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final exam Flashcards

1
Q

main gluconeogenic substrates

A

glycerol and alanine

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2
Q

thiamine

A

its deficiency cause wernike korsakoff encephalopathy

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3
Q

riboflavin

A

works as a hydrogen career in krebbs cycle as FAD

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4
Q

niacin

A

works as a hydrogen career in krebbs cycle as NAD

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5
Q

panthotenic acid

A

its a component of CoA as a acil defects

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6
Q

piridoxin

A

it deficiency cause sideroblastic anemia

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7
Q

biotin

A

its a cofactor of carboxylase enzymes in the mitochondria

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8
Q

folic acid

A

it has an important role before and during pregnancy to prevent neutral tube defects

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9
Q

cobalamin

A

its absorbed in the ileum with intrinsic factor produced in the stomach

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10
Q

if you have and elderly male px with a Hb of 11.3 mg/dL and VCM of 114; what deficiency do you suspect?

A

folic acid

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11
Q

this mineral has an important role in insuline resistence

A

chromium

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12
Q

this vitamin has been used in neurologic px for its antioxidant properties

A

vitamin E

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13
Q

this vitamin has a crucial role in carboxylation and activation of coagulation factors:

A

vitamin K

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14
Q

if you have a ox with anorexia nervosa, who has been restricting her energy consumption for 2 months; her labs show glucose in upper limit, hypertrigliceridemia and normal albumin; which is the main substrate that she is using?

A

lipids from adipose tissue

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15
Q

regarding proteolysis during metabolic adaptation to simple starvation and stress starvation

A

lower in starvation that in stress

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16
Q

regarding gluconeogenesis during metabolic adaptation to simple starvation and stress starvation

A

lower starvation and high in stress

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17
Q

regarding ketogenesis during metabolic adaptation to simple starvation and stress starvation

A

higher in starvation than in stress

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18
Q

nutritional screening tool recommended by ASPEN for hospitalized px

A

SGA

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19
Q

nutritional screening tool recommended by ESPEN for hospitalized px

A

NRS

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20
Q

absolute gastrointestinal contraindications for enteral nutrition

A

intestinal obstruction and ileus

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21
Q

you have a female px with advance dementia, who suffered a stroke and consequent dysphagia; the neurology doesnt expect a full recovery in the next 3 months; which would be the best option?

A

EN with gastrostomy

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22
Q

you have an obese px who suffered a car accident and is in the ICU, he is tolerating the EN; he is sedated and with hig values of PEEP in the mechanical ventilation; which would be the best option?

A

nasoyeyunal tube with continuous infusion

23
Q

mention the parameters with which we calculate gastric capacity for the bolus:

A

5-7 ml/kg per bolus

24
Q

according to ASPEN and ESPEN, how do we advance the infusion rate for continuous EN

A

start with 20 ml/hr increase 20 every 6-8 hr according to tolerance until you achieve the infusion rate goal

25
Q

according to ESPEN, which is the max osmolarity we can use with a peripheral catheter

A

850 mosm/L

26
Q

orden according to the best option for a central access, being 1 the first choice and 5 the last one

A
  1. subclavian catheter
  2. jugular catheter
  3. brachial catheter
  4. axillar catheter
  5. femoral catheter
27
Q

true

A
  • trilumen catheter have a higher risk of infection
  • hickmann catheter is an example of a tunneled central catheter
28
Q

false

A
  • portacat catheter shoeld be used for PN for a long period of time
  • PICCS are collocated for peripherical access
  • PVI solutions are prederred to chlorhexidine for skin preparation for a CVC
29
Q

its a way to control hypercatabolism other that nutrition:

A

all of the above: analgesia; pain control/temperature/prevention of infections

30
Q

energy recommendation that you would ose for a undernourished px with a BMI 15.5 to prevent refeeding syndrome

A

10 kcal/kg

31
Q

in reffeding syndrome ist very important to supplement the following:

A

thiamine

32
Q

in the prevention of refeeding syndrome, thiamine supplement should be given:

A

intravenously

33
Q

in the prevention of refeeding syndrome, thiamine should be administered

A

30 min before nutrition administration starts

34
Q

main electrolyte we need to monitor in a px with refeeding risk

A

P

35
Q

in the management of anemia in a px with refeeding syndrome, in which way iron supplementation should be administered

A

after 7 days we started nutritional therapy

36
Q

dose in which we supplement omega 3 in critically ill px as immunotherapy

A

2000 mg per day

37
Q

dose in which most investigations report toxicity with omega 3 supplementation

A

over 6 g a day

38
Q

px at risk in which omega 3 supplementation should be carefully assessed and probably should not be used:

A

thombocytopenia

39
Q

you are using glutamine supplementation to modulate inflammation in critically ill px which via is preferred?

A

PN

40
Q

dose in which we supplement glutamine in a critically ill px

A

0.5 g/kg

41
Q

main consideration to supplement a px with glutamine

A

px live function test must be normal

42
Q

due to the fact that arginine is precursor of nitric oxide, its supplementation is not recommended and/or should be carefully assessed in this type of pathologies

A

sepsis

43
Q

predominant features of liver disease in px with HPN are:

A

cholestasis in children and steatosis in adults

44
Q

mention the safest limit for CHO infusion in PN when treating liver disease associate to PN

A

maximum 5 mg/kg/min

45
Q

main consideration in lipids emulsions for PN in relation with cholestatic syndrome:

A

combinations of long chain/medium chain fatty acids with polyunsaturated fatty acid seem to reduce the risk

46
Q

when treating cholestatic syndrome as a complication of PN, what should we do in terms of infusion rate?

A

cycle PN until the liver has recovered

47
Q

when se treat cholestatic syndrome as a complication of long term PN we should consider the following

A

remove oligoelements from the PN

48
Q

its an important risk factor for metabolic osteopathy as a complication of PN

A

to much phosphorus in the PN

49
Q

in px with HPN, bone mineral density assessment by DEXA scanning is recommended at the following interval?

A

yearly

50
Q

accoding to ESPEN guidelines, which is the limit of life expectancy we consider for using PN in a terminally ill px?

A

3 months

51
Q

under which karnofsky score in a cancer px, HPN is recommended?

A

50

52
Q

in acute pancreatitis, which should be the preferred via of administration for the nutrition

A

nasojejunal tube

53
Q

consequence of overfeeding an ICU px

A

all of the answer are correct: difficulty to wean from ventilator, increased cardiac output, hyperglycemia

54
Q

euglycemic concept in ICU px

A

140-480 mg/dL

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