Midterm Review Flashcards
True or False
The male reproductive system is a cyclic process.
False, process is ongoing
The process of male reproduction is related to interactions between ___, ___, and testes
hypothalamus, pituitary, and testes
Fluctuations in GRH cause release of LH and FSH which trigger ___ production in testes.
testosterone
GnRH is in fluctuation and causes release of which hormones to trigger testosterone production in testes?
LH and FSH
How long does sperm maturation take?
70-80 days
Cholesterol must become ___ before being used to make progesterone or DHEA.
pregnenolone
Pregnenolone comes from cholesterol.
Which steroids can come of pregnenolone?
- Progesterone
- DHEA
DHEA comes from pregnenolone.
Which hormones can come of DHEA?
- Estradiol
- Testosterone
Estradiol would need ___ to form testosterone.
aromatase enzyme
How do estradiol and testosterone come from cholesterol?
Cholesterol –> Pregnenolone –> DHEA –> Testosterone and Estradiol
___ amounts of body fat are related to decreased fertility.
Low and high
Which hormones are produced/altered by fat cells?
Estrogen and leptin
Body fat altering hormone levels occur in which sex?
Both sexes
Fertility is compromised in women with BMIs under ___ or over ___ kg/m.
under 20 or over 30 kg/m
With obesity and waist circumference over 35 inches, there is a reduction in ___ which normally binds excess hormone.
sex hormone binding globulin (SHBG)
With obesity and waist circumference over 35 inches, men have ___
decreased sperm counts
With obesity and waist circumference over 35 inches, women have ___
irregular, anovulatory, or no menstrual cycles with increased estrogen levels
Leptin is an ___-regulating hormone but also stimulates ___
appetite-regulating hormone but also stimulates GnRH in hypothalamus
Abnormal levels of ___ produced by fat cells affects the menstrual cycle.
estrogen
Contraceptive pills of the 1960s had high doses of ___ and ___ with many side effects.
estrogen and progesterone
How do current oral contraceptive pills compare to those of the past?
Current have lower doses of hormones and are mainly progesterone based
What are four significant risks of oral contraceptive pills?
- Breast cancer
- HPV/cervical cancer
- CVD
- Increased risk of DVT/PE
Which vitamin is decreased by 33% in the blood if oral contraceptive pills are used?
Vitamin B
Using oral contraceptive pills, serum ___ levels are 34-55% higher.
copper
Oral contraceptive pills may be related to increased risk of clots because ___
serum copper levels are higher
Because oral contraceptive pills increase serum copper levels, the patient will need ___ supplementation support as well.
zinc
What are some contraindications for oral contraceptive pills?
- Obese
- Over age 35
- Smoking
- History of cardiovascular disease
- Hypertension
- Diabetes
- Immobility
Oral contraceptives have been shown to have drug-induced nutrient depletions in which nutrients?
- Folic acid
- B2 (riboflavin)
- B6 (pyridoxine)
- B12 (cobalamin)
- Vitamin C
- Vitamin E
- Magnesium
- Selenium
- Zinc
When does the maternal anabolic phase occur?
What takes place during this time?
1st 20 weeks of pregnancy
Build mother’s capacity to deliver nutrients
When does the maternal catabolic phase occur?
What takes place during this time?
2nd 20 weeks of pregnancy
Nutrient and energy delivery takes place (90% of fetal growth)
A pregnant woman’s total body water ___ by 7-10 L (2-2.5 gals).
increases
A pregnant woman’s total body water increases by 7-10 L (2-2.5 gals).
What does this mean for her dietary recommendations?
Increased need for Na and other minerals
(low salt diet not recommended in pregnancy)
What are the caloric needs for a pregnant woman?
Increased need at about 300 calories/day
(350 in 2nd trimester)
(450 in 3rd trimester)
In pregnancy, you want ___ calorie balance throughout
positive
What is the minimum amount of daily carbs recommended to a pregnant woman?
Why is this so?
Minimum 175 grams/day; 50-65% of calories should come from carbs
Need to meet glucose requirements of developing baby brain
What are some examples of helpful carbs to include in a pregnant woman’s diet?
- High fiber foods to help provide phytochemicals and ease constipation
- Fruits and vegetables
- Whole grains
What is the daily protein requirement for a pregnant woman?
At least 75 grams/day or 1.5g/kg of body weight (pre-pregnancy)
Risk of chronic disease, such as MS increases depending on the status of which vitamin in the mom?
Vitamin D
How much vitamin D3 is recommended for a pregnant woman?
At least 2000IU; most will need 4000-5000IU
When pregnant, absorption of calcium from food ___, and excretion of calcium from urine ___.
increases and increases
When pregnant, bone mineral turnover takes place at a ___ rate (with the exception of teeth).
higher
Low calcium during pregnancy is related to ___ in the mother and infant.
increased blood pressure
How much calcium will be transferred to the fetus?
30 grams
The demand for calcium is high in the ___ trimester. The recommendation is ___mg/day.
high in the 3rd trimester
recommendation is 300mg/day
What is the data on caffeine/coffee during pregnancy?
Moderate intake does not negatively affect outcomes
Lack of caffeine does not show improvement in outcomes
Data is inconclusive
During pregnancy, a woman experiences ___ thirst, consuming ___ cups of water per day on average.
increased thirst
9 cups of water per day
What does the National Institute of Medicine say the AI is for water intake in pregnant women?
About 13 cups (3000mL/day)
How is gestational diabetes detected?
- One hour fasting glucose test between 24 and 28 weeks gestation
- Three hour glucose test if one hour fails
What is the first route of care in managing gestational diabetes?
- Monitor blood glucose (FBG and PPG)
- Monitor urine for ketones
- Diet/exercise modification
What may be recommended for a mother with uncontrolled gestational diabetes?
Medication or insulin
What are some recommendations for pregnant women with insomnia?
- Magnesium (200-400mg per night in magnesium taurate)
- Chamomile tea
- Relaxation techniques
- Physical activity
- Acupuncture
What are some dietary recommendations for pregnant women with constipation?
- Increase water intake
- Prunes and berries
- Insoluble fiber (celery and other roughage)
What are some supplement recommendations for pregnant women with constipation?
- Magnesium citrate (300-400mg at night)
- Vitamin C (500-1000mg per day after first trimester)
Constipation is common throughout pregnancy, but especially in ___ half.
later
What are three natural ways to help a woman in uterine and labor support in the third trimester?
- Evening primrose oil
- Black cohosh and blue cohosh
- Red raspberry leaf (tea)
How might evening primrose oil help a woman in her third trimester of pregnancy?
500mg-3 grams orally or used topically will mimic prostaglandins which ripen the cervix
How might black cohosh and blue cohosh help a woman in her third trimester of pregnancy?
Uterine tonics help to prepare uterus for labor
Blue cohosh may stimulate uterine contractions
How might red raspberry leaf tea help a woman in her third trimester of pregnancy?
Rich in iron, helps to tone the uterus, eases nausea and helps with labor pain
If an infant has breastfed for any amount of time, they will have a lower risk for which conditions?
- Otitis media
- Gastroenteritis
- Inflammatory bowel disease
- Obesity
- Type II diabetes mellitus
If an infant has breastfed for over 3 months, they will have a lower risk for which conditions?
- Otitis media
- Asthma
- Atopic dermatitis
- Type I diabetes
If an infant has breastfed for over 4 months, they have a 72% lower risk for which condition?
LRTI
If an infant has breastfed for over 6 months, they have a 63% lower risk for which condition?
URTI
AAP recommends exclusive breastfeeding for about ___, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infants.
6 months
What are the recommendations for breastfeeding by WHO and UNICEF?
- Initiation of breastfeeding within 1 hour of birth
- Exclusive breastfeeding for first 6 months of life
- Introduction of nutritionally adequate and safe solid foods at 6 months together with continued breastfeeding up to 2 years of age (or beyond)
Are proteins in human milk more affected by maternal intake or infant age?
Infant age
What are the proteins found in human milk?
- Casein
- Whey proteins
What is the function of casein in human milk?
Major protein in mature milk
Makes digestive products that keep calcium in soluble form for easier digestion
What is the function of whey proteins in human milk?
Remain soluble in water after casein precipitates out
Contain lactoferrin which carries iron in an absorbable form
Which human milk protein keeps calcium in a soluble form for the infant?
Casein
Which human milk protein keeps iron in an absorbable form for the infant?
Whey proteins: lactoferrin
What is the dominant carbohydrate in human milk?
What is the second largest carbohydrate in human milk?
Dominant: lactose
Second largest: polysaccharides
What is the purpose of lactose in human milk?
Carbohydrate enhances calcium
What is the purpose of polysaccharides in human milk?
Carbohydrate:
- contributes to calories
- helps bifidus bacterium (prebiotic)
- inhibits pathogenic bacteria like e. coli
Can human milk oligosaccharides be found in formula or cow’s milk?
No, exclusive to human milk
What is the third highest component of breastmilk?
Oligosaccharides
What is 2’FL (2’-fucosyllactose)?
Oligosaccharide found in human milk
Infants who are formula fed are more prone to ___ and ___
infectious disease, such as gastroenteritis and acute otitis media, and immune-mediated diseases such as allergy
In studies with ___ treated formula, tissues in rats are shown to not develop infectious and immune-mediated diseases. This is evidence that it is a major player in benefits of breast milk.
2’FL (oligosaccharide)
What are three fat soluble vitamins?
- Vitamin A
- Vitamin D
- Vitamin E
What is colostrum?
First form of breast milk released after giving birth
There is two times more vitamin A in ___ as compared to mature breast milk.
colostrum
Vitamin D varies with diet and sunlight exposure.
AAP recommends ___ Vitamin D/day 2 months post labor.
400IU
Vitamin E levels after labor are related to ___ and ___.
fat content and maternal intake
What are two reflexes assessed for neurological consideration of an infant?
Oral search: open mouth and thrust tongue
Rooting: turn toward side when cheek is stimulated
How can you identify hunger and satiety in a breastfeeding infant?
Hunger signs:
- Bring hands to mouth and suck on them
- Move head side to side with mouth open
How can you identify breastfeeding malnutrition in a breastfeeding infant?
- Newborns normally lose 7% body weight in first week; 10% or more is a warning sign for evaluation
- Malnourished infants have a weak cry, are sleepy, nonresponsive, and few wet diapers
A nursing mom needs an extra ___ calories per day.
400-500
How does protein-calorie malnutrition for a mother affect milk composition?
Will cause decreased volume but not content
A nursing mother’s diet should include 200-300mg of ___ per day which can be achieved through 1-2 servings of fish per week.
DHA
How can a nursing mother maintain 200-300mg DHA per day?
1-2 servings of fish per week
When should vitamin and mineral supplements be used in a nursing mother?
For specific deficiencies, especially D and B12
How does exercise impact breastfeeding/lactation?
No negative impact
How is hydration still important after labor?
Maternal dietary need during breastfeeding
If a mother is nursing, should she continue her prenatal vitamin?
Yes, along with a well balanced diet
At birth, an infant can digest ___ and can absorb ___.
can digest fats, proteins, and simple sugars and can absorb fats and amino acids
How long does it take for the GI system to mature?
Why is this important?
Takes 6 months
Important to limit (if not restrict) foods until 6 months
Would rice cereal be recommended for an infant?
No, even a simple carbohydrate is not easily digested
What is the estimated serving size of food for kids?
1 tablespoon of food per year of age
Children’s appetite will vary with ___
growth rate and activity level
Which of the following foods are encouraged for feeding an early infant?
- Honey
- Nuts
- Raw foods
- Cow’s milk
None of the above
Infants need ___ of vitamin D; ___ when sick
400IU
800IU when sick
How much vitamin D is needed by toddlers?
800-1000IU
How much vitamin D is needed by children?
1000-1400IU (400IU in multivitamin)
How much vitamin D is needed by adolescents?
Up to 2000IU as with an adult
C-section babies may have a deficiency in which probiotic?
Bifidobacterium
Probiotic supplementation is used in infants for ___
immune system support
When supplementing probiotics in infants, how can you encourage different gut flora development?
Look for 4 to 5 strains, changing between brands
Why is iron deficiency anemia less common in infants than toddlers?
Infants have maternal iron stores if full term
Iron deficiency anemia in infants/toddlers has a link to early use of ___
cow’s milk
Which infants/toddlers are at risk for iron deficiency anemia?
- Preterm
- High lead
- Poor nutrition
What is a consequence of long term iron deficiency anemia beginning in infancy?
Learning delays from CNS development
In infants/toddlers, do the following cause constipation or diarrhea/loose stools?
- Food intolerance
- Dehydration
- Low fiber/high fat diet
- “Holding in”
Constipation
In infants/toddlers, do the following cause constipation or diarrhea/loose stools?
- Medications
- Changes in routine
- Toilet training
- Inactivity
Constipation
In infants/toddlers, do the following cause constipation or diarrhea/loose stools?
- Pathogens
- Too much sugar
- Food intolerance
- Irritable bowel
Diarrhea/loose stools
It’s not appropriate to use the BMI categories for adults to interpret BMI numbers for children and teens.
How do BMI percentiles work?
<5th percentile: underweight
5th-85th percentile: healthy weight
85th-95th percentile: overweight
>95th percentile: obese
Childhood obesity has ___ in children and ___ in adolescents in the past 30 years.
more than doubled in children and quadrupled in adolescents
Empty calories from ___ and ___ contribute to 40% of daily calories for children ages 2-18.
added sugars and solid fats
Empty calories from added sugars and solid fats contribute to 40% of daily calories for children ages 2-18.
Half of these empty calories are from which six sources?
- Soda
- Fruit drinks
- Dairy desserts
- Grain desserts
- Pizza
- Whole milk
What is hidden hunger?
Nutritional deficiency that occurs in the presence of an otherwise nutritionally or calorically appropriate diet
What causes hidden hunger?
Eating food that is cheap and filling but deficient in essential vitamins and micronutrients; leads to insidious type of hunger
How does a child with hidden hunger appear?
Body has no change in size and the child has the appearance of being well-nourished
You have a patient who has a 2 month old baby that is currently being solely breastfed. She expressed to you during a visit that she is concerned about knowing how much and what to eat during this time and that she is unsure the baby is getting enough milk. She is also discouraged and wonders if breastfeeding is really “worth it for the baby.”
What are three benefits of breast feeding for the infant?
How long should she breastfeed for?
- Optimal nutrition for an infant
- Immunologic benefits
- Intellectual/cognitive benefits
Exclusively breastfeed for 6 months, continue longer as mutually desired
You have a patient who has a 2 month old baby that is currently being solely breastfed. She expressed to you during a visit that she is concerned about knowing how much and what to eat during this time and that she is unsure the baby is getting enough milk. She is also discouraged and wonders if breastfeeding is really “worth it for the baby.”
What are three suggestions for mom to help support and improve milk supply?
- Herbal galactagogues
- Whole food galactagogues
- Lactation cookies/brownies
You have a patient who has a 2 month old baby that is currently being solely breastfed. She expressed to you during a visit that she is concerned about knowing how much and what to eat during this time and that she is unsure the baby is getting enough milk. She is also discouraged and wonders if breastfeeding is really “worth it for the baby.”
What are three nutritional recommendations you would make for this mom to support her caloric intake during breastfeeding?
- 200-300mg of DHA/day (1-2 servings of fish/week)
- Vitamins D and B12 supplementation according to deficiency
- Extra 400-500 calories/day
Inadequate nursing and pumping may lead to clogged milk ducts that can lead to a painful, swollen, and red breast. Infection is also possible.
What are three suggestions that you would give a patient that presents with mastitis?
- Apply ice/cold compress after feeding
- Apply cabbage leaves before symptoms present
- Refer to primary care if infection needs antibiotics
