Final Review Flashcards
CB is 24 y/o with unintentional weight loss of 30lbs over past 4 months w/ normal intake. Complains of foul smelling stills and after work up, she is diagnosed with Crohn’s disease. What is responsible for weight loss?
Malabsorption
TR is 48 y/o male w/ peptic ulcer disease. MNT includes what? A. reducing ETOH B. Reduce tobacco C. Reduce Caffeine D. All Above
D
SH is 60 y/o man w/ chronic liver disease and ascites. He has lost significant amount of weight and is at risk of malnutrition. Which is likely to contribute to poor dietary intake?
a. hyperkalemia
b. hypoglycemia
c. dehydration
d. early satiety
D
PV is 35 y/o obese women w/ GERD. She states symptoms occur in middle of night. What can you recommend she do?
A. Avoid eating at least 2 hrs before bed.
B. Sleep w/ at least 2 pillows at night
C. drink warm milk before bed
D. Take OTC sleeping pill
A
LK is 30 y/o female with severe Crohn’s disease. She recently required intestinal resection of her ileum. Which is the most common cause of fat malabsorption in Crohn’s pts?
A. decreased hepatic syntehsis of bile salts
B. Poor liver function
C. inability to reabsorb bile salts
D. Decreased fat intake
C
What is considered an optical HgbA1C for pts with DM?
A. <7%
D. None
A
Which of the following conditions increases pt’s likelihood of developing insulin resistance?
A. personal hx of impaired glucose tolerance
B. a 1st degree relative w/ type 2 DM
C. Obesity
D. All Above
D
Instant oatmeal contains 30g CHO, which would be equivalent of how many carb servings? A. 1 serving CHO B. 2 servings CHO C. 3 servings CHO D. 4 servings CHO
B
CK is 71 y/o with COPD who recently experienced 10lb weight loss since last visit a few months ago. What is the most likely contributor to weight loss?
increased energy expenditure due to work of breathing
KL is 35 y/o male w/ OSAS. MNT for pts with OSAS focuses on... A. weight reduction B. vitamin and mineral deficiencies C. protein repletion D. fluid retention
A
LP 59 y/o female undergoes lung transplant. She is prescribed prednisone treatment. What is complication of prednisone? A. hypokalemia B. hyperglycemia C. Hypoglycemia D. Hypoatremia
B
DR is hospitalized w/ pneumonia and requires mechanical ventilation x 14 days. Her GI tract functions normally. How should she receive nutritional support?
A. EN via nasogastric tube
B. PN via central line
C. peripheral PN
D. isn’t necessary to feed pts on ventilator
A
NB is 12 y/.o with cystic fibrosis x 3 years. She has had multiple infections and is taking antibiotics. What vitamin deficiency is likely w/ prolonged antibiotics? A. B12 B. K C. A D. Thiamin
B
Osteopenia is common w/ pts with CF. In addition to malabsorption, which is following factor contributes to osteopenia seen in pts with CF? A. malabsorption B. vitamin D deficiency C. delayed puberty D All above
D
Which of following increases REE and promotes wt loss and lean body mass in pts with COPD?
A, increase cytokines
B. decrease in levels of cell derived proteins
C. frequent, recurrent respiratory infections
D. All
D
AB is 71 y/o male with COPD and elevated Hb and hematocrit. What is likely cause of lab findings? A. chronic hypoxia B low mean corpuscular volume C. Arterial hypoxemia D. dietary changes
A
What are the 5 indicators of metabolic syndrome?
- large waist circumference
- HTN (or HTN meds)
- Elevated blood triglycerides
- Blood cholesterol (low HDL)
- Impaired fasting glucose
How many indicators does a person need to have metabolic syndrome?
3
In metabolic syndrome, what is large waist circumference?
> 40 inches men
>35 inches women
In metabolic syndrome, what is HTN?
> 130 mm Hg systolic or >85 mm Hg diastolic
In metabolic syndrome, what is elevated blood triglycerides?
> 150 mg/dL or drug therapy for elevated TG
In metabolic syndrome, what is blood cholesterol (low HDL)?
<50mg/dL women
In metabolic syndrome, what is impaired fasting glucose?
> 100mg/dL or drug tx for elevated glucose
What is calculation for BMI?
BMI = (weight/ height^2) x 703 = (kg/ in^2) x 703
What is BMI class for normal weight?
18.5-24.9
What is calculation for % weight change?
(Current weight/ past weight) - 1
Also, ((usual weight-current weight)/usual weight) x 100
What is obesity class 1 BMI?
30-34.9
What is significant and severe weight loss for 1 week?
1-2%
> 2%
Calculation for IBW in Males
106 lbs for 1st 60 inches + 6 lbs for every inch in height above 60 inches
Calculation for IBW in Females
100 lbs for 1st 60 inches + 5 lbs for every inch in height above 60 inches
What is underweight BMI?
<18.5
What is extreme obesity? (Class 3)
> 40
What is significant/severe wt loss for 1 year?
20%
>20%
Calculation for adj. BW
((Actual weight - IBW) x 0.25) + IBW
When do you use adj. BW?
when weight is >125% of IBW or for obese individuals
What is obesity class 2 BMI?
35-39.9
What is significant/severe wt loss for 1 month?
5%
>5%
What is significant/severe wt loss for 6 months?
10%
>10%
What should protein restriction be for Stage 1-3 CKD?
0.75gm/kg
What should protein restriction be for Stage 4-5?
0.6 mg/kg
What percent should protein needs be from HBV?
50%
What should be calorie needs for CKD?
30-35kcals/kg (due to REE increase)
What can excess sodium retention lead to in CKD pts?
edema, HTN, CHF
What should the sodium restriction be for CKD?
<2.4 gm/day
What does 23 mg sodium equal in mEq?
1 mEq of Na = 23 mg Na
What can ACE inhibitors and angiotensin receptor antagonists do for someone with CKD?
elevate potassium levels
When should potassium restriction begin for CKD?
when serum potassium is consistently >5mEq/L
What should potassium restriction be for CKD with elevated serum potassium?
2-3gm/day
When is calcium supplementation needed with CKD?
when following low phos diet, causes low calcium
What is recommended intake for calcium for stages 3-4 CKD?
1.5-2 gm/day
What is recommended intake for calcium for stages 4-5 CKD not on dialysis?
1.5-1.8gm
For CKD stages 3-4, what should phosphorus restriction be if serum phos remains?
restrict 800-1000mg/day
When should phos restriction be recommended?
serum >4.6 mg/dL
What form of vitamin D should dialysis and CKD pts have?
1,25-dihydroxycholecalciferol
active form
According to the professor, what should protein intake be for HD?
1.2-1.3g/day
According to the professor, what should protein intake be for PD?
1.2-1.5gm/day
What is albumin goal for HD or PD?
> 4
What should sodium intake be for HD?
2-3gm/day
Fluid intake for HD
1000mL/day + urine output
Potassium intake for HD
2-3gm/day to maintain levels at 3.5-5.5mEq/L
Calcium lab values for HD and PD
8.4-9.5mg/dL
Phosphorus for HD and PD
1000-1200mg/day
What is serum phosphorus goal for Hd and PD?
3.5-5.5mg/dL
What is goal calcium/phosphate multiplier goal?
<55
What is corrected calcium calculation?
((normal alb - serum alb)(correction factor)) + serum calcium
Correction factor = 0.8
Normal alb= 4.0mg/dL
Which of the following is the best definition of dry weight?
A. weight when pt is dehydrated
B. weight when patient has not drunk any fluids in 12 hours
C. weight when patient has taken diuretics for several days
D. Weight of patient minus estimated amount of fluid retention
D
Which of the following is at greatest risk for breast cancer? A. pre-menopausal with BMI of 30 B. pre-menopausal with BMI of 22 C. post-menopausal with BMI of 30 D. post-menopausal with BMI of 40
D
What is strongest and most consistent indicator of breast cancer risk? A. Amount of physical activity B. weight gain during adulthood C. high intake of saturated fat D. irregular menstruation
B
What should calorie intake be for ARF?
35 kcals/kg per day (may actually be closer to 20-30kcal/kg per day)
What should protein intake be for ARF?
0.8g/kg per day
if GFR <10ml/min, not catabolic, not dialysis, or CRRT
What should kcals be for IBD patient?
35-45 kcals/kg/day
What should be the PA for IBD patient using harris-benedict equation?
1.5-1.7
What should protein be for IBD patient?
1-1.5 gm/kg
what are 4 s/s of IBS?
abdominal pain
cramping
diarrhea
constipation
How is celiac disease treated?
eliminating all gluten from diet
What should wheat, rye, and barley be substituted with in gluten intolerance?
corn, potato, rice, soybean, tapioca, arrowroot
