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Pediatrics Board Exam > FEN/Nutrition > Flashcards

FEN/Nutrition Flashcards

1
Q

Serum osmolality equation

A

2Na + (BUN/2.8) + (glucose/18)

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2
Q

What meds are associated with metabolic alkalosis?

A

Loops (Furosemide) and thiazides (HCTZ and metolazone)

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3
Q

What meds are associated with metabolic acidosis?

A

Acetazolamide and potassium sparing agents like spironolactone

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4
Q

What is the primary issue in type 1 distal tubular acidosis?

A

Inability to acidify urine/ excrete H+ in the urine (urine pH >5.5)

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5
Q

What is the primary issue in type 2 proximal tubular acidosis?

A

Inability to absorb HCO3 (urine pH <5.5)

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6
Q

What is the primary issue in RTA type 4?

A

Resistance to aldosterone, hyperkalemia

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7
Q

Infant that appears well at birth, but later develops lethargy, poor feeding, seizures. Elevated serum ammonia and elevated anion gap metabolic acidosis on labs.

A

Organic acidemias (methylmalonic/proprionic/isovaleric acidemia)

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8
Q

Infant that appears well at birth, but later develops lethargy, poor feeding, seizures. Elevated serum ammonia and no metabolic acidosis.

A

Urea cycle defects

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9
Q

Daily requirement of sodium

A

2-3 mEq/kg/day

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10
Q

Inheritance of nephrogenic DI

A

X-linked (only found in males)

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11
Q

What should urinary sodium be in SIADH

A

> 25

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12
Q

When is hypertonic sodium (3%) indicated

A

When serum sodium <120

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13
Q

Next step if fluid restriction is not adequate in SIADH

A

Furosemide or hypertonic saline

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14
Q

What is the total body sodium in dilutional hyponatremia

A

NORMAL

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15
Q

How do you distinguish dilutional hyponatremia from 3rd spacing?

A

Urine sodium is high in dilutional hyponatremia

Urine sodium is LOW in 3rd spacing

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16
Q

Total body sodium in nephrotic syndrome

A

Labs will report hyponatremia, but total body sodium is elevated

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17
Q

Daily requirement of potassium

A

1-2 mEq/kg/day

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18
Q

What electrolyte disturbance causes muscle weakness and QT prolongation

A

Hypocalcemia

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19
Q

Infant with abdominal mass who becomes hypotensive, non-palpable pulses and distant heart sounds. EKG with widened QRS complex. Immediate treatment?

A

Adrenal failure with hyperkalemia and electromagnetic dissociation. Tx with calcium chloride

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20
Q

How do you calculate FeNa

A

(Urine sodium/serum sodium) divided by (Urine creatinine/plasma creatinine)

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21
Q

What FeNa indicates low urinary sodium loss? High urinary sodium loss?

A

2.5= high

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22
Q

How many mEq/L/day should sodium be decreased in hypernatremia to avoid cerebral edema?

A

No more than 10-12 mEq/day

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23
Q

If dehydration is chronic, sodium should be decreased at what rate per hour

A

0.5 to 1 mEq per hour

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24
Q

Child with tachycardia, decreased tears and urine production. What % dehydration and how to replace?

A

5% or 50cc/kg. Add 50 cc/kg to maintenance, replace the first 1/2 over 8 hours, remaining over 16 hours.

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25
Q

Child with tachycardia, decreased urine, sunken eyes, poor skin turgor, sunken fontanelle. What % dehydration and how to replace?

A

10% or 100cc/kg. Add 100cc/kg to maintenance. Give 20cc/kg over first hour, remaining 1/2 over next 7 hours and rest over 16 hours

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26
Q

Child with signs of dehydration, plus signs of shock, such as delayed cap refill time. What percent dehydration and how to replace?

A

15% or 150cc/kg. Add 150cc/kg to maintenance. Give 20cc/kg boluses until you see clinical improvement. Take remaining and replace over 24 hours

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27
Q

How does glucose affect serum sodium measurement?

A

Every 100 mg/dl increase in glucose above normal lowers serum sodium by 1.6 mg/dl

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28
Q

What is normal serum osmolality?

A

around 300

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29
Q

What is normal urine potassium excretion?

A

20 mEq/L

30
Q

What are some associated findings with Distal RTA?

A

Nephrocalcinosis, Rickets, sensorineural deafness

31
Q

When should premies get iron supplementation?

A

If exclusively breastfed, starting at 1 month of age until 12 months

32
Q

What vitamin is folate?

A

B9

33
Q

What vitamin abnormality causes congestive heart failure, tachycardia, and peripheral edema??

A

Vitamin B1 (thiamine) deficiency “wet beri beri”

34
Q

What vitamin abnormality causes seborrheic dermatitis, angular stomatitis, and anemia?

A

Vitamin B2 (Riboflavin) deficiency

35
Q

What vitamin abnormality are preemies on prolonged phototherapy at risk for?

A

Vitamin B2 (Riboflavin) deficiency

36
Q

What vitamin abnormality causes memory problems, diarrhea, glossitis, and skin rash in sun-exposed skin?

A

Vitamin B3 (Niacin) deficiency “Pellagra”

37
Q

Swelling of tongue, rash, and neuropathy. What vitamin abnormality? What drug can cause this?

A

Vitamin B6 (pyridoxine) deficiency; Can be caused by INH therapy in older children

38
Q

Large tongue and macrocytic anemia

A

Vitamin B9 (Folate) deficiency

39
Q

What vitamin is goat’s milk deficient in?

A

Folate (B9)

40
Q

Macrocytic anemia, pernicious anemia, peripheral neuropathy

A

B12 (Cyanocobalamin) deficiency

41
Q

Leg tenderness, poor wound healing, bleeding gums

A

Scurvy caused by Vitamin C deficiency

42
Q

This vitamin deficiency causes hemolytic anemia in preemies

A

Vitamin E

43
Q

What does vitamin K deficiency lead to? how to tx?

A

Hemorrhagic disease of the newborn- treat active bleeding with vitamin K and FFP

44
Q

Vegan diets are poor in what vitamin?

A

B12

45
Q

Toxicity of which vitamin causes sensory neuropathy, progressive ataxia?

A

Vitamin B6 (Pyridoxine) toxicity

46
Q

What vitamin toxicity causes hepatosplenomegaly?

A

Vitamin A Toxicity

47
Q

What mineral deficiency causes myositis, cardiomyopathy, loss of pigmentation in skin and hair?

A

Selenium

48
Q

Bullous and pustular lesions of oral, anal, genital, and extremities. Alopecia, diarrhea, and eye problems. Which disease and what is the inheritance?

A

Acrodermatitis enteropathica (autosomal recessive); defect in zinc absorption

49
Q

What to think about when patient has microcytic anemia that does not respond to iron, neutropenia, depigmentation of skin/hair

A

Copper deficiency

50
Q

2-3 month old male with loss of milestones, FTT, kinky lightly pigmented hair, skeletal abnormalities?

A

Menke’s disease (X-linked); copper deficiency

51
Q

Occurs when there is severe deficiency of protein and calories

A

Kwashiorkor

52
Q

Occurs when there is severe deficiency of calories

A

Marasmus

53
Q

How to calculate caloric requirements based on weight?

A

100 kcal/kg (1st 10kg), 50 kcal/kg (next 10kg), 20 kcal/kg (any additional kg). So the 1st 20 kg has 1500 kcal (20 kcal/kg for each additional)

54
Q

Protein requirement in preemies? Full term infants?

A

3.5g/kg/day in preemies. 2.5g/kg/day in term infants

55
Q

Recommended iron concentration in iron fortified formula?

A

12mg/L

56
Q

What is the main type of protein in human milk? What is the content and how much is nutritionally available?

A

Whey protein; Protein content is 9g/L (About 7 g/L is nutritionally available)

57
Q

1 week old infant with scaly dermatitis, hair loss, diarrhea, poor wound healing, and growth failure. What deficiency to think of, especially in a preemie?

A

Essential fatty acids. Linoleic and linolenic acid.

58
Q

What is the Whey:Casein ration in early breast milk? Mature breast milk? Cow’s milk formula? Cow’s milk?

A

Early breast milk 90:10; Mature breastmilk 60:40; Cow’s milk formula 40:60; and cow’s milk 20:80

59
Q

2 month old with heme positive stools, or blood streak in stools, with normal exam. Tx?

A

Think Severe milk protein intolerance (Food protein-induced enterocolitis syndrome). TX by switching to protein hydrolysate formula (or if breastfeeding, to completely eliminate the protein from mom’s diet)

60
Q

Infant weaned from breast milk recently, now with facial dermatitis, scaly rash on hands/feet, diarrhea, and thin hair. What is the most likely cause?

A

Zinc deficiency (Human breast milk facilitates zinc absorption)

61
Q

What percent of total fat is MCTs in preemie formula? Mature breast milk?

A

50% in preemie formula, 12% in mature breast milk (Doesn’t need as much because of high absorptive abilities)

62
Q

What is the difference in protein content, fat content, energy content, and lactose content in colostrum vs. mature milk?

A

Colostrum has higher protein, lower fat, lower energy content, and slightly less lactose than mature milk

63
Q

Cow’s milk is much higher in what electrolyte than breastmilk? If an infant drinks cow’s milk, what can result?

A

Cow’s milk is higher in phosphorus leading to hypocalcemia

64
Q

What 2 components important for neurological development decrease in mature milk?

A

Arachadonic Acid and docosahexaenoic acid

65
Q

What medications are contraindicated in breastfeeding?

A

Flagyl, Diazepam, anti-thyroid meds, sulfa drugs and tetracycline

66
Q

What illnesses in the mother are contraindicated with breastfeeding?

A

HIV, TB, CMV, or HSV with lesions on breast

67
Q

What is the protein content of modified cow formula?

A

1.4 g/dL or 14 g/L

68
Q

A child who is obese at age 6 has a what % chance of being obese as an adult? A child at age 12?

A

25% and 75%

69
Q

What type of formula do infants in renal failure require?

A

Low phosphorus formula; Should get 70% calories from carbs, 20% from lipids

70
Q

Symptoms of hyperaldosteronism (Hyperkalemia/hyponatremia) but with LOW serum aldosterone. Inheritance?

A

Liddle Syndrome. Autosomal dominant

71
Q

In this vitamin derangement, radiographic findings typically reveal long, wavy cortical hyperostosis of the bones, often sparing the metaphyseal areas

A

Hypervitaminosis A

Pediatrics Board Exam (23 decks)

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