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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
Child with tachycardia, decreased urine, sunken eyes, poor skin turgor, sunken fontanelle. What % dehydration and how to replace?
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
26
Child with signs of dehydration, plus signs of shock, such as delayed cap refill time. What percent dehydration and how to replace?
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
27
How does glucose affect serum sodium measurement?
Every 100 mg/dl increase in glucose above normal lowers serum sodium by 1.6 mg/dl
28
What is normal serum osmolality?
around 300
29
What is normal urine potassium excretion?
20 mEq/L
30
What are some associated findings with Distal RTA?
Nephrocalcinosis, Rickets, sensorineural deafness
31
When should premies get iron supplementation?
If exclusively breastfed, starting at 1 month of age until 12 months
32
What vitamin is folate?
B9
33
What vitamin abnormality causes congestive heart failure, tachycardia, and peripheral edema??
Vitamin B1 (thiamine) deficiency "wet beri beri"
34
What vitamin abnormality causes seborrheic dermatitis, angular stomatitis, and anemia?
Vitamin B2 (Riboflavin) deficiency
35
What vitamin abnormality are preemies on prolonged phototherapy at risk for?
Vitamin B2 (Riboflavin) deficiency
36
What vitamin abnormality causes memory problems, diarrhea, glossitis, and skin rash in sun-exposed skin?
Vitamin B3 (Niacin) deficiency "Pellagra"
37
Swelling of tongue, rash, and neuropathy. What vitamin abnormality? What drug can cause this?
Vitamin B6 (pyridoxine) deficiency; Can be caused by INH therapy in older children
38
Large tongue and macrocytic anemia
Vitamin B9 (Folate) deficiency
39
What vitamin is goat's milk deficient in?
Folate (B9)
40
Macrocytic anemia, pernicious anemia, peripheral neuropathy
B12 (Cyanocobalamin) deficiency
41
Leg tenderness, poor wound healing, bleeding gums
Scurvy caused by Vitamin C deficiency
42
This vitamin deficiency causes hemolytic anemia in preemies
Vitamin E
43
What does vitamin K deficiency lead to? how to tx?
Hemorrhagic disease of the newborn- treat active bleeding with vitamin K and FFP
44
Vegan diets are poor in what vitamin?
B12
45
Toxicity of which vitamin causes sensory neuropathy, progressive ataxia?
Vitamin B6 (Pyridoxine) toxicity
46
What vitamin toxicity causes hepatosplenomegaly?
Vitamin A Toxicity
47
What mineral deficiency causes myositis, cardiomyopathy, loss of pigmentation in skin and hair?
Selenium
48
Bullous and pustular lesions of oral, anal, genital, and extremities. Alopecia, diarrhea, and eye problems. Which disease and what is the inheritance?
Acrodermatitis enteropathica (autosomal recessive); defect in zinc absorption
49
What to think about when patient has microcytic anemia that does not respond to iron, neutropenia, depigmentation of skin/hair
Copper deficiency
50
2-3 month old male with loss of milestones, FTT, kinky lightly pigmented hair, skeletal abnormalities?
Menke's disease (X-linked); copper deficiency
51
Occurs when there is severe deficiency of protein and calories
Kwashiorkor
52
Occurs when there is severe deficiency of calories
Marasmus
53
How to calculate caloric requirements based on weight?
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
Protein requirement in preemies? Full term infants?
3.5g/kg/day in preemies. 2.5g/kg/day in term infants
55
Recommended iron concentration in iron fortified formula?
12mg/L
56
What is the main type of protein in human milk? What is the content and how much is nutritionally available?
Whey protein; Protein content is 9g/L (About 7 g/L is nutritionally available)
57
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?
Essential fatty acids. Linoleic and linolenic acid.
58
What is the Whey:Casein ration in early breast milk? Mature breast milk? Cow's milk formula? Cow's milk?
Early breast milk 90:10; Mature breastmilk 60:40; Cow's milk formula 40:60; and cow's milk 20:80
59
2 month old with heme positive stools, or blood streak in stools, with normal exam. Tx?
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
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?
Zinc deficiency (Human breast milk facilitates zinc absorption)
61
What percent of total fat is MCTs in preemie formula? Mature breast milk?
50% in preemie formula, 12% in mature breast milk (Doesn't need as much because of high absorptive abilities)
62
What is the difference in protein content, fat content, energy content, and lactose content in colostrum vs. mature milk?
Colostrum has higher protein, lower fat, lower energy content, and slightly less lactose than mature milk
63
Cow's milk is much higher in what electrolyte than breastmilk? If an infant drinks cow's milk, what can result?
Cow's milk is higher in phosphorus leading to hypocalcemia
64
What 2 components important for neurological development decrease in mature milk?
Arachadonic Acid and docosahexaenoic acid
65
What medications are contraindicated in breastfeeding?
Flagyl, Diazepam, anti-thyroid meds, sulfa drugs and tetracycline
66
What illnesses in the mother are contraindicated with breastfeeding?
HIV, TB, CMV, or HSV with lesions on breast
67
What is the protein content of modified cow formula?
1.4 g/dL or 14 g/L
68
A child who is obese at age 6 has a what % chance of being obese as an adult? A child at age 12?
25% and 75%
69
What type of formula do infants in renal failure require?
Low phosphorus formula; Should get 70% calories from carbs, 20% from lipids
70
Symptoms of hyperaldosteronism (Hyperkalemia/hyponatremia) but with LOW serum aldosterone. Inheritance?
Liddle Syndrome. Autosomal dominant
71
In this vitamin derangement, radiographic findings typically reveal long, wavy cortical hyperostosis of the bones, often sparing the metaphyseal areas
Hypervitaminosis A

Pediatrics Board Exam (23 decks)

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