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DEMS > Malnutrition/Obesity > Flashcards

Malnutrition/Obesity Flashcards

1
Q

Define Marasmus

A

Severe wasting of fat and muscle mass, due primarily to energy deficiency

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2
Q

Define Kwashiorkor

A

Edematous PEM, w/o wasting. Related to metabolic stress and inflammation.

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3
Q

Define Cachexia

A

Wasting associated with inflammatory or neoplastic conditions.

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4
Q

Define sarcopenia

A

Subnormal amount of skeletal muscle w/o weight loss

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5
Q

When should I use motivational interviewing?

A

When patient is totally ambivalent.

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6
Q

What is the pathway that insulin and leptin stimulate?

A

Leptin and insulin inhibit NPY and stimulate POMC-alphaMSH-MCR which leads to decreased food intake.

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7
Q

What is the pathway that ghrelin stimulates?

A

Ghrelin stimulates NPY and inhibits POMC-alphaMSH-MCR which leads to increased food intake.

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8
Q

What are the criteria for Metabolic Syndrome?

A

Any 3/5 risk factors:

  1. high waist circumference
  2. high Tgs
  3. low HDL
  4. BP >130/85
  5. fasting glucose >100 or on hypoglycemic drug
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9
Q

What are some characteristic clinical findings of Kwashiorkor?

A

“Flaky paint” skin, “flag sign,” “moon facies.”

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10
Q

Which findings are necessary for diagnosis of Kwashiorkor?

A

Hypoalbuminemia and edema

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11
Q

What is refeeding syndrome?

A

Refeeding a starved person quickly can lead to hypokalemia, decrease in serum phosphorus, and higher Mg requirements.

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12
Q

What is a normal value of TC (total cholesterol)?

A
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13
Q

What is a normal value of Tg (triglycerides)?

A
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14
Q

What is a normal value of LDL?

A
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15
Q

What is a normal value of HDL?

A

> 40 M, > 50 F

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16
Q

How is LDL calculated?

A

LDL = TC - Tg/5 - HDL

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17
Q

What are risky waist circumference measurements?

A

> 88cm F, >102cm M

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18
Q

Which four thalamic nuclei are responsible for hunger regulation?

A

PVN, VMN, Arc, LH

19
Q

What defines pediatric “overweight?”

A

BMI 85th - 95th percentile

20
Q

What defines pediatric “obesity?”

A

BMI over 95th percentile

21
Q

What defines pediatric “severe obesity?”

A

BMI over 99th percentile

22
Q

When should I use stages of change?

A

When I am not sure what stage the patient is in in terms pf meeting a health goal.

23
Q

When should I use the health belief model?

A

When patient’s actions are inhibited by beliefs that we could help them with.

24
Q

When should I use values based counseling?

A

When health is not the primary motivating factor in a patient’s life.

25
Q

When should I use CBT?

A

When patients needs specific tools to make a positive change.

26
Q

When should we start drawing labs in children?

A

10 YO or Tanner 2; or earlier if severely obese

27
Q

Which medications are currently available for treatment of obesity?

A

Phentermine, orlistat, lorcasarin, phentermine/topiramate, naltrexone/bupropion, liraglutide

28
Q

Which obesity surgery option is the most effective?

A

Gastric bypass

29
Q

Which obesity surgery option has the lowest post-op mortality?

A

Lap band

30
Q

Which obesity surgery option is currently the most popular?

A

Gastric sleeve

31
Q

What are some benefits of bariatric surgery?

A

Decreased risk of cancer, HTN, GERD, DM, and urinary incontinence. Weight loss.

32
Q

What is the mechanism of phentermine?

A

Stimulant

33
Q

What is the mechanism of orlistat?

A

Pancreatic lipase inhibitor

34
Q

What is the mechanism of phentermine/topiramate?

A

Stimulant + migraine medication.

35
Q

What is the mechanism of lorcasarin?

A

Selective serotonin 2C R agonist

36
Q

What is the mechanism of naltrexone/bupropion?

A

Opioid R antagonist (naltrexone) + DA/NE reuptake inhibitor (bupropion)

37
Q

What is the benefit, effectiveness, and cost of phentermine?

A

$20-40/mo. Limited to 3 mo of use but often prescribe long-term.

38
Q

What is the benefit, effectiveness, and cost of orlistat?

A

OTC, safest, $100/mo. Must be taken with a multivitamin. Improves dyslipidemia and DM.

39
Q

What is the benefit, effectiveness, and cost of phentermine/topiramate?

A

Big weight loss, little side effects. $150/mo. Teratogenic potential.

40
Q

What is the benefit, effectiveness, and cost of naltrexone/bupropion?

A

Moderate effectiveness. $200/mo. Black box warning for suicidal ideation.

41
Q

What is the benefit, effectiveness, and cost of lorcasarin?

A

Moderate weight loss. Approved for long-term use. $230/mo.

42
Q

Which weight loss medication is the safest?

A

Orlistat

43
Q

Which weight loss medication is the cheapest?

A

Phentermine

DEMS (4 decks)

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