 15

<100ug/L

Question 16

The following is true of Iron Deficiency Anemia EXCEPT:
A. It is due to low iron intake or poor absorption
B. Women may have high rates of anemia as a result of menstrual blood loss.
C. Hemoglobin cut offs to define anemia decreases as age increases, that is, from infancy to adolescence.

Answer 16

C. Hemoglobin cut offs to define anemia decreases as age increases, that is, from infancy to adolescence.

Question 17

most profound consequence of undernutrition is:

Answer 17

Premature death

Question 18

True of children with Severe Acute Malnutrition
A. Affected children present similarly in their manifestations and degree of metabolic disturbances
B. Children who developed edematous malnutrition are more likely to have been exposed to noxae that generate oxidative stress.
Non-edematous children have greater deficits in free radical-scavenging antioxidants.
D. All of the above
E. None of the above

Answer 18

B. Children who developed edematous malnutrition are more likely to have been exposed to noxae that generate oxidative stress.

Question 19

When a child’s intake is insufficient to meet daily needs, physiologic and metabolic changes take place to conserve energy and prolong life. Which is true of these changes:
A. The kidneys excrete more excess fluids and sodium to prevent fluid overload
B. Heat production is less making the child more vulnerable to hypothermia
C. The heart is bigger but weaker with a reduce output.
D. All of the above

Answer 19

B. Heat production is less making the child more vulnerable to hypothermia

Question 20

A 2-year old male weighing 6kg was rushed to the ER due to several episodes of vomiting after eating noodles. The boy was unconscious with cold hands and weak, fast pulse. The emergency treatment in this case consists of

Answer 20

Giving IVF at 15ml/kg over 1 hour using Ringer’s lactate

Question 21

The following are ingredients of a recipe for concentrated electrolyte/mineral solution:

Answer 21

Magnesium chloride

Water

Question 22

When excess carbohydrates are administered during refeeding, the resultant increase in insulin levels may produce what kind of electrolyte imbalance?

Answer 22

Hypomagnesemia

Question 23

The following is/are TRUE regarding vitamin A:
A. It is a water-soluble micronutrient
B. It is a fat-soluble macronutrient
C. It is synthesized de-novo by mammals
D. It is not an obligatory dietary factor
E. None of the above

Answer 23

e. NONE

Question 24

food are VERY RICH in Vitamin A:

Answer 24

Organ meats (e.g. liver and kidney)

Question 25

This is the form required for cell differentiation and regulation of gene transcription and is the most bioactive form of vitamin A:

Answer 25

All-trans retinoic acid

Question 26

The following are TRUE regarding vitamin A in newborns:
A. Neonates begin life with low levels of vitamin A, in plasma, liver, and extrahepatic tissues, compared with those in adults.
B. Normal plasma levels of retinol are 20-50 ug/dL in infants, and decrease gradually as children become older
C. Retinol levels are lower in developed countries
D. Higher vitamin A stores and plasma retinol concentration are seen in low birthweight infants and in preterm newborns
E. All of the above

Answer 26

A. Neonates begin life with low levels of vitamin A, in plasma, liver, and extrahepatic tissues, compared with those in adults

Question 27

The most characteristic and specific signs of vitamin A deficiency are

Answer 27

Eye lesions

Question 28

Lesions caused by vitamin A deficiency develop insidiously and rarely occur before this age:

Answer 28

2 years old

Question 29

The following statement is true regarding the diagnosis of Vitamin A deficiency:

Answer 29

A diet history can be useful in suggesting or ruling out low intake as a cause.

Question 30

A daily supplement of this amount of vitamin A is sufficient for treating latent vitamin A deficiency

Answer 30

1,500 micrograms

Question 31

In children without overt vitamin A deficiency, morbidity and mortality rates from viral infections, such as measles, have been reduced by administration of vitamin A:

Answer 31

Weekly doses of 100,000-200,000 IU

Question 32

following is the antidote for hypervitaminosis A:
A. leucovorin
B. N-acetylcysteine
C. Charcoal
D. Dimercaprol
E. None of the above

Answer 32

E. None of the above

Question 33

Which of the following is TRUE:
A. Rickets occurs with inadequate mineralization of bone osteoid in children and adults
B. Osteomalacia is a disease of growing bone caused by unmineralized matrix at the growth plates in children only before fusion of the epiphyses
C. Rickets is principally caused by vitamin C deficiency and was rampant in Northern Europe and the US furing the early years of the 20th century
D. Ricekts remains a significatn problem in developing counteries but has been largely no longer a problem in developed countries
E. None of the above

Answer 33

E. None of the above

Question 34

Most of the manifestation of rickets are a result of skeletal change such as the following, EXCEPT:
A. Craniotabes
B. Rachitic rosary
C. Growth plate narrowing
D. Harrison grove
E. All of the above

Answer 34

C. Growth plate narrowing

Question 35

Patients with rickets and osteomalacia are advised to eat which of the following foods?

Answer 35

Fish oils, egg yolks, fatty fish

Question 36

On radiography, rachitic changes are most easily visualized in which body part

Answer 36

Wrist

Question 37

The intake of the following medication(s) need to be elicited in patients with rickets as they increase the degradation of vitamin D:

Answer 37

Phenytoin

Phenobarbital

Question 38

Which of the following statements regarding Vit D deficiency is/are INCORRECT?
A. Vitamin D deficiency most commonly occurs in childhood
B. Transplacental transport of vitamin D typically provides enough Vit D for the 1st 6 months of life unless there is severe maternal vitamin D deficiency
C. Breastfeeding should be encouraged as it has very high vitamin D content.
D. Most cases of rickets in the US and northern Europe occur in breastfed children of Caucasian descent of other light-pigmented populations
E. All of the above

Answer 38

E. All of the above

Question 39

The following statement/s is/are INCORRECT regarding the treatment of children with Vitamin D deficiency :
A. With stoss therapy, 300,000-600,000 IU of vitamin D are administered orally or intramuscularly as 2-4 doses over 1 day.
B. Stoss therapy is ideal in situations where adherence to therapy is questionable
C. An alternative to Stoss therapy is daily, high dose vitamin D, with doses ranging from 2,000-5000 IU/day over 4-6 weeks.
D. Intravenous calcium is initially given, as an acute bolus for symptomatic hypocalcemia
E. None of the above

Answer 39

E. None of the above

Question 40

To prevent rickets, universal administration of the following amount of Vitamin D to infants who are breastfed is needed

Answer 40

400 IU

Question 41

Which antibiotic medication can cause rickets

Answer 41

Isoniazid

Question 42

Which of the following statements is CORRECT
A. Fanconi syndrome is secondary to generalized dysfunction of the loop of Henle and is one possible renal cause of Rickets
B. Dent disease is an autosomal recessive disorder caused by mutations in the gene SLC 34A3
C. Tumor-induced osteomalacia is more common in children than adults and rarely produce classic rachitic findings
D. Most cases of rickets of prematurity occur in infants with a birthweight <1,000 g.

Answer 42

D. Most cases of rickets of prematurity occur in infants with a birthweight <1,000 g.