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_Clin Med > Nutrition > Flashcards

Nutrition Flashcards

1
Q

How many kcal in a gram of
carbs
protein
fat

A

carbs - 4 kcal
protein - 4 kcal
fat - 9 kcal

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2
Q

What substances can be used to make glucose in gluconeogenesis?

A

amino acids, triglycerides, lactate

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3
Q

What is marasmus?

A

protein deficiency with inadequate calorie intake

NONEDEMATOUS malnutrition

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4
Q

What is kwashiorkor?

A

protein deficiency with adequate carbohydrate intake

EDEMATOUS malnutrition

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5
Q

What is the RDA for protein for adults?

A

56g/day men
45 g/day women
10-35% of total calories

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6
Q

What is the RDA for fat?

A

20-35% of total calories

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7
Q

What is the RDA for carbohydrates?

A

45-65% of total calories

130 g/day

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8
Q

Name 3 monosaccharides

A

glucose
fructose
galactose

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9
Q

Name 3 disaccharides

A

sucrose (glucose + fructose)
maltose (glucose + glucose)
lactose (glucose + galactose)

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10
Q

What is the RDA for fiber?

A

38 g/day men

25 g/day women

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11
Q

What are some benefits of fiber?

A

lower cholesterol
lower blood sugar
stool softener

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12
Q

What eating disorder is the deadliest and most difficult to treat? What are the signs and symptoms of this disorder? What are the health problems associated with this disorder?

A 
Anorexia nervosa
signs/symptoms:
BMI 17.5 or less
amenorrhea
lanugo
malnutrition
Health problems: osteoporosis, cardiac failure, electrolyte disturbances
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13
Q

What are the signs/symptoms of bulimia nervosa?

A 
binge episodes 2x/wk for 3+ months
plus
inappropriate compensatory behaviors like vomiting and/or laxative use 2x/wk for 3+ months, or excessive exercise or periods of fasting (nonpurge type of bulimia)
--raw fingers/hands from vomiting
--tooth erosion
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14
Q

What are the 3 subgroups of ‘eating disorder not otherwise specified’?

A
  1. Subthreshold cases of AN or BN - e.g. BMI above 17.5 or binge episodes only once a week - give them time and they will likely become anorexic/bulimic
  2. Mixed cases - largest subgroup
  3. Binge Eating Disorder:
    binge episodes 2x/wk for 6 months without compensatory behaviors; loss of control, rapid eating, feeling uncomfortably full, eating when not hungry, eating alone because embarrassed
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15
Q

What are the 2 subtypes of AN?

A

nonbinge/nonpurge

binge/purge

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16
Q

What is the female athlete triad?

A

eating disorder, amenorrhea, osteoporosis

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17
Q

Which disorder is ego syntonic and which disorder is ego dystonic? (AN or BN)

A

AN: ego syntonic - the disorder becomes who they are, gives them an identity; they respond to any questions about it as attacks on their being; they are not embarrassed about their behavior

BN: ego dystonic - they know what they are doing is “weird” but they can’t help themselves and they are embarrassed about their behavior

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18
Q

What are the criteria for hospitalization for AN?

A
  1. unstable vitals
  2. bradycardia < 30 bpm or < 40 bpm if hypotension
  3. hypothermia 95F or below
  4. cardiac dysrhythmia
  5. less than 70% of normal body weight
  6. marked dehydration
  7. acute medical complications of malnutrition e.g. syncope, seizures, cardiac failure, liver failure, electrolyte disturbance
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19
Q

What is the BMI defined as obesity?

A

BMI 30-40

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20
Q

What is the BMI defined as malnutrition?

A

BMI of less than 20

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21
Q

What is the BMI defined as normal?

A

BMI 20-25

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22
Q

What is the BMI defined as overweight?

A

BMI 25-30

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23
Q

What is the BMI defined as morbid obesity?

A

BMI above 40

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24
Q

What are the three hormones of satiety?

A

Ghrelin
Orexin
Leptin

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25
Q

What is the function of ghrelin?
Where is ghrelin produced?
When is it released?
How is ghrelin related to obesity?

A

Ghrelin: peptide hormone that stimulates hunger, growth hormone, and orexin
Produced by stomach and pancreas
Levels increase before meals and decrease after meals
People with obesity have blunted after-meal ghrelin response

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26
Q

What is the function of orexin?
Where is orexin produced?
What stimulates its release?

A

Orexin: neurotransmitter that regulates energy expenditure, wakefulness, and appetite
Produced by hypothalamus
Release stimulated by hypoglycemia and ghrelin; release inhibited by leptin

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27
Q

What is the function of leptin?
Where is leptin produced?
When is it released?
What happens if you have impaired leptin response?

A

Leptin: acts on hypothalamus to signal satiety (done eating); inhibits orexin
Produced by adipocytes
Levels should rise as you eat
Leptin knockout mouse eats continuously and gets very fat

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28
Q

hypertriglyceridemia: drugs of choice to treat?

A

fibrates, niacin

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29
Q

familial hypercholesteremia (FH): drugs of choice to treat?

A

bile acid sequestrates, niacin

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30
Q

What is the most effective drug for increasing HDL levels?

A

niacin

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31
Q

What are fibrates best at (lower LDL, raise HDL, lower TG)?

A

lowering triglycerides

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32
Q

What is niacin best at (lower LDL, raise HDL, lower TG)?

A

increasing HDL

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33
Q

What are statins best at (lower LDL, raise HDL, lower TG)?

A

lowering LDL

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34
Q

What are bile acid sequestrants best at (lower LDL, raise HDL, lower TG)?

A

lowering LDL

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35
Q

What is the desirable blood level of total cholesterol?

A

Less than 200 mg/dL

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36
Q

What is the optimal blood level of LDL?

A

< 130 mg/dL for patient with no risk factors (note that elevated cholesterol is a risk factor. So someone with LDL 180, their treatment goal is 100, not 130.)
< 70 mg/dL with history of CHD or metabolic syndrome
< 100 mg/dL with risk factors for CHD

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37
Q

What is the optimal blood level of HDL?

A

above 60 mg/dL is optimal

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38
Q

What is the normal level of triglycerides?

A

normal is < 165 mg/dL

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39
Q

Name 3 primary causes of dyslipidemia.

A

familial hypercholesterolemia,
familial hypertriglyceridemia,
familial hyperchylomicronemia

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40
Q

Name 4 secondary causes of dyslipidemia.

A

Obesity
uncontrolled diabetes mellitus
sedentary lifestyle
obstructive liver disease

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41
Q

What are the 5 A’s of the 5A intervention framework for weight loss?

A

ASSESS: ask about behaviors; assess BMI every visit; assess if they’re ready to change
ADVISE: give clear, specific personalized behavior change advice; urge every obese patient to work on weight loss
AGREE: collaborate with the patient in selecting attainable goals
ASSIST: use counseling with or without pharmacotherapy; aid patient in acquiring the necessary skills/support system/etc to make changes
ARRANGE: schedule followup appts within the first week after starting each major change

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42
Q

What is the difference between roux-en-y gastric bypass and gastric banding?

A

In Roux-en-Y Gastric Bypass, a small part of the stomach is used to make a pouch that is connected directly to the jejunum.

In Gastric Banding, a band is placed around the upper part of the stomach to limit the amount of food a person can eat (no change in where the intestine joins the stomach).

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43
Q

What are the major complications of roux-en-y gastric bypass?

A
  1. peritonitis due to leakage
  2. nutritional deficiencies! B12, folate, calcium, vitamin D
  3. DUMPING syndrome!
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44
Q

What are the major complications of gastric banding?

A
  1. band slips out of place

2. vomiting/reflux (from eating more than the stomach can now hold)

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45
Q

Which weight loss surgery is associated with dumping syndrome?

A

gastric bypass (roux-en-y)

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46
Q

B1 is

A

thiamin

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47
Q

B2 is

A

riboflavin

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48
Q

B3 is

A

niacin

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49
Q

B5 is

A

pantothenic acid

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50
Q

B6 is

A

pyroxidine

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51
Q

B7 is

A

biotin

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52
Q

B9 is

A

folate

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53
Q

B12 is

A

cyanocabalamin

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54
Q

If you have an alcoholic patient, what is their most likely vitamin deficiency?

A

thiamin

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55
Q

What is the name of the disease associated with thiamin deficiency?

A

beriberi

56
Q

Most water-soluble vitamins don’t have an associated toxicity, but a few do - which are these?

A

niacin, pyroxidine, vitamin C

57
Q

What is the most common cause of riboflavin deficiency?

A

malnutrition

58
Q

What are symptoms of riboflavin deficiency?

A

cheilosis, glossitis

59
Q

What is a risk factor for niacin deficiency?

A

diets based on corn

60
Q

What is the name of the disease associated with niacin deficiency? What are its symptoms?

A

pellagra

triad of pellagra: diarrhea, dementia, dermatitis

61
Q

What are the effects of niacin toxicity?

A

flushing, hyperglycemia, gout

62
Q

What is the vitamin your patients are LEAST LIKELY to be deficient in?

A

pantothenic acid, B5

63
Q

What is the most likely cause of pyroxidine deficiency?

A

medication interactions

pyroxidine supplements are often prescribed to patients taking isoniazid (anti-TB)

64
Q

What are the symptoms of pyroxidine deficiency?

A

cheilosis, glossitis

65
Q

What is a serious toxicity effect of pyroxidine?

A

sensory neuropathy, potentially irreversible

66
Q

What is the most likely cause of a biotin deficiency?

A

inborn errors of metabolism

67
Q

Folate:
causes of deficiency
serious effects of deficiency

A

causes of deficiency:
inadequate dietary intake
decreased absorption due to drugs like phenytoin, TMP-SMX
serious effects of deficiency: megaloblastic anemia, spina bifida in fetus of mom with folate deficiency

68
Q

cyanocabalamin:
causes of deficiency
how to supplement for deficient patients

A 
causes of deficiency:
decreased production of INTRINSIC FACTOR, which is produced by the stomach and is required for absorption of B12 (e.g. gastrectomy, h. pylori infection)
decreased absorption (absorbed in ileum of intestine): crohn's disease, surgical resection, PPIs

how to supplement: IM injections

69
Q

What is the most common cause of vitamin C deficiency?

A

inadequate dietary intake (in U.S. - urban poor, elderly, alcoholism)

70
Q

What are the symptoms of vitamin C deficiency?

and what is the name of the condition associated with vitamin C deficiency?

A

Scurvy: petechiae, purpura, bleeding gums, impaired wound healing

71
Q

What are the effects of vitamin C toxicity?

A

flatulence, diarrhea; can cause false-negative fecal occult tests as well as erroneous urine glucose tests

72
Q

What is the most toxic vitamin?

What is the least toxic fat-soluble vitamin?

A

most toxic: vitamin A

least toxic fat-soluble: vitamin E

73
Q

What is the optimal ratio of LDL:HDL?

A

3-3.5:1

74
Q

What time of day are statins given? Why?

A

At night; because that is when your body makes cholesterol (while sleeping)

75
Q

What is the definition of metabolic syndrome?

What is metabolic syndrome a precursor to?

A

3 of the following 5 factors:

  • -high waist circumference (men over 40 inches/102 cm, women over 35 inches/88 cm)
  • -high blood pressure
  • -high triglycerides
  • -high blood sugar
  • -low HDL (if you have high HDL, it can “cancel out” one of the previous bad factors)
  • Metabolic syndrome is a precursor to DM2*
76
Q

Which familial dyslipidemia increases the risk for pancreatitis?

A

familial hypertriglyceridemia

77
Q

What is a critical lifestyle change for trying to increase HDL and lower LDL?

A

stop smoking

78
Q

What other lifestyle change (besides stopping smoking) may be able to increase HDL?

A

aerobic exercise

79
Q

What is the herbal supplement that has the most documented interactions with prescription drugs?

A

St. John’s wort. This herbal supplement can reduce levels of verapamil, statins, antiretrovirals, antidepressants, etc. St. John’s wort makes warfarin less effective.

80
Q

What supplements should not be taken or should be taken with caution with warfarin?

A

St. John’s wort
vitamin E
ginseng

81
Q

What is the difference between the FDA requirements for safety and efficacy for drugs vs supplements?

A

Drugs: manufacturers must prove safe before drug is approved

Supplements: for supplements it’s the opposite - the FDA must prove, after some adverse effects are observed, that the product poses a significant risk to the health of Americans.

Also, supplements are self-prescribed, so there is no controlled system for reporting adverse effects.

82
Q

What do people take echinacea for?

A

Used to treat or prevent colds, flu, URI. Studies have shown no effect.

83
Q

What do people take ginseng for?

What are the interactions?

A

Overall health, immune system, boost energy.

Interacts with warfarin and digoxin; do not take if previous CVA.

84
Q

What do people take valerian for?

What are the interactions?

A

Mild sedative for insomnia or anxiety.
Should not be taken with other sedatives.
No evidence to support the use of valerian for insomnia/anxiety.

85
Q

What do people take gingko for?

What does it interact with?

A

Memory, dementia.
Interacts with antiplatelets like aspirin and anticoagulants such as warfarin and heparin.
Reports of severe bleeding.
No studies have shown any improvement in cognition.

86
Q

What vitamin is important for vision?

A

Vitamin A

87
Q

What is the major effect of vitamin A deficiency (seen mostly in developing world)?

A

xerophthalmia (inadequate tears)
mild xerophthalmia causes night blindness
severe xerophthalmia causes blindness (from corneal ulceration/necrosis)
Also see Bitot spots in early deficiency (white patches on the conjunctiva)

88
Q

What are the effects of vitamin A toxicity (seen mostly in developed countries)?

A

diplopia
bulging fontanels in infants
increased intracranial pressure, with papilledema, headaches, and decreased cognition

89
Q

What are the functions of vitamin D?

A

vitamin D promotes calcium absorption - therefore vitamin D is important for bone health

90
Q

What is a unique clinical finding that indicates vitamin D deficiency?

A

thoracic rosary, aka rachitic rosary

91
Q

Vitamin D toxicity is not common, but what could it cause?

A

HYPERCALCEMIA

stones, bones, groans, thrones (pee a lot), psychiatric overtones

92
Q

What is the name of the condition associated with vitamin D deficiency? What are its symptoms?

A

rickets
rickets is impaired mineralization of growing bones, and can be observed clinically especially in weight-bearing long bones (curved).

93
Q

What happens to adults with vitamin D deficiency?

A

Osteomalacia - poorly mineralized bones-> increased fracture risk

94
Q

What symptoms can vitamin E deficiency cause?

A

ataxic gait
impaired balance & coordination
damage to retina of eye

95
Q

Vitamin E is very low toxicity, but excessive supplementation can cause problems.
What is a population that may oversupplement vitamin E?
What is an effect of vitamin E toxicity?

A

Some elderly men oversupplement vitamin E, having heard that taking a lot of vitamin E is good for the prostate.
Vitamin E toxicity can impair the function of vitamin K, which would interfere with blood clotting.

96
Q

Because of vitamin K’s role in clotting, what dietary advice is given to patients with history of DVT and/or patients taking warfarin?

A

Vitamin K is primarily found in dark green leafy vegetables, so patients may be advised to decrease or at least not increase their consumption of these veggies.

97
Q

What are some patient populations that may have vitamin K deficiency?

A

newborns
celiac disease/small bowel resection
patients taking broad-spectrum antibiotics

98
Q

What is a drug prescribed for obesity and how does it work?

What are some side effects?

A

Orlistat, or Alli (smaller dose)
interferes with fat absorption in the intestines (take the drug with meals)
diarrhea, gas, cramps
reduced absorption of fat-soluble vitamins

99
Q

What are two other drugs prescribed for obesity?

How do they work?

A

lorcaserin - increases feeling of satiety = eat less

phentermine + topiramate = appetite suppressant + feelings of fullness

100
Q

What is the current recommendation for referring patients for bariatric surgery?

A

BMI over 40, or BMI over 35 with obesity-related comorbities

101
Q

What drug class should not be taken with vitamin A?

A

acne drugs in the Accutane class are a form of vitamin A; taking them with vitamin A can lead to vitamin A toxicity

102
Q

How is hypercarotenosis (excess intake of beta carotenes) distinguished from jaundice?

A

Hypercarotenosis: palms and soles become pigmented, but not sclera
Jaundice: sclera will be pigmented as well

103
Q

What is a main benefit of omega-3 fatty acids?

A

lower TG

104
Q

What patients benefit from low protein diet?

A

chronic kidney disease, chronic liver disease

105
Q

In what conditions is a high fiber diet recommended?

A

irritable bowel syndrome, diverticulitis

106
Q

In what conditions is a diet low in potassium and phosphate recommended?

A

chronic kidney disease

107
Q

What is the most common cause of hypocalcemia?

A

advanced CKD

108
Q

What are the symptoms of hypocalcemia?

A

tetany, arrhythmias, seizures

109
Q

What are the two main causes of hypercalcemia?

What are two other causes?

A 
two main causes:
--hyperparathyroidism
--malignancy
two other causes:
--excess intake of vitamin D
--thiazide diuretics
110
Q

What is the treatment for malignant hypercalcemia?

A

bisphosphonates

111
Q

Hyponatremia usually reflects _____ rather than ______.

A

Hyponatremia usually reflects excess water retention relative to sodium rather than sodium deficiency.

112
Q

What are the symptoms of hyponatremia?

A

headache, lethargy, disorientation

respiratory arrest, seizure, coma, brain damage

113
Q

What are the elements of treatment for hyponatremia?

A

For all: restrict free water/hypotonic intake

For hypovolemic: IV isotonic fluids (e.g. normal saline, lactated Ringer’s)

For hypervolemic: diuretics or dialysis

For euvolemic: restricting free water may be sufficient

114
Q

What are the main defenses against hypernatremia? And, therefore, what is the main cause of hypernatremia?

A

The main defenses against hypernatremia are intact thirst mechanism and access to water (hypothalamus can detect minute changes in serum osmolality, triggering thirst mechanism and increased water intake).

Whatever the underlying mechanism, excess water loss can cause hypernatremia (but only when adequate water intake is not possible).

115
Q

What are the symptoms of dehydration?

What are subsequent signs of hypernatremia?

A

dehydration: orthostatic hypotension, oliguria
subsequently: lethargy, weakness, irritability
hyperthermia, delirium, seizures, coma

116
Q

What is the general treatment for hypernatremia?

A

Correcting the cause of the fluid loss, replacing water, replacing electrolytes

117
Q

complication of NG tube:

A

aspiration

118
Q

complications of TPN (parenteral nutrition into central or peripheral line):

A

2 categories of complications, catheter-related and metabolic (due to what you’re actually infusing into the person)

catheter-related: infiltration, phlebitis
ALSO - gut mucosal breakdown!

metabolic: various over or under levels of nutrients/components -> increase or decrease concentrations of the components in the solution you’re infusing

119
Q

Name 3 sports supplements

A

androstenedione
creatine
phosphocreatine

120
Q

Why do people take androstenedione? What are its adverse effects?

A

supposedly builds muscle
Adverse effects:
1. decrease HDL
2. increase estrogen levels
3. false positive for anabolic steroids on urine test
4. banned by NCAA and International Doping Agency

121
Q

Why do people take creatine and phosphocreatine? What are their adverse effects?

A

Since creatine and phosphocreatine in the body are used to create ATP, these supplements are thought to increase the amount of ATP available for intense exercise.
Adverse effects:
1. weight gain
2. muscle cramps

122
Q

What are the most potent statins?

A

atorvastatin, rosuvastatin

123
Q 
What are the BMIs for
class I obesity
class II obesity
class III obesity
A 
class I obesity: 30 - 34.9
class II obesity: 35 - 39.9
class III obesity: 40 and higher
124
Q

What is the main difference in the treatment of kwashiorkor and marasmus?

A

For kwashiorkor, aggressive nutritional support is indicated.
For marasmus, treatment should be cautious and slow to avoid life-threatening imbalances.

125
Q

Severe hypophosphatemia is common in ______

A

alcoholics

126
Q

Symptoms of severe hypophospatemia are:

A

rhabdomyolysis, paresthesias, encephalopathy

127
Q

What is the most common cause of hyperphosphatemia?

A

advanced CKD

128
Q

Hyperkalemia can develop in patients taking ______, ______, _______

A

Hyperkalemia can develop in patients taking ACE inhibitors, angiotension-receptor blockers (ARBs), potassium-sparing diuretics

129
Q

What is the most common cause of hypokalemia?

A

The most common cause of hypokalemia, especially in developing countries, is GI loss from diarrhea.

130
Q

What are the visible symptoms of familial hypercholesteremia?

A

Corneal arcus, xanthomas

131
Q

What is tested with a lipid profile/lipid panel?

A

total cholesterol, LDL, HDL, triglycerides

132
Q

How is folate related to heart disease?

A

Homocysteine levels have been associated with an increased risk of heart disease.
Folate plays a role in converting homocysteine to methionine.
Therefore low levels of folate would lead to increased homocysteine -> heart disease risk.
High folate levels -> more conversion of homocysteine -> decreased risk of heart disease.

133
Q

What are the differences in COMPOSITION and USE of the following oral rehydration solutions?
Resomal
ORS (oral rehydration solution/salts)

A

Both contain salt, chloride, glucose

Resomal also contains POTASSIUM and is used after LONG-TERM/SEVERE malnutrition

ORS does not contain potassium and is used after short-term malnutrition problems

134
Q

What are the top 3 drugs for lowering LDL, in order from best to less-best?

A

Best: statins

next: bile sequestrants
next: niacin

135
Q

How do you test for dehydration (hypernatremia)?

A

serum electrolytes, serum creatinine, serum osmolality, urine sodium

_Clin Med (9 decks)

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