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RC Studying > GI/Nutrition > Flashcards

GI/Nutrition Flashcards

1
Q

What are the symptoms of Vit C deficiency?

A

Anorexia, fatigue, myalgia

Severe: bleeding gums, petechiae, wound healing, joint effusions, weakening of teeth, bones, connective tissue, death

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2
Q

An infant presents at 2 weeks of life with jaundice, what test MUST you do?

A

Fractionated bilirubin

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3
Q

What is the most sensitive and specific US finding for biliary atresia?

A

Triangular cord sign

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4
Q

What is the gold standard for diagnosis of biliary atresia?

A

Intra-operative cholangiogram

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5
Q

What is the most important prognostic finding for patients with Alagille Syndrome?

A

Cardiac disease - severe cardiac disease is associated with poor outcomes. They are likely to have right sided outflow obstructive processes = PS and TOF.

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6
Q

Name the skeletal findings in rickets.

A
  • Delayed fontanelle closure
  • Parietal & frontal bossing
  • Craniotabes (soft skull)
  • Rachitic rosary (enlarged costochondral junction)
  • Widening of the wrist
  • Bowing of the distal radius and ulna
  • Lateral bowing of femur and tibia
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7
Q

Name the x-ray findings in rickets.

A
  • Widening of the epiphyseal plate, loss of definition at the epiphyseal/metaphyseal interface
  • Cupping, splaying, cortical spurs, stippling
  • Osteopenia in long bone shaft, thin cortices
  • Pathologic fractures
  • Looser zones (pseudofractures, radiolucent lines)
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8
Q

What are the lab findings in vitamin D deficiency for calcium, phosphorous, ALP, PTH, 25-Vit D, 1,25-dihydroxyvitamin D?

A 
Calcium = N/L 
Phosphorous = Low 
ALP = High
PTH = High 
25-vitamin D = Low 
1,25dihyrdoxyvitamin D = L/N/H
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9
Q

What is the first line management recommendations for GERD treatment in infants as per NASPGHAN? If not improved from this, what is your next step?

A

-Avoid overfeeding
-Thicken feeds
-Continue breastfeeding
If not improved:
-2-4 wk of protein hydrolysate or amino acid based formula or in breastfed infants, elimination of cow’s milk in maternal diet

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10
Q

What is the first line management recommendations for GERD treatment in children as per NASPGHAN? If not improved from this, what is your next step?

A

-Lifestyle and dietary modification
If not improved:
-Acid suppression for 4-8 weeks

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11
Q

Which vitamin deficiency in children presents with the following symptoms:

  • Ataxia
  • Hyporeflexia/loss of DTRs
  • Limited upward gaze/opthalmoplegia
  • Decreased propioception
A

Vitamin E deficiency

Clinical presentation in preterm infants:

  • Hemolytic anemia
  • Thrombocytosis
  • Edema

-Can have prolonged PT, abN bone development

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12
Q

Which clotting factors require vitamin K for synthesis?

A

X, IX, VII, II

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13
Q

Which lab abnormality is first impacted by vitamin K deficiency?
A. Prolonged PT/INR
B. Prolonged PTT
C. Low factor VII

A

All of these lab abnormalities occur with Vit K def. Low factor VII occurs first as it has the shortest half life.

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14
Q

What element deficiency is associated with a male infant who has sparse/coarse/brittle hair, FTT, seizures, hypotonia, congenital #s, and subdural hematomas?

A

Menkes Disease

  • Mutation in gene for protein needed for intestinal copper absorption, leads to copper deficiency
  • X-linked, more common in males
  • Part of DDx for NAT considering presentation of subdurals and #s
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15
Q

A 6mo who is transitioning to solids presents with significant perioral and perineal eczematous lesions and diarrhea. What is the most likely element deficiency?

A 
Zinc deficiency
Acrodermatitis enteropathica
-Often presents when weaning from breast
-Cutaneous eruptions
-Symmetrically in perioral, acral, perineal areas and on cheeks, knees, elbows 
-Hair often w/ red tint, alopecia
-Photophobia, conjunctivitis, blepharitis
-Diarrhea
-Stomatitis, glossitis 
-Paronychia
-Delayed wound healing
-Super infection w/ Candida
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16
Q

A 16yo female with a history of chronic bloody diarrhea and abdominal pain presents with paresthesias and weakness. What vitamin deficiency is most likely?

A

Vitamin B12/Cobalamin/Cyanocobalamin

  • At risk for deficiency with chronic gastritis, Crohn’s, bariatric surgery, ileal resections
  • Irritability, hypotonia, regression, involuntary movements, peripheral neuritis, hyperpigmentation of knuckles and palms
  • Macrocytic megaloblastic anemia with MCV >110, low retics
17
Q

Name 3 medications associated with folate deficiency.

A
  • NSAIDs
  • Methotrexate
  • Phenytoin
  • Phenobarbital
18
Q

What deficiencies are associated with a vegan diet?

A

Vitamin B12 and D, calcium, iron

19
Q

A child is consuming goat’s milk instead of cow’s milk. What deficiency are they at risk for?

A

Folic acid

20
Q

A child is on a gluten free diet. What deficiencies are they at risk for?

A

B vitamins, iron

21
Q

A neonate develops seizures in the first few days of life which are refractory to multiple anti-epileptics. When considering the differential diagnosis, which vitamin deficiency might be the cause?

A 
Vitamin B6/Pyridoxine
Clinical presentation can include:
-Seizures
-Vomiting
-FTT
-Cheilosis/glossitis
-Seborrheic dermatitis around eyes, nose, mouth
-Microcytic anemia
-Bladder stones
-Hyperglycemia
-Lymphopenia
-Infections
22
Q

A child presents with glove and stocking distribution dermatitis. What vitamin deficiency is most likely?

A 
Vitamin B3/Niacin
Pellagra:
-Dermatitis, diarrhea, dementia
-Stomatitis/glossitis
-Dermatitis; glove and stocking common, casal necklace is when around neck
23
Q

A child presents with cheilosis glossitis, angular stomatitis and a normocytic, normochromic anemia. What is the most likely vitamin deficiency?

A

Vitamin B2/Riboflavin

24
Q

A 14yo F is admitted with severe malnourishment due to an eating disorder. She develops confusion, ataxia and opthalmoplegia. Subsequently, she develops a polyneuropathy. What vitamin deficiency is most likely the cause?

A

Vitamin B1/Thiamine

  • Fatigue, apathy, irritability, depression, anorexia, poor concentration
  • Beriberi: peripheral neuritis, hyporeflexia, loss of vibration sense, leg cramps, ptosis, psychosis, aphonia, ataxia, increased ICP, CHF
  • Wernicke: mental status changes, ocular signs, ataxia (rare)
  • Korsokoff: progressive (less reversible on spectrum w/ Wernicke), confabulation, amnesia, psychosis, loss of insight
25
Q

An young boy with autism who is extremely restrictive in food choices presents with vision loss. What vitamin deficiency is most likely?

A

Vitamin A
-Diarrhea, increased ICP, anemia, wide separation of sutures, eye findings blindness, keratinization of the cornea and conjunctiva, plaques (bitot spots), xeropthalmia

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